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Teoh Z, Conrey S, McNeal M, Burrell A, Burke RM, Mattison CP, McMorrow M, Thornburg N, Payne DC, Morrow AL, Staat MA. Factors Associated With Prolonged Respiratory Virus Detection From Polymerase Chain Reaction of Nasal Specimens Collected Longitudinally in Healthy Children in a US Birth Cohort. J Pediatric Infect Dis Soc 2024; 13:189-195. [PMID: 38366142 DOI: 10.1093/jpids/piae009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 02/06/2024] [Indexed: 02/18/2024]
Abstract
BACKGROUND Respiratory viral shedding is incompletely characterized by existing studies due to the lack of longitudinal nasal sampling and limited inclusion of healthy/asymptomatic children. We describe characteristics associated with prolonged virus detection by polymerase chain reaction (PCR) in a community-based birth cohort. METHODS Children were followed from birth to 2 years of age in the PREVAIL cohort. Weekly nasal swabs were collected and tested using the Luminex Respiratory Pathogen Panel. Weekly text surveys were administered to ascertain the presence of acute respiratory illnesses defined as fever and/or cough. Maternal reports and medical chart abstractions identified healthcare utilization. Prolonged virus detection was defined as a persistently positive test lasting ≥4 weeks. Factors associated with prolonged virus detection were assessed using mixed effects multivariable logistic regression. RESULTS From a sub-cohort of 101 children with ≥70% weekly swabs collected, a total of 1489 viral infections were detected. Prolonged virus detection was found in 23.4% of viral infections overall, 39% of bocavirus infections, 33% of rhinovirus/enterovirus infections, 14% of respiratory syncytial virus (RSV) A infections, and 7% of RSV B infections. No prolonged detection was found for influenza virus A or B, coronavirus 229E or HKU1, and parainfluenza virus 2 or 4 infections. First-lifetime infection with each virus, and co-detection of another respiratory virus were significantly associated with prolonged detection, while symptom status, child sex, and child age were not. CONCLUSIONS Prolonged virus detection was observed in 1 in 4 viral infections in this cohort of healthy children and varied by pathogen, occurring most often for bocavirus and rhinovirus/enterovirus. Evaluating the immunological basis of how viral co-detections and recurrent viral infections impact duration of virus detection by PCR is needed to better understand the dynamics of prolonged viral shedding.
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Affiliation(s)
- Zheyi Teoh
- Division of Infectious Diseases, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Shannon Conrey
- Division of Infectious Diseases, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Environmental and Public Health Sciences, Division of Epidemiology, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Monica McNeal
- Division of Infectious Diseases, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Allison Burrell
- Division of Infectious Diseases, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Environmental and Public Health Sciences, Division of Epidemiology, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Rachel M Burke
- Coronavirus and Other Respiratory Viruses Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Claire P Mattison
- Coronavirus and Other Respiratory Viruses Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- Cherokee Nation Assurance, Arlington, Virginia, USA
| | - Meredith McMorrow
- Coronavirus and Other Respiratory Viruses Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Natalie Thornburg
- Coronavirus and Other Respiratory Viruses Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Daniel C Payne
- Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Ardythe L Morrow
- Department of Environmental and Public Health Sciences, Division of Epidemiology, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Mary Allen Staat
- Division of Infectious Diseases, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
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Morrow AL, Payne DC, Conrey SC, McMorrow M, McNeal MM, Niu L, Burrell AR, Schlaudecker EP, Mattison C, Burke RM, DeFranco E, Teoh Z, Wrammert J, Atherton LJ, Thornburg NJ, Staat MA. Endemic coronavirus infections are associated with strong homotypic immunity in a US cohort of children from birth to 4 years. J Pediatric Infect Dis Soc 2024:piae016. [PMID: 38442245 DOI: 10.1093/jpids/piae016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Indexed: 03/07/2024]
Abstract
BACKGROUND The endemic coronaviruses OC43, HKU1, NL63 and 229E cause cold-like symptoms and are related to SARS-CoV-2, but their natural histories are poorly understood. In a cohort of children followed from birth to 4 years, we documented all coronavirus infections, including SARS-CoV-2, to understand protection against subsequent infections with the same virus (homotypic immunity) or a different coronavirus (heterotypic immunity). METHODS Mother-child pairs were enrolled in metropolitan Cincinnati during the third trimester of pregnancy in 2017-18. Mothers reported their child's socio-demographics, risk factors, and weekly symptoms. Mid-turbinate nasal swabs were collected weekly. Blood was collected at 6 weeks, 6, 12, 18, 24 months and annually thereafter. Infections were detected by testing nasal swabs by an RT-PCR multi-pathogen panel and by serum IgG responses. Health care visits were documented from pediatric records. Analysis was limited to 116 children with high sample adherence. Re-consent for monitoring SARS-CoV-2 infections from June 2020 through November 2021 was obtained for 74 (64%) children. RESULTS We detected 345 endemic coronavirus infections (1.1 infections/child-year) and 21 SARS-CoV-2 infections (0.3 infections/child-year). Endemic coronavirus and SARS-CoV-2 infections were asymptomatic or mild. Significant protective homotypic immunity occurred after a single infection with OC43 (77%) and HKU1 (84%), and after two infections with NL63 (73%). No heterotypic protection against endemic coronaviruses or SARS-CoV-2 was identified. CONCLUSIONS Natural coronavirus infections were common and resulted in strong homotypic immunity but not heterotypic immunity against other coronaviruses, including SARS-CoV-2. Endemic coronavirus and SARS-CoV-2 infections in this US cohort were typically asymptomatic or mild.
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Affiliation(s)
- Ardythe L Morrow
- Division of Infectious Diseases, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Environmental and Public Health Sciences, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Daniel C Payne
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Shannon C Conrey
- Division of Infectious Diseases, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Environmental and Public Health Sciences, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Meredith McMorrow
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Monica M McNeal
- Division of Infectious Diseases, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Liang Niu
- Department of Environmental and Public Health Sciences, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Allison R Burrell
- Division of Infectious Diseases, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Environmental and Public Health Sciences, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Elizabeth P Schlaudecker
- Division of Infectious Diseases, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Claire Mattison
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Rachel M Burke
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Emily DeFranco
- Department of Obstetrics & Gynecology, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Zheyi Teoh
- Division of Infectious Diseases, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Jens Wrammert
- Division of Infectious Diseases, Department of Pediatrics, School of Medicine, Emory University, Atlanta, Georgia, USA
- Emory Vaccine Center, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Lydia J Atherton
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Natalie J Thornburg
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Mary A Staat
- Division of Infectious Diseases, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
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Toepfer AP, Amarin JZ, Spieker AJ, Stewart LS, Staat MA, Schlaudecker EP, Weinberg GA, Szilagyi PG, Englund JA, Klein EJ, Michaels MG, Williams JV, Selvarangan R, Harrison CJ, Lively JY, Piedra PA, Avadhanula V, Rha B, Chappell J, McMorrow M, Moline H, Halasa NB. Seasonality, clinical characteristics, and outcomes of respiratory syncytial virus disease by subtype among children less than five years old, New Vaccine Surveillance Network, United States, 2016-2020. Clin Infect Dis 2024:ciae085. [PMID: 38366649 DOI: 10.1093/cid/ciae085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 02/06/2024] [Accepted: 02/13/2024] [Indexed: 02/18/2024] Open
Abstract
BACKGROUND Respiratory syncytial virus (RSV) is a leading cause of acute respiratory illnesses (ARI) in children. RSV can be broadly categorized into two major subtypes (A and B). RSV subtypes have been known to co-circulate with variability in different regions of the world. Clinical associations with viral subtype have been studied among children with conflicting findings such that no conclusive relationships between RSV subtype and severity have been established. METHODS During 2016-2020, children <5 years old were enrolled in prospective surveillance in the emergency department (ED) or inpatient (IP) settings from seven U.S. pediatric medical centers. Surveillance data collection included parent/guardian interviews, chart reviews, and collection of mid-turbinate nasal +/- throat swabs for RSV (RSV-A, RSV-B, and Untyped) by reverse transcription polymerase chain reaction (RT-PCR). RESULTS Among 6398 RSV-positive children <5 years old, 3424 (54%) had subtype RSV-A infections, 2602 (41%) had subtype RSV-B infections, and 272 (5%) were not typed, inconclusive, or mixed infections. In both adjusted and unadjusted analyses, RSV-A-positive children were more likely to be hospitalized, as well as when restricted to <1 year. By season, RSV-A and RSV-B co-circulated in varying levels, with one subtype dominating proportionally. CONCLUSION Findings indicate that RSV-A and RSV-B may only be marginally clinically distinguishable but both subtypes are associated with medically attended illness in children <5 years old. Furthermore, circulation of RSV subtypes varies substantially each year, seasonally and geographically. With introduction of new RSV prevention products, this highlights the importance of continued monitoring of RSV-A and RSV-B subtypes.
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Affiliation(s)
- Ariana P Toepfer
- Coronavirus and Other Respiratory Viruses Division, National Center for Immunization and Respiratory Diseases, CDC, Atlanta, Georgia, USA
| | - Justin Z Amarin
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Andrew J Spieker
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Laura S Stewart
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Mary Allen Staat
- Division of Infectious Diseases, Cincinnati Children's Hospital, Cincinnati, Ohio, USA
| | | | - Geoffrey A Weinberg
- Department of Pediatrics, University of Rochester School of Medicine & Dentistry, Rochester, New York, USA
| | - Peter G Szilagyi
- Department of Pediatrics, University of Rochester School of Medicine & Dentistry, Rochester, New York, USA
| | - Janet A Englund
- Department of Pediatrics, Seattle Children's Hospital, Seattle, Washington, USA
| | - Eileen J Klein
- Department of Pediatrics, Seattle Children's Hospital, Seattle, Washington, USA
| | - Marian G Michaels
- UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - John V Williams
- UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Rangaraj Selvarangan
- Department of Pathology and Laboratory Medicine, Children's Mercy, Kansas City, Missouri, USA
| | - Christopher J Harrison
- Department of Pathology and Laboratory Medicine, Children's Mercy, Kansas City, Missouri, USA
| | - Joana Y Lively
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, CDC, Atlanta, Georgia, USA
| | | | | | - Brian Rha
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, CDC, Atlanta, Georgia, USA
| | - James Chappell
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Meredith McMorrow
- Coronavirus and Other Respiratory Viruses Division, National Center for Immunization and Respiratory Diseases, CDC, Atlanta, Georgia, USA
- U.S. Public Health Service, Rockville, Maryland, USA
| | - Heidi Moline
- Coronavirus and Other Respiratory Viruses Division, National Center for Immunization and Respiratory Diseases, CDC, Atlanta, Georgia, USA
- U.S. Public Health Service, Rockville, Maryland, USA
| | - Natasha B Halasa
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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Kovacs D, Mambule I, Read JM, Kiran A, Chilombe M, Bvumbwe T, Aston S, Menyere M, Masina M, Kamzati M, Ganiza TN, Iuliano D, McMorrow M, Bar-Zeev N, Everett D, French N, Ho A. Epidemiology of Human Seasonal Coronaviruses Among People With Mild and Severe Acute Respiratory Illness in Blantyre, Malawi, 2011-2017. J Infect Dis 2024:jiad587. [PMID: 38365443 DOI: 10.1093/infdis/jiad587] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 12/18/2023] [Indexed: 02/18/2024] Open
Abstract
BACKGROUND The aim of this study was to characterize the epidemiology of human seasonal coronaviruses (HCoVs) in southern Malawi. METHODS We tested for HCoVs 229E, OC43, NL63, and HKU1 using real-time polymerase chain reaction (PCR) on upper respiratory specimens from asymptomatic controls and individuals of all ages recruited through severe acute respiratory illness (SARI) surveillance at Queen Elizabeth Central Hospital, Blantyre, and a prospective influenza-like illness (ILI) observational study between 2011 and 2017. We modeled the probability of having a positive PCR for each HCoV using negative binomial models, and calculated pathogen-attributable fractions (PAFs). RESULTS Overall, 8.8% (539/6107) of specimens were positive for ≥1 HCoV. OC43 was the most frequently detected HCoV (3.1% [191/6107]). NL63 was more frequently detected in ILI patients (adjusted incidence rate ratio [aIRR], 9.60 [95% confidence interval {CI}, 3.25-28.30]), while 229E (aIRR, 8.99 [95% CI, 1.81-44.70]) was more frequent in SARI patients than asymptomatic controls. In adults, 229E and OC43 were associated with SARI (PAF, 86.5% and 89.4%, respectively), while NL63 was associated with ILI (PAF, 85.1%). The prevalence of HCoVs was similar between children with SARI and controls. All HCoVs had bimodal peaks but distinct seasonality. CONCLUSIONS OC43 was the most prevalent HCoV in acute respiratory illness of all ages. Individual HCoVs had distinct seasonality that differed from temperate settings.
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Affiliation(s)
- Dory Kovacs
- School of Biodiversity, One Health and Veterinary Medicine, University of Glasgow, Glasgow, United Kingdom
| | - Ivan Mambule
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, University of Malawi College of Medicine, Blantyre, Malawi
- Research Department, Joint Clinical Research Centre, Kampala, Uganda
| | - Jonathan M Read
- Centre for Health Information Computation and Statistics, Lancaster Medical School, Lancaster University, Lancaster, United Kingdom
| | - Anmol Kiran
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, University of Malawi College of Medicine, Blantyre, Malawi
| | - Moses Chilombe
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, University of Malawi College of Medicine, Blantyre, Malawi
- Malaria Alert Centre, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Thandiwe Bvumbwe
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, University of Malawi College of Medicine, Blantyre, Malawi
- Blantyre Malaria Project, Blantyre, Malawi
| | - Stephen Aston
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, University of Malawi College of Medicine, Blantyre, Malawi
- Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, United Kingdom
| | - Mavis Menyere
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, University of Malawi College of Medicine, Blantyre, Malawi
| | - Mazuba Masina
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, University of Malawi College of Medicine, Blantyre, Malawi
| | - Moses Kamzati
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, University of Malawi College of Medicine, Blantyre, Malawi
| | - Thokozani Namale Ganiza
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, University of Malawi College of Medicine, Blantyre, Malawi
| | - Danielle Iuliano
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Meredith McMorrow
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Naor Bar-Zeev
- International Vaccine Access Center, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States
| | - Dean Everett
- Department of Pathology and Infectious Diseases, College of Medicine and Health Sciences, Abu Dhabi, United Arab Emirates
- Infection Research Unit, Khalifa University, Abu Dhabi, United Arab Emirates
| | - Neil French
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, University of Malawi College of Medicine, Blantyre, Malawi
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Antonia Ho
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, University of Malawi College of Medicine, Blantyre, Malawi
- Medical Research Council-University of Glasgow Centre for Virus Research, University of Glasgow, Glasgow, United Kingdom
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Kubale J, Kujawski S, Chen I, Wu Z, Khader IA, Hasibra I, Whitaker B, Gresh L, Simaku A, Simões EAF, Al-Gazo M, Rogers S, Gerber SI, Balmaseda A, Tallo VL, Al-Sanouri TM, Porter R, Bino S, Azziz-Baumgartner E, McMorrow M, Hunt D, Thompson M, Biggs HM, Gordon A. Etiology of Acute Lower Respiratory Illness Hospitalizations Among Infants in 4 Countries. Open Forum Infect Dis 2023; 10:ofad580. [PMID: 38130597 PMCID: PMC10733183 DOI: 10.1093/ofid/ofad580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 11/15/2023] [Indexed: 12/23/2023] Open
Abstract
Background Recent studies explored which pathogens drive the global burden of pneumonia hospitalizations among young children. However, the etiology of broader acute lower respiratory tract infections (ALRIs) remains unclear. Methods Using a multicountry study (Albania, Jordan, Nicaragua, and the Philippines) of hospitalized infants and non-ill community controls between 2015 and 2017, we assessed the prevalence and severity of viral infections and coinfections. We also estimated the proportion of ALRI hospitalizations caused by 21 respiratory pathogens identified via multiplex real-time reverse transcription polymerase chain reaction with bayesian nested partially latent class models. Results An overall 3632 hospitalized infants and 1068 non-ill community controls participated in the study and had specimens tested. Among hospitalized infants, 1743 (48.0%) met the ALRI case definition for the etiology analysis. After accounting for the prevalence in non-ill controls, respiratory syncytial virus (RSV) was responsible for the largest proportion of ALRI hospitalizations, although the magnitude varied across sites-ranging from 65.2% (95% credible interval, 46.3%-79.6%) in Albania to 34.9% (95% credible interval, 20.0%-49.0%) in the Philippines. While the fraction of ALRI hospitalizations caused by RSV decreased as age increased, it remained the greatest driver. After RSV, rhinovirus/enterovirus (range, 13.4%-27.1%) and human metapneumovirus (range, 6.3%-12.0%) were the next-highest contributors to ALRI hospitalizations. Conclusions We observed substantial numbers of ALRI hospitalizations, with RSV as the largest source, particularly in infants aged <3 months. This underscores the potential for vaccines and long-lasting monoclonal antibodies on the horizon to reduce the burden of ALRI in infants worldwide.
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Affiliation(s)
- John Kubale
- Institute for Social Research, University of Michigan, Ann Arbor, Michigan, USA
| | - Stephanie Kujawski
- Epidemic Intelligence Service, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- National Center for Immunization and Respiratory Diseases, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Irena Chen
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Zhenke Wu
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | | | - Iris Hasibra
- Department of Epidemiology and Control of Infectious Diseases, Institute of Public Health, Tirana, Albania
| | - Brett Whitaker
- National Center for Immunization and Respiratory Diseases, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Lionel Gresh
- Sustainable Sciences Institute, Managua, Nicaragua
| | - Artan Simaku
- Department of Epidemiology and Control of Infectious Diseases, Institute of Public Health, Tirana, Albania
| | - Eric A F Simões
- Section of Infectious Diseases, Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, USA
- Center for Global Health, Department of Epidemiology, Colorado School of Public Health, Aurora, Colorado, USA
| | - Mahmoud Al-Gazo
- The Eastern Mediterranean Public Health Network, Amman, Jordan
| | - Shannon Rogers
- National Center for Immunization and Respiratory Diseases, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Susan I Gerber
- National Center for Immunization and Respiratory Diseases, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Angel Balmaseda
- Sustainable Sciences Institute, Managua, Nicaragua
- Centro Nacional de Diagnóstico y Referencia, Ministry of Health, Managua, Nicaragua
| | - Veronica L Tallo
- Department of Health, Research Institute for Tropical Medicine, Muntinlupa City, Metro Manila, Philippines
| | | | - Rachael Porter
- National Center for Immunization and Respiratory Diseases, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Silvia Bino
- Department of Epidemiology and Control of Infectious Diseases, Institute of Public Health, Tirana, Albania
| | - Eduardo Azziz-Baumgartner
- National Center for Immunization and Respiratory Diseases, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Meredith McMorrow
- National Center for Immunization and Respiratory Diseases, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | - Mark Thompson
- National Center for Immunization and Respiratory Diseases, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Holly M Biggs
- National Center for Immunization and Respiratory Diseases, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Aubree Gordon
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
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6
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Teoh Z, Conrey S, McNeal M, Burrell A, Burke RM, Mattison C, McMorrow M, Payne DC, Morrow AL, Staat MA. Burden of Respiratory Viruses in Children Less Than 2 Years Old in a Community-based Longitudinal US Birth Cohort. Clin Infect Dis 2023; 77:901-909. [PMID: 37157868 PMCID: PMC10838707 DOI: 10.1093/cid/ciad289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 04/24/2023] [Accepted: 05/04/2023] [Indexed: 05/10/2023] Open
Abstract
BACKGROUND Respiratory viral infections are a major cause of morbidity and hospitalization in young children. Nevertheless, the population burden of respiratory viral infections, especially asymptomatic cases, is not known due to the lack of prospective community-based cohort studies with intensive monitoring. METHODS To address this gap, we enacted the PREVAIL cohort, a Centers for Disease Control and Prevention-sponsored birth cohort in Cincinnati, Ohio, where children were followed from 0 to 2 years of age. Weekly text surveys were administered to record acute respiratory illnesses (ARIs), which were defined as the presence of cough or fever (≥38°C). Weekly midturbinate nasal swabs were collected and tested using the Luminex Respiratory Pathogen Panel, which detected 16 viral pathogens. Viral infection was defined as ≥1 positive tests from the same virus or viral subtype ≤30 days of a previous positive test. Maternal report and medical chart abstractions identified healthcare utilization. RESULTS From 4/2017 to 7/2020, 245 mother-infant pairs were recruited and followed. From the 13 781 nasal swabs tested, a total of 2211 viral infections were detected, of which 821 (37%) were symptomatic. Children experienced 9.4 respiratory viral infections/child-year; half were rhinovirus/enterovirus. Viral ARI incidence was 3.3 episodes/child-year. Emergency department visits or hospitalization occurred with only 15% of respiratory syncytial virus infections, 10% of influenza infections, and only 4% of all viral infections. Regardless of pathogen, most infections were asymptomatic or mild. CONCLUSIONS Respiratory viral infections are common in children 0-2 years. Most viral infections are asymptomatic or non-medically attended, underscoring the importance of community-based cohort studies.
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Affiliation(s)
- Zheyi Teoh
- Division of Infectious Diseases, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Shannon Conrey
- Division of Infectious Diseases, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Division of Epidemiology, Department of Environmental and Public Health Sciences, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Monica McNeal
- Division of Infectious Diseases, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Allison Burrell
- Division of Infectious Diseases, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Division of Epidemiology, Department of Environmental and Public Health Sciences, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Rachel M Burke
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Claire Mattison
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- Cherokee Nation Assurance, Arlington, Virginia, USA
| | - Meredith McMorrow
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Daniel C Payne
- Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Ardythe L Morrow
- Division of Infectious Diseases, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Division of Epidemiology, Department of Environmental and Public Health Sciences, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Mary Allen Staat
- Division of Infectious Diseases, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
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7
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Biggs HM, Simões EAF, Abu Khader I, Thompson MG, Gordon A, Hunt DR, DeGroote NP, Porter RM, Bino S, Marar BI, Gresh L, de Jesus-Cornejo J, Langley G, Thornburg NJ, Peret TCT, Whitaker B, Zhang Y, Wang L, Patel MC, McMorrow M, Campbell W, Hasibra I, Duka E, Al-Gazo M, Kubale J, Sanchez F, Lucero MG, Tallo VL, Azziz-Baumgartner E, Simaku A, Gerber SI. Respiratory Syncytial Virus Infection among Hospitalized Infants in Four Middle-Income Countries. J Pediatric Infect Dis Soc 2023:piad042. [PMID: 37313727 DOI: 10.1093/jpids/piad042] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Understanding respiratory syncytial virus (RSV) global epidemiology is important to inform future prevention strategies. METHODS Hospitalized infants <1-year-old with acute illness were enrolled prospectively in Albania, Jordan, Nicaragua, and Philippines during respiratory seasons in 2015-2017. Medical chart review, parental interview, and post-discharge follow up were conducted. Respiratory specimens were tested using real-time RT-PCR for RSV. Infant characteristics associated with very severe illness (intensive care unit [ICU] admission or receipt of supplemental oxygen) were assessed using logistic regression to adjust for potential confounders (age, sex, study site, preterm birth). RESULTS Of 3,634 enrolled hospitalized infants, 1,129 (31%) tested positive for RSV. The median age of RSV-positive infants was 2.7 (IQR: 1.4 to 6.1) months and 665 (59%) were male. Very severe illness in 583 (52%) RSV-positive infants was associated with younger age (aOR 4.1, 95% CI: 2.6-6.5 for 0-2 compared to 9-11-months; p<0.01), , low weight-for-age z-score (aOR 1.9, 95%CI: 1.2-2.8; p<0.01), ICU care after birth (aOR 1.6, 95%CI: 1.0-2.5; p=0.48), and cesarean delivery (aOR 1.4, 95% CI: 1.0-1.8; p=.03). RSV subgroups A and B co-circulated at all sites with alternating predominance by year; subgroup was not associated with severity (aOR 1.0, 95% CI: 0.8-1.4). Nine (0.8%) RSV-positive infants died during admission or within ≤30 days of discharge, of which 7 (78%) were <6-months-old. CONCLUSIONS RSV was associated with nearly a third of infant acute illness hospitalizations in four middle-income countries during the respiratory season, where, in addition to young age, factors including low weight-for-age might be important predictors of severity. RSV prevention strategies targeting young infants could substantially reduce RSV-associated hospitalizations in middle-income countries.
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Affiliation(s)
- Holly M Biggs
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Eric A F Simões
- Section of Infectious Diseases, Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, USA
- Center for Global Health, Department of Epidemiology, Colorado School of Public Health, Aurora, Colorado, USA
| | - Ilham Abu Khader
- The Eastern Mediterranean Public Health Network (EMPHNET), Amman, Jordan
| | - Mark G Thompson
- Influenza Division, National Center for Immunization and Respiratory Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Aubree Gordon
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | | | - Nicholas P DeGroote
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Rachael M Porter
- Influenza Division, National Center for Immunization and Respiratory Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Silvia Bino
- Department of Epidemiology & Control of Infectious Diseases, Institute of Public Health, Tirana, Albania
| | | | - Lionel Gresh
- Sustainable Sciences Institute, Managua, Nicaragua
| | - Joanne de Jesus-Cornejo
- Research Institute for Tropical Medicine, Department of Health, Muntinlupa City, Metro Manila, Philippines
| | - Gayle Langley
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Natalie J Thornburg
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Teresa C T Peret
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Brett Whitaker
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Yange Zhang
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Lijuan Wang
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Mira C Patel
- Influenza Division, National Center for Immunization and Respiratory Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Meredith McMorrow
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | - Iris Hasibra
- Department of Epidemiology & Control of Infectious Diseases, Institute of Public Health, Tirana, Albania
| | - Enkeleda Duka
- Pediatric Department, Mother Theresa University Hospital Center, Tirana, Albania
| | - Mahmoud Al-Gazo
- The Eastern Mediterranean Public Health Network (EMPHNET), Amman, Jordan
| | - John Kubale
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Felix Sanchez
- Hospital Infantil Manuel de Jesus Rivera, Ministry of Health, Managua, Nicaragua
| | - Marilla G Lucero
- Research Institute for Tropical Medicine, Department of Health, Muntinlupa City, Metro Manila, Philippines
| | - Veronica L Tallo
- Research Institute for Tropical Medicine, Department of Health, Muntinlupa City, Metro Manila, Philippines
| | - Eduardo Azziz-Baumgartner
- Influenza Division, National Center for Immunization and Respiratory Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Artan Simaku
- Department of Epidemiology & Control of Infectious Diseases, Institute of Public Health, Tirana, Albania
| | - Susan I Gerber
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Silk BJ, Scobie HM, Duck WM, Palmer T, Ahmad FB, Binder AM, Cisewski JA, Kroop S, Soetebier K, Park M, Kite-Powell A, Cool A, Connelly E, Dietz S, Kirby AE, Hartnett K, Johnston J, Khan D, Stokley S, Paden CR, Sheppard M, Sutton P, Razzaghi H, Anderson RN, Thornburg N, Meyer S, Womack C, Weakland AP, McMorrow M, Broeker LR, Winn A, Hall AJ, Jackson B, Mahon BE, Ritchey MD. COVID-19 Surveillance After Expiration of the Public Health Emergency Declaration - United States, May 11, 2023. MMWR Morb Mortal Wkly Rep 2023; 72:523-528. [PMID: 37167154 DOI: 10.15585/mmwr.mm7219e1] [Citation(s) in RCA: 21] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
On January 31, 2020, the U.S. Department of Health and Human Services (HHS) declared, under Section 319 of the Public Health Service Act, a U.S. public health emergency because of the emergence of a novel virus, SARS-CoV-2.* After 13 renewals, the public health emergency will expire on May 11, 2023. Authorizations to collect certain public health data will expire on that date as well. Monitoring the impact of COVID-19 and the effectiveness of prevention and control strategies remains a public health priority, and a number of surveillance indicators have been identified to facilitate ongoing monitoring. After expiration of the public health emergency, COVID-19-associated hospital admission levels will be the primary indicator of COVID-19 trends to help guide community and personal decisions related to risk and prevention behaviors; the percentage of COVID-19-associated deaths among all reported deaths, based on provisional death certificate data, will be the primary indicator used to monitor COVID-19 mortality. Emergency department (ED) visits with a COVID-19 diagnosis and the percentage of positive SARS-CoV-2 test results, derived from an established sentinel network, will help detect early changes in trends. National genomic surveillance will continue to be used to estimate SARS-CoV-2 variant proportions; wastewater surveillance and traveler-based genomic surveillance will also continue to be used to monitor SARS-CoV-2 variants. Disease severity and hospitalization-related outcomes are monitored via sentinel surveillance and large health care databases. Monitoring of COVID-19 vaccination coverage, vaccine effectiveness (VE), and vaccine safety will also continue. Integrated strategies for surveillance of COVID-19 and other respiratory viruses can further guide prevention efforts. COVID-19-associated hospitalizations and deaths are largely preventable through receipt of updated vaccines and timely administration of therapeutics (1-4).
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9
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Hamid S, Winn A, Parikh R, Jones JM, McMorrow M, Prill MM, Silk BJ, Scobie HM, Hall AJ. Seasonality of Respiratory Syncytial Virus - United States, 2017-2023. MMWR Morb Mortal Wkly Rep 2023; 72:355-361. [PMID: 37022977 PMCID: PMC10078848 DOI: 10.15585/mmwr.mm7214a1] [Citation(s) in RCA: 38] [Impact Index Per Article: 38.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
In the United States, respiratory syncytial virus (RSV) infections cause an estimated 58,000-80,000 hospitalizations among children aged <5 years (1,2) and 60,000-160,000 hospitalizations among adults aged ≥65 years each year (3-5). U.S. RSV epidemics typically follow seasonal patterns, peaking in December or January (6,7), but the COVID-19 pandemic disrupted RSV seasonality during 2020-2022 (8). To describe U.S. RSV seasonality during prepandemic and pandemic periods, polymerase chain reaction (PCR) test results reported to the National Respiratory and Enteric Virus Surveillance System (NREVSS)* during July 2017-February 2023 were analyzed. Seasonal RSV epidemics were defined as the weeks during which the percentage of PCR test results that were positive for RSV was ≥3% (9). Nationally, prepandemic seasons (2017-2020) began in October, peaked in December, and ended in April. During 2020-21, the typical winter RSV epidemic did not occur. The 2021-22 season began in May, peaked in July, and ended in January. The 2022-23 season started (June) and peaked (November) later than the 2021-22 season, but earlier than prepandemic seasons. In both prepandemic and pandemic periods, epidemics began earlier in Florida and the Southeast and later in regions further north and west. With several RSV prevention products in development,† ongoing monitoring of RSV circulation can guide the timing of RSV immunoprophylaxis and of clinical trials and postlicensure effectiveness studies. Although the timing of the 2022-23 season suggests that seasonal patterns are returning toward those observed in prepandemic years, clinicians should be aware that off-season RSV circulation might continue.
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10
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Lutz CS, Hartman RM, Vigil DE, Britton A, Burrage AB, Campbell AP, Close RM, Desnoyers C, Dobson J, Garcia S, Halasa N, Honie E, Kobayashi M, McMorrow M, Mostafa HH, Parker D, Pohl K, Prill MM, Richards J, Roessler KC, Sutcliffe CG, Taylor K, Swango-Wilson A, Va P, Verani JR, Singleton RJ, Hammitt LL. Effectiveness of COVID-19 mRNA vaccines in preventing COVID-19-associated outpatient visits and hospitalizations among American Indian and Alaska Native persons, January–November 2021: a test-negative case-control analysis using surveillance data. Open Forum Infect Dis 2023; 10:ofad172. [PMID: 37089780 PMCID: PMC10114530 DOI: 10.1093/ofid/ofad172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 03/23/2023] [Indexed: 03/29/2023] Open
Abstract
Abstract
Background
Despite the disproportionate morbidity and mortality experienced by American Indian and Alaska Native (AI/AN) persons during the COVID-19 pandemic, few studies have reported vaccine effectiveness (VE) estimates among these communities.
Methods
We conducted a test-negative case-control analysis among AI/AN persons aged ≥12 years presenting for care from January 1, 2021 through November 30, 2021 to evaluate effectiveness of mRNA COVID-19 vaccines against COVID-19-associated outpatient visits and hospitalizations. Cases and controls were patients with ≥1 symptom consistent with COVID-19-like illness; cases were defined as those test-positive for SARS-CoV-2 and controls were defined as those test-negative for SARS-CoV-2. We used unconditional multivariable logistic regression to estimate VE, defined as 1 minus the adjusted odds ratio for vaccination among cases versus controls.
Results
The analysis included 207 cases and 267 test-negative controls. Forty-four percent of cases and 78% of controls received two doses of either BNT162b2 or mRNA-1273 vaccine. VE point estimates for two doses of mRNA vaccine were higher for hospitalized participants (94.6% [88.0–97.6]) than outpatient participants (86.5% [63.0–95.0]), but confidence intervals overlapped.
Conclusions
Among AI/AN persons, mRNA COVID-19 vaccines were highly effective in preventing COVID-associated outpatient visits and hospitalizations. Maintaining high vaccine coverage, including booster doses, will reduce the burden of disease in this population.
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Affiliation(s)
- Chelsea S Lutz
- Correspondence: Chelsea S. Lutz, MPH, Department of International Health, Johns Hopkins Bloomberg School of Public Health, 415 N. Washington St, Baltimore, MD 21231 (); or Laura L. Hammitt, MD, Department of International Health, Johns Hopkins Bloomberg School of Public Health, 415 N. Washington St, Baltimore, MD 21231 ()
| | - Rachel M Hartman
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Deionna E Vigil
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Amadea Britton
- CDC COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Amanda B Burrage
- Tuba City Service Unit, Navajo Area, Indian Health Service, Tuba City, Arizona, USA
| | - Angela P Campbell
- CDC COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Ryan M Close
- Whiteriver Service Unit, Phoenix Area, Indian Health Service, Whiteriver, Arizona, USA
| | | | - Jennifer Dobson
- Alaska Native Tribal Health Consortium, Anchorage, Alaska, USA
| | - Starla Garcia
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Natasha Halasa
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Elvira Honie
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Miwako Kobayashi
- CDC COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Meredith McMorrow
- CDC COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Heba H Mostafa
- Division of Medical Microbiology, Department of Pathology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Dennie Parker
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Kyle Pohl
- Alaska Native Tribal Health Consortium, Anchorage, Alaska, USA
| | - Mila M Prill
- CDC COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Jennifer Richards
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Kristen C Roessler
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Catherine G Sutcliffe
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Kim Taylor
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | | | - Puthiery Va
- Chinle Service Unit, Navajo Area, Indian Health Service, Chinle, Arizona, USA
| | - Jennifer R Verani
- CDC COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | - Laura L Hammitt
- Correspondence: Chelsea S. Lutz, MPH, Department of International Health, Johns Hopkins Bloomberg School of Public Health, 415 N. Washington St, Baltimore, MD 21231 (); or Laura L. Hammitt, MD, Department of International Health, Johns Hopkins Bloomberg School of Public Health, 415 N. Washington St, Baltimore, MD 21231 ()
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11
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Delahoy MJ, Ujamaa D, Taylor CA, Cummings C, Anglin O, Holstein R, Milucky J, O’Halloran A, Patel K, Pham H, Whitaker M, Reingold A, Chai SJ, Alden NB, Kawasaki B, Meek J, Yousey-Hindes K, Anderson EJ, Openo KP, Weigel A, Teno K, Reeg L, Leegwater L, Lynfield R, McMahon M, Ropp S, Rudin D, Muse A, Spina N, Bennett NM, Popham K, Billing LM, Shiltz E, Sutton M, Thomas A, Schaffner W, Talbot HK, Crossland MT, McCaffrey K, Hall AJ, Burns E, McMorrow M, Reed C, Havers FP, Garg S. Comparison of Influenza and Coronavirus Disease 2019-Associated Hospitalizations Among Children Younger Than 18 Years Old in the United States: FluSurv-NET (October-April 2017-2021) and COVID-NET (October 2020-September 2021). Clin Infect Dis 2023; 76:e450-e459. [PMID: 35594564 PMCID: PMC9129156 DOI: 10.1093/cid/ciac388] [Citation(s) in RCA: 21] [Impact Index Per Article: 21.0] [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: 03/14/2022] [Revised: 05/04/2022] [Accepted: 05/13/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Influenza virus and SARS-CoV-2 are significant causes of respiratory illness in children. METHODS Influenza- and COVID-19-associated hospitalizations among children <18 years old were analyzed from FluSurv-NET and COVID-NET, 2 population-based surveillance systems with similar catchment areas and methodology. The annual COVID-19-associated hospitalization rate per 100 000 during the ongoing COVID-19 pandemic (1 October 2020-30 September 2021) was compared with influenza-associated hospitalization rates during the 2017-2018 through 2019-2020 influenza seasons. In-hospital outcomes, including intensive care unit (ICU) admission and death, were compared. RESULTS Among children <18 years, the COVID-19-associated hospitalization rate (48.2) was higher than influenza-associated hospitalization rates: 2017-2018 (33.5), 2018-2019 (33.8), and 2019-2020 (41.7). The COVID-19-associated hospitalization rate was higher among adolescents 12-17 years old (COVID-19: 59.9; influenza range: 12.2-14.1), but similar or lower among children 5-11 (COVID-19: 25.0; influenza range: 24.3-31.7) and 0-4 (COVID-19: 66.8; influenza range: 70.9-91.5) years old. Among children <18 years, a higher proportion with COVID-19 required ICU admission compared with influenza (26.4% vs 21.6%; P < .01). Pediatric deaths were uncommon during both COVID-19- and influenza-associated hospitalizations (0.7% vs 0.5%; P = .28). CONCLUSIONS In the setting of extensive mitigation measures during the COVID-19 pandemic, the annual COVID-19-associated hospitalization rate during 2020-2021 was higher among adolescents and similar or lower among children <12 years compared with influenza during the 3 seasons before the COVID-19 pandemic. COVID-19 adds substantially to the existing burden of pediatric hospitalizations and severe outcomes caused by influenza and other respiratory viruses.
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Affiliation(s)
- Miranda J. Delahoy
- CDC COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, United States
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia, United States
- Corresponding author: Miranda J. Delahoy, Influenza Division, Centers for Disease Control and Prevention, 1600 Clifton Rd. MS H24-7, Atlanta, Georgia 30329, United States;
| | - Dawud Ujamaa
- CDC COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, United States
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States
| | - Christopher A. Taylor
- CDC COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, United States
| | - Charisse Cummings
- CDC COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, United States
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States
| | - Onika Anglin
- CDC COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, United States
| | - Rachel Holstein
- CDC COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, United States
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States
| | - Jennifer Milucky
- CDC COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, United States
| | - Alissa O’Halloran
- CDC COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, United States
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States
| | - Kadam Patel
- CDC COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, United States
| | - Huong Pham
- CDC COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, United States
| | - Michael Whitaker
- CDC COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, United States
| | - Arthur Reingold
- California Emerging Infections Program, Oakland, California, United States
- University of California, Berkeley School of Public Health, Berkeley, California, United States
| | - Shua J. Chai
- California Emerging Infections Program, Oakland, California, United States
- Career Epidemiology Field Officer Program, Centers for Disease Control and Prevention, Atlanta, Georgia, United States
| | - Nisha B. Alden
- Colorado Department of Public Health and Environment, Denver, Colorado, United States
| | - Breanna Kawasaki
- Colorado Department of Public Health and Environment, Denver, Colorado, United States
| | - James Meek
- Connecticut Emerging Infections Program, Yale School of Public Health, New Haven, Connecticut, United States
| | - Kimberly Yousey-Hindes
- Connecticut Emerging Infections Program, Yale School of Public Health, New Haven, Connecticut, United States
| | - Evan J. Anderson
- Emory University School of Medicine, Atlanta, Georgia, United States
- Georgia Emerging Infections Program, Georgia Department of Health, Atlanta, Georgia, United States
- Atlanta Veterans Affairs Medical Center, Atlanta, Georgia, United States
| | - Kyle P. Openo
- Emory University School of Medicine, Atlanta, Georgia, United States
- Georgia Emerging Infections Program, Georgia Department of Health, Atlanta, Georgia, United States
- Atlanta Veterans Affairs Medical Center, Atlanta, Georgia, United States
| | - Andy Weigel
- Iowa Department of Health, Des Moines, Iowa, United States
| | - Kenzie Teno
- Iowa Department of Health, Des Moines, Iowa, United States
| | - Libby Reeg
- Michigan Department of Health and Human Services, Lansing, Michigan, United States
| | - Lauren Leegwater
- Michigan Department of Health and Human Services, Lansing, Michigan, United States
| | - Ruth Lynfield
- Minnesota Department of Health, Saint Paul, Minnesota, United States
| | - Melissa McMahon
- Minnesota Department of Health, Saint Paul, Minnesota, United States
| | - Susan Ropp
- New Mexico Emerging Infections Program, New Mexico Department of Health, Santa Fe, New Mexico, United States
| | - Dominic Rudin
- New Mexico Emerging Infections Program, New Mexico Department of Health, Santa Fe, New Mexico, United States
| | - Alison Muse
- New York State Department of Health, Albany, New York, United States
| | - Nancy Spina
- New York State Department of Health, Albany, New York, United States
| | - Nancy M. Bennett
- University of Rochester School of Medicine and Dentistry, Rochester, New York, United States
| | - Kevin Popham
- Rochester Emerging Infections Program, University of Rochester Medical Center, Rochester, New York, United States
| | | | - Eli Shiltz
- Ohio Department of Health, Columbus, Ohio, United States
| | - Melissa Sutton
- Public Health Division, Oregon Health Authority, Salem, Oregon, United States
| | - Ann Thomas
- Public Health Division, Oregon Health Authority, Salem, Oregon, United States
| | - William Schaffner
- Vanderbilt University Medical Center, Nashville, Tennessee, United States
| | - H. Keipp Talbot
- Vanderbilt University Medical Center, Nashville, Tennessee, United States
| | | | | | - Aron J. Hall
- CDC COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, United States
| | - Erin Burns
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States
| | - Meredith McMorrow
- CDC COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, United States
| | - Carrie Reed
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States
| | - Fiona P. Havers
- CDC COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, United States
| | - Shikha Garg
- CDC COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, United States
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States
- Alternative corresponding authors: Shikha Garg, Influenza Division, Centers for Disease Control and Prevention, 1600 Clifton Rd. MS H24-7, Atlanta, Georgia 30329, United States;
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12
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Rankin DA, Spieker AJ, Perez A, Stahl AL, Rahman HK, Stewart LS, Schuster JE, Lively JY, Haddadin Z, Probst V, Michaels MG, Williams JV, Boom JA, Sahni LC, Staat MA, Schlaudecker EP, McNeal MM, Harrison CJ, Weinberg GA, Szilagyi PG, Englund JA, Klein EJ, Gerber SI, McMorrow M, Rha B, Chappell JD, Selvarangan R, Midgley CM, Halasa NB. Circulation of Rhinoviruses and/or Enteroviruses in Pediatric Patients With Acute Respiratory Illness Before and During the COVID-19 Pandemic in the US. JAMA Netw Open 2023; 6:e2254909. [PMID: 36749589 PMCID: PMC10408278 DOI: 10.1001/jamanetworkopen.2022.54909] [Citation(s) in RCA: 19] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 12/19/2022] [Indexed: 02/08/2023] Open
Abstract
IMPORTANCE Rhinoviruses and/or enteroviruses, which continued to circulate during the COVID-19 pandemic, are commonly detected in pediatric patients with acute respiratory illness (ARI). Yet detailed characterization of rhinovirus and/or enterovirus detection over time is limited, especially by age group and health care setting. OBJECTIVE To quantify and characterize rhinovirus and/or enterovirus detection before and during the COVID-19 pandemic among children and adolescents seeking medical care for ARI at emergency departments (EDs) or hospitals. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study used data from the New Vaccine Surveillance Network (NVSN), a multicenter, active, prospective surveillance platform, for pediatric patients who sought medical care for fever and/or respiratory symptoms at 7 EDs or hospitals within NVSN across the US between December 2016 and February 2021. Persons younger than 18 years were enrolled in NVSN, and respiratory specimens were collected and tested for multiple viruses. MAIN OUTCOMES AND MEASURES Proportion of patients in whom rhinovirus and/or enterovirus, or another virus, was detected by calendar month and by prepandemic (December 1, 2016, to March 11, 2020) or pandemic (March 12, 2020, to February 28, 2021) periods. Month-specific adjusted odds ratios (aORs) for rhinovirus and/or enterovirus-positive test results (among all tested) by setting (ED or inpatient) and age group (<2, 2-4, or 5-17 years) were calculated, comparing each month during the pandemic to equivalent months of previous years. RESULTS Of the 38 198 children and adolescents who were enrolled and tested, 11 303 (29.6%; mean [SD] age, 2.8 [3.7] years; 6733 boys [59.6%]) had rhinovirus and/or enterovirus-positive test results. In prepandemic and pandemic periods, rhinoviruses and/or enteroviruses were detected in 29.4% (9795 of 33 317) and 30.9% (1508 of 4881) of all patients who were enrolled and tested and in 42.2% (9795 of 23 236) and 73.0% (1508 of 2066) of those with test positivity for any virus, respectively. Rhinoviruses and/or enteroviruses were the most frequently detected viruses in both periods and all age groups in the ED and inpatient setting. From April to September 2020 (pandemic period), rhinoviruses and/or enteroviruses were detectable at similar or lower odds than in prepandemic years, with aORs ranging from 0.08 (95% CI, 0.04-0.19) to 0.76 (95% CI, 0.55-1.05) in the ED and 0.04 (95% CI, 0.01-0.11) to 0.71 (95% CI, 0.47-1.07) in the inpatient setting. However, unlike some other viruses, rhinoviruses and/or enteroviruses soon returned to prepandemic levels and from October 2020 to February 2021 were detected at similar or higher odds than in prepandemic months in both settings, with aORs ranging from 1.47 (95% CI, 1.12-1.93) to 3.01 (95% CI, 2.30-3.94) in the ED and 1.36 (95% CI, 1.03-1.79) to 2.44 (95% CI, 1.78-3.34) in the inpatient setting, and in all age groups. Compared with prepandemic years, during the pandemic, rhinoviruses and/or enteroviruses were detected in patients who were slightly older, although most (74.5% [1124 of 1508]) were younger than 5 years. CONCLUSIONS AND RELEVANCE Results of this study show that rhinoviruses and/or enteroviruses persisted and were the most common respiratory virus group detected across all pediatric age groups and in both ED and inpatient settings. Rhinoviruses and/or enteroviruses remain a leading factor in ARI health care burden, and active ARI surveillance in children and adolescents remains critical for defining the health care burden of respiratory viruses.
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Affiliation(s)
- Danielle A. Rankin
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
- Vanderbilt Epidemiology PhD Program, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Andrew J. Spieker
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Ariana Perez
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
- General Dynamics Information Technology Inc, Falls Church, Virginia
| | - Anna L. Stahl
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Herdi K. Rahman
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Laura S. Stewart
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Jennifer E. Schuster
- Division of Pediatric Infectious Diseases, Children’s Mercy Kansas City, Kansas City, Missouri
| | - Joana Y. Lively
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Zaid Haddadin
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Varvara Probst
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Marian G. Michaels
- Department of Pediatrics, University of Pittsburgh School of Medicine, University of Pittsburgh Medical Center Children’s Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - John V. Williams
- Department of Pediatrics, University of Pittsburgh School of Medicine, University of Pittsburgh Medical Center Children’s Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Julie A. Boom
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas
- Texas Children’s Hospital, Houston
| | - Leila C. Sahni
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas
- Texas Children’s Hospital, Houston
| | - Mary A. Staat
- Division of Infectious Diseases, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Elizabeth P. Schlaudecker
- Division of Infectious Diseases, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Monica M. McNeal
- Division of Infectious Diseases, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Christopher J. Harrison
- Division of Pediatric Infectious Diseases, Children’s Mercy Kansas City, Kansas City, Missouri
| | - Geoffrey A. Weinberg
- Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Peter G. Szilagyi
- Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, New York
- Department of Pediatrics, UCLA (University of California, Los Angeles) Mattel Children’s Hospital, UCLA, Los Angeles
| | - Janet A. Englund
- Seattle Children’s Hospital, Department of Pediatrics, University of Washington School of Medicine, Seattle
| | - Eileen J. Klein
- Seattle Children’s Hospital, Department of Pediatrics, University of Washington School of Medicine, Seattle
| | - Susan I. Gerber
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Meredith McMorrow
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Brian Rha
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - James D. Chappell
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Rangaraj Selvarangan
- Division of Pediatric Infectious Diseases, Children’s Mercy Kansas City, Kansas City, Missouri
- Department of Pathology and Laboratory Medicine, Children’s Mercy Kansas City, Kansas City, Missouri
| | - Claire M. Midgley
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Natasha B. Halasa
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
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13
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Moosa F, Tempia S, Kleynhans J, McMorrow M, Moyes J, du Plessis M, Carrim M, Treurnicht FK, Helferscee O, Mkhencele T, Mathunjwa A, Martinson NA, Kahn K, Lebina L, Wafawanaka F, Cohen C, von Gottberg A, Wolter N. Incidence and Transmission Dynamics of Bordetella pertussis Infection in Rural and Urban Communities, South Africa, 2016‒2018. Emerg Infect Dis 2023; 29:294-303. [PMID: 36692337 PMCID: PMC9881781 DOI: 10.3201/eid2902.221125] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
We conducted 3 prospective cohort studies (2016-2018), enrolling persons from 2 communities in South Africa. Nasopharyngeal swab specimens were collected twice a week from participants. Factors associated with Bordetella pertussis incidence, episode duration, and household transmission were determined by using Poisson regression, Weibull accelerated time-failure, and logistic regression hierarchical models, respectively. Among 1,684 participants, 118 episodes of infection were detected in 107 participants (incidence 0.21, 95% CI 0.17-0.25 infections/100 person-weeks). Children <5 years of age who had incomplete vaccination were more likely to have pertussis infection. Episode duration was longer for participants who had higher bacterial loads. Transmission was more likely to occur from male index case-patients and persons who had >7 days infection duration. In both communities, there was high incidence of B. pertussis infection and most cases were colonized.
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14
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Agathis NT, Patel K, Milucky J, Taylor CA, Whitaker M, Pham H, Anglin O, Chai SJ, Alden NB, Meek J, Anderson EJ, Weigel A, Kim S, Lynfield R, Smelser C, Muse A, Popham K, Billing LM, Sutton M, Talbot HK, George A, McMorrow M, Havers FP. Codetections of Other Respiratory Viruses Among Children Hospitalized With COVID-19. Pediatrics 2023; 151:190475. [PMID: 36995184 DOI: 10.1542/peds.2022-059037] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/25/2022] [Indexed: 01/20/2023] Open
Abstract
OBJECTIVES:
To assess the clinical impact of respiratory virus codetections among children hospitalized with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection.
METHODS:
During March 2020 to February 2022, the US coronavirus disease 2019 (COVID-19)-Associated Hospitalization Surveillance Network (COVID-NET) identified 4372 children hospitalized with SARS-CoV-2 infection admitted primarily for fever, respiratory illness, or presumed COVID-19. We compared demographics, clinical features, and outcomes between those with and without codetections who had any non-SARS-CoV-2 virus testing. Among a subgroup of 1670 children with complete additional viral testing, we described the association between presence of codetections and severe respiratory illness using age-stratified multivariable logistic regression models.
RESULTS:
Among 4372 children hospitalized, 62% had non-SARS-CoV-2 respiratory virus testing, of which 21% had a codetection. Children with codetections were more likely to be <5 years old (yo), receive increased oxygen support, or be admitted to the ICU (P < .001). Among children <5 yo, having any viral codetection (<2 yo: adjusted odds ratio [aOR] 2.1 [95% confidence interval [CI] 1.5–3.0]; 2–4 yo: aOR 1.9 [95% CI 1.2–3.1]) or rhinovirus/enterovirus codetection (<2 yo: aOR 2.4 [95% CI 1.6–3.7]; 2-4: aOR 2.4 [95% CI 1.2–4.6]) was significantly associated with severe illness. Among children <2 yo, respiratory syncytial virus (RSV) codetections were also significantly associated with severe illness (aOR 1.9 [95% CI 1.3–2.9]). No significant associations were seen among children ≥5 yo.
CONCLUSIONS:
Respiratory virus codetections, including RSV and rhinovirus/enterovirus, may increase illness severity among children <5 yo hospitalized with SARS-CoV-2 infection.
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Affiliation(s)
| | - Kadam Patel
- COVID-19 Emergency Response Team
- Coronavirus Disease2019-Associated Hospitalization Surveillance Network, Division for Viral Diseases, National Center for Immunization and Respiratory Diseases
- General Dynamics Information Technology, Atlanta, Georgia
| | - Jennifer Milucky
- COVID-19 Emergency Response Team
- Coronavirus Disease2019-Associated Hospitalization Surveillance Network, Division for Viral Diseases, National Center for Immunization and Respiratory Diseases
| | - Christopher A Taylor
- COVID-19 Emergency Response Team
- Coronavirus Disease2019-Associated Hospitalization Surveillance Network, Division for Viral Diseases, National Center for Immunization and Respiratory Diseases
| | - Michael Whitaker
- COVID-19 Emergency Response Team
- Coronavirus Disease2019-Associated Hospitalization Surveillance Network, Division for Viral Diseases, National Center for Immunization and Respiratory Diseases
| | - Huong Pham
- COVID-19 Emergency Response Team
- Coronavirus Disease2019-Associated Hospitalization Surveillance Network, Division for Viral Diseases, National Center for Immunization and Respiratory Diseases
| | - Onika Anglin
- COVID-19 Emergency Response Team
- Coronavirus Disease2019-Associated Hospitalization Surveillance Network, Division for Viral Diseases, National Center for Immunization and Respiratory Diseases
- General Dynamics Information Technology, Atlanta, Georgia
| | - Shua J Chai
- Career Epidemiology Field Officer Program, Centers for Disease Control and Prevention, Atlanta, Georgia
- California Emerging Infections Program, Oakland, California
| | - Nisha B Alden
- Colorado Department of Public Health and Environment, Denver, Colorado
| | - James Meek
- Connecticut Emerging Infections Program, Yale School of Public Health, New Haven, Connecticut
| | - Evan J Anderson
- Emory University School of Medicine, Atlanta, Georgia
- Georgia Emerging Infections Program, Georgia Department of Public Health, Atlanta
- Atlanta Veterans Affairs Medical Center, Atlanta, Georgia
| | - Andy Weigel
- Iowa Department of Public Health, Des Moines, Iowa
| | - Sue Kim
- Michigan Department of Health and Human Services, Lansing, Michigan
| | | | - Chad Smelser
- New MexicoDepartment of Health, Santa Fe, New Mexico
| | - Alison Muse
- New York State Department of Health, Albany, New York
| | - Kevin Popham
- University of Rochester School of Medicine and Dentistry, Rochester, New York
| | | | - Melissa Sutton
- Public Health Division, Oregon Health Authority, Portland, Oregon
| | - H Keipp Talbot
- Vanderbilt University Medical Center, Nashville, Tennessee
| | - Andrea George
- Salt Lake County Health Department, Salt Lake City, Utah
| | - Meredith McMorrow
- COVID-19 Emergency Response Team
- Coronavirus Disease2019-Associated Hospitalization Surveillance Network, Division for Viral Diseases, National Center for Immunization and Respiratory Diseases
- US Public Health Service Commissioned Corps, Rockville, Maryland
| | - Fiona P Havers
- COVID-19 Emergency Response Team
- Coronavirus Disease2019-Associated Hospitalization Surveillance Network, Division for Viral Diseases, National Center for Immunization and Respiratory Diseases
- US Public Health Service Commissioned Corps, Rockville, Maryland
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15
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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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16
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Nunes MC, Walaza S, Meiring S, Zar HJ, Reubenson G, McMorrow M, Tempia S, Rossi L, Itzikowitz R, Bishop K, Mathunjwa A, Wise A, Treurnicht FK, Hellferscee O, Laubscher M, Serafin N, Cutland CL, Madhi SA, Cohen C. Effectiveness of Influenza Vaccination of Pregnant Women for Prevention of Maternal and Early Infant Influenza-Associated Hospitalizations in South Africa: A Prospective Test-Negative Study. Open Forum Infect Dis 2022; 9:ofac552. [PMID: 36447608 PMCID: PMC9697604 DOI: 10.1093/ofid/ofac552] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 10/17/2022] [Indexed: 12/01/2023] Open
Abstract
BACKGROUND Influenza vaccination during pregnancy reduces influenza-associated illness in the women and their infants, but effectiveness estimates against influenza-associated hospitalization are limited and lacking from settings with high human immunodeficiency virus (HIV) infection prevalence. We assessed the effect of maternal vaccination in HIV-uninfected women and women with HIV in preventing influenza-associated hospitalizations in infants and the women. METHODS During 2015-2018, influenza vaccination campaigns targeting pregnant women were augmented at selected antenatal clinics; these were coupled with prospective hospital-based surveillance for acute respiratory or febrile illness in infants aged <6 months and cardiorespiratory illness among pregnant or postpartum women. Vaccine effectiveness (VE) was assessed using a test-negative case-control study. RESULTS Overall, 71 influenza-positive and 371 influenza-negative infants were included in the analysis; mothers of 26.8% of influenza-positive infants were vaccinated during pregnancy compared with 35.6% of influenza-negative infants, corresponding to an adjusted VE (aVE) of 29.0% (95% confidence interval [CI], -33.6% to 62.3%). When limited to vaccine-matched strains, aVE was 65.2% (95% CI, 11.7%-86.3%). For maternal hospitalizations, 56 influenza-positive and 345 influenza-negative women were included in the analysis, with 28.6% of influenza-positive women being vaccinated compared with 38.3% of influenza-negatives, for an aVE of 46.9% (95% CI, -2.8% to 72.5%). Analysis restricted to HIV-uninfected women resulted in 82.8% (95% CI, 40.7%-95.0%) aVE. No significant aVE (-32.5% [95% CI, -208.7% to 43.1%]) was detected among women with HIV. CONCLUSIONS Influenza vaccination during pregnancy prevented influenza-associated hospitalizations among young infants when infected with vaccine strains and among HIV-uninfected women.
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Affiliation(s)
- Marta C Nunes
- South African Medical Research Council, Faculty of Health Sciences, Vaccines and Infectious Diseases Analytics Research Unit, University of the Witwatersrand, Johannesburg, South Africa
- Department of Science and Technology/National Research Foundation, Faculty of Health Sciences, South African Research Chair Initiative in Vaccine Preventable Diseases, University of the Witwatersrand, Johannesburg, South Africa
| | - Sibongile Walaza
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases, Johannesburg, South Africa
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Susan Meiring
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases, Johannesburg, South Africa
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Division of Public Health Surveillance and Response, National Institute for Communicable Diseases, Johannesburg, South Africa
| | - Heather J Zar
- Department of Paediatrics and Child Health, and South African Medical Research Council Unit on Child and Adolescent Health, University of Cape Town, Cape Town, South Africa
| | - Gary Reubenson
- Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Meredith McMorrow
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Stefano Tempia
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Liza Rossi
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases, Johannesburg, South Africa
| | - Raphaela Itzikowitz
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases, Johannesburg, South Africa
| | - Kate Bishop
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases, Johannesburg, South Africa
| | - Azwifarwi Mathunjwa
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases, Johannesburg, South Africa
| | - Amy Wise
- Department of Obstetrics and Gynaecology, Rahima Moosa Mother and Child Hospital, University of the Witwatersrand, Johannesburg, South Africa
| | - Florette K Treurnicht
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases, Johannesburg, South Africa
| | - Orienka Hellferscee
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases, Johannesburg, South Africa
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Matt Laubscher
- South African Medical Research Council, Faculty of Health Sciences, Vaccines and Infectious Diseases Analytics Research Unit, University of the Witwatersrand, Johannesburg, South Africa
- Department of Science and Technology/National Research Foundation, Faculty of Health Sciences, South African Research Chair Initiative in Vaccine Preventable Diseases, University of the Witwatersrand, Johannesburg, South Africa
| | - Natali Serafin
- South African Medical Research Council, Faculty of Health Sciences, Vaccines and Infectious Diseases Analytics Research Unit, University of the Witwatersrand, Johannesburg, South Africa
- Department of Science and Technology/National Research Foundation, Faculty of Health Sciences, South African Research Chair Initiative in Vaccine Preventable Diseases, University of the Witwatersrand, Johannesburg, South Africa
| | - Clare L Cutland
- South African Medical Research Council, Faculty of Health Sciences, Vaccines and Infectious Diseases Analytics Research Unit, University of the Witwatersrand, Johannesburg, South Africa
- Department of Science and Technology/National Research Foundation, Faculty of Health Sciences, South African Research Chair Initiative in Vaccine Preventable Diseases, University of the Witwatersrand, Johannesburg, South Africa
- African Leadership in Vaccinology Expertise, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Shabir A Madhi
- South African Medical Research Council, Faculty of Health Sciences, Vaccines and Infectious Diseases Analytics Research Unit, University of the Witwatersrand, Johannesburg, South Africa
- Department of Science and Technology/National Research Foundation, Faculty of Health Sciences, South African Research Chair Initiative in Vaccine Preventable Diseases, University of the Witwatersrand, Johannesburg, South Africa
- African Leadership in Vaccinology Expertise, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Cheryl Cohen
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases, Johannesburg, South Africa
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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17
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Perez A, Lively JY, Curns A, Weinberg GA, Halasa NB, Staat MA, Szilagyi PG, Stewart LS, McNeal MM, Clopper B, Zhou Y, Whitaker BL, LeMasters E, Harker E, Englund JA, Klein EJ, Selvarangan R, Harrison CJ, Boom JA, Sahni LC, Michaels MG, Williams JV, Langley GE, Gerber SI, Campbell A, Hall AJ, Rha B, McMorrow M. Respiratory Virus Surveillance Among Children with Acute Respiratory Illnesses - New Vaccine Surveillance Network, United States, 2016-2021. MMWR Morb Mortal Wkly Rep 2022; 71:1253-1259. [PMID: 36201373 PMCID: PMC9541034 DOI: 10.15585/mmwr.mm7140a1] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [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: 11/27/2022]
Abstract
The New Vaccine Surveillance Network (NVSN) is a prospective, active, population-based surveillance platform that enrolls children with acute respiratory illnesses (ARIs) at seven pediatric medical centers. ARIs are caused by respiratory viruses including influenza virus, respiratory syncytial virus (RSV), human metapneumovirus (HMPV), human parainfluenza viruses (HPIVs), and most recently SARS-CoV-2 (the virus that causes COVID-19), which result in morbidity among infants and young children (1-6). NVSN estimates the incidence of pathogen-specific pediatric ARIs and collects clinical data (e.g., underlying medical conditions and vaccination status) to assess risk factors for severe disease and calculate influenza and COVID-19 vaccine effectiveness. Current NVSN inpatient (i.e., hospital) surveillance began in 2015, expanded to emergency departments (EDs) in 2016, and to outpatient clinics in 2018. This report describes demographic characteristics of enrolled children who received care in these settings, and yearly circulation of influenza, RSV, HMPV, HPIV1-3, adenovirus, human rhinovirus and enterovirus (RV/EV),* and SARS-CoV-2 during December 2016-August 2021. Among 90,085 eligible infants, children, and adolescents (children) aged <18 years† with ARI, 51,441 (57%) were enrolled, nearly 75% of whom were aged <5 years; 43% were hospitalized. Infants aged <1 year accounted for the largest proportion (38%) of those hospitalized. The most common pathogens detected were RV/EV and RSV. Before the emergence of SARS-CoV-2, detected respiratory viruses followed previously described seasonal trends, with annual peaks of influenza and RSV in late fall and winter (7,8). After the emergence of SARS-CoV-2 and implementation of associated pandemic nonpharmaceutical interventions and community mitigation measures, many respiratory viruses circulated at lower-than-expected levels during April 2020-May 2021. Beginning in summer 2021, NVSN detected higher than anticipated enrollment of hospitalized children as well as atypical interseasonal circulation of RSV. Further analyses of NVSN data and continued surveillance are vital in highlighting risk factors for severe disease and health disparities, measuring the effectiveness of vaccines and monoclonal antibody-based prophylactics, and guiding policies to protect young children from pathogens such as SARS-CoV-2, influenza, and RSV.
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18
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Havers FP, Pham H, Taylor CA, Whitaker M, Patel K, Anglin O, Kambhampati AK, Milucky J, Zell E, Moline HL, Chai SJ, Kirley PD, Alden NB, Armistead I, Yousey-Hindes K, Meek J, Openo KP, Anderson EJ, Reeg L, Kohrman A, Lynfield R, Como-Sabetti K, Davis EM, Cline C, Muse A, Barney G, Bushey S, Felsen CB, Billing LM, Shiltz E, Sutton M, Abdullah N, Talbot HK, Schaffner W, Hill M, George A, Hall AJ, Bialek SR, Murthy NC, Murthy BP, McMorrow M. COVID-19-Associated Hospitalizations Among Vaccinated and Unvaccinated Adults 18 Years or Older in 13 US States, January 2021 to April 2022. JAMA Intern Med 2022; 182:1071-1081. [PMID: 36074486 PMCID: PMC9459904 DOI: 10.1001/jamainternmed.2022.4299] [Citation(s) in RCA: 67] [Impact Index Per Article: 33.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 08/04/2022] [Indexed: 12/24/2022]
Abstract
Importance Understanding risk factors for hospitalization in vaccinated persons and the association of COVID-19 vaccines with hospitalization rates is critical for public health efforts to control COVID-19. Objective To determine characteristics of COVID-19-associated hospitalizations among vaccinated persons and comparative hospitalization rates in unvaccinated and vaccinated persons. Design, Setting, and Participants From January 1, 2021, to April 30, 2022, patients 18 years or older with laboratory-confirmed SARS-CoV-2 infection were identified from more than 250 hospitals in the population-based COVID-19-Associated Hospitalization Surveillance Network. State immunization information system data were linked to cases, and the vaccination coverage data of the defined catchment population were used to compare hospitalization rates in unvaccinated and vaccinated individuals. Vaccinated and unvaccinated patient characteristics were compared in a representative sample with detailed medical record review; unweighted case counts and weighted percentages were calculated. Exposures Laboratory-confirmed COVID-19-associated hospitalization, defined as a positive SARS-CoV-2 test result within 14 days before or during hospitalization. Main Outcomes and Measures COVID-19-associated hospitalization rates among vaccinated vs unvaccinated persons and factors associated with COVID-19-associated hospitalization in vaccinated persons were assessed. Results Using representative data from 192 509 hospitalizations (see Table 1 for demographic information), monthly COVID-19-associated hospitalization rates ranged from 3.5 times to 17.7 times higher in unvaccinated persons than vaccinated persons regardless of booster dose status. From January to April 2022, when the Omicron variant was predominant, hospitalization rates were 10.5 times higher in unvaccinated persons and 2.5 times higher in vaccinated persons with no booster dose, respectively, compared with those who had received a booster dose. Among sampled cases, vaccinated hospitalized patients with COVID-19 were older than those who were unvaccinated (median [IQR] age, 70 [58-80] years vs 58 [46-70] years, respectively; P < .001) and more likely to have 3 or more underlying medical conditions (1926 [77.8%] vs 4124 [51.6%], respectively; P < .001). Conclusions and Relevance In this cross-sectional study of US adults hospitalized with COVID-19, unvaccinated adults were more likely to be hospitalized compared with vaccinated adults; hospitalization rates were lowest in those who had received a booster dose. Hospitalized vaccinated persons were older and more likely to have 3 or more underlying medical conditions and be long-term care facility residents compared with hospitalized unvaccinated persons. The study results suggest that clinicians and public health practitioners should continue to promote vaccination with all recommended doses for eligible persons.
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Affiliation(s)
- Fiona P Havers
- US Centers for Disease Control and Prevention COVID-19 Response, Atlanta, Georgia
- Public Health Service Commissioned Corps, Rockville, Maryland
| | - Huong Pham
- US Centers for Disease Control and Prevention COVID-19 Response, Atlanta, Georgia
| | - Christopher A Taylor
- US Centers for Disease Control and Prevention COVID-19 Response, Atlanta, Georgia
| | - Michael Whitaker
- US Centers for Disease Control and Prevention COVID-19 Response, Atlanta, Georgia
| | - Kadam Patel
- US Centers for Disease Control and Prevention COVID-19 Response, Atlanta, Georgia
- General Dynamics Information Technology, Atlanta, Georgia
| | - Onika Anglin
- US Centers for Disease Control and Prevention COVID-19 Response, Atlanta, Georgia
- General Dynamics Information Technology, Atlanta, Georgia
| | - Anita K Kambhampati
- US Centers for Disease Control and Prevention COVID-19 Response, Atlanta, Georgia
| | - Jennifer Milucky
- US Centers for Disease Control and Prevention COVID-19 Response, Atlanta, Georgia
| | - Elizabeth Zell
- US Centers for Disease Control and Prevention COVID-19 Response, Atlanta, Georgia
- Stat-Epi Associates, Inc, Ponte Vedra Beach, Florida
| | - Heidi L Moline
- US Centers for Disease Control and Prevention COVID-19 Response, Atlanta, Georgia
- Public Health Service Commissioned Corps, Rockville, Maryland
| | - Shua J Chai
- Field Services Branch, Division of State and Local Readiness, Center for Preparedness and Response, US Centers for Disease Control and Prevention, Atlanta, Georgia
- California Emerging Infections Program, Oakland
| | | | - Nisha B Alden
- Colorado Department of Public Health and Environment, Denver
| | - Isaac Armistead
- Colorado Department of Public Health and Environment, Denver
| | | | - James Meek
- Connecticut Emerging Infections Program, Yale School of Public Health, New Haven
| | - Kyle P Openo
- Division of Infectious Diseases, School of Medicine, Emory University, Atlanta, Georgia
- Georgia Emerging Infections Program, Georgia Department of Public Health, Atlanta
| | - Evan J Anderson
- Georgia Emerging Infections Program, Georgia Department of Public Health, Atlanta
- Departments of Medicine and Pediatrics, Emory School of Medicine, Atlanta, Georgia
- Atlanta Veterans Affairs Medical Center, Atlanta, Georgia
| | - Libby Reeg
- Michigan Department of Health and Human Services, Lansing
| | | | | | | | | | - Cory Cline
- New Mexico Department of Health, Santa Fe
| | | | | | - Sophrena Bushey
- University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Christina B Felsen
- University of Rochester School of Medicine and Dentistry, Rochester, New York
| | | | | | - Melissa Sutton
- Public Health Division, Oregon Health Authority, Portland
| | | | - H Keipp Talbot
- Vanderbilt University Medical Center, Nashville, Tennessee
| | | | - Mary Hill
- Salt Lake County Health Department, Salt Lake City, Utah
| | - Andrea George
- Salt Lake County Health Department, Salt Lake City, Utah
| | - Aron J Hall
- US Centers for Disease Control and Prevention COVID-19 Response, Atlanta, Georgia
| | - Stephanie R Bialek
- US Centers for Disease Control and Prevention COVID-19 Response, Atlanta, Georgia
- Public Health Service Commissioned Corps, Rockville, Maryland
| | - Neil C Murthy
- US Centers for Disease Control and Prevention COVID-19 Response, Atlanta, Georgia
- Public Health Service Commissioned Corps, Rockville, Maryland
| | - Bhavini Patel Murthy
- US Centers for Disease Control and Prevention COVID-19 Response, Atlanta, Georgia
- Public Health Service Commissioned Corps, Rockville, Maryland
| | - Meredith McMorrow
- US Centers for Disease Control and Prevention COVID-19 Response, Atlanta, Georgia
- Public Health Service Commissioned Corps, Rockville, Maryland
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19
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Meiring S, Tempia S, Bhiman JN, Buys A, Kleynhans J, Makhasi M, McMorrow M, Moyes J, Quan V, Walaza S, du Plessis M, Wolter N, von Gottberg A, Cohen C. Prolonged Shedding of Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) at High Viral Loads Among Hospitalized Immunocompromised Persons Living With Human Immunodeficiency Virus (HIV), South Africa. Clin Infect Dis 2022; 75:e144-e156. [PMID: 35134129 PMCID: PMC8903337 DOI: 10.1093/cid/ciac077] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [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: 09/13/2021] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND We assessed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA shedding duration and magnitude among persons living with human immunodeficiency virus (HIV, PLHIV). METHODS From May through December 2020, we conducted a prospective cohort study at 20 hospitals in South Africa. Adults hospitalized with symptomatic coronavirus disease 2019 (COVID-19) were enrolled and followed every 2 days with nasopharyngeal/oropharyngeal (NP/OP) swabs until documentation of cessation of SARS-CoV-2 shedding (2 consecutive negative NP/OP swabs). Real-time reverse transcription-polymerase chain reaction testing for SARS-CoV-2 was performed, and cycle-threshold (Ct) values < 30 were considered a proxy for high SARS-CoV-2 viral load. Factors associated with prolonged shedding were assessed using accelerated time-failure Weibull regression models. RESULTS Of 2175 COVID-19 patients screened, 300 were enrolled, and 257 individuals (155 HIV-uninfected and 102 PLHIV) had > 1 swabbing visit (median 5 visits [range 2-21]). Median time to cessation of shedding was 13 days (interquartile range [IQR] 6-25) and did not differ significantly by HIV infection. Among a subset of 94 patients (41 PLHIV and 53 HIV-uninfected) with initial respiratory sample Ct-value < 30, median time of shedding at high SARS-CoV-2 viral load was 8 days (IQR 4-17). This was significantly longer in PLHIV with CD4 count < 200 cells/µL, compared to HIV-uninfected persons (median 27 days [IQR 8-43] vs 7 days [IQR 4-13]; adjusted hazard ratio [aHR] 0.14, 95% confidence interval [CI] .07-.28, P < .001), as well as in unsuppressed-HIV versus HIV-uninfected persons. CONCLUSIONS Although SARS-CoV-2 shedding duration did not differ significantly by HIV infection, among a subset with high initial SARS-CoV-2 viral loads, immunocompromised PLHIV shed SARS-CoV-2 at high viral loads for longer than HIV-uninfected persons. Better HIV control may potentially decrease transmission time of SARS-CoV-2.
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Affiliation(s)
- Susan Meiring
- Division of Public Health Surveillance and Response, National Institute for Communicable Diseases, a Division of the National Health Laboratory Service, Johannesburg, South Africa
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Stefano Tempia
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases, a Division of the National Health Laboratory Service, Johannesburg, South Africa
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Jinal N Bhiman
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases, a Division of the National Health Laboratory Service, Johannesburg, South Africa
- School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Amelia Buys
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases, a Division of the National Health Laboratory Service, Johannesburg, South Africa
| | - Jackie Kleynhans
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases, a Division of the National Health Laboratory Service, Johannesburg, South Africa
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Mvuyo Makhasi
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases, a Division of the National Health Laboratory Service, Johannesburg, South Africa
| | - Meredith McMorrow
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- Division of Viral Diseases, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Jocelyn Moyes
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases, a Division of the National Health Laboratory Service, Johannesburg, South Africa
| | - Vanessa Quan
- Division of Public Health Surveillance and Response, National Institute for Communicable Diseases, a Division of the National Health Laboratory Service, Johannesburg, South Africa
| | - Sibongile Walaza
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases, a Division of the National Health Laboratory Service, Johannesburg, South Africa
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Mignon du Plessis
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases, a Division of the National Health Laboratory Service, Johannesburg, South Africa
- School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Nicole Wolter
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases, a Division of the National Health Laboratory Service, Johannesburg, South Africa
- School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Anne von Gottberg
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases, a Division of the National Health Laboratory Service, Johannesburg, South Africa
- School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Cheryl Cohen
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases, a Division of the National Health Laboratory Service, Johannesburg, South Africa
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Moleleki M, du Plessis M, Ndlangisa K, Reddy C, Hellferscee O, Mekgoe O, McMorrow M, Walaza S, Cohen C, Tempia S, von Gottberg A, Wolter N. Pathogens detected using a syndromic molecular diagnostic platform in patients hospitalized with severe respiratory illness in South Africa in 2017. Int J Infect Dis 2022; 122:389-397. [PMID: 35700877 DOI: 10.1016/j.ijid.2022.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 05/30/2022] [Accepted: 06/08/2022] [Indexed: 10/18/2022] Open
Abstract
OBJECTIVES We describe the use of a multi-pathogen platform, TaqMan array card (TAC) real-time PCR, for the detection of pathogens in patients hospitalized with severe respiratory illness (SRI). METHODS Prospective hospital-based syndromic surveillance for acute and chronic SRI was carried out at two sentinel sites in South Africa between January and December 2017. We tested respiratory specimens for 21 respiratory pathogens and blood samples for nine bacteria using TAC. Pathogen detection was compared by age group and HIV status using the chi-squared test. RESULTS During 2017, 956 patients of all ages were enrolled in the SRI surveillance, and of these, 637 (67%) patients were included in this study (637 blood, 487 naso- and oro-pharyngeal swabs and 411 sputum specimens tested). At least one pathogen was detected in 83% (527/637) of patients. Common pathogens detected included H. influenzae (225/637; 35%), S. pneumoniae (224/637; 35%), rhinovirus (144/637; 23%), S. aureus (129/637; 20%), K. pneumoniae (85/637; 13%), M. tuberculosis (75/637; 12%), and respiratory syncytial virus (57/637; 9%). Multiple pathogens (≥2) were co-detected in 57% (364/637) of patients. CONCLUSION While use of a multi-pathogen platform improved pathogen yield, pathogen co-detections were common and would need clinical assessment for usefulness in individual-level treatment and management decisions.
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Affiliation(s)
- Malefu Moleleki
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa; Department of Clinical Microbiology and Infectious Diseases, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
| | - Mignon du Plessis
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa; Department of Clinical Microbiology and Infectious Diseases, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Kedibone Ndlangisa
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa; Department of Clinical Microbiology and Infectious Diseases, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Cayla Reddy
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa; Department of Clinical Microbiology and Infectious Diseases, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Orienka Hellferscee
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa; Department of Medical Virology, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Omphe Mekgoe
- Department of Paediatrics, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Meredith McMorrow
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America; Influenza Program, Centers for Disease Control and Prevention, Pretoria, South Africa
| | - Sibongile Walaza
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa; School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Cheryl Cohen
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa; School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Stefano Tempia
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa; Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America; Influenza Program, Centers for Disease Control and Prevention, Pretoria, South Africa; School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; MassGenics, Duluth, Georgia, United States of America
| | - Anne von Gottberg
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa; Department of Clinical Microbiology and Infectious Diseases, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Nicole Wolter
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa; Department of Clinical Microbiology and Infectious Diseases, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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21
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Fraser H, Tombe-Mdewa W, Kohli-Lynch C, Hofman K, Tempia S, McMorrow M, Lambach P, Ramkrishna W, Cohen C, Hutubessy R, Edoka I. Costs of seasonal influenza vaccination in South Africa. Influenza Other Respir Viruses 2022; 16:873-880. [PMID: 35355414 PMCID: PMC9343325 DOI: 10.1111/irv.12987] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 03/13/2022] [Indexed: 11/30/2022] Open
Abstract
Background Influenza accounts for a substantial number of deaths and hospitalisations annually in South Africa. To address this disease burden, the South African National Department of Health introduced a trivalent inactivated influenza vaccination programme in 2010. Methods We adapted and populated the WHO Seasonal Influenza Immunization Costing Tool (WHO SIICT) with country‐specific data to estimate the cost of the influenza vaccination programme in South Africa. Data were obtained through key‐informant interviews at different levels of the health system and through a review of existing secondary data sources. Costs were estimated from a public provider perspective and expressed in 2018 prices. We conducted scenario analyses to assess the impact of different levels of programme expansion and the use of quadrivalent vaccines on total programme costs. Results Total financial and economic costs were estimated at approximately USD 2.93 million and USD 7.91 million, respectively, while financial and economic cost per person immunised was estimated at USD 3.29 and USD 8.88, respectively. Expanding the programme by 5% and 10% increased economic cost per person immunised to USD 9.36 and USD 9.52 in the two scenarios, respectively. Finally, replacing trivalent inactivated influenza vaccine (TIV) with quadrivalent vaccine increased financial and economic costs to USD 4.89 and USD 10.48 per person immunised, respectively. Conclusion We adapted the WHO SIICT and provide estimates of the total costs of the seasonal influenza vaccination programme in South Africa. These estimates provide a basis for planning future programme expansion and may serve as inputs for cost‐effectiveness analyses of seasonal influenza vaccination programmes.
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Affiliation(s)
- Heather Fraser
- SAMRC Centre for Health Economics and Decision Science-PRICELESS SA, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,Health Economics and Health Technology Assessment, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Winfrida Tombe-Mdewa
- SAMRC Centre for Health Economics and Decision Science-PRICELESS SA, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Ciaran Kohli-Lynch
- SAMRC Centre for Health Economics and Decision Science-PRICELESS SA, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Karen Hofman
- SAMRC Centre for Health Economics and Decision Science-PRICELESS SA, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Stefano Tempia
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.,Influenza Program, Centers for Disease Control and Prevention, Pretoria, South Africa.,MassGenics, Duluth, Georgia, USA.,School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Meredith McMorrow
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.,Influenza Program, Centers for Disease Control and Prevention, Pretoria, South Africa.,US Public Health Service, Rockville, Maryland, USA
| | - Philipp Lambach
- Department of Immunization, Vaccines and Biologicals, World Health Organization, Geneva, Switzerland
| | - Wayne Ramkrishna
- Communicable Disease Cluster, National Department of Health, Pretoria, South Africa
| | - Cheryl Cohen
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa
| | - Raymond Hutubessy
- Department of Immunization, Vaccines and Biologicals, World Health Organization, Geneva, Switzerland
| | - Ijeoma Edoka
- SAMRC Centre for Health Economics and Decision Science-PRICELESS SA, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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22
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Valley‐Omar Z, Tempia S, Hellferscee O, Walaza S, Variava E, Dawood H, Kahn K, McMorrow M, Pretorius M, Mtshali S, Mamorobela E, Wolter N, Venter M, von Gottberg A, Cohen C, Treurnicht FK. Human respiratory syncytial virus diversity and epidemiology among patients hospitalized with severe respiratory illness in South Africa, 2012-2015. Influenza Other Respir Viruses 2022; 16:222-235. [PMID: 34528769 PMCID: PMC8818822 DOI: 10.1111/irv.12905] [Citation(s) in RCA: 6] [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: 02/11/2021] [Revised: 08/13/2021] [Accepted: 08/16/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND We aimed to describe the prevalence of human respiratory syncytial virus (HRSV) and evaluate associations between HRSV subgroups and/or genotypes and epidemiologic characteristics and clinical outcomes in patients hospitalized with severe respiratory illness (SRI). METHODS Between January 2012 and December 2015, we enrolled patients of all ages admitted to two South African hospitals with SRI in prospective hospital-based syndromic surveillance. We collected respiratory specimens and clinical and epidemiological data. Unconditional random effect multivariable logistic regression was used to assess factors associated with HRSV infection. RESULTS HRSV was detected in 11.2% (772/6908) of enrolled patients of which 47.0% (363/772) were under the age of 6 months. There were no differences in clinical outcomes of HRSV subgroup A-infected patients compared with HRSV subgroup B-infected patients but among patients aged <5 years, children with HRSV subgroup A were more likely be coinfected with Streptococcus pneumoniae (23/208, 11.0% vs. 2/90, 2.0%; adjusted odds ratio 5.7). No significant associations of HRSV A genotypes NA1 and ON1 with specific clinical outcomes were observed. CONCLUSIONS While HRSV subgroup and genotype dominance shifted between seasons, we showed similar genotype diversity as noted worldwide. We found no association between clinical outcomes and HRSV subgroups or genotypes.
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Affiliation(s)
- Ziyaad Valley‐Omar
- National Institute for Communicable Diseases of the National Health Laboratory ServiceJohannesburgSouth Africa
- University of Cape TownCape TownSouth Africa
| | - Stefano Tempia
- Centers for Disease Control and PreventionPretoriaSouth Africa
- Centers for Disease Control and PreventionAtlantaGeorgiaUSA
- MassGenicsDuluthGeorgiaUSA
- University of the WitwatersrandJohannesburgSouth Africa
| | - Orienka Hellferscee
- National Institute for Communicable Diseases of the National Health Laboratory ServiceJohannesburgSouth Africa
| | - Sibongile Walaza
- National Institute for Communicable Diseases of the National Health Laboratory ServiceJohannesburgSouth Africa
- University of the WitwatersrandJohannesburgSouth Africa
| | | | - Halima Dawood
- University of KwaZulu‐NatalKwaZulu‐NatalSouth Africa
- Greys hospitalPietermaritzburgSouth Africa
| | - Kathleen Kahn
- National Institute for Communicable Diseases of the National Health Laboratory ServiceJohannesburgSouth Africa
| | - Meredith McMorrow
- Centers for Disease Control and PreventionPretoriaSouth Africa
- Centers for Disease Control and PreventionAtlantaGeorgiaUSA
| | - Marthi Pretorius
- National Institute for Communicable Diseases of the National Health Laboratory ServiceJohannesburgSouth Africa
- Novartis Pharma AGBaselSwitzerland
| | - Senzo Mtshali
- National Institute for Communicable Diseases of the National Health Laboratory ServiceJohannesburgSouth Africa
| | - Ernest Mamorobela
- National Institute for Communicable Diseases of the National Health Laboratory ServiceJohannesburgSouth Africa
| | - Nicole Wolter
- National Institute for Communicable Diseases of the National Health Laboratory ServiceJohannesburgSouth Africa
- University of the WitwatersrandJohannesburgSouth Africa
| | - Marietjie Venter
- National Institute for Communicable Diseases of the National Health Laboratory ServiceJohannesburgSouth Africa
- University of PretoriaPretoriaSouth Africa
| | - Anne von Gottberg
- National Institute for Communicable Diseases of the National Health Laboratory ServiceJohannesburgSouth Africa
- University of the WitwatersrandJohannesburgSouth Africa
| | - Cheryl Cohen
- National Institute for Communicable Diseases of the National Health Laboratory ServiceJohannesburgSouth Africa
- University of the WitwatersrandJohannesburgSouth Africa
| | - Florette K. Treurnicht
- University of the WitwatersrandJohannesburgSouth Africa
- National Health Laboratory Service, Charlotte Maxeke Johannesburg Academic HospitalJohannesburgSouth Africa
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23
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Otieno NA, Nyawanda BO, McMorrow M, Oneko M, Omollo D, Lidechi S, Widdowson M, Flannery B, Chaves SS, Azziz‐Baumgartner E, Emukule GO. The burden of influenza among Kenyan pregnant and postpartum women and their infants, 2015–2020. Influenza Other Respir Viruses 2022; 16:452-461. [PMID: 35066993 PMCID: PMC8983887 DOI: 10.1111/irv.12950] [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: 11/11/2021] [Accepted: 12/05/2021] [Indexed: 11/30/2022] Open
Abstract
Background In tropical Africa, data about influenza‐associated illness burden are needed to assess potential benefits of influenza vaccination among pregnant women. We estimated the incidence of influenza among pregnant women and their infants in Siaya County, Kenya. Methods We enrolled women at <31 weeks of gestation and conducted weekly follow‐up until 6‐month postpartum to identify acute respiratory illnesses (ARIs). We defined ARI among mothers as reported cough, rhinorrhoea or sore throat and among infants as maternal‐reported cough, difficulty breathing, rhinorrhoea or clinician diagnosis of respiratory illness. We collected nasal/nasopharyngeal and oropharyngeal swabs from mothers/infants with ARI and tested for influenza A and B using molecular assays. We calculated antenatal incidence of laboratory‐confirmed influenza among mothers and postnatal incidence among mothers and infants. Results During June 2015 to May 2020, we analysed data from 3,026 pregnant women at a median gestational age of 16 weeks (interquartile range [IQR], 13, 18) and followed 2,550 infants. Incidence of laboratory‐confirmed influenza during pregnancy (10.3 episodes per 1,000 person‐months [95% confidence interval {CI} 8.6–11.8]) was twofold higher than in the postpartum period (4.0 [95% CI 2.6–5.5]; p < 0.01). Incidence was significantly higher among human immunodeficiency virus (HIV)‐infected pregnant women (15.6 [95% CI 11.0–20.6] vs. 9.1 [95% CI 7.5–10.8]; p < 0.01). Incidence among young infants was 4.4 (95% CI 3.0–5.9) and similar among HIV‐exposed and HIV‐unexposed infants. Conclusion Our findings suggest a substantial burden of influenza illnesses during pregnancy, with a higher burden among HIV‐infected mothers. Kenyan authorities should consider the value of vaccinating pregnant women, especially if HIV infected.
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Affiliation(s)
- Nancy A. Otieno
- Kenya Medical Research Institute Center for Global Health Research Kisumu Kenya
| | - Bryan O. Nyawanda
- Kenya Medical Research Institute Center for Global Health Research Kisumu Kenya
| | - Meredith McMorrow
- Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Diseases Influenza Division Atlanta Georgia USA
| | - Martina Oneko
- Kenya Medical Research Institute Center for Global Health Research Kisumu Kenya
| | - Daniel Omollo
- Kenya Medical Research Institute Center for Global Health Research Kisumu Kenya
| | - Shirley Lidechi
- Kenya Medical Research Institute Center for Global Health Research Kisumu Kenya
| | - Marc‐Alain Widdowson
- Centers for Disease Control and Prevention Division of Global Health Protection Nairobi Kenya
- Institute of Tropical Medicine Antwerp Belgium
| | - Brendan Flannery
- Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Diseases Influenza Division Atlanta Georgia USA
| | - Sandra S. Chaves
- Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Diseases Influenza Division Atlanta Georgia USA
- Centers for Disease Control and Prevention, Influenza Program Nairobi Kenya
| | - Eduardo Azziz‐Baumgartner
- Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Diseases Influenza Division Atlanta Georgia USA
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24
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McNamara LA, Wiegand RE, Burke RM, Sharma AJ, Sheppard M, Adjemian J, Ahmad FB, Anderson RN, Barbour KE, Binder AM, Dasgupta S, Dee DL, Jones ES, Kriss JL, Lyons BC, McMorrow M, Payne DC, Reses HE, Rodgers LE, Walker D, Verani JR, Schrag SJ. Estimating the early impact of the US COVID-19 vaccination programme on COVID-19 cases, emergency department visits, hospital admissions, and deaths among adults aged 65 years and older: an ecological analysis of national surveillance data. Lancet 2022; 399:152-160. [PMID: 34741818 PMCID: PMC8565933 DOI: 10.1016/s0140-6736(21)02226-1] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 09/21/2021] [Accepted: 09/28/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND In the USA, COVID-19 vaccines became available in mid-December, 2020, with adults aged 65 years and older among the first groups prioritised for vaccination. We estimated the national-level impact of the initial phases of the US COVID-19 vaccination programme on COVID-19 cases, emergency department visits, hospital admissions, and deaths among adults aged 65 years and older. METHODS We analysed population-based data reported to US federal agencies on COVID-19 cases, emergency department visits, hospital admissions, and deaths among adults aged 50 years and older during the period Nov 1, 2020, to April 10, 2021. We calculated the relative change in incidence among older age groups compared with a younger reference group for pre-vaccination and post-vaccination periods, defined by the week when vaccination coverage in a given age group first exceeded coverage in the reference age group by at least 1%; time lags for immune response and time to outcome were incorporated. We assessed whether the ratio of these relative changes differed when comparing the pre-vaccination and post-vaccination periods. FINDINGS The ratio of relative changes comparing the change in the COVID-19 case incidence ratio over the post-vaccine versus pre-vaccine periods showed relative decreases of 53% (95% CI 50 to 55) and 62% (59 to 64) among adults aged 65 to 74 years and 75 years and older, respectively, compared with those aged 50 to 64 years. We found similar results for emergency department visits with relative decreases of 61% (52 to 68) for adults aged 65 to 74 years and 77% (71 to 78) for those aged 75 years and older compared with adults aged 50 to 64 years. Hospital admissions declined by 39% (29 to 48) among those aged 60 to 69 years, 60% (54 to 66) among those aged 70 to 79 years, and 68% (62 to 73), among those aged 80 years and older, compared with adults aged 50 to 59 years. COVID-19 deaths also declined (by 41%, 95% CI -14 to 69 among adults aged 65-74 years and by 30%, -47 to 66 among those aged ≥75 years, compared with adults aged 50 to 64 years), but the magnitude of the impact of vaccination roll-out on deaths was unclear. INTERPRETATION The initial roll-out of the US COVID-19 vaccination programme was associated with reductions in COVID-19 cases, emergency department visits, and hospital admissions among older adults. FUNDING None.
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Affiliation(s)
- Lucy A McNamara
- CDC COVID-19 Response Team, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Ryan E Wiegand
- CDC COVID-19 Response Team, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Rachel M Burke
- CDC COVID-19 Response Team, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Andrea J Sharma
- CDC COVID-19 Response Team, US Centers for Disease Control and Prevention, Atlanta, GA, USA; US Public Health Service Commissioned Corps, Atlanta, GA, USA
| | - Michael Sheppard
- CDC COVID-19 Response Team, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Jennifer Adjemian
- CDC COVID-19 Response Team, US Centers for Disease Control and Prevention, Atlanta, GA, USA; US Public Health Service Commissioned Corps, Atlanta, GA, USA
| | - Farida B Ahmad
- CDC COVID-19 Response Team, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Robert N Anderson
- CDC COVID-19 Response Team, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Kamil E Barbour
- CDC COVID-19 Response Team, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Alison M Binder
- CDC COVID-19 Response Team, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Sharoda Dasgupta
- CDC COVID-19 Response Team, US Centers for Disease Control and Prevention, Atlanta, GA, USA; US Public Health Service Commissioned Corps, Atlanta, GA, USA
| | - Deborah L Dee
- CDC COVID-19 Response Team, US Centers for Disease Control and Prevention, Atlanta, GA, USA; US Public Health Service Commissioned Corps, Atlanta, GA, USA
| | - Emma S Jones
- CDC COVID-19 Response Team, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Jennifer L Kriss
- CDC COVID-19 Response Team, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - B Casey Lyons
- CDC COVID-19 Response Team, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Meredith McMorrow
- CDC COVID-19 Response Team, US Centers for Disease Control and Prevention, Atlanta, GA, USA; US Public Health Service Commissioned Corps, Atlanta, GA, USA
| | - Daniel C Payne
- CDC COVID-19 Response Team, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Hannah E Reses
- CDC COVID-19 Response Team, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Loren E Rodgers
- CDC COVID-19 Response Team, US Centers for Disease Control and Prevention, Atlanta, GA, USA; US Public Health Service Commissioned Corps, Atlanta, GA, USA
| | - David Walker
- CDC COVID-19 Response Team, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Jennifer R Verani
- CDC COVID-19 Response Team, US Centers for Disease Control and Prevention, Atlanta, GA, USA; US Public Health Service Commissioned Corps, Atlanta, GA, USA.
| | - Stephanie J Schrag
- CDC COVID-19 Response Team, US Centers for Disease Control and Prevention, Atlanta, GA, USA.
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25
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Woodruff RC, Campbell AP, Taylor CA, Chai SJ, Kawasaki B, Meek J, Anderson EJ, Weigel A, Monroe ML, Reeg L, Bye E, Sosin DM, Muse A, Bennett NM, Billing LM, Sutton M, Talbot HK, McCaffrey K, Pham H, Patel K, Whitaker M, McMorrow M, Havers F. Risk Factors for Severe COVID-19 in Children. Pediatrics 2022; 149:e2021053418. [PMID: 34935038 PMCID: PMC9213563 DOI: 10.1542/peds.2021-053418] [Citation(s) in RCA: 115] [Impact Index Per Article: 57.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/19/2021] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVES Describe population-based rates and risk factors for severe coronavirus disease 2019 (COVID-19) (ie, ICU admission, invasive mechanical ventilation, or death) among hospitalized children. METHODS During March 2020 to May 2021, the COVID-19-Associated Hospitalization Surveillance Network identified 3106 children hospitalized with laboratory-confirmed severe acute respiratory syndrome coronavirus 2 infection in 14 states. Among 2293 children primarily admitted for COVID-19, multivariable generalized estimating equations generated adjusted risk ratios (aRRs) and 95% confidence intervals (CIs) of the associations between demographic and medical characteristics abstracted from medical records and severe COVID-19. We calculated age-adjusted cumulative population-based rates of severe COVID-19 among all children. RESULTS Approximately 30% of hospitalized children had severe COVID-19; 0.5% died during hospitalization. Among hospitalized children aged <2 years, chronic lung disease (aRR: 2.2; 95% CI: 1.1-4.3), neurologic disorders (aRR: 2.0; 95% CI: 1.5‒2.6), cardiovascular disease (aRR: 1.7; 95% CI: 1.2‒2.3), prematurity (aRR: 1.6; 95% CI: 1.1‒2.2), and airway abnormality (aRR: 1.6; 95% CI: 1.1‒2.2) were associated with severe COVID-19. Among hospitalized children aged 2 to 17 years, feeding tube dependence (aRR: 2.0; 95% CI: 1.5‒2.5), diabetes mellitus (aRR: 1.9; 95% CI: 1.6‒2.3) and obesity (aRR: 1.2; 95% CI: 1.0‒1.4) were associated with severe COVID-19. Severe COVID-19 occurred among 12.0 per 100 000 children overall and was highest among infants, Hispanic children, and non-Hispanic Black children. CONCLUSIONS Results identify children at potentially higher risk of severe COVID-19 who may benefit from prevention efforts, including vaccination. Rates establish a baseline for monitoring changes in pediatric illness severity after increased availability of COVID-19 vaccines and the emergence of new variants.
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Affiliation(s)
- Rebecca C. Woodruff
- Coronavirus Disease 2019–Associated Hospitalization Surveillance Network, Division for Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
- US Public Health Service Commissioned Corps, Rockville, Maryland
| | - Angela P. Campbell
- Coronavirus Disease 2019–Associated Hospitalization Surveillance Network, Division for Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Christopher A. Taylor
- Coronavirus Disease 2019–Associated Hospitalization Surveillance Network, Division for Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Shua J. Chai
- Division of State and Local Readiness, Center for Preparedness and Response, Centers for Disease Control and Prevention, Atlanta, Georgia
- California Emerging Infections Program, Oakland, California
| | - Breanna Kawasaki
- Colorado Department of Public Health and Environment, Denver, Colorado
| | - James Meek
- Connecticut Emerging Infections Program, Yale School of Public Health, New Haven, Connecticut
| | - Evan J. Anderson
- Departments of Medicine and Pediatrics, Emory School of Medicine, Atlanta, Georgia
- Georgia Emerging Infections Program, Georgia Department of Public Health, Atlanta, Georgia
- Atlanta Veterans Affairs Medical Center, Atlanta, Georgia
| | - Andy Weigel
- Iowa Department of Public Health, Des Moines, Iowa
| | | | - Libby Reeg
- Michigan Department of Health and Human Services, Lansing, Michigan
| | - Erica Bye
- Minnesota Department of Health, St Paul, Minnesota
| | - Daniel M. Sosin
- New Mexico Emerging Infections Program, Santa Fe, New Mexico
- New Mexico Department of Health, Santa Fe, New Mexico
| | - Alison Muse
- New York State Department of Health, Albany, New York
| | - Nancy M. Bennett
- University of Rochester School of Medicine and Dentistry, Rochester, New York
| | | | - Melissa Sutton
- Public Health Division, Oregon Health Authority, Portland, Oregon
| | | | | | - Huong Pham
- Coronavirus Disease 2019–Associated Hospitalization Surveillance Network, Division for Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Kadam Patel
- Coronavirus Disease 2019–Associated Hospitalization Surveillance Network, Division for Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
- General Dynamics Information Technology, Atlanta, Georgia
| | - Michael Whitaker
- Coronavirus Disease 2019–Associated Hospitalization Surveillance Network, Division for Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Meredith McMorrow
- Coronavirus Disease 2019–Associated Hospitalization Surveillance Network, Division for Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
- US Public Health Service Commissioned Corps, Rockville, Maryland
| | - Fiona Havers
- Coronavirus Disease 2019–Associated Hospitalization Surveillance Network, Division for Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
- US Public Health Service Commissioned Corps, Rockville, Maryland
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26
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Embi PJ, Levy ME, Naleway AL, Patel P, Gaglani M, Natarajan K, Dascomb K, Ong TC, Klein NP, Liao IC, Grannis SJ, Han J, Stenehjem E, Dunne MM, Lewis N, Irving SA, Rao S, McEvoy C, Bozio CH, Murthy K, Dixon BE, Grisel N, Yang DH, Goddard K, Kharbanda AB, Reynolds S, Raiyani C, Fadel WF, Arndorfer J, Rowley EA, Fireman B, Ferdinands J, Valvi NR, Ball SW, Zerbo O, Griggs EP, Mitchell PK, Porter RM, Kiduko SA, Blanton L, Zhuang Y, Steffens A, Reese SE, Olson N, Williams J, Dickerson M, McMorrow M, Schrag SJ, Verani JR, Fry AM, Azziz-Baumgartner E, Barron MA, Thompson MG, DeSilva MB. Effectiveness of two-dose vaccination with mRNA COVID-19 vaccines against COVID-19-associated hospitalizations among immunocompromised adults-Nine States, January-September 2021. Am J Transplant 2022; 22:306-314. [PMID: 34967121 PMCID: PMC9805402 DOI: 10.1111/ajt.16641] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- Peter J. Embi
- Regenstrief Institute, Indianapolis, Indiana, USA,Indiana University School of Medicine, Indianapolis, Indiana, USA,Correspondence Peter J. Embi, Regenstrief Institute, Indianapolis, IN, USA.
| | | | - Allison L. Naleway
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon
| | | | - Manjusha Gaglani
- Baylor Scott & White Health, Texas A&M University College of Medicine, Temple, Texas
| | - Karthik Natarajan
- Department of Biomedical Informatics, Columbia University, New York, New York,New York Presbyterian Hospital, New York New, York
| | - Kristin Dascomb
- Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City, Utah
| | - Toan C. Ong
- School of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, Colorado
| | - Nicola P. Klein
- Kaiser Permanente Vaccine Study Center, Kaiser Permanente Northern California, Oakland, California
| | - I-Chia Liao
- Baylor Scott & White Health, Texas A&M University College of Medicine, Temple, Texas
| | - Shaun J. Grannis
- Indiana University School of Medicine, Indianapolis, Indiana, USA,Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, Indiana
| | - Jungmi Han
- Department of Biomedical Informatics, Columbia University, New York, New York
| | - Edward Stenehjem
- Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City, Utah
| | | | - Ned Lewis
- Kaiser Permanente Vaccine Study Center, Kaiser Permanente Northern California, Oakland, California
| | | | - Suchitra Rao
- School of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, Colorado
| | | | | | - Kempapura Murthy
- Baylor Scott & White Health, Texas A&M University College of Medicine, Temple, Texas
| | - Brian E. Dixon
- Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, Indiana,Fairbanks School of Public Health, Indiana University, Indianapolis, Indiana
| | - Nancy Grisel
- Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City, Utah
| | | | - Kristin Goddard
- Kaiser Permanente Vaccine Study Center, Kaiser Permanente Northern California, Oakland, California
| | | | | | - Chandni Raiyani
- Baylor Scott & White Health, Texas A&M University College of Medicine, Temple, Texas
| | - William F. Fadel
- Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, Indiana,Fairbanks School of Public Health, Indiana University, Indianapolis, Indiana
| | - Julie Arndorfer
- Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City, Utah
| | | | - Bruce Fireman
- Kaiser Permanente Vaccine Study Center, Kaiser Permanente Northern California, Oakland, California
| | | | - Nimish R. Valvi
- Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, Indiana
| | | | - Ousseny Zerbo
- Kaiser Permanente Vaccine Study Center, Kaiser Permanente Northern California, Oakland, California
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Michelle A. Barron
- School of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, Colorado
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27
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Thindwa D, Wolter N, Pinsent A, Carrim M, Ojal J, Tempia S, Moyes J, McMorrow M, Kleynhans J, von Gottberg A, French N, Cohen C, Flasche S. Estimating the contribution of HIV-infected adults to household pneumococcal transmission in South Africa, 2016–2018: A hidden Markov modelling study. PLoS Comput Biol 2021; 17:e1009680. [PMID: 34941865 PMCID: PMC8699682 DOI: 10.1371/journal.pcbi.1009680] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 11/24/2021] [Indexed: 12/17/2022] Open
Abstract
Human immunodeficiency virus (HIV) infected adults are at a higher risk of pneumococcal colonisation and disease, even while receiving antiretroviral therapy (ART). To help evaluate potential indirect effects of vaccination of HIV-infected adults, we assessed whether HIV-infected adults disproportionately contribute to household transmission of pneumococci. We constructed a hidden Markov model to capture the dynamics of pneumococcal carriage acquisition and clearance observed during a longitudinal household-based nasopharyngeal swabbing study, while accounting for sample misclassifications. Households were followed-up twice weekly for approximately 10 months each year during a three-year study period for nasopharyngeal carriage detection via real-time PCR. We estimated the effect of participant’s age, HIV status, presence of a HIV-infected adult within the household and other covariates on pneumococcal acquisition and clearance probabilities. Of 1,684 individuals enrolled, 279 (16.6%) were younger children (<5 years-old) of whom 4 (1.5%) were HIV-infected and 726 (43.1%) were adults (≥18 years-old) of whom 214 (30.4%) were HIV-infected, most (173, 81.2%) with high CD4+ count. The observed range of pneumococcal carriage prevalence across visits was substantially higher in younger children (56.9–80.5%) than older children (5–17 years-old) (31.7–50.0%) or adults (11.5–23.5%). We estimate that 14.4% (95% Confidence Interval [CI]: 13.7–15.0) of pneumococcal-negative swabs were false negatives. Daily carriage acquisition probabilities among HIV-uninfected younger children were similar in households with and without HIV-infected adults (hazard ratio: 0.95, 95%CI: 0.91–1.01). Longer average carriage duration (11.4 days, 95%CI: 10.2–12.8 vs 6.0 days, 95%CI: 5.6–6.3) and higher median carriage density (622 genome equivalents per millilitre, 95%CI: 507–714 vs 389, 95%CI: 311.1–435.5) were estimated in HIV-infected vs HIV-uninfected adults. The use of ART and antibiotics substantially reduced carriage duration in all age groups, and acquisition rates increased with household size. Although South African HIV-infected adults on ART have longer carriage duration and density than their HIV-uninfected counterparts, they show similar patterns of pneumococcal acquisition and onward transmission. We assessed the contribution of HIV-infected adults to household pneumococcal transmission by applying a hidden Markov model to pneumococcal cohort data comprising 115,595 nasopharyngeal samples from 1,684 individuals in rural and urban settings in South Africa. We estimated 14.4% of sample misclassifications (false negatives), representing 85.6% sensitivity of a test that was used to detect pneumococcus. Pneumococcal carriage prevalence and acquisition rates, and average duration were usually higher in younger or older children than adults. The use of ART and antibiotics reduced the average carriage duration across all age and HIV groups, and carriage acquisition risks increased in larger household sizes. Despite the longer average carriage duration and higher median carriage density in HIV-infected than HIV-uninfected adults, we found similar carriage acquisition and onward transmission risks in the dual groups. These findings suggest that vaccinating HIV-infected adults on ART with PCV would reduce their risk for pneumococcal disease but may add little to the indirect protection against carriage of the rest of the population.
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Affiliation(s)
- Deus Thindwa
- Centre for the Mathematical Modelling of Infectious Diseases, Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Malawi Liverpool Wellcome Trust Clinical Research Programme, Blantyre, Malawi
- * E-mail:
| | - Nicole Wolter
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa
- School of Pathology, University of the Witwatersrand, Johannesburg, South Africa
| | - Amy Pinsent
- Centre for the Mathematical Modelling of Infectious Diseases, Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Aquarius Population Health, London, United Kingdom
| | - Maimuna Carrim
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa
| | - John Ojal
- Centre for the Mathematical Modelling of Infectious Diseases, Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
- KEMRI-Wellcome Trust Research Programme, Geographic Medicine Centre, Kilifi, Kenya
| | - Stefano Tempia
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa
- Influenza Program, Centers for Disease Control and Prevention, Pretoria, South Africa
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- MassGenics, Duluth, Georgia, United States of America
| | - Jocelyn Moyes
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa
| | - Meredith McMorrow
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Jackie Kleynhans
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa
- School of Public Health, Faculty of Health Science, University of the Witwatersrand, Johannesburg, South Africa
| | - Anne von Gottberg
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa
- School of Pathology, University of the Witwatersrand, Johannesburg, South Africa
| | - Neil French
- Malawi Liverpool Wellcome Trust Clinical Research Programme, Blantyre, Malawi
- Institute of Infection, Veterinary and Ecological Science, Department of Clinical Infection, Microbiology, and Immunology, University of Liverpool, Liverpool, United Kingdom
| | | | - Cheryl Cohen
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa
- School of Public Health, Faculty of Health Science, University of the Witwatersrand, Johannesburg, South Africa
| | - Stefan Flasche
- Centre for the Mathematical Modelling of Infectious Diseases, Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
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28
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Bajema KL, Dahl RM, Evener SL, Prill MM, Rodriguez-Barradas MC, Marconi VC, Beenhouwer DO, Holodniy M, Lucero-Obusan C, Brown ST, Tremarelli M, Epperson M, Mills L, Park SH, Rivera-Dominguez G, Morones RG, Ahmadi-Izadi G, Deovic R, Mendoza C, Jeong C, Schrag SJ, Meites E, Hall AJ, Kobayashi M, McMorrow M, Verani JR, Thornburg NJ, Surie D. Comparative Effectiveness and Antibody Responses to Moderna and Pfizer-BioNTech COVID-19 Vaccines among Hospitalized Veterans - Five Veterans Affairs Medical Centers, United States, February 1-September 30, 2021. MMWR Morb Mortal Wkly Rep 2021; 70:1700-1705. [PMID: 34882654 PMCID: PMC8659185 DOI: 10.15585/mmwr.mm7049a2] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
The mRNA COVID-19 vaccines (Moderna and Pfizer-BioNTech) provide strong protection against severe COVID-19, including hospitalization, for at least several months after receipt of the second dose (1,2). However, studies examining immune responses and differences in protection against COVID-19-associated hospitalization in real-world settings, including by vaccine product, are limited. To understand how vaccine effectiveness (VE) might change with time, CDC and collaborators assessed the comparative effectiveness of Moderna and Pfizer-BioNTech vaccines in preventing COVID-19-associated hospitalization at two periods (14-119 days and ≥120 days) after receipt of the second vaccine dose among 1,896 U.S. veterans at five Veterans Affairs medical centers (VAMCs) during February 1-September 30, 2021. Among 234 U.S. veterans fully vaccinated with an mRNA COVID-19 vaccine and without evidence of current or prior SARS-CoV-2 infection, serum antibody levels (anti-spike immunoglobulin G [IgG] and anti-receptor binding domain [RBD] IgG) to SARS-CoV-2 were also compared. Adjusted VE 14-119 days following second Moderna vaccine dose was 89.6% (95% CI = 80.1%-94.5%) and after the second Pfizer-BioNTech dose was 86.0% (95% CI = 77.6%-91.3%); at ≥120 days VE was 86.1% (95% CI = 77.7%-91.3%) for Moderna and 75.1% (95% CI = 64.6%-82.4%) for Pfizer-BioNTech. Antibody levels were significantly higher among Moderna recipients than Pfizer-BioNTech recipients across all age groups and periods since vaccination; however, antibody levels among recipients of both products declined between 14-119 days and ≥120 days. These findings from a cohort of older, hospitalized veterans with high prevalences of underlying conditions suggest the importance of booster doses to help maintain long-term protection against severe COVID-19.†.
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29
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Rankin DA, Speaker A, Perez A, Haddadin Z, Probst V, Schuster JE, Blozinski AL, Rahman HK, Stewart LS, Rha B, Michaels MG, Williams JV, Boom JA, Sahni LC, Allen Staat M, Schlaudecker EP, McNeal M, Selvarangan R, Harrison CJ, Weinberg GA, Szilagyi PG, Englund JA, Klein EJ, McMorrow M, Patel M, Chappell J, Midgley C, Halasa NB, Halasa NB. 154. Circulation of Rhinovirus/Enterovirus Respiratory Infections in Children During 2020-21 in the United States. Open Forum Infect Dis 2021. [PMCID: PMC8644659 DOI: 10.1093/ofid/ofab466.154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background Sharp declines in influenza and respiratory syncytial virus (RSV) circulation across the U.S. have been described during the pandemic in temporal association with community mitigation for control of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We aimed to determine relative frequencies of rhinovirus/enterovirus (RV/EV) and other respiratory viruses in children presenting to emergency departments or hospitalized with acute respiratory illness (ARI) prior to and during the COVID-19 pandemic. Methods We conducted a multi-center active prospective ARI surveillance study in children as part of the New Vaccine Surveillance Network (NVSN) from December 2016 through January 2021. Molecular testing for RV/EV, RSV, influenza, and other respiratory viruses [i.e., human metapneumovirus, parainfluenza virus (Types 1-4), and adenovirus] were performed on specimens collected from children enrolled children. Cumulative percent positivity of each virus type during March 2020–January 2021 was compared from March-January in the prior seasons (2017-2018, 2018-2019, 2019-2020) using Pearson’s chi-squared. Data are provisional. Results Among 69,403 eligible children, 37,676 (54%) were enrolled and tested for respiratory viruses. The number of both eligible and enrolled children declined in early 2020 (Figure 1), but 4,691 children (52% of eligible) were enrolled and tested during March 2020-January 2021. From March 2020-January 2021, the overall percentage of enrolled children with respiratory testing who had detectable RV/EV was similar compared to the same time period in 2017-2018 and 2019-2020 (Figure 1, Table 1). In contrast, the percent positivity of RSV, influenza, and other respiratory viruses combined declined compared to prior years, (p< 0.001, Figure 1, Table 1). ![]()
Figure 1. Percentage of Viral Detection Among Enrolled Children Who Received Respiratory Testing, New Vaccine Surveillance Network (NVSN), United States, December 2016 – January 2021 ![]()
Table 1. Percent of Respiratory Viruses Circulating in March 2020– January 2021, compared to March-January in Prior Years, New Vaccine Surveillance Network (NVSN), United States, March 2017 – January 2021 Conclusion During 2020, RV/EV continued to circulate among children receiving care for ARI despite abrupt declines in other respiratory viruses within this population. These findings warrant further studies to understand virologic, behavioral, biological, and/or environmental factors associated with this continued RV/EV circulation. Disclosures Jennifer E. Schuster, MD, Merck, Sharpe, and Dohme (Individual(s) Involved: Self): Grant/Research Support Marian G. Michaels, MD, MPH, Viracor (Grant/Research Support, performs assay for research study no financial support) John V. Williams, MD, GlaxoSmithKline (Advisor or Review Panel member, Independent Data Monitoring Committee)Quidel (Advisor or Review Panel member, Scientific Advisory Board) Elizabeth P. Schlaudecker, MD, MPH, Pfizer (Grant/Research Support)Sanofi Pasteur (Advisor or Review Panel member) Christopher J. Harrison, MD, GSK (Grant/Research Support)Merck (Grant/Research Support)Pfizer (Grant/Research Support, Scientific Research Study Investigator, Research Grant or Support) Janet A. Englund, MD, AstraZeneca (Consultant, Grant/Research Support)GlaxoSmithKline (Research Grant or Support)Meissa Vaccines (Consultant)Pfizer (Research Grant or Support)Sanofi Pasteur (Consultant)Teva Pharmaceuticals (Consultant) Claire Midgley, PhD, Nothing to disclose Natasha B. Halasa, MD, MPH, Genentech (Other Financial or Material Support, I receive an honorarium for lectures - it’s a education grant, supported by genetech)Quidel (Grant/Research Support, Other Financial or Material Support, Donation of supplies/kits)Sanofi (Grant/Research Support, Other Financial or Material Support, HAI/NAI testing) Natasha B. Halasa, MD, MPH, Genentech (Individual(s) Involved: Self): I receive an honorarium for lectures - it’s a education grant, supported by genetech, Other Financial or Material Support, Other Financial or Material Support; Sanofi (Individual(s) Involved: Self): Grant/Research Support, Research Grant or Support
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Affiliation(s)
- Danielle A Rankin
- Vanderbilt University Medical Center; Division of Pediatric Infectious Diseases, Nashville, TN
| | | | - Ariana Perez
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Zaid Haddadin
- Vanderbilt University Medical Center; Division of Pediatric Infectious Diseases, Nashville, TN
| | - Varvara Probst
- University of Florida, Jacksonville, Jacksonville, Florida
| | | | | | | | | | - Brian Rha
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | | | | | | | | | - Elizabeth P Schlaudecker
- Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Monica McNeal
- Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
| | | | | | | | | | - Janet A Englund
- Seattle Children’s Hospital/Univ. of Washington, Seattle, Washington
| | | | | | - Manish Patel
- Centers for Disease Control and Prevention, Atlanta, Georgia
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Bozio CH, Grannis SJ, Naleway AL, Ong TC, Butterfield KA, DeSilva MB, Natarajan K, Yang DH, Rao S, Klein NP, Irving SA, Dixon BE, Dascomb K, Liao IC, Reynolds S, McEvoy C, Han J, Reese SE, Lewis N, Fadel WF, Grisel N, Murthy K, Ferdinands J, Kharbanda AB, Mitchell PK, Goddard K, Embi PJ, Arndorfer J, Raiyani C, Patel P, Rowley EA, Fireman B, Valvi NR, Griggs EP, Levy ME, Zerbo O, Porter RM, Birch RJ, Blanton L, Ball SW, Steffens A, Olson N, Williams J, Dickerson M, McMorrow M, Schrag SJ, Verani JR, Fry AM, Azziz-Baumgartner E, Barron M, Gaglani M, Thompson MG, Stenehjem E. Laboratory-Confirmed COVID-19 Among Adults Hospitalized with COVID-19-Like Illness with Infection-Induced or mRNA Vaccine-Induced SARS-CoV-2 Immunity - Nine States, January-September 2021. MMWR Morb Mortal Wkly Rep 2021; 70:1539-1544. [PMID: 34735425 PMCID: PMC8568091 DOI: 10.15585/mmwr.mm7044e1] [Citation(s) in RCA: 68] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Previous infection with SARS-CoV-2 (the virus that causes COVID-19) or COVID-19 vaccination can provide immunity and protection from subsequent SARS-CoV-2 infection and illness. CDC used data from the VISION Network* to examine hospitalizations in adults with COVID-19-like illness and compared the odds of receiving a positive SARS-CoV-2 test result, and thus having laboratory-confirmed COVID-19, between unvaccinated patients with a previous SARS-CoV-2 infection occurring 90-179 days before COVID-19-like illness hospitalization, and patients who were fully vaccinated with an mRNA COVID-19 vaccine 90-179 days before hospitalization with no previous documented SARS-CoV-2 infection. Hospitalized adults aged ≥18 years with COVID-19-like illness were included if they had received testing at least twice: once associated with a COVID-19-like illness hospitalization during January-September 2021 and at least once earlier (since February 1, 2020, and ≥14 days before that hospitalization). Among COVID-19-like illness hospitalizations in persons whose previous infection or vaccination occurred 90-179 days earlier, the odds of laboratory-confirmed COVID-19 (adjusted for sociodemographic and health characteristics) among unvaccinated, previously infected adults were higher than the odds among fully vaccinated recipients of an mRNA COVID-19 vaccine with no previous documented infection (adjusted odds ratio [aOR] = 5.49; 95% confidence interval [CI] = 2.75-10.99). These findings suggest that among hospitalized adults with COVID-19-like illness whose previous infection or vaccination occurred 90-179 days earlier, vaccine-induced immunity was more protective than infection-induced immunity against laboratory-confirmed COVID-19. All eligible persons should be vaccinated against COVID-19 as soon as possible, including unvaccinated persons previously infected with SARS-CoV-2.
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Embi PJ, Levy ME, Naleway AL, Patel P, Gaglani M, Natarajan K, Dascomb K, Ong TC, Klein NP, Liao IC, Grannis SJ, Han J, Stenehjem E, Dunne MM, Lewis N, Irving SA, Rao S, McEvoy C, Bozio CH, Murthy K, Dixon BE, Grisel N, Yang DH, Goddard K, Kharbanda AB, Reynolds S, Raiyani C, Fadel WF, Arndorfer J, Rowley EA, Fireman B, Ferdinands J, Valvi NR, Ball SW, Zerbo O, Griggs EP, Mitchell PK, Porter RM, Kiduko SA, Blanton L, Zhuang Y, Steffens A, Reese SE, Olson N, Williams J, Dickerson M, McMorrow M, Schrag SJ, Verani JR, Fry AM, Azziz-Baumgartner E, Barron MA, Thompson MG, DeSilva MB. Effectiveness of 2-Dose Vaccination with mRNA COVID-19 Vaccines Against COVID-19-Associated Hospitalizations Among Immunocompromised Adults - Nine States, January-September 2021. MMWR Morb Mortal Wkly Rep 2021; 70:1553-1559. [PMID: 34735426 PMCID: PMC8568092 DOI: 10.15585/mmwr.mm7044e3] [Citation(s) in RCA: 113] [Impact Index Per Article: 37.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Immunocompromised persons, defined as those with suppressed humoral or cellular immunity resulting from health conditions or medications, account for approximately 3% of the U.S. adult population (1). Immunocompromised adults are at increased risk for severe COVID-19 outcomes (2) and might not acquire the same level of protection from COVID-19 mRNA vaccines as do immunocompetent adults (3,4). To evaluate vaccine effectiveness (VE) among immunocompromised adults, data from the VISION Network* on hospitalizations among persons aged ≥18 years with COVID-19-like illness from 187 hospitals in nine states during January 17-September 5, 2021 were analyzed. Using selected discharge diagnoses,† VE against COVID-19-associated hospitalization conferred by completing a 2-dose series of an mRNA COVID-19 vaccine ≥14 days before the index hospitalization date§ (i.e., being fully vaccinated) was evaluated using a test-negative design comparing 20,101 immunocompromised adults (10,564 [53%] of whom were fully vaccinated) and 69,116 immunocompetent adults (29,456 [43%] of whom were fully vaccinated). VE of 2 doses of mRNA COVID-19 vaccine against COVID-19-associated hospitalization was lower among immunocompromised patients (77%; 95% confidence interval [CI] = 74%-80%) than among immunocompetent patients (90%; 95% CI = 89%-91%). This difference persisted irrespective of mRNA vaccine product, age group, and timing of hospitalization relative to SARS-CoV-2 (the virus that causes COVID-19) B.1.617.2 (Delta) variant predominance in the state of hospitalization. VE varied across immunocompromising condition subgroups, ranging from 59% (organ or stem cell transplant recipients) to 81% (persons with a rheumatologic or inflammatory disorder). Immunocompromised persons benefit from mRNA COVID-19 vaccination but are less protected from severe COVID-19 outcomes than are immunocompetent persons, and VE varies among immunocompromised subgroups. Immunocompromised persons receiving mRNA COVID-19 vaccines should receive 3 doses and a booster, consistent with CDC recommendations (5), practice nonpharmaceutical interventions, and, if infected, be monitored closely and considered early for proven therapies that can prevent severe outcomes.
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Bajema KL, Dahl RM, Prill MM, Meites E, Rodriguez-Barradas MC, Marconi VC, Beenhouwer DO, Brown ST, Holodniy M, Lucero-Obusan C, Rivera-Dominguez G, Morones RG, Whitmire A, Goldin EB, Evener SL, Tremarelli M, Tong S, Hall AJ, Schrag SJ, McMorrow M, Kobayashi M, Verani JR, Surie D. Effectiveness of COVID-19 mRNA Vaccines Against COVID-19-Associated Hospitalization - Five Veterans Affairs Medical Centers, United States, February 1-August 6, 2021. MMWR Morb Mortal Wkly Rep 2021; 70:1294-1299. [PMID: 34529636 PMCID: PMC8445376 DOI: 10.15585/mmwr.mm7037e3] [Citation(s) in RCA: 62] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
COVID-19 mRNA vaccines (Pfizer-BioNTech and Moderna) have been shown to be highly protective against COVID-19-associated hospitalizations (1-3). Data are limited on the level of protection against hospitalization among disproportionately affected populations in the United States, particularly during periods in which the B.1.617.2 (Delta) variant of SARS-CoV-2, the virus that causes COVID-19, predominates (2). U.S. veterans are older, more racially diverse, and have higher prevalences of underlying medical conditions than persons in the general U.S. population (2,4). CDC assessed the effectiveness of mRNA vaccines against COVID-19-associated hospitalization among 1,175 U.S. veterans aged ≥18 years hospitalized at five Veterans Affairs Medical Centers (VAMCs) during February 1-August 6, 2021. Among these hospitalized persons, 1,093 (93.0%) were men, the median age was 68 years, 574 (48.9%) were non-Hispanic Black (Black), 475 were non-Hispanic White (White), and 522 (44.4%) had a Charlson comorbidity index score of ≥3 (5). Overall adjusted vaccine effectiveness against COVID-19-associated hospitalization was 86.8% (95% confidence interval [CI] = 80.4%-91.1%) and was similar before (February 1-June 30) and during (July 1-August 6) SARS-CoV-2 Delta variant predominance (84.1% versus 89.3%, respectively). Vaccine effectiveness was 79.8% (95% CI = 67.7%-87.4%) among adults aged ≥65 years and 95.1% (95% CI = 89.1%-97.8%) among those aged 18-64 years. COVID-19 mRNA vaccines are highly effective in preventing COVID-19-associated hospitalization in this older, racially diverse population of predominately male U.S. veterans. Additional evaluations of vaccine effectiveness among various age groups are warranted. To prevent COVID-19-related hospitalizations, all eligible persons should receive COVID-19 vaccination.
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Delahoy MJ, Ujamaa D, Whitaker M, O'Halloran A, Anglin O, Burns E, Cummings C, Holstein R, Kambhampati AK, Milucky J, Patel K, Pham H, Taylor CA, Chai SJ, Reingold A, Alden NB, Kawasaki B, Meek J, Yousey-Hindes K, Anderson EJ, Openo KP, Teno K, Weigel A, Kim S, Leegwater L, Bye E, Como-Sabetti K, Ropp S, Rudin D, Muse A, Spina N, Bennett NM, Popham K, Billing LM, Shiltz E, Sutton M, Thomas A, Schaffner W, Talbot HK, Crossland MT, McCaffrey K, Hall AJ, Fry AM, McMorrow M, Reed C, Garg S, Havers FP. Hospitalizations Associated with COVID-19 Among Children and Adolescents - COVID-NET, 14 States, March 1, 2020-August 14, 2021. MMWR Morb Mortal Wkly Rep 2021; 70:1255-1260. [PMID: 34499627 PMCID: PMC8437052 DOI: 10.15585/mmwr.mm7036e2] [Citation(s) in RCA: 196] [Impact Index Per Article: 65.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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Bishop K, McMorrow M, Meiring S, Walaza S, Rossi L, Mhlanga S, Tempia S, Mathunjwa A, Kleynhans J, Appiah GD, McAnerney JM, Zar HJ, Cohen C. An evaluation of an influenza vaccination campaign targeting pregnant women in 27 clinics in two provinces of South Africa, 2015 - 2018. BMC Health Serv Res 2021; 21:941. [PMID: 34503508 PMCID: PMC8427945 DOI: 10.1186/s12913-021-06962-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 08/31/2021] [Indexed: 01/22/2023] Open
Abstract
Introduction Despite prioritization, routine antenatal influenza vaccine coverage is < 16% in South Africa. We aimed to describe maternal influenza vaccine coverage in 27 antenatal clinics (ANCs) in Gauteng and Western Cape (WC) Provinces, where in collaboration with the Department of Health (DoH), we augmented the annual influenza vaccination programme among pregnant women. Methods From 2015 through 2018, 40,230 additional doses of influenza vaccine were added to the available stock and administered as part of routine antenatal care. Educational talks were given daily and data were collected on women attending ANCs. We compared characteristics of vaccinated and unvaccinated women using multivariable logistic regression. Results We screened 62,979 pregnant women during the period when Southern Hemisphere influenza vaccines were available (27,068 in Gauteng and 35,911 in WC). Vaccine coverage at the targeted clinics was 78.7% (49,355/62682), although pregnant women in WC were more likely to be vaccinated compared to those in the Gauteng (Odds ratio (OR) =3.7 p < 0.001). Women aged 25—29 and > 35 years were less likely to be vaccinated than women aged 18—24 years (OR = 0.9 p = 0.053; OR = 0.9 p < 0.001). HIV positive status was not associated with vaccination (OR = 1.0 p = 0.266). Reasons for not vaccinating included: vaccine stock-outs where ANCs depleted available stock of vaccines and/or were awaiting delivery of vaccines (54.6%, 6949/12723), refusal/indecision (25.8%, 3285), and current illness that contraindicated vaccination (19.6%, 2489). Conclusion Antenatal vaccination uptake was likely improved by the increased vaccine supply and vaccine education offered during our campaign.
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Affiliation(s)
- Kate Bishop
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases (NICD), a division of the National Health Laboratory Service (NHLS), Johannesburg, South Africa. .,Division of Public Health Services and Response, National Institute for Communicable Diseases (NICD), a division of the National Health Laboratory Service (NHLS), Johannesburg, South Africa.
| | - Meredith McMorrow
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, USA.,Influenza Program, Centers for Disease Control and Prevention, Pretoria, South Africa
| | - Susan Meiring
- Division of Public Health Services and Response, National Institute for Communicable Diseases (NICD), a division of the National Health Laboratory Service (NHLS), Johannesburg, South Africa
| | - Sibongile Walaza
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases (NICD), a division of the National Health Laboratory Service (NHLS), Johannesburg, South Africa.,DST/NRF Vaccine Preventable Diseases/Respiratory and Meningeal Pathogens Research Unit (RMPRU), Johannesburg, South Africa
| | - Liza Rossi
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases (NICD), a division of the National Health Laboratory Service (NHLS), Johannesburg, South Africa
| | - Sarona Mhlanga
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases (NICD), a division of the National Health Laboratory Service (NHLS), Johannesburg, South Africa
| | - Stefano Tempia
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases (NICD), a division of the National Health Laboratory Service (NHLS), Johannesburg, South Africa.,Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, USA.,Influenza Program, Centers for Disease Control and Prevention, Pretoria, South Africa.,School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Azwifarwi Mathunjwa
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases (NICD), a division of the National Health Laboratory Service (NHLS), Johannesburg, South Africa
| | - Jackie Kleynhans
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases (NICD), a division of the National Health Laboratory Service (NHLS), Johannesburg, South Africa.,School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Grace D Appiah
- Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Johanna M McAnerney
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases (NICD), a division of the National Health Laboratory Service (NHLS), Johannesburg, South Africa
| | - Heather J Zar
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, and SA-MRC Unit on Child & Adolescent Health, University of Cape Town, Cape Town, South Africa
| | - Cheryl Cohen
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases (NICD), a division of the National Health Laboratory Service (NHLS), Johannesburg, South Africa.,School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Hellferscee O, Treurnicht F, Gaelejwe L, Moerdyk A, Reubenson G, McMorrow M, Tempia S, McAnerney J, Walaza S, Wolter N, von Gottberg A, Cohen C. Detection of Victoria lineage influenza B viruses with K162 and N163 deletions in the hemagglutinin gene, South Africa, 2018. Health Sci Rep 2021; 4:e367. [PMID: 34557595 PMCID: PMC8448392 DOI: 10.1002/hsr2.367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 07/29/2021] [Accepted: 08/08/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND A group of Victoria lineage influenza B viruses with a two amino acid deletion in the hemagglutinin (HA) at residues K162 and N163, was detected during the 2016 to 2017 Northern Hemisphere influenza season and continues to spread geographically. We describe the first identification of viruses with these deletions from South Africa in 2018. METHODS Nasopharyngeal samples were obtained from the syndromic surveillance programs. Real-time reverse transcription-polymerase chain reaction was used for virus detection and lineage determination. Influenza genetic characterization was done using next-generation sequencing on the MiSeq platform. The duration of virus circulation was determined using thresholds calculated using the Moving Epidemic Method; duration was used as an indicator of disease transmissibility and impact. RESULTS In 2018, 42% (426/1015) of influenza-positive specimens were influenza B viruses. Of 426 influenza B-positive samples, 376 (88%) had the lineage determined of which 75% (283/376) were Victoria lineage. The transmissibility of the 2018 South African influenza season was high for a few weeks, although the severity remained moderate through most of the season. The sequenced 2018 South African Victoria lineage influenza B viruses clustered in sub-clade V1A.1 with the 162-163 deletions. CONCLUSIONS We report the first detection of the 162-163 deletion variant of influenza B/Victoria viruses from South Africa in 2018, and suggest that this deletion variant replaced the previous circulating influenza B/Victoria viruses. These deletions putatively affect the antigenic properties of the viruses because they border an immune-dominant region at the tip of the HA. Therefore, close monitoring of these newly emerging viruses is essential.
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Affiliation(s)
- Orienka Hellferscee
- Centre for Respiratory Diseases and MeningitisNational Institute for Communicable Diseases of the National Health Laboratory ServiceJohannesburgSouth Africa
- Department of Medical Virology, School of Pathology, Faculty of Health SciencesUniversity of the WitwatersrandJohannesburgSouth Africa
| | - Florette Treurnicht
- Department of Medical Virology, School of Pathology, Faculty of Health SciencesUniversity of the WitwatersrandJohannesburgSouth Africa
| | - Lucinda Gaelejwe
- Centre for Respiratory Diseases and MeningitisNational Institute for Communicable Diseases of the National Health Laboratory ServiceJohannesburgSouth Africa
| | - Alexandra Moerdyk
- Centre for Respiratory Diseases and MeningitisNational Institute for Communicable Diseases of the National Health Laboratory ServiceJohannesburgSouth Africa
| | - Gary Reubenson
- Department of Paediatrics & Child Health, Faculty of Health SciencesUniversity of the WitwatersrandJohannesburgSouth Africa
| | - Meredith McMorrow
- Influenza DivisionCenters for Disease Control and PreventionAtlantaGeorgiaUSA
- Influenza ProgramCenters for Disease Control and PreventionPretoriaSouth Africa
| | - Stefano Tempia
- Centre for Respiratory Diseases and MeningitisNational Institute for Communicable Diseases of the National Health Laboratory ServiceJohannesburgSouth Africa
- Influenza DivisionCenters for Disease Control and PreventionAtlantaGeorgiaUSA
- Influenza ProgramCenters for Disease Control and PreventionPretoriaSouth Africa
- MassGenicsDuluthGeorgiaUSA
- School of Public Health, Faculty of Health SciencesUniversity of the WitwatersrandJohannesburgSouth Africa
| | - Johanna McAnerney
- Centre for Respiratory Diseases and MeningitisNational Institute for Communicable Diseases of the National Health Laboratory ServiceJohannesburgSouth Africa
| | - Sibongile Walaza
- Centre for Respiratory Diseases and MeningitisNational Institute for Communicable Diseases of the National Health Laboratory ServiceJohannesburgSouth Africa
- School of Public Health, Faculty of Health SciencesUniversity of the WitwatersrandJohannesburgSouth Africa
| | - Nicole Wolter
- Centre for Respiratory Diseases and MeningitisNational Institute for Communicable Diseases of the National Health Laboratory ServiceJohannesburgSouth Africa
- School of Pathology, Faculty of Health SciencesUniversity of the WitwatersrandJohannesburgSouth Africa
| | - Anne von Gottberg
- Centre for Respiratory Diseases and MeningitisNational Institute for Communicable Diseases of the National Health Laboratory ServiceJohannesburgSouth Africa
- School of Pathology, Faculty of Health SciencesUniversity of the WitwatersrandJohannesburgSouth Africa
| | - Cheryl Cohen
- Centre for Respiratory Diseases and MeningitisNational Institute for Communicable Diseases of the National Health Laboratory ServiceJohannesburgSouth Africa
- School of Public Health, Faculty of Health SciencesUniversity of the WitwatersrandJohannesburgSouth Africa
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Azziz-Baumgartner E, Bruno A, Daugherty M, Chico ME, Lopez A, Arriola CS, de Mora D, Ropero AM, Davis WW, McMorrow M, Cooper PJ. Incidence and seasonality of respiratory viruses among medically attended children with acute respiratory infections in an Ecuador birth cohort, 2011-2014. Influenza Other Respir Viruses 2021; 16:24-33. [PMID: 34432362 PMCID: PMC8692806 DOI: 10.1111/irv.12887] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 06/21/2021] [Accepted: 06/24/2021] [Indexed: 01/04/2023] Open
Abstract
Background Ecuador annually has handwashing and respiratory hygiene campaigns and seasonal influenza vaccination to prevent respiratory virus illnesses but has yet to quantify disease burden and determine epidemic timing. Methods To identify respiratory virus burden and assess months with epidemic activity, we followed a birth cohort in northwest Ecuador during 2011–2014. Mothers brought children to the study clinic for routine checkups at ages 1, 2, 3, 5, and 8 years or if children experienced any acute respiratory illness symptoms (e.g., cough, fever, or difficulty breathing); clinical care was provided free of charge. Those with medically attended acute respiratory infections (MAARIs) were tested for common respiratory viruses via real‐time reverse‐transcription polymerase chain reaction (rRT‐PCR). Results In 2011, 2376 children aged 1–4 years (median 35 months) were enrolled in the respiratory cohort and monitored for 7017.5 child‐years (cy). The incidence of respiratory syncytial virus (RSV) was 23.9 (95% CI 17.3–30.5), influenza 10.6 (2.4–18.8), adenoviruses 6.7 (4.6–28.0), parainfluenzas 5.0 (2.3–10.5), and rhinoviruses, bocaviruses, human metapneumoviruses, seasonal coronaviruses, and enteroviruses <3/100 cy among children aged 12–23 months and declined with age. Most (75%) influenza detections occurred April–September. Conclusion Cohort children frequently had MAARIs, and while the incidence decreased rapidly among older children, more than one in five children aged 12–23 months tested positive for RSV, and one in 10 tested positive for influenza. Our findings suggest this substantial burden of influenza occurred more commonly during the winter Southern Hemisphere influenza season.
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Affiliation(s)
- Eduardo Azziz-Baumgartner
- International Epidemiology and Research Team, Influenza Division, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Alfredo Bruno
- Faculty of Veterinary Medicine and Zootechnics, Universidad Agraria del Ecuador, Guayaquil, Ecuador.,National Reference Laboratory for Influenza and Other Respiratory Viruses, Instituto Nacional de Investigación en Salud Pública (INSPI), Guayaquil, Ecuador
| | - Michael Daugherty
- International Epidemiology and Research Team, Influenza Division, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Martha E Chico
- Fundación Ecuatoriana Para Investigación en Salud, Quinindé, Ecuador
| | - Andrea Lopez
- School of Medicine, Universidad Internacional del Ecuador, Quito, Ecuador
| | - Carmen Sofia Arriola
- International Epidemiology and Research Team, Influenza Division, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Domenica de Mora
- International Epidemiology and Research Team, Influenza Division, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Alba María Ropero
- Immunizations Program, Pan American Health Organization, Washington, DC, USA
| | - William W Davis
- International Epidemiology and Research Team, Influenza Division, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Meredith McMorrow
- Enhanced Surveillance Platforms Team, Division of Viral Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Philip J Cooper
- School of Medicine, Universidad Internacional del Ecuador, Quito, Ecuador.,Institute of Infection and Immunity, St George's University of London, London, UK
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Balachandran N, Ntiri M, Duque J, Addo C, Edu-Quansah E, Badji E, Brightson K, Houphouet EE, Ndahwouh TN, Koram K, McMorrow M, Ampofo W. Incidence of Laboratory-Confirmed Influenza among HIV-Infected versus HIV-Uninfected Individuals in Two Districts of Ghana, 2014 to 2016. Am J Trop Med Hyg 2021; 105:783-787. [PMID: 34228633 DOI: 10.4269/ajtmh.20-1437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Accepted: 04/25/2021] [Indexed: 11/07/2022] Open
Abstract
Influenza is known to cause severe respiratory illness in HIV-infected adults, but there are few data describing the relationship between HIV infection and influenza in West African countries such as Ghana. We conducted a prospective cohort study in the Shai-Osudoku and Ningo Prampram districts of Ghana from 2014 to 2016. Beginning May 2014, 266 HIV-infected and 510 HIV-uninfected participants age 18 to 73 years were enrolled and monitored for 12 months. We observed 4 and 11 laboratory-confirmed influenza cases among HIV-infected and HIV-uninfected persons, respectively. The overall rate of laboratory-confirmed influenza among HIV-infected participants was 15.0 per 1,000 person years (PY) (95% CI, 0.3-29.80 per 1,000 PY), whereas that among HIV-uninfected participants was 21.6 per 1,000 PY (95% CI, 8.8-34.3 per 1,000 PY) (incidence density ratio, 0.70; P = 0.56). Our study found no significant difference in the incidence of laboratory-confirmed influenza-associated illness among HIV-infected and HIV-uninfected individuals in Ghana.
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Affiliation(s)
- Neha Balachandran
- Influenza Division, National Center for Immunization and Respiratory Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia.,Emory Rollins School of Public Health, Atlanta, Georgia
| | - Michael Ntiri
- Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | - Jazmin Duque
- Influenza Division, National Center for Immunization and Respiratory Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia.,Battelle Atlanta, Atlanta, Georgia
| | - Christabel Addo
- Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | - Elijah Edu-Quansah
- Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | - Edem Badji
- Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | | | | | - Talla Nzussouo Ndahwouh
- Influenza Division, National Center for Immunization and Respiratory Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia.,Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana.,MassGenics, Atlanta, Georgia
| | - Kwadwo Koram
- Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | - Meredith McMorrow
- Influenza Division, National Center for Immunization and Respiratory Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
| | - William Ampofo
- Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
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Edoka I, Kohli-Lynch C, Fraser H, Hofman K, Tempia S, McMorrow M, Ramkrishna W, Lambach P, Hutubessy R, Cohen C. A cost-effectiveness analysis of South Africa's seasonal influenza vaccination programme. Vaccine 2020; 39:412-422. [PMID: 33272702 DOI: 10.1016/j.vaccine.2020.11.028] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 10/02/2020] [Accepted: 11/09/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND Seasonal influenza imposes a significant health and economic burden in South Africa, particularly in populations vulnerable to severe consequences of influenza. This study assesses the cost-effectiveness of South Africa's seasonal influenza vaccination strategy, which involves vaccinating vulnerable populations with trivalent inactivated influenza vaccine (TIV) during routine facility visits. Vulnerable populations included in our analysis are persons aged ≥ 65 years; pregnant women; persons living with HIV/AIDS (PLWHA), persons of any age with underlying medical conditions (UMC) and children aged 6-59 months. METHOD We employed the World Health Organisation's (WHO) Cost Effectiveness Tool for Seasonal Influenza Vaccination (CETSIV), a decision tree model, to evaluate the 2018 seasonal influenza vaccination campaign from a public healthcare provider and societal perspective. CETSIV was populated with existing country-specific demographic, epidemiologic and coverage data to estimate incremental cost-effectiveness ratios (ICERs) by comparing costs and benefits of the influenza vaccination programme to no vaccination. RESULTS The highest number of clinical events (influenza cases, outpatient visits, hospitalisation and deaths) were averted in PLWHA and persons with other UMCs. Using a cost-effectiveness threshold of US$ 3400 per quality-adjusted life year (QALY), our findings suggest that the vaccination programme is cost-effective for all vulnerable populations except for children aged 6-59 months. ICERs ranged from ~US$ 1 750 /QALY in PLWHA to ~US$ 7500/QALY in children. In probabilistic sensitivity analyses, the vaccination programme was cost-effective in pregnant women, PLWHA, persons with UMCs and persons aged ≥65 years in >80% of simulations. These findings were robust to changes in many model inputs but were most sensitive to uncertainty in estimates of influenza-associated illness burden. CONCLUSION South Africa's seasonal influenza vaccination strategy of opportunistically targeting vulnerable populations during routine visits is cost-effective. A budget impact analysis will be useful for supporting future expansions of the programme.
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Affiliation(s)
- Ijeoma Edoka
- SAMRC Centre for Health Economics and Decision Science - PRICELESS SA, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
| | - Ciaran Kohli-Lynch
- SAMRC Centre for Health Economics and Decision Science - PRICELESS SA, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Heather Fraser
- SAMRC Centre for Health Economics and Decision Science - PRICELESS SA, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Karen Hofman
- SAMRC Centre for Health Economics and Decision Science - PRICELESS SA, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Stefano Tempia
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, USA; Influenza Program, Centers for Disease Control and Prevention, Pretoria, South Africa; Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa; MassGenics, Duluth, GA, USA; School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Meredith McMorrow
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, USA; Influenza Program, Centers for Disease Control and Prevention, Pretoria, South Africa; US Public Health Service, Rockville, MD, USA
| | - Wayne Ramkrishna
- Communicable Disease Cluster, National Department of Health, South Africa
| | - Philipp Lambach
- Department of Immunization, Vaccines and Biologicals, Initiative for Vaccine Research, World Health Organization, Geneva, Switzerland
| | - Raymond Hutubessy
- Department of Immunization, Vaccines and Biologicals, Initiative for Vaccine Research, World Health Organization, Geneva, Switzerland
| | - Cheryl Cohen
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa; School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Igboh LS, McMorrow M, Tempia S, Emukule GO, Talla Nzussouo N, McCarron M, Williams T, Weatherspoon V, Moen A, Fawzi D, Njouom R, Nakoune E, Dauoda C, Kavunga-Membo H, Okeyo M, Heraud JM, Mambule IK, Sow SO, Tivane A, Lagare A, Adebayo A, Dia N, Mmbaga V, Maman I, Lutwama J, Simusika P, Walaza S, Mangtani P, Nguipdop-Djomo P, Cohen C, Azziz-Baumgartner E. Influenza surveillance capacity improvements in Africa during 2011-2017. Influenza Other Respir Viruses 2020; 15:495-505. [PMID: 33150650 PMCID: PMC8189239 DOI: 10.1111/irv.12818] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 09/06/2020] [Indexed: 12/14/2022] Open
Abstract
Background Influenza surveillance helps time prevention and control interventions especially where complex seasonal patterns exist. We assessed influenza surveillance sustainability in Africa where influenza activity varies and external funds for surveillance have decreased. Methods We surveyed African Network for Influenza Surveillance and Epidemiology (ANISE) countries about 2011‐2017 surveillance system characteristics. Data were summarized with descriptive statistics and analyzed with univariate and multivariable analyses to quantify sustained or expanded influenza surveillance capacity in Africa. Results Eighteen (75%) of 24 ANISE members participated in the survey; their cumulative population of 710 751 471 represent 56% of Africa's total population. All 18 countries scored a mean 95% on WHO laboratory quality assurance panels. The number of samples collected from severe acute respiratory infection case‐patients remained consistent between 2011 and 2017 (13 823 vs 13 674 respectively) but decreased by 12% for influenza‐like illness case‐patients (16 210 vs 14 477). Nine (50%) gained capacity to lineage‐type influenza B. The number of countries reporting each week to WHO FluNet increased from 15 (83%) in 2011 to 17 (94%) in 2017. Conclusions Despite declines in external surveillance funding, ANISE countries gained additional laboratory testing capacity and continued influenza testing and reporting to WHO. These gains represent important achievements toward sustainable surveillance and epidemic/pandemic preparedness.
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Affiliation(s)
- Ledor S Igboh
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA.,London School of Hygiene and Tropical Medicine, London, UK
| | - Meredith McMorrow
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA.,Influenza Program, Centers for Disease Control and Prevention, Pretoria, South Africa
| | - Stefano Tempia
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA.,School of Public Health, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa.,MassGenics, Atlanta, GA, USA.,National Influenza Center, Johannesburg, South Africa
| | | | - Ndahwouh Talla Nzussouo
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA.,MassGenics, Atlanta, GA, USA.,Centers for Disease Control and Prevention, Accra, Ghana
| | - Margaret McCarron
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Thelma Williams
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Vashonia Weatherspoon
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Ann Moen
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | | | | | - Coulibaly Dauoda
- National Institute Public Hygiene/Ministry of Health, Abidjan, Cote d'Ivoire
| | - Hugo Kavunga-Membo
- Institut National de Recherche Bio-medicale, Kinshasa, Democratic Republic of Congo
| | - Mary Okeyo
- National Public Health Institute, Nairobi, Kenya
| | - Jean-Michel Heraud
- Virology Unit, National Influenza Centre, Institute Pasteur de Madagascar, Antananarivo, Madagascar
| | | | - Samba Ousmane Sow
- Central National Influenza Laboratory/Ministry of Health, Bamako, Mali
| | | | - Adamou Lagare
- Center de Recherche Medicale et Sanitaire, Niamey, Niger
| | | | - Ndongo Dia
- Institut Pasteur de Dakar, Dakar, Senegal
| | - Vida Mmbaga
- National Reference Laboratory, Dar es Salaam, Tanzania
| | - Issaka Maman
- National Influenza Reference Laboratory, Lome, Togo
| | | | - Paul Simusika
- National Influenza Center, University of Zambia Teaching Hospital, Lusaka, Zambia
| | - Sibongile Walaza
- School of Public Health, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa.,National Influenza Center, Johannesburg, South Africa.,Centre for Respiratory Disease and Meningitis, National Institute for Communicable Diseases, Johannesburg, South Africa
| | - Punam Mangtani
- London School of Hygiene and Tropical Medicine, London, UK
| | | | - Cheryl Cohen
- School of Public Health, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa.,National Influenza Center, Johannesburg, South Africa.,Centre for Respiratory Disease and Meningitis, National Institute for Communicable Diseases, Johannesburg, South Africa
| | - Eduardo Azziz-Baumgartner
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
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40
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Cohen C, Tshangela A, Valley-Omar Z, Iyengar P, Von Mollendorf C, Walaza S, Hellferscee O, Venter M, Martinson N, Mahlase G, McMorrow M, Cowling BJ, Treurnicht FK, Cohen AL, Tempia S. Household Transmission of Seasonal Influenza From HIV-Infected and HIV-Uninfected Individuals in South Africa, 2013-2014. J Infect Dis 2020; 219:1605-1615. [PMID: 30541140 DOI: 10.1093/infdis/jiy702] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Accepted: 12/10/2018] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND We estimated the household secondary infection risk (SIR) and serial interval (SI) for influenza transmission from HIV-infected and HIV-uninfected index cases. METHODS Index cases were the first symptomatic person in a household with influenza-like illness, testing influenza positive on real-time reverse transcription polymerase chain reaction (rRT-PCR). Nasopharyngeal swabs collected from household contacts every 4 days were tested by rRT-PCR. Factors associated with SIR were evaluated using logistic regression. RESULTS We enrolled 28 HIV-infected and 57 HIV-uninfected index cases. On multivariable analysis, HIV-infected index cases were less likely to transmit influenza to household contacts (odds ratio [OR] 0.2; 95% confidence interval [CI], 0.1-0.6; SIR 16%, 18/113 vs 27%, 59/220). Factors associated with increased SIR included index age group 1-4 years (OR 3.6; 95% CI, 1.2-11.3) and 25-44 years (OR 8.0; 95% CI, 1.8-36.7), and contact age group 1-4 years (OR 3.5; 95% CI, 1.2-10.3) compared to 5-14 years, and sleeping with index case (OR 2.7; 95% CI, 1.3-5.5). HIV infection of index case was not associated with SI. CONCLUSIONS HIV-infection was not associated with SI. Increased infectiousness of HIV-infected individuals is likely not an important driver of community influenza transmission.
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Affiliation(s)
- Cheryl Cohen
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa.,School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Akhona Tshangela
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa
| | - Ziyaad Valley-Omar
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa.,Department of Pathology, Faculty of Health Sciences, University of Cape Town, South Africa
| | | | - Claire Von Mollendorf
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa.,School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Sibongile Walaza
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa.,School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Orienka Hellferscee
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa.,School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Marietjie Venter
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa.,Centre for Viral Zoonoses, Department of Medical Virology, University of Pretoria
| | - Neil Martinson
- Perinatal HIV Research Unit, Klerksdorp-Tshepong Hospital, North West Province, South Africa
| | | | - Meredith McMorrow
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia.,Influenza Program, Centers for Disease Control and Prevention, Pretoria, South Africa
| | - Benjamin J Cowling
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong
| | - Florette K Treurnicht
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa
| | - Adam L Cohen
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia.,Influenza Program, Centers for Disease Control and Prevention, Pretoria, South Africa.,Expanded Programme on Immunization, Department of Immunizations, Vaccines, and Biologicals, World Health Organization, Geneva, Switzerland
| | - Stefano Tempia
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa.,Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia.,Influenza Program, Centers for Disease Control and Prevention, Pretoria, South Africa
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Biggs H, Simoes EA, Abu-Khader IB, Thompson MG, Gordon A, Hunt DR, DeGroote N, Whitaker BL, Wang L, Marar B, Gresh L, de Jesus J, Bino S, Porter RM, McMorrow M, Campbell W, Zhang Y, Lindstrom S, Thornburg NJ, Langley G, Langley G, Peret TCT, Simaku A, Gerber SI. 2629. Respiratory Syncytial Virus Epidemiology and Factors Associated with Severity among Hospitalized Infants in Four Middle-Income Countries, 2015–2017. Open Forum Infect Dis 2019. [PMCID: PMC6809635 DOI: 10.1093/ofid/ofz360.2307] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Respiratory syncytial virus (RSV) is the most commonly identified viral pathogen among young children with acute lower respiratory tract infection. Understanding global RSV epidemiology and risk factors for severe illness in low- and middle-income settings is critical as new vaccine candidates become available.
Methods
We prospectively enrolled infants aged < 1 year hospitalized with any acute illness from sites in Albania, Jordan, Nicaragua and Philippines during 2015–2017. Standardized parental interviews and medical record review were conducted. Respiratory specimens collected during enrollment were tested for RSV using rRT–PCR. RSV A or B subgroup was determined using a CDC-developed rRT–PCR assay. Very severe RSV illness was defined as requiring ICU admission or supplemental oxygen. Factors potentially associated with severity were assessed using individual logistic regression models to adjust for age and study site.
Results
Overall, 1,129 (31%) of 3634 enrolled infants had RSV infection. The median age of RSV-positive infants was 2.7 (range: < 1 to 11.9) months, 665 (59%) were male, and 63 (6%) had ≥1 underlying medical condition. RSV subgroup was determined for 1,028 (91%); RSV A and B co-circulated at all sites with alternating predominance by study year (figure). 583 (52%) infants had very severe RSV illness, which was significantly associated with younger age (median: 2.0 vs. 4.3 months; P < 0.01), study site (aOR: Jordan 5.0, Albania 2.9, Philippines 1.2, Nicaragua reference; P < 0.01), birth by cesarean section (aOR: 1.4; 95% CI [CI] 1.0–1.8; P = 0.03), having received ICU care after birth (aOR: 1.6; CI 1.0–2.4; P = 0.03), chronic heart or respiratory tract disease (aOR: 1.9; CI 1.0–3.4; P = 0.04), and a low weight-for-age Z score (aOR: 1.8; CI 1.3–2.7; P < 0.01). RSV subgroup was not associated with severity (aOR: 1.0; CI: 0.7–1.3; P = 0.72).
Conclusion
RSV was associated with a substantial proportion of acute illness among hospitalized infants in middle-income countries. Subgroups co-circulated across sites and study years with varying predominance and resulted in similar illness severity. Significant comorbidities were uncommon, but factors including younger age, low weight-for-age and chronic heart or respiratory tract disease were associated with more severe illness.
Disclosures
All authors: No reported disclosures.
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Affiliation(s)
| | | | | | - Mark G Thompson
- US Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | | | - Nicholas DeGroote
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Lijuan Wang
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Lionel Gresh
- Sustainable Sciences Institute, Managua, Nicaragua
| | - Joanne de Jesus
- Research Institute for Tropical Medicine, Department of Health, Muntinlupa City, National Capital Region, Philippines
| | - Silva Bino
- Institute of Public Health, Tirana, Tirane, Albania
| | - Rachael M Porter
- Centers for Disease Control and Prevention, Influenza Division, Atlanta, Georgia
| | | | | | | | | | | | | | | | | | - Artan Simaku
- Institute of Public Health, Tirana, Tirane, Albania
| | - Susan I Gerber
- Centers for Disease Control and Prevention, Atlanta, Georgia
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Walaza S, Cohen C, Tempia S, Moyes J, Nguweneza A, Madhi SA, McMorrow M, Cohen AL. Influenza and tuberculosis co-infection: A systematic review. Influenza Other Respir Viruses 2019; 14:77-91. [PMID: 31568678 PMCID: PMC6928059 DOI: 10.1111/irv.12670] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [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: 10/09/2018] [Revised: 06/26/2019] [Accepted: 06/28/2019] [Indexed: 12/14/2022] Open
Abstract
Introduction There are limited data on risk of severe disease or outcomes in patients with influenza and pulmonary tuberculosis (PTB) co‐infection compared to those with single infection. Methods We conducted a systematic review of published literature on the interaction of influenza viruses and PTB. Studies were eligible for inclusion if they presented data on prevalence, disease association, presentation or severity of laboratory‐confirmed influenza among clinically diagnosed or laboratory‐confirmed PTB cases. We searched eight databases from inception until December 2018. Summary characteristics of each study were extracted, and a narrative summary was presented. Cohort or case‐control studies were assessed for potential bias using the Newcastle‐Ottawa scale. Results We assessed 5154 abstracts, reviewed 146 manuscripts and included 19 studies fulfilling selection criteria (13 human and six animal). Of seven studies reporting on the possible effect of the underlying PTB disease in patients with influenza, three of four analytical studies reported no association with disease severity of influenza infection in those with PTB, whilst one study reported PTB as a risk factor for influenza‐associated hospitalization. An association between influenza infection and PTB disease was found in three of five analytical studies; whereas the two other studies reported a high frequency of PTB disease progression and complications among patients with seasonal influenza co‐infection. Conclusion Human analytical studies of an association between co‐infection and severe influenza‐ or PTB‐associated disease or increased prevalence of influenza co‐infection in individuals' hospitalized for PTB were not conclusive. Data are limited from large, high‐quality, analytical epidemiological studies with laboratory‐confirmed endpoints.
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Affiliation(s)
- Sibongile Walaza
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa.,School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Cheryl Cohen
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa.,School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Stefano Tempia
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, USA.,Influenza Program, Centers for Disease Control and Prevention, Pretoria, South Africa
| | - Jocelyn Moyes
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa.,School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Athermon Nguweneza
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa
| | - Shabir A Madhi
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa.,Medical Research Council, Respiratory and Meningeal Pathogens Research Unit, University of the Witwatersrand, Johannesburg, South Africa.,Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases, University of the Witwatersrand, Johannesburg, South Africa
| | - Meredith McMorrow
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, USA.,Influenza Program, Centers for Disease Control and Prevention, Pretoria, South Africa.,U.S. Public Health Service, Rockville, MD, USA
| | - Adam L Cohen
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, USA.,Influenza Program, Centers for Disease Control and Prevention, Pretoria, South Africa.,Global Immunization Monitoring and Surveillance, Expanded Programme on Immunization Department of Immunization, Vaccines and Biologicals World Health Organization, Geneva, Switzerland
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43
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Thompson MG, Levine MZ, Bino S, Hunt DR, Al-Sanouri TM, Simões EAF, Porter RM, Biggs HM, Gresh L, Simaku A, Khader IA, Tallo VL, Meece JK, McMorrow M, Mercado ES, Joshi S, DeGroote NP, Hatibi I, Sanchez F, Lucero MG, Faouri S, Jefferson SN, Maliqari N, Balmaseda A, Sanvictores D, Holiday C, Sciuto C, Owens Z, Azziz-Baumgartner E, Gordon A. Underdetection of laboratory-confirmed influenza-associated hospital admissions among infants: a multicentre, prospective study. Lancet Child Adolesc Health 2019; 3:781-794. [PMID: 31492594 DOI: 10.1016/s2352-4642(19)30246-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 07/09/2019] [Accepted: 07/10/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND Since influenza often presents non-specifically in infancy, we aimed to assess the extent to which existing respiratory surveillance platforms might underestimate the frequency of severe influenza disease among infants. METHODS The Influenza and Respiratory Syncytial Virus in Infants (IRIS) study was a prospective observational study done at four hospitals in Albania, Jordan, Nicaragua, and the Philippines. We included acutely ill infants aged younger than 1 year admitted to hospital within 10 days or less of illness onset during two influenza seasons (2015-16 and 2016-17) in Albania, Jordan, and Nicaragua, and over a continuous 34 week period (2015-16) in the Philippines. We assessed the frequency of influenza virus infections by real-time RT-PCR (rRT-PCR) and serology. The main study outcome was seroconversion, defined as convalescent antibody titres more than or equal to four-fold higher than acute sera antibody titres, and convalescent antibody titres of 40 or higher. Seroconverison was confirmed by haemagglutination inhibition assay for influenza A viruses, and by hemagglutination inhibition assay and microneutralisation for influenza B viruses. FINDINGS Between June 27, 2015, and April 21, 2017, 3634 acutely ill infants were enrolled, of whom 1943 were enrolled during influenza seasons and had complete acute-convalescent pairs and thus were included in the final analytical sample. Of the 1943 infants, 94 (5%) were influenza-positive by both rRT-PCR and serology, 58 (3%) were positive by rRT-PCR-only, and 102 (5%) were positive by serology only. Seroconversion to at least one of the influenza A or B viruses was observed among 196 (77%) of 254 influenza-positive infants. Of the 254 infants with influenza virus, 84 (33%) only had non-respiratory clinical discharge diagnoses (eg, sepsis, febrile seizures, dehydration, or other non-respiratory viral illness). A focus on respiratory diagnoses and rRT-PCR-confirmed influenza underdetects influenza-associated hospital admissions among infants by a factor of 2·6 (95% CI 2·0-3·6). Findings were unchanged when syndromic severe acute respiratory infection criteria were applied instead of clinical diagnosis. INTERPRETATION If the true incidence of laboratory-confirmed influenza-associated hospital admissions among infants is at least twice that of previous estimates, this substantially increases the global burden of severe influenza and expands our estimates of the preventive value of maternal and infant influenza vaccination programmes. FUNDING US Centers for Disease Control and Prevention.
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Affiliation(s)
- Mark G Thompson
- Influenza Division, National Center for Immunization and Respiratory Disease, Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Min Z Levine
- Influenza Division, National Center for Immunization and Respiratory Disease, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Silvia Bino
- Department of Epidemiology and Control of Infectious Diseases, Institute of Public Health, Tirana, Albania
| | | | - Tareq M Al-Sanouri
- The Eastern Mediterranean Public Health Network (EMPHNET), Amman, Jordan
| | - Eric A F Simões
- Center for Global Health, Department of Epidemiology, Colorado School of Public Health, Aurora, CO, USA
| | - Rachael M Porter
- Influenza Division, National Center for Immunization and Respiratory Disease, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Holly M Biggs
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Lionel Gresh
- Sustainable Sciences Institute, Managua, Nicaragua
| | - Artan Simaku
- Department of Epidemiology and Control of Infectious Diseases, Institute of Public Health, Tirana, Albania
| | - Illham Abu Khader
- The Eastern Mediterranean Public Health Network (EMPHNET), Amman, Jordan
| | - Veronica L Tallo
- Research Institute for Tropical Medicine, Department of Health, Muntinlupa, Philippines
| | | | - Meredith McMorrow
- Influenza Division, National Center for Immunization and Respiratory Disease, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Edelwisa S Mercado
- Research Institute for Tropical Medicine, Department of Health, Muntinlupa, Philippines
| | - Sneha Joshi
- Influenza Division, National Center for Immunization and Respiratory Disease, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Nicholas P DeGroote
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Iris Hatibi
- Department of Epidemiology and Control of Infectious Diseases, Institute of Public Health, Tirana, Albania
| | - Felix Sanchez
- Hospital Infantil Manuel de Jesus Rivera, Ministry of Health, Managua, Nicaragua
| | - Marilla G Lucero
- Research Institute for Tropical Medicine, Department of Health, Muntinlupa, Philippines
| | - Samir Faouri
- Al Bashir Hospital, Ministry of Health, Amman, Jordan
| | - Stacie N Jefferson
- Influenza Division, National Center for Immunization and Respiratory Disease, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Numila Maliqari
- General Pediatrics Unit, University Hospital Center "Mother Teresa", Tirana, Albania
| | - Angel Balmaseda
- Laboratorio Nacional de Virologia, Centro Nacional de Diagnostico y Referencia, Ministry of Health, Managua, Nicaragua
| | - Diozele Sanvictores
- Research Institute for Tropical Medicine, Department of Health, Muntinlupa, Philippines
| | - Crystal Holiday
- Influenza Division, National Center for Immunization and Respiratory Disease, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Zachary Owens
- Influenza Division, National Center for Immunization and Respiratory Disease, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Eduardo Azziz-Baumgartner
- Influenza Division, National Center for Immunization and Respiratory Disease, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Aubree Gordon
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, USA
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Kleynhans J, Treurnicht FK, Cohen C, Vedan T, Seleka M, Maki L, von Gottberg A, McCarthy K, Ramkrishna W, McMorrow M, Walaza S. Outbreak of influenza A in a boarding school in South Africa, 2016. Pan Afr Med J 2019; 33:42. [PMID: 31384357 PMCID: PMC6658148 DOI: 10.11604/pamj.2019.33.42.16666] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Accepted: 02/07/2019] [Indexed: 01/09/2023] Open
Abstract
Introduction We investigated an outbreak of influenza-like illness (ILI) at a boarding school in Eastern Cape Province, South Africa. We aimed to confirm the etiological agent, estimate attack rates and identify risk factors for illness. Methods We conducted a retrospective cohort study including senior school boarders (n=308). Students with ILI (cough and fever) were identified through school medical records. We also conducted a questionnaire-based cross-sectional study among senior students including boarders (n=107) and day students (n=45). We collected respiratory specimens for respiratory pathogen testing by real-time polymerase chain reaction from a subset of symptomatic students. We calculated attack rates of medically attended ILI (medILI) and identified factors associated with medILI using logistic regression. We calculated seasonal influenza vaccine effectiveness (VE) against medILI. Results Influenza A (H3N2) virus was detected in 61% (23/38) of specimens. Attack rate for medILI was 13% among boarders (39/308) in the cohort study and 20% in both day students (9/45) and boarders (21/107) in the cross-sectional study. Playing squash was associated with medILI (aOR 5.35, 95% confidence interval [95% CI]: 1.68-17.07). Of the boarders, 19% (57/308) were vaccinated before the outbreak. The adjusted VE against medILI was 18% (aOR 0.82, 95% CI 0.38-1.78). The outbreak led to cancellation of several events and the need for academic remedial sessions. Conclusion We confirmed an influenza A (H3N2) virus outbreak with a high attack rate. The outbreak affected academic and sports activities. Participation in sports and social gatherings while experiencing ILI should be discouraged to reduce viral transmission and impact on school activities.
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Affiliation(s)
- Jackie Kleynhans
- Centre for Respiratory Diseases and Meningitis (CRDM), National Institute for Communicable Diseases (NICD) of the National Health Laboratory Service (NHLS), Johannesburg, South Africa.,South African Field Epidemiology Training Programme (SA-FETP), NICD of the NHLS, Johannesburg, South Africa
| | - Florette Kathleen Treurnicht
- Centre for Respiratory Diseases and Meningitis (CRDM), National Institute for Communicable Diseases (NICD) of the National Health Laboratory Service (NHLS), Johannesburg, South Africa
| | - Cheryl Cohen
- Centre for Respiratory Diseases and Meningitis (CRDM), National Institute for Communicable Diseases (NICD) of the National Health Laboratory Service (NHLS), Johannesburg, South Africa.,School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Theesan Vedan
- South African Field Epidemiology Training Programme (SA-FETP), NICD of the NHLS, Johannesburg, South Africa
| | - Mpho Seleka
- Centre for Respiratory Diseases and Meningitis (CRDM), National Institute for Communicable Diseases (NICD) of the National Health Laboratory Service (NHLS), Johannesburg, South Africa
| | - Lwando Maki
- Division of Public Health, Surveillance and Response (DPHSR), NICD of the NHLS, Johannesburg, South Africa
| | - Anne von Gottberg
- Centre for Respiratory Diseases and Meningitis (CRDM), National Institute for Communicable Diseases (NICD) of the National Health Laboratory Service (NHLS), Johannesburg, South Africa.,School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Kerrigan McCarthy
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,Division of Public Health, Surveillance and Response (DPHSR), NICD of the NHLS, Johannesburg, South Africa
| | - Wayne Ramkrishna
- South African National Department of Health (NDoH), Pretoria, South Africa
| | - Meredith McMorrow
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.,U.S. Centers for Disease Control and Prevention, Pretoria, South Africa
| | - Sibongile Walaza
- Centre for Respiratory Diseases and Meningitis (CRDM), National Institute for Communicable Diseases (NICD) of the National Health Laboratory Service (NHLS), Johannesburg, South Africa.,School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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45
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Phiri M, Gooding K, Peterson I, Mambule I, Nundwe S, McMorrow M, Desmond N. Dust or disease? Perceptions of influenza in rural Southern Malawi. PLoS One 2019; 14:e0208155. [PMID: 31009480 PMCID: PMC6476467 DOI: 10.1371/journal.pone.0208155] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Accepted: 04/05/2019] [Indexed: 01/10/2023] Open
Abstract
Influenza virus infections cause between 291 243 and 645 832 deaths annually, with the highest burden in low-income settings. Research in high-income countries has examined public understanding of influenza, but there is little information on views and behaviours about influenza in low-income countries. We explored communities' ideas about the severity, causes, prevention and treatment of influenza in Chikwawa district, Malawi. We conducted 64 in-depth interviews with parents of children aged <5 years, and 7 focus groups with community health workers, parents, and traditional healers. Data were analysed thematically and using a framework matrix to compare views between groups. Respondents held varied ideas about influenza, and many were uncertain about its causes and treatment. Some parents, traditional healers and health workers thought influenza was not severe because they felt it did not cause death or limit activities, but others disagreed. Many saw influenza as a symptom of other conditions, especially malaria and pneumonia, rather than as a disease of its own. Most mentioned dust as the main cause of influenza and believed influenza could be prevented by cleaning the home thoroughly. Treatment seeking for influenza followed different stages, usually starting with home remedies followed by purchasing drugs from groceries and then visiting a health centre. Seeking a clinician tended to be triggered by severe symptoms like high fever or difficulty breathing, and suspicions of malaria or pneumonia. Community health workers provide health education for communities, but some lacked understanding of influenza. Our findings suggest uncertainty about the causes and control of influenza among parents and varied levels of understanding among health providers. Strengthening the capacity of community health workers to provide relevant information about influenza prevention and treatment could address parents' interest in further information and support informed health seeking and engagement with future influenza interventions.
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Affiliation(s)
- Mackwellings Phiri
- Malawi Liverpool Welcome Trust Clinical Research Programme, Chichiri, Blantyre 3, Malawi
| | - Kate Gooding
- Malawi Liverpool Welcome Trust Clinical Research Programme, Chichiri, Blantyre 3, Malawi
- Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, United Kingdom
| | - Ingrid Peterson
- Malawi Liverpool Welcome Trust Clinical Research Programme, Chichiri, Blantyre 3, Malawi
- Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, United Kingdom
| | - Ivan Mambule
- Malawi Liverpool Welcome Trust Clinical Research Programme, Chichiri, Blantyre 3, Malawi
- Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, United Kingdom
| | - Spencer Nundwe
- Malawi Liverpool Welcome Trust Clinical Research Programme, Chichiri, Blantyre 3, Malawi
| | - Meredith McMorrow
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- Influenza Program, Centers for Disease Control and Prevention, Pretoria, South Africa
- U.S. Public Health Service, Rockville, Maryland, United States of America
| | - Nicola Desmond
- Malawi Liverpool Welcome Trust Clinical Research Programme, Chichiri, Blantyre 3, Malawi
- Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, United Kingdom
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Walaza S, Tempia S, Dawood H, Variava E, Wolter N, Dreyer A, Moyes J, Von Mollendorf C, McMorrow M, Von Gottberg A, Haffejee S, Venter M, Treurnicht FK, Hellferscee O, Martinson NA, Ismail N, Cohen C. The Impact of Influenza and Tuberculosis Interaction on Mortality Among Individuals Aged ≥15 Years Hospitalized With Severe Respiratory Illness in South Africa, 2010-2016. Open Forum Infect Dis 2019; 6:ofz020. [PMID: 30906797 PMCID: PMC6424478 DOI: 10.1093/ofid/ofz020] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [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: 01/10/2019] [Accepted: 01/22/2019] [Indexed: 11/12/2022] Open
Abstract
Background Data on the prevalence and impact of influenza–tuberculosis coinfection on clinical outcomes from high–HIV and –tuberculosis burden settings are limited. We explored the impact of influenza and tuberculosis coinfection on mortality among hospitalized adults with lower respiratory tract infection (LRTI). Methods We enrolled patients aged ≥15 years admitted with physician-diagnosed LRTI or suspected tuberculosis at 2 hospitals in South Africa from 2010 to 2016. Combined nasopharyngeal and oropharyngeal swabs were tested for influenza and 8 other respiratory viruses. Tuberculosis testing of sputum included smear microscopy, culture, and/or Xpert MTB/Rif. Results Among 6228 enrolled individuals, 4253 (68%) were tested for both influenza and tuberculosis. Of these, the detection rate was 6% (239/4253) for influenza, 26% (1092/4253) for tuberculosis, and 77% (3113/4053) for HIV. One percent (42/4253) tested positive for both influenza and tuberculosis. On multivariable analysis, among tuberculosis-positive patients, factors independently associated with death were age group ≥65 years compared with 15–24 years (adjusted odds ratio [aOR], 3.6; 95% confidence interval [CI], 1.2–11.0) and influenza coinfection (aOR, 2.3; 95% CI, 1.02–5.2). Among influenza-positive patients, laboratory-confirmed tuberculosis was associated with an increased risk of death (aOR, 4.5; 95% CI, 1.5–13.3). Coinfection with other respiratory viruses was not associated with increased mortality in patients positive for tuberculosis (OR, 0.7; 95% CI, 0.4–1.1) or influenza (OR, 1.6; 95% CI, 0.4–5.6). Conclusions Tuberculosis coinfection is associated with increased mortality in individuals with influenza, and influenza coinfection is associated with increased mortality in individuals with tuberculosis. These data may inform prioritization of influenza vaccines or antivirals for tuberculosis patients and inform tuberculosis testing guidelines for patients with influenza.
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Affiliation(s)
- Sibongile Walaza
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa.,School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Stefano Tempia
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa.,Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia.,Influenza Program, Centers for Disease Control and Prevention, Pretoria, South Africa
| | - Halima Dawood
- Pietermaritzburg Metropolitan Hospital Complex, KwaZulu-Natal, South Africa
| | - Ebrahim Variava
- Department of Medicine, Klerksdorp Tshepong Hospital, North West Province.,School of Clinical Medicine, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa.,Perinatal HIV Research Unit, MRC Soweto Matlosana Collaborating Centre for HIV/AIDS and TB
| | - Nicole Wolter
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa.,School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Andries Dreyer
- Centre for Tuberculosis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa
| | - Jocelyn Moyes
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa.,School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Claire Von Mollendorf
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa.,School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Meredith McMorrow
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia.,Influenza Program, Centers for Disease Control and Prevention, Pretoria, South Africa.,Division of Global Health Protection, Centers for Disease Control and Prevention, Pretoria, South Africa
| | - Anne Von Gottberg
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa.,School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Sumayya Haffejee
- Pietermaritzburg Metropolitan Hospital Complex, KwaZulu-Natal, South Africa
| | - Marietje Venter
- Zoonosis Research Program, Department of Medical Virology, University of Pretoria, Pretoria, South Africa
| | - Florette K Treurnicht
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa
| | - Orienka Hellferscee
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa.,School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Neil A Martinson
- Perinatal HIV Research Unit, MRC Soweto Matlosana Collaborating Centre for HIV/AIDS and TB.,DST/NRF Centre of Excellence for Biomedical Tuberculosis Research, University of the Witwatersrand, Johannesburg, South Africa.,Johns Hopkins University Center for TB Research, Baltimore, Maryland
| | - Nazir Ismail
- Centre for Tuberculosis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa.,Faculty of Health Sciences, University of Pretoria, Pretoria
| | - Cheryl Cohen
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa.,School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Subramoney K, Hellferscee O, Pretorius M, Tempia S, McMorrow M, von Gottberg A, Wolter N, Variava E, Dawood H, Kahn K, Walaza S, Madhi SA, Cohen C, Venter M, Treurnicht FK. Human bocavirus, coronavirus, and polyomavirus detected among patients hospitalised with severe acute respiratory illness in South Africa, 2012 to 2013. Health Sci Rep 2018; 1:e59. [PMID: 30623094 PMCID: PMC6266378 DOI: 10.1002/hsr2.59] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Revised: 05/09/2018] [Accepted: 05/18/2018] [Indexed: 12/13/2022] Open
Abstract
AIM To investigate the prevalence of human bocavirus (hBoV), human coronaviruses (hCoV), and human polyomaviruses (hPyV) among patients with severe acute respiratory illness (SARI), in South Africa. METHODS The study included 680 South African patients randomly selected in age-defined categories from hospitalised patients enrolled through SARI surveillance during 2012 to 2013. A multiplex reverse transcription real-time polymerase chain reaction assay was used to detect hBoV; hCoV-OC43, hCoV-229E, hCoV-NL63, and hCoV-HKU1; and Washington University hPyV (hPyV-WU) and Karolinska Insitute hPyV (hPyV-KI), in respiratory tract specimens collected from patients with SARI. All respiratory specimens from patients enrolled through SARI surveillance were also routinely tested by multiplex reverse transcription real-time polymerase chain reaction for adenovirus; enterovirus; human metapneumovirus; parainfluenza virus types 1, 2, and 3; respiratory syncytial virus; rhinovirus; influenza A, and influenza B. RESULTS Human bocavirus, hCoV-229E, and hPyV-WU were detected in 3.7% (25/680), 4.1% (28/680), and 4.1% (28/680) of respiratory specimens, respectively. All other viruses were detected in <2% of specimens. Rhinovirus was the most common coinfecting virus (21.4%-60.7%), followed by adenovirus (21.4%-39.3%), and respiratory syncytial virus (10.7%-24.0%). Testing for the additional viruses (hBoV, hCoV, and hPyV) decreased the number of specimens that initially tested negative by 2.9% (20/680). CONCLUSION Inclusion of laboratory tests for hBoV, hCoV-229E, and hPyV-WU in differential testing algorithms for surveillance and diagnostics for suspected cases of respiratory illness of unknown cause may improve our understanding of the etiology of SARI, especially in a country like South Africa with a high number of immune compromised persons.
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Affiliation(s)
- Kathleen Subramoney
- National Institute for Communicable Diseases of the National Health Laboratory ServiceCentre for Respiratory Diseases and MeningitisJohannesburgSouth Africa
| | - Orienka Hellferscee
- National Institute for Communicable Diseases of the National Health Laboratory ServiceCentre for Respiratory Diseases and MeningitisJohannesburgSouth Africa
- University of the WitwatersrandSchool of Pathology, Faculty of Health SciencesJohannesburgSouth Africa
| | - Marthi Pretorius
- National Institute for Communicable Diseases of the National Health Laboratory ServiceCentre for Respiratory Diseases and MeningitisJohannesburgSouth Africa
- Technical Research and Development, Novartis Pharma AGBaselSwitzerland
| | - Stefano Tempia
- National Institute for Communicable Diseases of the National Health Laboratory ServiceCentre for Respiratory Diseases and MeningitisJohannesburgSouth Africa
- Centers for Disease Control and PreventionInfluenza DivisionAtlantaGeorgiaUSA
- Centers for Disease Control and PreventionInfluenza ProgramPretoriaSouth Africa
| | - Meredith McMorrow
- Centers for Disease Control and PreventionInfluenza DivisionAtlantaGeorgiaUSA
- Centers for Disease Control and PreventionInfluenza ProgramPretoriaSouth Africa
| | - Anne von Gottberg
- National Institute for Communicable Diseases of the National Health Laboratory ServiceCentre for Respiratory Diseases and MeningitisJohannesburgSouth Africa
- University of the WitwatersrandSchool of Pathology, Faculty of Health SciencesJohannesburgSouth Africa
| | - Nicole Wolter
- National Institute for Communicable Diseases of the National Health Laboratory ServiceCentre for Respiratory Diseases and MeningitisJohannesburgSouth Africa
- University of the WitwatersrandSchool of Pathology, Faculty of Health SciencesJohannesburgSouth Africa
| | - Ebrahim Variava
- University of the WitwatersrandSchool of Pathology, Faculty of Health SciencesJohannesburgSouth Africa
- Klerksdorp‐Tshepong Hospital ComplexDepartment of MedicineKlerksdorpSouth Africa
- University of the WitwatersrandPerinatal HIV Research UnitJohannesburgSouth Africa
| | - Halima Dawood
- Pietermaritzburg Metropolitan HospitalDepartment of MedicinePietermaritzburgSouth Africa
- University of KwaZulu‐NatalDepartment of MedicinePietermaritzburgSouth Africa
| | - Kathleen Kahn
- University of the WitwatersrandSchool of Public Health, Faculty of Health SciencesJohannesburgSouth Africa
| | - Sibongile Walaza
- National Institute for Communicable Diseases of the National Health Laboratory ServiceCentre for Respiratory Diseases and MeningitisJohannesburgSouth Africa
- University of the WitwatersrandSchool of Public Health, Faculty of Health SciencesJohannesburgSouth Africa
| | - Shabir A. Madhi
- University of the WitwatersrandMedical Research Council, Respiratory and Meningeal Pathogens Research UnitJohannesburgSouth Africa
- University of the WitwatersrandDepartment of Science and Technology/National Research Foundation: Vaccine Preventable DiseasesJohannesburgSouth Africa
| | - Cheryl Cohen
- National Institute for Communicable Diseases of the National Health Laboratory ServiceCentre for Respiratory Diseases and MeningitisJohannesburgSouth Africa
- University of the WitwatersrandSchool of Public Health, Faculty of Health SciencesJohannesburgSouth Africa
| | - Marietjie Venter
- National Institute for Communicable Diseases of the National Health Laboratory ServiceCentre for Respiratory Diseases and MeningitisJohannesburgSouth Africa
- University of PretoriaEmerging Arbo And Respiratory Virus Program, Centre for Viral Zoonoses, Department of Medical VirologyPretoriaSouth Africa
| | - Florette K. Treurnicht
- National Institute for Communicable Diseases of the National Health Laboratory ServiceCentre for Respiratory Diseases and MeningitisJohannesburgSouth Africa
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Ho A, Mallewa J, Peterson I, SanJoaquin M, Garg S, Bar-Zeev N, Menyere M, Alaerts M, Mapurisa G, Chilombe M, Nyirenda M, Lalloo DG, Rothe C, Widdowson MA, McMorrow M, French N, Everett D, Heyderman RS. Epidemiology of Severe Acute Respiratory Illness and Risk Factors for Influenza Infection and Clinical Severity among Adults in Malawi, 2011-2013. Am J Trop Med Hyg 2018; 99:772-779. [PMID: 30039785 PMCID: PMC6169174 DOI: 10.4269/ajtmh.17-0905] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Data on the epidemiology of severe acute respiratory illness (SARI) in adults from low-income, high human immunodeficiency virus (HIV) prevalence African settings are scarce. We conducted adult SARI surveillance in Blantyre, Malawi. From January 2011 to December 2013, individuals aged ≥ 15 years with SARI (both inpatients and outpatients) were enrolled at a large teaching hospital in Blantyre, Malawi. Nasopharyngeal aspirates were tested for influenza and other respiratory viruses by polymerase chain reaction. We estimated hospital-attended influenza-positive SARI incidence rates and assessed factors associated with influenza positivity and clinical severity (Modified Early Warning Score > 4). We enrolled 1,126 SARI cases; 163 (14.5%) were positive for influenza. Human immunodeficiency virus prevalence was 50.3%. Annual incidence of hospital-attended influenza-associated SARI was 9.7–16.8 cases per 100,000 population. Human immunodeficiency virus was associated with a 5-fold greater incidence (incidence rate ratio 4.91, 95% confidence interval [CI]: 3.83–6.32). On multivariable analysis, female gender, as well as recruitment in hot, rainy season (December to March; adjusted odds ratios (aOR): 2.82, 95% CI: 1.57–5.06) and cool, dry season (April to August; aOR: 2.47, 95% CI: 1.35–4.15), was associated with influenza positivity, whereas influenza-positive patients were less likely to be HIV-infected (aOR: 0.59, 95% CI: 0.43–0.80) or have viral coinfection (aOR: 0.51, 95% CI: 0.36–0.73). Human immunodeficiency virus infection (aOR: 1.86; 95% CI: 1.35–2.56) and recruitment in hot, rainy season (aOR: 4.98, 95% CI: 3.17–7.81) were independently associated with clinical severity. In this high HIV prevalence population, influenza was associated with nearly 15% of hospital-attended SARI. Human immunodeficiency virus infection is an important risk factor for clinical severity in all-cause and influenza-associated SARI. Expanded access to HIV testing and antiretroviral treatment, as well as targeted influenza vaccination, may reduce the burden of SARI in Malawi and other high HIV prevalence settings.
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Affiliation(s)
- Antonia Ho
- Institute of Infection and Global Health, University of Liverpool, Liverpool, United Kingdom.,Malawi-Liverpool-Wellcome Trust Clinical Research Programme, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Jane Mallewa
- Department of Medicine, Queen Elizabeth Central Hospital, Blantyre, Malawi.,Malawi-Liverpool-Wellcome Trust Clinical Research Programme, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Ingrid Peterson
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, College of Medicine, University of Malawi, Blantyre, Malawi
| | | | - Shikha Garg
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Naor Bar-Zeev
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.,Institute of Infection and Global Health, University of Liverpool, Liverpool, United Kingdom.,Malawi-Liverpool-Wellcome Trust Clinical Research Programme, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Mavis Menyere
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Maaike Alaerts
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Gugulethu Mapurisa
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Moses Chilombe
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Mulinda Nyirenda
- Department of Medicine, Queen Elizabeth Central Hospital, Blantyre, Malawi
| | - David G Lalloo
- Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Camilla Rothe
- Division of Infectious Diseases and Tropical Medicine, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - Marc-Alain Widdowson
- Division of Global Health Protection, Centers for Disease Control and Prevention, Atlanta, Georgia.,Division of Global Health Protection, Centers for Disease Control and Prevention, Nairobi, Kenya
| | - Meredith McMorrow
- Influenza Division, Centers for Disease Control and Prevention, Pretoria, South Africa.,Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Neil French
- Institute of Infection and Global Health, University of Liverpool, Liverpool, United Kingdom.,Malawi-Liverpool-Wellcome Trust Clinical Research Programme, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Dean Everett
- University of Edinburgh, Edinburgh, United Kingdom.,Malawi-Liverpool-Wellcome Trust Clinical Research Programme, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Robert S Heyderman
- Division of Infection and Immunity, University College London, London, United Kingdom
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Valley-Omar Z, Iyengar P, von Mollendorf C, Tempia S, Moerdyk A, Hellferscee O, Martinson N, McMorrow M, Variava E, Masonoke K, Cohen AL, Cohen C, Treurnicht FK. Intra-host and intra-household diversity of influenza A viruses during household transmissions in the 2013 season in 2 peri-urban communities of South Africa. PLoS One 2018; 13:e0198101. [PMID: 29795677 PMCID: PMC5967731 DOI: 10.1371/journal.pone.0198101] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [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: 07/27/2017] [Accepted: 05/14/2018] [Indexed: 01/06/2023] Open
Abstract
Limited information is available on influenza virus sequence drift between transmission events. In countries with high HIV burdens, like South Africa, the direct and indirect effect of HIV on influenza sequence drift between transmission events may be of public health concern. To this end, we measured hemagglutinin sequence diversity between influenza transmission events using data and specimens from a study investigating household transmission dynamics of seasonal influenza viruses in 2 peri-urban communities in South Africa during the 2013 influenza season. Thirty index cases and 107 of 110 eligible household contacts were enrolled into the study, 47% (14/30) demonstrating intra-household laboratory-confirmed influenza transmission. In this study 35 partial hemagglutinin gene sequences were obtained by Sanger sequencing from 11 index cases (sampled at enrolment only) and 16 secondary cases (8 cases sampled at 1 and 8 cases sampled at 2 time-points). Viral sequence identities confirmed matched influenza transmission pairs within the 11 households with corresponding sequenced index and secondary cases. Phylogenetic analysis revealed 10 different influenza viral lineages in the 14 households. Influenza A(H1N1)pdm09 strains were shown to be genetically distinct between the 2 communities (from distinct geographic regions), which was not observed for the influenza A(H3N2) strains. Intra-host/intra-household influenza A(H3N2) sequence drift was identified in 2 households. The first was a synonymous mutation between the index case and a household contact, and the second a non-synonymous mutation between 2 serial samples taken at days 0 and 4 post enrolment from an HIV-infected secondary case. Limited inter-household sequence diversity was observed as highlighted by sharing of the same influenza strain between different households within each community. The limited intra-household sequence drift is in line with previous studies also using Sanger sequencing, corroborating the presence of strict selective bottlenecks that limit sequence variance. We were not able to directly ascertain the effect of HIV on influenza sequence drift between transmission events.
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Affiliation(s)
- Ziyaad Valley-Omar
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa
- Division of Medical Virology, Department of Pathology, University of Cape Town, Cape Town, South Africa
| | - Preetha Iyengar
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Claire von Mollendorf
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa
| | - Stefano Tempia
- Influenza Program, Centers for Disease Control and Prevention, Pretoria, South Africa
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Alexandra Moerdyk
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa
| | - Orienka Hellferscee
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa
- School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Neil Martinson
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Meredith McMorrow
- Influenza Program, Centers for Disease Control and Prevention, Pretoria, South Africa
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Ebrahim Variava
- Department of Internal Medicine, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | - Katlego Masonoke
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Adam L. Cohen
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- Global Immunization Monitoring and Surveillance, Expanded Programme on Immunization, Department of Immunization, Vaccines and Biologicals, World Health Organization, Geneva, Switzerland
| | - Cheryl Cohen
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Florette K. Treurnicht
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa
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Cohen C, Walaza S, Treurnicht FK, McMorrow M, Madhi SA, McAnerney JM, Tempia S. In- and Out-of-hospital Mortality Associated with Seasonal and Pandemic Influenza and Respiratory Syncytial Virus in South Africa, 2009-2013. Clin Infect Dis 2018; 66:95-103. [PMID: 29040527 PMCID: PMC5813484 DOI: 10.1093/cid/cix740] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [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: 05/03/2017] [Accepted: 08/28/2017] [Indexed: 11/13/2022] Open
Abstract
Background Estimates of influenza- and respiratory syncytial virus (RSV)-associated mortality burden are important to guide policy for control. Data are limited on the contribution of out-of-hospital deaths to this mortality. Methods We modeled excess mortality attributable to influenza and RSV infection by applying regression models to weekly deaths from national vital statistics from 2009 through 2013, using influenza and RSV laboratory surveillance data as covariates. We fitted separate models for in- and out-of-hospital deaths. Results There were 509791 average annual deaths in South Africa, of which 44% (95% confidence interval [CI] 43%-45%) occurred out-of-hospital. Seasonal influenza and RSV all-cause mortality rates were 23.0 (95% CI 11.0-30.6) and 13.2 (95% CI 6.4-33.8) per 100000 population annually (2.3% [95%CI 2.3%-2.4%] and 1.3% [95% CI 1.2%-1.4%] of all deaths respectively). The peak mortality rate was in individuals aged ≥75 years (386.0; 95% CI 176.5-466.3) for influenza and in infants (143.4; 95% CI 0-194.8) for RSV. Overall, 63% (95% CI 62%--65%) of seasonal influenza and 48% (95% CI 47%-49%) of RSV-associated deaths occurred out-of-hospital. Among children aged <5 years, RSV-associated deaths were more likely to occur in-hospital, whereas influenza-associated deaths were more likely to occur out-of-hospital. The mortality rate was 6.7 (95% CI 6.4-33.8) in the first influenza A(H1N1)pdm09 wave in 2009 and 20.9 (95% CI 6.4-33.8) in the second wave in 2011, with 30% (95% CI 29%-32%) of A(H1N1)pdm09-associated deaths in 2009 occurring out-of-hospital. Discussion More than 45% of seasonal influenza- and RSV-associated deaths occur out-of-hospital in South Africa. These data suggest that hospital-based studies may substantially underestimate mortality burden.
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Affiliation(s)
- Cheryl Cohen
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, South Africa
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Sibongile Walaza
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, South Africa
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Florette K Treurnicht
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, South Africa
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Meredith McMorrow
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia
- Influenza Program, Centers for Disease Control and Prevention, Pretoria, South Africa
- US Public Health Service, Rockville, Maryland
| | - Shabir A Madhi
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, South Africa
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases, University of the Witwatersrand, Johannesburg, South Africa
| | - Johanna M McAnerney
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, South Africa
| | - Stefano Tempia
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia
- Influenza Program, Centers for Disease Control and Prevention, Pretoria, South Africa
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