1
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Havers FP, Whitaker M, Melgar M, Chatwani B, Chai SJ, Alden NB, Meek J, Openo KP, Ryan PA, Kim S, Lynfield R, Shaw YP, Barney G, Tesini BL, Sutton M, Talbot HK, Olsen KP, Patton ME. Characteristics and Outcomes Among Adults Aged ≥60 Years Hospitalized with Laboratory-Confirmed Respiratory Syncytial Virus - RSV-NET, 12 States, July 2022-June 2023. Am J Transplant 2023; 23:2000-2007. [PMID: 37863432 DOI: 10.1016/j.ajt.2023.10.010] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2023]
Abstract
Respiratory syncytial virus (RSV) causes substantial morbidity and mortality in older adults. In May 2023, two RSV vaccines were approved for prevention of RSV lower respiratory tract disease in adults aged ≥60 years. In June 2023, CDC recommended RSV vaccination for adults aged ≥60 years, using shared clinical decision-making. Using data from the Respiratory Syncytial Virus-Associated Hospitalization Surveillance Network, a population-based hospitalization surveillance system operating in 12 states, this analysis examined characteristics (including age, underlying medical conditions, and clinical outcomes) of 3,218 adults aged ≥60 years who were hospitalized with laboratory-confirmed RSV infection during July 2022-June 2023. Among a random sample of 1,634 older adult patients with RSV-associated hospitalization, 54.1% were aged ≥75 years, and the most common underlying medical conditions were obesity, chronic obstructive pulmonary disease, congestive heart failure, and diabetes. Severe outcomes occurred in 18.5% (95% CI = 15.9%-21.2%) of hospitalized patients aged ≥60 years. Overall, 17.0% (95% CI = 14.5%-19.7%) of patients with RSV infection were admitted to an intensive care unit, 4.8% (95% CI = 3.5%-6.3%) required mechanical ventilation, and 4.7% (95% CI = 3.6%-6.1%) died; 17.2% (95% CI = 14.9%-19.8%) of all cases occurred in long-term care facility residents. These data highlight the importance of prioritizing those at highest risk for severe RSV disease and suggest that clinicians and patients consider age (particularly age ≥75 years), long-term care facility residence, and underlying medical conditions, including chronic obstructive pulmonary disease and congestive heart failure, in shared clinical decision-making when offering RSV vaccine to adults aged ≥60 years.
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Affiliation(s)
- Fiona P Havers
- Coronavirus and Other Respiratory Viruses Division, National Center for Immunization and Respiratory Diseases, CDC.
| | - Michael Whitaker
- Coronavirus and Other Respiratory Viruses Division, National Center for Immunization and Respiratory Diseases, CDC
| | - Michael Melgar
- Coronavirus and Other Respiratory Viruses Division, National Center for Immunization and Respiratory Diseases, CDC
| | - Bhoomija Chatwani
- Coronavirus and Other Respiratory Viruses Division, National Center for Immunization and Respiratory Diseases, CDC; Eagle Health Analytics, LLC., Atlanta, Georgia
| | - Shua J Chai
- California Emerging Infections Program, Oakland, California; Career Epidemiology Field Officer Program, CDC
| | | | - James Meek
- Connecticut Emerging Infections Program, Yale School of Public Health, New Haven, Connecticut
| | - Kyle P Openo
- Emory University School of Medicine, Atlanta, Georgia; Georgia Emerging Infections Program, Georgia Department of Public Health; Atlanta Veterans Affairs Medical Center, Decatur, Georgia
| | | | - Sue Kim
- Michigan Department of Health & Human Services
| | | | | | | | - Brenda L Tesini
- University of Rochester School of Medicine and Dentistry, Rochester, New York
| | | | - H Keipp Talbot
- Vanderbilt University Medical Center, Nashville, Tennessee
| | | | - Monica E Patton
- Coronavirus and Other Respiratory Viruses Division, National Center for Immunization and Respiratory Diseases, CDC
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2
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Havers FP, Whitaker M, Melgar M, Chatwani B, Chai SJ, Alden NB, Meek J, Openo KP, Ryan PA, Kim S, Lynfield R, Shaw YP, Barney G, Tesini BL, Sutton M, Talbot HK, Olsen KP, Patton ME. Characteristics and Outcomes Among Adults Aged ≥60 Years Hospitalized with Laboratory-Confirmed Respiratory Syncytial Virus - RSV-NET, 12 States, July 2022-June 2023. MMWR Morb Mortal Wkly Rep 2023; 72:1075-1082. [PMID: 37796742 PMCID: PMC10564327 DOI: 10.15585/mmwr.mm7240a1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/07/2023]
Abstract
Respiratory syncytial virus (RSV) causes substantial morbidity and mortality in older adults. In May 2023, two RSV vaccines were approved for prevention of RSV lower respiratory tract disease in adults aged ≥60 years. In June 2023, CDC recommended RSV vaccination for adults aged ≥60 years, using shared clinical decision-making. Using data from the Respiratory Syncytial Virus-Associated Hospitalization Surveillance Network, a population-based hospitalization surveillance system operating in 12 states, this analysis examined characteristics (including age, underlying medical conditions, and clinical outcomes) of 3,218 adults aged ≥60 years who were hospitalized with laboratory-confirmed RSV infection during July 2022-June 2023. Among a random sample of 1,634 older adult patients with RSV-associated hospitalization, 54.1% were aged ≥75 years, and the most common underlying medical conditions were obesity, chronic obstructive pulmonary disease, congestive heart failure, and diabetes. Severe outcomes occurred in 18.5% (95% CI = 15.9%-21.2%) of hospitalized patients aged ≥60 years. Overall, 17.0% (95% CI = 14.5%-19.7%) of patients with RSV infection were admitted to an intensive care unit, 4.8% (95% CI = 3.5%-6.3%) required mechanical ventilation, and 4.7% (95% CI = 3.6%-6.1%) died; 17.2% (95% CI = 14.9%-19.8%) of all cases occurred in long-term care facility residents. These data highlight the importance of prioritizing those at highest risk for severe RSV disease and suggest that clinicians and patients consider age (particularly age ≥75 years), long-term care facility residence, and underlying medical conditions, including chronic obstructive pulmonary disease and congestive heart failure, in shared clinical decision-making when offering RSV vaccine to adults aged ≥60 years.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - RSV-NET Surveillance Team
- Coronavirus and Other Respiratory Viruses Division, National Center for Immunization and Respiratory Diseases, CDC; Eagle Health Analytics, LLC., Atlanta, Georgia; California Emerging Infections Program, Oakland, California; Career Epidemiology Field Officer Program, CDC; Colorado Department of Public Health & Environment; Connecticut Emerging Infections Program, Yale School of Public Health, New Haven, Connecticut; Emory University School of Medicine, Atlanta, Georgia; Georgia Emerging Infections Program, Georgia Department of Public Health; Atlanta Veterans Affairs Medical Center, Decatur, Georgia; Maryland Department of Health; Michigan Department of Health & Human Services; Minnesota Department of Health; New Mexico Department of Health; New York State Department of Health; University of Rochester School of Medicine and Dentistry, Rochester, New York; Public Health Division, Oregon Health Authority; Vanderbilt University Medical Center, Nashville, Tennessee; Salt Lake County Health Department, Salt Lake City, Utah
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3
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Ortega-Villa AM, Hynes NA, Levine CB, Yang K, Wiley Z, Jilg N, Wang J, Whitaker JA, Colombo CJ, Nayak SU, Kim HJ, Iovine NM, Ince D, Cohen SH, Langer AJ, Wortham JM, Atmar RL, El Sahly HM, Jain MK, Mehta AK, Wolfe CR, Gomez CA, Beresnev T, Mularski RA, Paules CI, Kalil AC, Branche AR, Luetkemeyer A, Zingman BS, Voell J, Whitaker M, Harkins MS, Davey RT, Grossberg R, George SL, Tapson V, Short WR, Ghazaryan V, Benson CA, Dodd LE, Sweeney DA, Tomashek KM. Evaluating Demographic Representation in Clinical Trials: Use of the Adaptive Coronavirus Disease 2019 Treatment Trial (ACTT) as a Test Case. Open Forum Infect Dis 2023; 10:ofad290. [PMID: 37383244 PMCID: PMC10296069 DOI: 10.1093/ofid/ofad290] [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: 02/28/2023] [Accepted: 05/25/2023] [Indexed: 06/30/2023] Open
Abstract
Background Clinical trials initiated during emerging infectious disease outbreaks must quickly enroll participants to identify treatments to reduce morbidity and mortality. This may be at odds with enrolling a representative study population, especially when the population affected is undefined. Methods We evaluated the utility of the Centers for Disease Control and Prevention's COVID-19-Associated Hospitalization Surveillance Network (COVID-NET), the COVID-19 Case Surveillance System (CCSS), and 2020 United States (US) Census data to determine demographic representation in the 4 stages of the Adaptive COVID-19 Treatment Trial (ACTT). We compared the cumulative proportion of participants by sex, race, ethnicity, and age enrolled at US ACTT sites, with respective 95% confidence intervals, to the reference data in forest plots. Results US ACTT sites enrolled 3509 adults hospitalized with COVID-19. When compared with COVID-NET, ACTT enrolled a similar or higher proportion of Hispanic/Latino and White participants depending on the stage, and a similar proportion of African American participants in all stages. In contrast, ACTT enrolled a higher proportion of these groups when compared with US Census and CCSS. The proportion of participants aged ≥65 years was either similar or lower than COVID-NET and higher than CCSS and the US Census. The proportion of females enrolled in ACTT was lower than the proportion of females in the reference datasets. Conclusions Although surveillance data of hospitalized cases may not be available early in an outbreak, they are a better comparator than US Census data and surveillance of all cases, which may not reflect the population affected and at higher risk of severe disease.
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Affiliation(s)
- Ana M Ortega-Villa
- Biostatistics Research Branch, Division of Clinical Research, National Institute of Allergy and Infectious Diseases, Rockville, Maryland, USA
| | - Noreen A Hynes
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Corri B Levine
- Division of Infectious Disease, Department of Internal Medicine, University of Texas Medical Branch, Galveston, Texas, USA
| | - Katherine Yang
- Department of Clinical Pharmacy, University of California, San Francisco, San Francisco, California, USA
| | - Zanthia Wiley
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Nikolaus Jilg
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Jing Wang
- Clinical Monitoring Research Program Directorate, Frederick National Laboratory for Cancer Research, Frederick, Maryland, USA
| | - Jennifer A Whitaker
- Molecular Virology and Microbiology, Baylor College of Medicine, Houston, Texas, USA
| | - Christopher J Colombo
- Department of Virtual Health and Department of Medicine, Madigan Army Medical Center, Tacoma, Washington, USA
- Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Seema U Nayak
- Division of Microbiology and Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Hannah Jang Kim
- Department of Community Health Systems, School of Nursing, University of California, San Francisco,San Francisco, California, USA
- National Patient Care Services, Kaiser Permanente, Oakland, California, USA
| | - Nicole M Iovine
- Division of Infectious Diseases and Global Medicine, Department of Medicine, University of Florida Health, Gainesville, Florida, USA
| | - Dilek Ince
- Division of Infectious Diseases, Department of Internal Medicine, University of Iowa, Iowa City, Iowa, USA
| | - Stuart H Cohen
- Division of Infectious Diseases, University of California, Davis, Sacramento, California, USA
| | - Adam J Langer
- COVID-19 Emergency Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Jonathan M Wortham
- COVID-19–Associated Hospitalization Surveillance Network, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Robert L Atmar
- Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Hana M El Sahly
- Molecular Virology and Microbiology, Baylor College of Medicine, Houston, Texas, USA
| | - Mamta K Jain
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Aneesh K Mehta
- Division of Infection Diseases, Emory University School of Medicine, Atlanta, Georgia, USA
- National Emerging Special Pathogens Treatment and Education Center, Atlanta, Georgia, USA
| | - Cameron R Wolfe
- Division of Infectious Diseases, Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA
| | - Carlos A Gomez
- Division of Infectious Diseases, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Tatiana Beresnev
- Division of Microbiology and Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Richard A Mularski
- Department of Pulmonary and Critical Care Medicine, Northwest Permanente, Kaiser Permanente Northwest, Portland, Oregon, USA
- The Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon, USA
| | - Catharine I Paules
- Division of Infectious Diseases, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Andre C Kalil
- Division of Infectious Diseases, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Angela R Branche
- Division of Infectious Diseases, Department of Medicine, University of Rochester Medical Center, Rochester, New York, USA
| | - Annie Luetkemeyer
- Department of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Barry S Zingman
- Department of Medicine, Montefiore Medical Center, University Hospital for Albert Einstein College of Medicine, Bronx, New York, USA
| | - Jocelyn Voell
- Laboratory of Immunoregulation, National Institute of Allergy and Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Michael Whitaker
- COVID-19–Associated Hospitalization Surveillance Network, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Michelle S Harkins
- Division of Pulmonary and Critical Care, Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
| | - Richard T Davey
- Laboratory of Immunoregulation, National Institute of Allergy and Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Robert Grossberg
- Division of Infectious Diseases, Department of Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York, USA
| | - Sarah L George
- Department of Internal Medicine, Saint Louis University and St Louis Veterans Affairs Medical Center, St Louis, Missouri, USA
| | - Victor Tapson
- Division of Pulmonary and Critical Care, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - William R Short
- Division of Infectious Diseases, Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Varduhi Ghazaryan
- Division of Microbiology and Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Constance A Benson
- Division of Infectious Diseases and Global Public Health, University of California, San Diego, San Diego, California, USA
| | - Lori E Dodd
- Biostatistics Research Branch, Division of Clinical Research, National Institute of Allergy and Infectious Diseases, Rockville, Maryland, USA
| | - Daniel A Sweeney
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University of California, San Diego, San Diego, California, USA
| | - Kay M Tomashek
- Division of Microbiology and Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
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4
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Caceres DH, Rodriguez-Barradas MC, Whitaker M, Jackson BR, Kim L, Surie D, Cikesh B, Lindsley MD, McCotter OZ, Berkow EL, Toda M. Fungal Pathogens as Causes of Acute Respiratory Illness in Hospitalized Veterans: Frequency of Fungal Positive Test Results Using Rapid Immunodiagnostic Assays. J Fungi (Basel) 2023; 9:jof9040456. [PMID: 37108910 PMCID: PMC10145596 DOI: 10.3390/jof9040456] [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: 02/13/2023] [Revised: 04/01/2023] [Accepted: 04/03/2023] [Indexed: 04/29/2023] Open
Abstract
Fungal respiratory illnesses caused by endemic mycoses can be nonspecific and are often mistaken for viral or bacterial infections. We performed fungal testing on serum specimens from patients hospitalized with acute respiratory illness (ARI) to assess the possible role of endemic fungi as etiologic agents. Patients hospitalized with ARI at a Veterans Affairs hospital in Houston, Texas, during November 2016-August 2017 were enrolled. Epidemiologic and clinical data, nasopharyngeal and oropharyngeal samples for viral testing (PCR), and serum specimens were collected at admission. We retrospectively tested remnant sera from a subset of patients with negative initial viral testing using immunoassays for the detection of Coccidioides and Histoplasma antibodies (Ab) and Cryptococcus, Aspergillus, and Histoplasma antigens (Ag). Of 224 patient serum specimens tested, 49 (22%) had positive results for fungal pathogens, including 30 (13%) by Coccidioides immunodiagnostic assays, 19 (8%) by Histoplasma immunodiagnostic assays, 2 (1%) by Aspergillus Ag, and none by Cryptococcus Ag testing. A high proportion of veterans hospitalized with ARI had positive serological results for fungal pathogens, primarily endemic mycoses, which cause fungal pneumonia. The high proportion of Coccidioides positivity is unexpected as this fungus is not thought to be common in southeastern Texas or metropolitan Houston, though is known to be endemic in southwestern Texas. Although serological testing suffers from low specificity, these results suggest that these fungi may be more common causes of ARI in southeast Texas than commonly appreciated and more increased clinical evaluation may be warranted.
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Affiliation(s)
- Diego H Caceres
- Centers for Disease Control and Prevention (CDC), Atlanta, GA 30329, USA
- Center of Expertise in Mycology Radboudumc, Canisius Wilhelmina Hospital, 6532 SZ Nijmegen, The Netherlands
- Studies in Translational Microbiology and Emerging Diseases (MICROS) Research Group, School of Medicine and Health Sciences, Universidad del Rosario, Bogota 111221, Colombia
| | | | - Michael Whitaker
- Centers for Disease Control and Prevention (CDC), Atlanta, GA 30329, USA
| | - Brendan R Jackson
- Centers for Disease Control and Prevention (CDC), Atlanta, GA 30329, USA
- US Public Health Service, Rockville, MD 20852, USA
| | - Lindsay Kim
- Centers for Disease Control and Prevention (CDC), Atlanta, GA 30329, USA
- US Public Health Service, Rockville, MD 20852, USA
| | - Diya Surie
- Centers for Disease Control and Prevention (CDC), Atlanta, GA 30329, USA
- US Public Health Service, Rockville, MD 20852, USA
| | - Bryanna Cikesh
- Centers for Disease Control and Prevention (CDC), Atlanta, GA 30329, USA
| | - Mark D Lindsley
- Centers for Disease Control and Prevention (CDC), Atlanta, GA 30329, USA
| | - Orion Z McCotter
- Centers for Disease Control and Prevention (CDC), Atlanta, GA 30329, USA
- Oregon Health Authority, Portland, OR 97232, USA
| | - Elizabeth L Berkow
- Centers for Disease Control and Prevention (CDC), Atlanta, GA 30329, USA
| | - Mitsuru Toda
- Centers for Disease Control and Prevention (CDC), Atlanta, GA 30329, USA
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5
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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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6
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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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7
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O'Halloran A, Whitaker M, Patel K, Allen AE, Copeland KR, Reed C, Reynolds S, Taylor CA, Havers F, Kim L, Wolter K, Garg S. Developing a sampling methodology for timely reporting of population-based COVID-19-associated hospitalization surveillance in the United States, COVID-NET 2020-2021. Influenza Other Respir Viruses 2023; 17:e13089. [PMID: 36625234 PMCID: PMC9835436 DOI: 10.1111/irv.13089] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 11/29/2022] [Accepted: 12/04/2022] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND The COVID-19-Associated Hospitalization Surveillance Network (COVID-NET) required a sampling methodology that allowed for production of timely population-based clinical estimates to inform the ongoing US COVID-19 pandemic response. METHODS We developed a flexible sampling approach that considered reporting delays, differential hospitalized case burden across surveillance sites, and changing geographic and demographic trends over time. We incorporated weighting methods to adjust for the probability of selection and non-response, and to calibrate the sampled case distribution to the population distribution on demographics. We additionally developed procedures for variance estimation. RESULTS Between March 2020 and June 2021, 19,293 (10.4%) of all adult hospitalized cases were sampled for chart abstraction. Variance estimates for select variables of interest were within desired ranges. CONCLUSIONS COVID-NET's sampling methodology allowed for reporting of robust and timely, population-based data on the clinical epidemiology of COVID-19-associated hospitalizations and evolving trends over time, while attempting to reduce data collection burden on surveillance sites. Such methods may provide a general framework for other surveillance systems needing to quickly and efficiently collect and disseminate data for public health action.
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Affiliation(s)
- Alissa O'Halloran
- COVID‐19 Response TeamCenters for Disease Control and PreventionAtlantaGeorgiaUSA
| | - Michael Whitaker
- COVID‐19 Response TeamCenters for Disease Control and PreventionAtlantaGeorgiaUSA
| | - Kadam Patel
- COVID‐19 Response TeamCenters for Disease Control and PreventionAtlantaGeorgiaUSA,General Dynamics Information TechnologyAtlantaGeorgiaUSA
| | | | | | - Carrie Reed
- COVID‐19 Response TeamCenters for Disease Control and PreventionAtlantaGeorgiaUSA
| | - Sue Reynolds
- COVID‐19 Response TeamCenters for Disease Control and PreventionAtlantaGeorgiaUSA
| | | | - Fiona Havers
- COVID‐19 Response TeamCenters for Disease Control and PreventionAtlantaGeorgiaUSA
| | - Lindsay Kim
- COVID‐19 Response TeamCenters for Disease Control and PreventionAtlantaGeorgiaUSA
| | - Kirk Wolter
- NORCThe University of ChicagoChicagoIllinoisUSA
| | - Shikha Garg
- COVID‐19 Response TeamCenters for Disease Control and PreventionAtlantaGeorgiaUSA
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8
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Taylor C, Whitaker M, Anglin O, Pham H, Patel K, Milucky J, Reingold A, Alden NB, Meek J, Ward K, Teno K, Kohrman A, Como-Sabetti K, Eisenberg N, Spina NL, Bushey S, Billing LM, Sutton M, Talbot K, Swain A, Havers FP. 1877. COVID-19-Associated Hospitalizations among Long-Term Care Facility Residents Ages ≥65 Years — COVID-NET, 14 U.S. States, March 2020–January 2022. Open Forum Infect Dis 2022. [DOI: 10.1093/ofid/ofac492.1504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Abstract
Background
Adults aged ≥65 years and those with underlying medical conditions, including residents of long-term care facilities (LTCF), are at increased risk for COVID-19-associated hospitalizations and other severe outcomes.
Methods
Hospitalizations among LTCF residents aged ≥ 65 years from March 2020–January 2022 were described using data on a representative sample of hospitalizations from the CDC’s COVID-19-Associated Hospitalization Surveillance Network (COVID-NET), a population-based surveillance network of > 250 acute care hospitals in 99 counties across 14 states. A Poisson regression model adjusting for age, race/ethnicity, underlying medical conditions, vaccination status, month of admission, and do-not-resuscitate/intubate-or-provide comfort-measures-only (DNR/DNI/CMO) code status examined the relationship of LTCF residency to death during COVID-19-associated hospitalization.
Results
Of 11,901 hospitalizations among adults aged ≥ 65 years reported during the study period, 2,965 (24.9%) were LTCF residents; most resided in nursing homes (53.8%) or assisted living facilities (26.8%). LTCF residents hospitalized with COVID-19 were older and more likely to have cardiovascular disease, congestive heart failure, a neurologic condition, dementia, or ≥ 3 underlying medical conditions than non-residents (Figure). The proportion of LTCF residents vs non-residents who required intensive care unit admission or invasive mechanical ventilation were not statistically different (23.2% vs 23.5% and 10.7 vs 13.5%, respectively). The proportion of in-hospital death was higher among LTCF residents than non-residents (22.8% vs 14.4%, p < 0.01). More LTCF residents have a DNR/DNI/CMO code status (48%) compared to non-residents (19%). The fully adjusted regression model found the risk ratio for death was 1.03 (95% CI, 1.01–1.05) among LTCF residents compared to non-residents.
Conclusion
Compared to non-residents, LTCF residents were older, had more underlying conditions, and had a higher risk of in-hospital death. After adjusting for multiple potential confounders, results suggest that LTCF residency is a weak but significant independent risk factor for death during COVID-19-associated hospitalization.
Disclosures
All Authors: No reported disclosures.
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Affiliation(s)
| | | | | | - Huong Pham
- Centers for Disease Control and Prevention , Atlanta , Georgia
| | - Kadam Patel
- Centers for Disease Control and Prevention , Atlanta , Georgia
| | | | | | - Nisha B Alden
- Colorado Department of Public Health and Environment , Denver, Colorado
| | - James Meek
- Connecticut Emerging Infections Program , New Haven, Connecticut
| | | | - Kenzie Teno
- Iowa Department of Public Health , Des Moines, Iowa
| | - Alexander Kohrman
- Michigan Department of Health and Human Services , Lansing, Michigan
| | | | - Nancy Eisenberg
- New Mexico Emerging Infections Program , Albuquerque , New Mexico
| | - Nancy L Spina
- New York State Department of Health , Albany, New York
| | - Sophrena Bushey
- University of Rochester School of Medicine and Dentistry , Rochester, New York
| | | | | | - Keipp Talbot
- Vanderbilt University Medical Center , Nashville, Tennessee
| | - Ashley Swain
- Salt Lake County Health Department , Salt Lake City, Utah
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9
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Melisa S, Taylor C, Patel K, Milucky J, Whitaker M, Pham H, Anglin O, Reingold A, Armistead I, Yousey-Hindes K, Anderson EJ, Weigel A, Reeg L, Mumm E, Ropp SL, Muse AG, Bushey S, Shiltz E, Sutton M, Talbot K, Price A, Havers FP. 303. Viral and bacterial infections among adults hospitalized with COVID-19, Coronavirus Disease 2019-Associated Hospitalization Surveillance Network, 14 states, March 2020–February 2022. Open Forum Infect Dis 2022. [PMCID: PMC9751616 DOI: 10.1093/ofid/ofac492.381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background Coinfections, both bacterial and viral, occur with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, but prevalence, risk factors, and associated clinical outcomes are not fully understood. Methods We used the Coronavirus Disease 2019-Associated Hospitalization Surveillance Network (COVID-NET), a population-based surveillance platform to investigate the occurrence of viral and bacterial coinfections among hospitalized adults with laboratory-confirmed SARS-CoV-2 infection during March 2020 and February 2022. Patients receiving additional standard of care (SOC) molecular testing for viral pathogens (14 days prior to admission or 7 days after), including respiratory syncytial virus, rhinovirus/enterovirus (RV/EV), influenza, adenovirus, human metapneumovirus, parainfluenza viruses, and endemic coronaviruses, were included. SOC testing for clinically relevant bacterial pathogens (7 days before admission or 7 days after) from sputum, deep respiratory, and sterile sites were included. The demographic and clinical features of those with and without bacterial infections were compared. Results Among 2,654 adults hospitalized with COVID-19 and tested for all 7 virus groups, another virus was identified in 3.1% of patients. RV/EV (1.2%) and influenza (0.4%) were the most commonly detected viruses. Half (17,842/35,528, 50.2%) of hospitalized adults with COVID-19 had bacterial cultures taken within 7 days of admission, and 1,092 (6.1%) of these had a clinically relevant bacterial pathogen. A higher percentage of those with a positive culture died compared to those with negative cultures (32.3% vs 13.3%, p< 0.001). Staphylococcus aureus was the most common isolate overall; Pseudomonas aeruginosa was the second most common respiratory isolate (Figure 1).
Microbial cultures from hospitalized sampled adults with COVID-19 from Coronavirus Disease 2019-Associated Hospitalization Surveillance Network (COVID-NET) from March 2020 to February 2022 with bacterial pathogens detected in sputum, deep respiratory, or blood cultures within 7 days of admission. ![]() This figure includes 1,408 bacterial cultures from 1,066 individuals. Deep respiratory sites include endotracheal aspirate, bronchoalveolar lavage fluid, bronchial washings, pleural fluid, and lung tissue. Commensal organisms were excluded. Conclusion Consistent with previous studies, a relatively low proportion of adults hospitalized with COVID-19 had concomitantly identified viral or bacterial infections. Identification of a bacterial infection within 7 days of admission is associated with increased mortality among adults hospitalized with COVID-19. Conclusions about the clinical relevance of bacterial infections is limited by the retrospective nature of this study. Disclosures Evan J. Anderson, MD, GSK: Advisor/Consultant|GSK: Grant/Research Support|Janssen: Advisor/Consultant|Janssen: Grant/Research Support|Kentucky Bioprocessing, Inc: Data Safety Monitoring Board|MedImmune: Grant/Research Support|Medscape: Advisor/Consultant|Merck: Grant/Research Support|Micron: Grant/Research Support|NIH: Funding from NIH to conduct clinical trials of Moderna and Janssen COVID-19 vaccines|PaxVax: Grant/Research Support|Pfizer: Advisor/Consultant|Pfizer: Grant/Research Support|Regeneron: Grant/Research Support|Sanofi Pasteur: Advisor/Consultant|Sanofi Pasteur: Grant/Research Support|Sanofi Pasteur: Data Adjudication and Data Safety Monitoring Boards|WCG and ACI Clinical: Data Adjudication Board.
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Affiliation(s)
- Shah Melisa
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Kadam Patel
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | | | - Huong Pham
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | | | - Isaac Armistead
- Colorado Department of Public Health and Environment, Denver, Colorado
| | | | | | - Andy Weigel
- Iowa Department of Public Health, Des Moines, Iowa
| | - Libby Reeg
- Michigan Department of Health and Human Services, Lansing, Michigan
| | - Erica Mumm
- Minnesota Department of Health, Saint Paul, Minnesota
| | - Susan L Ropp
- New Mexico Department of Health, Santa Fe, New Mexico
| | - Alison G Muse
- New York State Department of Health, Albany, New York
| | - Sophrena Bushey
- University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Eli Shiltz
- Ohio Department of Health, Columbus, Ohio
| | | | - Keipp Talbot
- Vanderbilt University Medical Center, Nashville, Tennessee
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10
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Sekkarie A, Woodruff R, Whitaker M, Kramer MR, Zapata LB, Ellington SR, Meaney-Delman DM, Pham H, Patel K, Taylor CA, Chai SJ, Kawasaki B, Meek J, Openo KP, Weigel A, Leegwater L, Como-Sabetti K, Ropp SL, Muse A, Bennett NM, Billing LM, Sutton M, Talbot HK, Hill M, Havers FP. Characteristics and treatment of hospitalized pregnant women with COVID-19. Am J Obstet Gynecol MFM 2022; 4:100715. [PMID: 35970493 PMCID: PMC9371979 DOI: 10.1016/j.ajogmf.2022.100715] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 07/22/2022] [Accepted: 08/08/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Pregnant women less frequently receive COVID-19 vaccination and are at increased risk for adverse pregnancy outcomes from COVID-19. OBJECTIVE This study aimed to first, describe the vaccination status, treatment, and outcomes of hospitalized, symptomatic pregnant women with COVID-19, and second, estimate whether treatment differs by pregnancy status among treatment-eligible (ie, requiring supplemental oxygen per National Institutes of Health guidelines at the time of the study) women. STUDY DESIGN From January to November 2021, the COVID-19-Associated Hospitalization Surveillance Network completed medical chart abstraction for a probability sample of 2715 hospitalized women aged 15 to 49 years with laboratory-confirmed SARS-CoV-2 infection. Of these, 1950 women had symptoms of COVID-19 on admission, and 336 were pregnant. We calculated weighted prevalence estimates of demographic and clinical characteristics, vaccination status, and outcomes among pregnant women with symptoms of COVID-19 on admission. We used propensity score matching to estimate prevalence ratios and 95% confidence intervals of treatment-eligible patients who received remdesivir or systemic steroids by pregnancy status. RESULTS Among 336 hospitalized pregnant women with symptomatic COVID-19, 39.6% were non-Hispanic Black, 24.8% were Hispanic or Latino, and 61.9% were aged 25 to 34 years. Among those with known COVID-19 vaccination status, 92.9% were unvaccinated. One-third (32.7%) were treatment-eligible. Among treatment-eligible pregnant women, 74.1% received systemic steroids and 61.4% received remdesivir. Among those that were no longer pregnant at discharge (n=180), 5.4% had spontaneous abortions and 3.5% had stillbirths. Of the 159 live births, 29.0% were preterm. Among a propensity score-matched cohort of treatment-eligible hospitalized women of reproductive age, pregnant women were less likely than nonpregnant women to receive remdesivir (prevalence ratio, 0.82; 95% confidence interval, 0.69-0.97) and systemic steroids (prevalence ratio, 0.80; 95% confidence interval, 0.73-0.87). CONCLUSION Most hospitalized pregnant patients with symptomatic COVID-19 were unvaccinated. Hospitalized pregnant patients were less likely to receive recommended remdesivir and systemic steroids compared with similar hospitalized nonpregnant women. Our results underscore the need to identify opportunities for improving COVID-19 vaccination, implementation of treatment of pregnant women, and the inclusion of pregnant women in clinical trials.
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Affiliation(s)
- Ahlia Sekkarie
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, GA (Drs Sekkarie and Woodruff, Mr Whitaker, Drs Zapata, Ellington, and Meaney-Delman, Ms Pham, Mr Kadam, and Drs Taylor and Havers); Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA (Dr Sekkarie).
| | - Rebecca Woodruff
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, GA (Drs Sekkarie and Woodruff, Mr Whitaker, Drs Zapata, Ellington, and Meaney-Delman, Ms Pham, Mr Kadam, and Drs Taylor and Havers); United States Public Health Service Commissioned Corps, Rockville, MD (Drs Woodruff, Zapata, and Havers)
| | - Michael Whitaker
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, GA (Drs Sekkarie and Woodruff, Mr Whitaker, Drs Zapata, Ellington, and Meaney-Delman, Ms Pham, Mr Kadam, and Drs Taylor and Havers)
| | - Michael R Kramer
- Epidemiology Department, Rollins School of Public Health, Emory University, Atlanta, GA (Dr Kramer)
| | - Lauren B Zapata
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, GA (Drs Sekkarie and Woodruff, Mr Whitaker, Drs Zapata, Ellington, and Meaney-Delman, Ms Pham, Mr Kadam, and Drs Taylor and Havers); United States Public Health Service Commissioned Corps, Rockville, MD (Drs Woodruff, Zapata, and Havers)
| | - Sascha R Ellington
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, GA (Drs Sekkarie and Woodruff, Mr Whitaker, Drs Zapata, Ellington, and Meaney-Delman, Ms Pham, Mr Kadam, and Drs Taylor and Havers)
| | - Dana M Meaney-Delman
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, GA (Drs Sekkarie and Woodruff, Mr Whitaker, Drs Zapata, Ellington, and Meaney-Delman, Ms Pham, Mr Kadam, and Drs Taylor and Havers)
| | - Huong Pham
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, GA (Drs Sekkarie and Woodruff, Mr Whitaker, Drs Zapata, Ellington, and Meaney-Delman, Ms Pham, Mr Kadam, and Drs Taylor and Havers)
| | - Kadam Patel
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, GA (Drs Sekkarie and Woodruff, Mr Whitaker, Drs Zapata, Ellington, and Meaney-Delman, Ms Pham, Mr Kadam, and Drs Taylor and Havers); General Dynamics Information Technology, Atlanta, GA (Mr Patel)
| | - Christopher A Taylor
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, GA (Drs Sekkarie and Woodruff, Mr Whitaker, Drs Zapata, Ellington, and Meaney-Delman, Ms Pham, Mr Kadam, and Drs Taylor and Havers)
| | - Shua J Chai
- California Emerging Infections Program, Oakland, CA (Dr Chai); Career Epidemiology Field Officer Program, Centers for Disease Control and Prevention, Atlanta, GA (Dr Chai)
| | - Breanna Kawasaki
- Colorado Department of Public Health and Environment, Denver, CO (Ms Kawasaki)
| | - James Meek
- Connecticut Emerging Infections Program, Yale School of Public Health, New Haven, CT (Mr Meek)
| | - Kyle P Openo
- Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA (Dr Openo); Georgia Emerging Infections Program, Georgia Department of Public Health, Atlanta, GA (Dr Openo); Foundation for Atlanta Veterans Education and Research, Atlanta Veterans Affairs Medical Center, Atlanta, GA (Dr Openo)
| | - Andy Weigel
- Iowa Department of Public Health, Des Moines, IA (Mr Weigel)
| | - Lauren Leegwater
- Michigan Department of Health and Human Services, Lansing, MI (Ms Leegwater)
| | | | - Susan L Ropp
- New Mexico Department of Health, Santa Fe, NM (Dr Ropp)
| | - Alison Muse
- New York State Department of Health, Albany, NY (Ms Muse)
| | - Nancy M Bennett
- University of Rochester School of Medicine and Dentistry, Rochester, NY (Dr Bennett)
| | | | - Melissa Sutton
- Public Health Division, Oregon Health Authority, Portland, OR (Dr Sutton)
| | - H Keipp Talbot
- Vanderbilt University School of Medicine, Nashville, TN (Dr Talbot)
| | - Mary Hill
- Salt Lake County Health Department, Salt Lake City, UT (Ms Hill)
| | - Fiona P Havers
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, GA (Drs Sekkarie and Woodruff, Mr Whitaker, Drs Zapata, Ellington, and Meaney-Delman, Ms Pham, Mr Kadam, and Drs Taylor and Havers); United States Public Health Service Commissioned Corps, Rockville, MD (Drs Woodruff, Zapata, and Havers)
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11
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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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Whitaker M. The Advanced Therapies Treatment Centres and their Network: a Model for the Accelerated Adoption of Advanced Therapies. Hum Gene Ther 2022; 33:857-864. [PMID: 36070453 DOI: 10.1089/hum.2022.150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Emerging advanced therapies that include cell and gene therapies and tissue-engineered products offer substantial therapeutic benefits. They also present challenges for health services in their modes of delivery to patients. Funding was made available in the UK to establish three Advanced Therapies Treatment Centres (ATTCs) and a network to coordinate their activities, supported by the Cell and Gene Therapy Catapult (CGTC). The aim of this initiative was to grow the advanced therapies sector in the UK by enhancing access to the NHS for patients and industry through close collaboration between advanced therapy companies and publicly funded services and regulators. Here, we describe the initiative's antecedents, its collaborative structures and management and its activities. A guiding concept in shaping and assessing progress has been the idea of institutional readiness, an idea developed in the context of social sciences that defines and so can measure movement towards an organisation's full competence in delivering new technologies and approaches. We also report the initiative's outcomes and impacts as assessed by ourselves and by third parties. As the initiative has progressed it has excited increasing interest from advanced therapy companies who were not aware of or engaged in it at the outset and from healthcare systems that wished to learn from its practices. It is to further that end that we present our work.
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13
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Havers FP, Patel K, Whitaker M, Milucky J, Reingold A, Armistead I, Meek J, Anderson EJ, Weigel A, Reeg L, Seys S, Ropp SL, Spina N, Felsen CB, Moran NE, Sutton M, Talbot HK, George A, Taylor CA. Laboratory-Confirmed COVID-19-Associated Hospitalizations Among Adults During SARS-CoV-2 Omicron BA.2 Variant Predominance - COVID-19-Associated Hospitalization Surveillance Network, 14 States, June 20, 2021-May 31, 2022. MMWR Morb Mortal Wkly Rep 2022; 71:1085-1091. [PMID: 36006841 PMCID: PMC9422959 DOI: 10.15585/mmwr.mm7134a3] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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14
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Steele MK, Couture A, Reed C, Iuliano D, Whitaker M, Fast H, Hall AJ, MacNeil A, Cadwell B, Marks KJ, Silk BJ. Estimated Number of COVID-19 Infections, Hospitalizations, and Deaths Prevented Among Vaccinated Persons in the US, December 2020 to September 2021. JAMA Netw Open 2022; 5:e2220385. [PMID: 35793085 PMCID: PMC9260489 DOI: 10.1001/jamanetworkopen.2022.20385] [Citation(s) in RCA: 49] [Impact Index Per Article: 24.5] [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] [Indexed: 12/17/2022] Open
Abstract
IMPORTANCE The number of SARS-CoV-2 infections and COVID-19-associated hospitalizations and deaths prevented among vaccinated persons, independent of the effect of reduced transmission, is a key measure of vaccine impact. OBJECTIVE To estimate the number of SARS-CoV-2 infections and COVID-19-associated hospitalizations and deaths prevented among vaccinated adults in the US. DESIGN, SETTING, AND PARTICIPANTS In this modeling study, a multiplier model was used to extrapolate the number of SARS-CoV-2 infections and COVID-19-associated deaths from data on the number of COVID-19-associated hospitalizations stratified by state, month, and age group (18-49, 50-64, and ≥65 years) in the US from December 1, 2020, to September 30, 2021. These estimates were combined with data on vaccine coverage and effectiveness to estimate the risks of infections, hospitalizations, and deaths. Risks were applied to the US population 18 years or older to estimate the expected burden in that population without vaccination. The estimated burden in the US population 18 years or older given observed levels of vaccination was subtracted from the expected burden in the US population 18 years or older without vaccination (ie, counterfactual) to estimate the impact of vaccination among vaccinated persons. EXPOSURES Completion of the COVID-19 vaccination course, defined as 2 doses of messenger RNA (BNT162b2 or mRNA-1273) vaccines or 1 dose of JNJ-78436735 vaccine. MAIN OUTCOMES AND MEASURES Monthly numbers and percentages of SARS-CoV-2 infections and COVID-19-associated hospitalizations and deaths prevented were estimated among those who have been vaccinated in the US. RESULTS COVID-19 vaccination was estimated to prevent approximately 27 million (95% uncertainty interval [UI], 22 million to 34 million) infections, 1.6 million (95% UI, 1.4 million to 1.8 million) hospitalizations, and 235 000 (95% UI, 175 000-305 000) deaths in the US from December 1, 2020, to September 30, 2021, among vaccinated adults 18 years or older. From September 1 to September 30, 2021, vaccination was estimated to prevent 52% (95% UI, 45%-62%) of expected infections, 56% (95% UI, 52%-62%) of expected hospitalizations, and 58% (95% UI, 53%-63%) of expected deaths in adults 18 years or older. CONCLUSIONS AND RELEVANCE These findings indicate that the US COVID-19 vaccination program prevented a substantial burden of morbidity and mortality through direct protection of vaccinated individuals.
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Affiliation(s)
- Molly K. Steele
- COVID-19 Emergency Response, Centers for Disease Control and Prevention, Atlanta, Georgia
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Alexia Couture
- COVID-19 Emergency Response, Centers for Disease Control and Prevention, Atlanta, Georgia
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Carrie Reed
- COVID-19 Emergency Response, Centers for Disease Control and Prevention, Atlanta, Georgia
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Danielle Iuliano
- COVID-19 Emergency Response, Centers for Disease Control and Prevention, Atlanta, Georgia
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
- US Public Health Service, Rockville, Maryland
| | - Michael Whitaker
- COVID-19 Emergency Response, Centers for Disease Control and Prevention, Atlanta, Georgia
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Hannah Fast
- COVID-19 Emergency Response, Centers for Disease Control and Prevention, Atlanta, Georgia
- Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Aron J. Hall
- COVID-19 Emergency Response, Centers for Disease Control and Prevention, Atlanta, Georgia
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Adam MacNeil
- COVID-19 Emergency Response, Centers for Disease Control and Prevention, Atlanta, Georgia
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Betsy Cadwell
- COVID-19 Emergency Response, Centers for Disease Control and Prevention, Atlanta, Georgia
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Kristin J. Marks
- COVID-19 Emergency Response, Centers for Disease Control and Prevention, Atlanta, Georgia
- US Public Health Service, Rockville, Maryland
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia
- Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Atlanta, Georgia
| | - Benjamin J. Silk
- COVID-19 Emergency Response, Centers for Disease Control and Prevention, Atlanta, Georgia
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
- US Public Health Service, Rockville, Maryland
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15
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Shi DS, Whitaker M, Marks KJ, Anglin O, Milucky J, Patel K, Pham H, Chai SJ, Kawasaki B, Meek J, Anderson EJ, Weigel A, Henderson J, Lynfield R, Ropp SL, Muse A, Bushey S, Billing LM, Sutton M, Talbot HK, Price A, Taylor CA, Havers FP. Hospitalizations of Children Aged 5-11 Years with Laboratory-Confirmed COVID-19 - COVID-NET, 14 States, March 2020-February 2022. MMWR Morb Mortal Wkly Rep 2022; 71:574-581. [PMID: 35446827 PMCID: PMC9042359 DOI: 10.15585/mmwr.mm7116e1] [Citation(s) in RCA: 78] [Impact Index Per Article: 39.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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16
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Couture A, Iuliano D, Chang H, Patel N, Gilmer M, Steele M, Havers F, Whitaker M, Reed C. Estimating COVID-19 Hospitalizations in the United States with Surveillance Data Using a Bayesian Hierarchical Model: A Modeling Study. JMIR Public Health Surveill 2022; 8:e34296. [PMID: 35452402 PMCID: PMC9169704 DOI: 10.2196/34296] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 12/21/2021] [Accepted: 04/21/2022] [Indexed: 01/20/2023] Open
Abstract
Background In the United States, COVID-19 is a nationally notifiable disease, meaning cases and hospitalizations are reported by states to the Centers for Disease Control and Prevention (CDC). Identifying and reporting every case from every facility in the United States may not be feasible in the long term. Creating sustainable methods for estimating the burden of COVID-19 from established sentinel surveillance systems is becoming more important. Objective We aimed to provide a method leveraging surveillance data to create a long-term solution to estimate monthly rates of hospitalizations for COVID-19. Methods We estimated monthly hospitalization rates for COVID-19 from May 2020 through April 2021 for the 50 states using surveillance data from the COVID-19-Associated Hospitalization Surveillance Network (COVID-NET) and a Bayesian hierarchical model for extrapolation. Hospitalization rates were calculated from patients hospitalized with a lab-confirmed SARS-CoV-2 test during or within 14 days before admission. We created a model for 6 age groups (0-17, 18-49, 50-64, 65-74, 75-84, and ≥85 years) separately. We identified covariates from multiple data sources that varied by age, state, and month and performed covariate selection for each age group based on 2 methods, Least Absolute Shrinkage and Selection Operator (LASSO) and spike and slab selection methods. We validated our method by checking the sensitivity of model estimates to covariate selection and model extrapolation as well as comparing our results to external data. Results We estimated 3,583,100 (90% credible interval [CrI] 3,250,500-3,945,400) hospitalizations for a cumulative incidence of 1093.9 (992.4-1204.6) hospitalizations per 100,000 population with COVID-19 in the United States from May 2020 through April 2021. Cumulative incidence varied from 359 to 1856 per 100,000 between states. The age group with the highest cumulative incidence was those aged ≥85 years (5575.6; 90% CrI 5066.4-6133.7). The monthly hospitalization rate was highest in December (183.7; 90% CrI 154.3-217.4). Our monthly estimates by state showed variations in magnitudes of peak rates, number of peaks, and timing of peaks between states. Conclusions Our novel approach to estimate hospitalizations for COVID-19 has potential to provide sustainable estimates for monitoring COVID-19 burden as well as a flexible framework leveraging surveillance data.
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Affiliation(s)
- Alexia Couture
- Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, US
| | - Danielle Iuliano
- Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, US
| | | | - Neha Patel
- Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, US
| | - Matthew Gilmer
- Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, US
| | - Molly Steele
- Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, US
| | - Fiona Havers
- Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, US
| | - Michael Whitaker
- Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, US
| | - Carrie Reed
- Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, US
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17
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Taylor CA, Whitaker M, Anglin O, Milucky J, Patel K, Pham H, Chai SJ, Alden NB, Yousey-Hindes K, Anderson EJ, Teno K, Reeg L, Como-Sabetti K, Bleecker M, Barney G, Bennett NM, Billing LM, Sutton M, Talbot HK, McCaffrey K, Havers FP. COVID-19-Associated Hospitalizations Among Adults During SARS-CoV-2 Delta and Omicron Variant Predominance, by Race/Ethnicity and Vaccination Status - COVID-NET, 14 States, July 2021-January 2022. MMWR Morb Mortal Wkly Rep 2022; 71:466-473. [PMID: 35324880 PMCID: PMC8956338 DOI: 10.15585/mmwr.mm7112e2] [Citation(s) in RCA: 51] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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18
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Marks KJ, Whitaker M, Agathis NT, Anglin O, Milucky J, Patel K, Pham H, Kirley PD, Kawasaki B, Meek J, Anderson EJ, Weigel A, Kim S, Lynfield R, Ropp SL, Spina NL, Bennett NM, Shiltz E, Sutton M, Talbot HK, Price A, Taylor CA, Havers FP. Hospitalization of Infants and Children Aged 0-4 Years with Laboratory-Confirmed COVID-19 - COVID-NET, 14 States, March 2020-February 2022. MMWR Morb Mortal Wkly Rep 2022; 71:429-436. [PMID: 35298458 PMCID: PMC8942304 DOI: 10.15585/mmwr.mm7111e2] [Citation(s) in RCA: 104] [Impact Index Per Article: 52.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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19
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Kujawski SA, Whitaker M, Ritchey MD, Reingold AL, Chai SJ, Anderson EJ, Openo KP, Monroe M, Ryan P, Bye E, Como-Sabetti K, Barney GR, Muse A, Bennett NM, Felsen CB, Thomas A, Crawford C, Talbot HK, Schaffner W, Gerber SI, Langley GE, Kim L. Rates of respiratory syncytial virus (RSV)-associated hospitalization among adults with congestive heart failure—United States, 2015–2017. PLoS One 2022; 17:e0264890. [PMID: 35263382 PMCID: PMC8906631 DOI: 10.1371/journal.pone.0264890] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 02/19/2022] [Indexed: 11/19/2022] Open
Abstract
Background Respiratory syncytial virus (RSV) can cause severe disease in adults with cardiopulmonary conditions, such as congestive heart failure (CHF). We quantified the rate of RSV-associated hospitalization in adults by CHF status using population-based surveillance in the United States. Methods Population-based surveillance for RSV (RSV-NET) was performed in 35 counties in seven sites during two respiratory seasons (2015–2017) from October 1–April 30. Adults (≥18 years) admitted to a hospital within the surveillance catchment area with laboratory-confirmed RSV identified by clinician-directed testing were included. Presence of underlying CHF was determined by medical chart abstraction. We calculated overall and age-stratified (<65 years and ≥65 years) RSV-associated hospitalization rates by CHF status. Estimates were adjusted for age and the under-detection of RSV. We also report rate differences (RD) and rate ratios (RR) by comparing the rates for those with and without CHF. Results 2042 hospitalized RSV cases with CHF status recorded were identified. Most (60.2%, n = 1230) were ≥65 years, and 28.3% (n = 577) had CHF. The adjusted RSV hospitalization rate was 26.7 (95% CI: 22.2, 31.8) per 10,000 population in adults with CHF versus 3.3 (95% CI: 3.3, 3.3) per 10,000 in adults without CHF (RR: 8.1, 95% CI: 6.8, 9.7; RD: 23.4, 95% CI: 18.9, 28.5). Adults with CHF had higher rates of RSV-associated hospitalization in both age groups (<65 years and ≥65 years). Adults ≥65 years with CHF had the highest rate (40.5 per 10,000 population, 95% CI: 35.1, 46.6). Conclusions Adults with CHF had 8 times the rate of RSV-associated hospitalization compared with adults without CHF. Identifying high-risk populations for RSV infection can inform future RSV vaccination policies and recommendations.
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Affiliation(s)
- Stephanie A. Kujawski
- Epidemic Intelligence Service, Centers for Disease Control and Prevention (CDC), Atlanta, GA, United States of America
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, GA, United States of America
| | - Michael Whitaker
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, GA, United States of America
- Eagle Global Scientific, Atlanta, GA, United States of America
| | - Matthew D. Ritchey
- Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention (CDC), Atlanta, GA, United States of America
- US Public Health Service, Rockville, MD, United States of America
| | - Arthur L. Reingold
- Division of Epidemiology, School of Public Health, University of California, Berkeley, CA, United States of America
| | - Shua J. Chai
- US Public Health Service, Rockville, MD, United States of America
- California Emerging Infections Program, Oakland, CA, United States of America
- Career Epidemiology Field Officer, Center for Preparedness and Response, Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | - Evan J. Anderson
- Departments of Medicine and Pediatrics, Emory University School of Medicine, Atlanta, GA, United States of America
- Georgia Emerging Infections Program, Atlanta, GA, United States of America
- Atlanta Veterans Affairs Medical Center, Atlanta, GA, United States of America
| | - Kyle P. Openo
- Georgia Emerging Infections Program, Atlanta, GA, United States of America
- Atlanta Veterans Affairs Medical Center, Atlanta, GA, United States of America
- Foundation for Atlanta Veterans Education and Research, Decatur, GA, United States of America
| | - Maya Monroe
- Maryland Department of Health, Baltimore, MD, United States of America
| | - Patricia Ryan
- Maryland Department of Health, Baltimore, MD, United States of America
| | - Erica Bye
- Minnesota Department of Health, St. Paul, MN, United States of America
| | | | - Grant R. Barney
- New York State Department of Health, Albany, NY, United States of America
| | - Alison Muse
- New York State Department of Health, Albany, NY, United States of America
| | - Nancy M. Bennett
- University of Rochester School of Medicine and Dentistry, Rochester, NY, United States of America
| | - Christina B. Felsen
- University of Rochester School of Medicine and Dentistry, Rochester, NY, United States of America
| | - Ann Thomas
- Public Health Division, Oregon Health Authority, Portland, OR, United States of America
| | - Courtney Crawford
- Public Health Division, Oregon Health Authority, Portland, OR, United States of America
| | - H. Keipp Talbot
- Vanderbilt University Medical Center, Nashville, TN, United States of America
| | - William Schaffner
- Vanderbilt University Medical Center, Nashville, TN, United States of America
| | - Susan I. Gerber
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, GA, United States of America
| | - Gayle E. Langley
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, GA, United States of America
| | - Lindsay Kim
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, GA, United States of America
- US Public Health Service, Rockville, MD, United States of America
- * E-mail:
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20
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Marks KJ, Whitaker M, Anglin O, Milucky J, Patel K, Pham H, Chai SJ, Kirley PD, Armistead I, McLafferty S, Meek J, Yousey-Hindes K, Anderson EJ, Openo KP, Weigel A, Henderson J, Nunez VT, Como-Sabetti K, Lynfield R, Ropp SL, Smelser C, Barney GR, Muse A, Bennett NM, Bushey S, Billing LM, Shiltz E, Abdullah N, Sutton M, Schaffner W, Talbot HK, Chatelain R, George A, Taylor CA, McMorrow ML, Perrine CG, Havers FP. Hospitalizations of Children and Adolescents with Laboratory-Confirmed COVID-19 - COVID-NET, 14 States, July 2021-January 2022. MMWR Morb Mortal Wkly Rep 2022; 71:271-278. [PMID: 35176003 PMCID: PMC8853476 DOI: 10.15585/mmwr.mm7107e4] [Citation(s) in RCA: 105] [Impact Index Per Article: 52.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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21
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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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22
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Pappa S, Barnett J, Gomme S, Iliopoulou A, Moore I, Whitaker M, McGrath J, Sie M. Shared and Supported Decision Making in Medication in a Mental Health Setting: How Far Have We Come? Community Ment Health J 2021; 57:1566-1578. [PMID: 33544295 PMCID: PMC8531065 DOI: 10.1007/s10597-021-00780-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 01/12/2021] [Indexed: 11/30/2022]
Abstract
Personalised care involves shared decision making (SDM) across all levels including choice in medication. However, there are a number of barriers which prevent its effective implementation in routine mental health settings. Therefore, we undertook a study to benchmark current practice across clinical services of a large urban mental health provider. The study formed part of the trust-wide 'Supported Decision Making in Medication' Co-Production Project and aims to inform future recommendations in delivering against contemporary best practice, guidance and policy. A survey exploring the views and experiences of service users and prescribers on shared and supported decision-making in medication was carried out in West London NHS Trust. Questionnaires were fully co-designed and co-delivered by a group of health professionals and individuals with lived experience. There were 100 responses from service users and 35 from prescribers. There was some good practice where both parties reported good quality conversations concerning dialogic styles, collaborative process, information provided and range of choice offered. However, prescriber's perception of their practice was not always mirrored by service user feedback whose experiences often depended upon the prescriber, the time available or the part of the service. Generally, service user experience fell short of the good practice cited by clinicians though there was noticeable variability. Commitment from organizations and increasing understanding from practitioners are vital in transforming SDM from rhetoric into reality. From our findings a further challenge is to ensure that prescribers and service users have the time, information and tools to implement it consistently.
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Affiliation(s)
- Sofia Pappa
- West London NHS Trust, London, UK.
- Dept of Psychiatry, Imperial College London, London, UK.
| | | | | | | | | | | | - Jane McGrath
- West London NHS Trust, London, UK
- We Coproduce CIC, London, UK
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Taylor CA, Patel K, Pham H, Whitaker M, Anglin O, Kambhampati AK, Milucky J, Chai SJ, Kirley PD, Alden NB, Armistead I, Meek J, Yousey-Hindes K, Anderson EJ, Openo KP, Teno K, Weigel A, Monroe ML, Ryan PA, Henderson J, Nunez VT, Bye E, Lynfield R, Poblete M, Smelser C, Barney GR, Spina NL, Bennett NM, Popham K, Billing LM, Shiltz E, Abdullah N, Sutton M, Schaffner W, Talbot HK, Ortega J, Price A, Garg S, Havers FP. Severity of Disease Among Adults Hospitalized with Laboratory-Confirmed COVID-19 Before and During the Period of SARS-CoV-2 B.1.617.2 (Delta) Predominance - COVID-NET, 14 States, January-August 2021. MMWR Morb Mortal Wkly Rep 2021; 70:1513-1519. [PMID: 34710076 PMCID: PMC8553023 DOI: 10.15585/mmwr.mm7043e1] [Citation(s) in RCA: 61] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Garg S, Patel K, Pham H, Whitaker M, O'Halloran A, Milucky J, Anglin O, Kirley PD, Reingold A, Kawasaki B, Herlihy R, Yousey-Hindes K, Maslar A, Anderson EJ, Openo KP, Weigel A, Teno K, Ryan PA, Monroe ML, Reeg L, Kim S, Como-Sabetti K, Bye E, Shrum Davis S, Eisenberg N, Muse A, Barney G, Bennett NM, Felsen CB, Billing L, Shiltz J, Sutton M, Abdullah N, Talbot HK, Schaffner W, Hill M, Chatelain R, Wortham J, Taylor C, Hall A, Fry AM, Kim L, Havers FP. Clinical Trends Among U.S. Adults Hospitalized With COVID-19, March to December 2020 : A Cross-Sectional Study. Ann Intern Med 2021; 174:1409-1419. [PMID: 34370517 PMCID: PMC8381761 DOI: 10.7326/m21-1991] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic has caused substantial morbidity and mortality. OBJECTIVE To describe monthly clinical trends among adults hospitalized with COVID-19. DESIGN Pooled cross-sectional study. SETTING 99 counties in 14 states participating in the Coronavirus Disease 2019-Associated Hospitalization Surveillance Network (COVID-NET). PATIENTS U.S. adults (aged ≥18 years) hospitalized with laboratory-confirmed COVID-19 during 1 March to 31 December 2020. MEASUREMENTS Monthly hospitalizations, intensive care unit (ICU) admissions, and in-hospital death rates per 100 000 persons in the population; monthly trends in weighted percentages of interventions, including ICU admission, mechanical ventilation, and vasopressor use, among an age- and site-stratified random sample of hospitalized case patients. RESULTS Among 116 743 hospitalized adults with COVID-19, the median age was 62 years, 50.7% were male, and 40.8% were non-Hispanic White. Monthly rates of hospitalization (105.3 per 100 000 persons), ICU admission (20.2 per 100 000 persons), and death (11.7 per 100 000 persons) peaked during December 2020. Rates of all 3 outcomes were highest among adults aged 65 years or older, males, and Hispanic or non-Hispanic Black persons. Among 18 508 sampled hospitalized adults, use of remdesivir and systemic corticosteroids increased from 1.7% and 18.9%, respectively, in March to 53.8% and 74.2%, respectively, in December. Frequency of ICU admission, mechanical ventilation, and vasopressor use decreased from March (37.8%, 27.8%, and 22.7%, respectively) to December (20.5%, 12.3%, and 12.8%, respectively); use of noninvasive respiratory support increased from March to December. LIMITATION COVID-NET covers approximately 10% of the U.S. population; findings may not be generalizable to the entire country. CONCLUSION Rates of COVID-19-associated hospitalization, ICU admission, and death were highest in December 2020, corresponding with the third peak of the U.S. pandemic. The frequency of intensive interventions for management of hospitalized patients decreased over time. These data provide a longitudinal assessment of clinical trends among adults hospitalized with COVID-19 before widespread implementation of COVID-19 vaccines. PRIMARY FUNDING SOURCE Centers for Disease Control and Prevention.
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Affiliation(s)
- Shikha Garg
- Centers for Disease Control and Prevention, Atlanta, Georgia, and U.S. Public Health Service, Rockville, Maryland (S.G., J.W., A.M.F., L.K., F.P.H.)
| | - Kadam Patel
- Centers for Disease Control and Prevention and General Dynamics Information Technology, Atlanta, Georgia (K.P., O.A.)
| | - Huong Pham
- Centers for Disease Control and Prevention, Atlanta, Georgia (H.P., M.W., A.O., J.M., C.T., A.H.)
| | - Michael Whitaker
- Centers for Disease Control and Prevention, Atlanta, Georgia (H.P., M.W., A.O., J.M., C.T., A.H.)
| | - Alissa O'Halloran
- Centers for Disease Control and Prevention, Atlanta, Georgia (H.P., M.W., A.O., J.M., C.T., A.H.)
| | - Jennifer Milucky
- Centers for Disease Control and Prevention, Atlanta, Georgia (H.P., M.W., A.O., J.M., C.T., A.H.)
| | - Onika Anglin
- Centers for Disease Control and Prevention and General Dynamics Information Technology, Atlanta, Georgia (K.P., O.A.)
| | - Pam D Kirley
- California Emerging Infections Program, Oakland, California (P.D.K., A.R.)
| | - Arthur Reingold
- California Emerging Infections Program, Oakland, California (P.D.K., A.R.)
| | - Breanna Kawasaki
- Colorado Department of Public Health and Environment, Denver, Colorado (B.K., R.H.)
| | - Rachel Herlihy
- Colorado Department of Public Health and Environment, Denver, Colorado (B.K., R.H.)
| | - Kimberly Yousey-Hindes
- Connecticut Emerging Infections Program, Yale School of Public Health, New Haven, Connecticut (K.Y., A.M.)
| | - Amber Maslar
- Connecticut Emerging Infections Program, Yale School of Public Health, New Haven, Connecticut (K.Y., A.M.)
| | - Evan J Anderson
- Emory University School of Medicine and Georgia Emerging Infections Program, Georgia Department of Health, Atlanta, Georgia (E.J.A.)
| | - Kyle P Openo
- Georgia Emerging Infections Program, Georgia Department of Health, Atlanta, Georgia (K.P.O.)
| | - Andrew Weigel
- Iowa Department of Public Health, Des Moines, Iowa (A.W., K.T.)
| | - Kenzie Teno
- Iowa Department of Public Health, Des Moines, Iowa (A.W., K.T.)
| | - Patricia A Ryan
- Maryland Department of Health, Baltimore, Maryland (P.A.R., M.L.M.)
| | - Maya L Monroe
- Maryland Department of Health, Baltimore, Maryland (P.A.R., M.L.M.)
| | - Libby Reeg
- Michigan Department of Health and Human Services, Lansing, Michigan (L.R., S.K.)
| | - Sue Kim
- Michigan Department of Health and Human Services, Lansing, Michigan (L.R., S.K.)
| | | | - Erica Bye
- Minnesota Department of Health, St. Paul, Minnesota (K.C., E.B.)
| | - Sarah Shrum Davis
- New Mexico Department of Health, Santa Fe, New Mexico (S.S.D., N.E.)
| | - Nancy Eisenberg
- New Mexico Department of Health, Santa Fe, New Mexico (S.S.D., N.E.)
| | - Alison Muse
- New York State Department of Health, Albany, New York (A.M., G.B.)
| | - Grant Barney
- New York State Department of Health, Albany, New York (A.M., G.B.)
| | - Nancy M Bennett
- University of Rochester School of Medicine and Dentistry, Rochester, New York (N.M.B., C.B.F.)
| | - Christina B Felsen
- University of Rochester School of Medicine and Dentistry, Rochester, New York (N.M.B., C.B.F.)
| | | | - Jess Shiltz
- Ohio Department of Health, Columbus, Ohio (L.B., J.S.)
| | | | | | - H Keipp Talbot
- Vanderbilt University School of Medicine, Nashville, Tennessee (H.K.T., W.S.)
| | - William Schaffner
- Vanderbilt University School of Medicine, Nashville, Tennessee (H.K.T., W.S.)
| | - Mary Hill
- Salt Lake County Health Department, Salt Lake City, Utah (M.H., R.C.)
| | - Ryan Chatelain
- Salt Lake County Health Department, Salt Lake City, Utah (M.H., R.C.)
| | - Jonathan Wortham
- Centers for Disease Control and Prevention, Atlanta, Georgia, and U.S. Public Health Service, Rockville, Maryland (S.G., J.W., A.M.F., L.K., F.P.H.)
| | - Christopher Taylor
- Centers for Disease Control and Prevention, Atlanta, Georgia (H.P., M.W., A.O., J.M., C.T., A.H.)
| | - Aron Hall
- Centers for Disease Control and Prevention, Atlanta, Georgia (H.P., M.W., A.O., J.M., C.T., A.H.)
| | - Alicia M Fry
- Centers for Disease Control and Prevention, Atlanta, Georgia, and U.S. Public Health Service, Rockville, Maryland (S.G., J.W., A.M.F., L.K., F.P.H.)
| | - Lindsay Kim
- Centers for Disease Control and Prevention, Atlanta, Georgia, and U.S. Public Health Service, Rockville, Maryland (S.G., J.W., A.M.F., L.K., F.P.H.)
| | - Fiona P Havers
- Centers for Disease Control and Prevention, Atlanta, Georgia, and U.S. Public Health Service, Rockville, Maryland (S.G., J.W., A.M.F., L.K., F.P.H.)
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Acosta AM, Garg S, Pham H, Whitaker M, Anglin O, O’Halloran A, Milucky J, Patel K, Taylor C, Wortham J, Chai SJ, Kirley PD, Alden NB, Kawasaki B, Meek J, Yousey-Hindes K, Anderson EJ, Openo KP, Weigel A, Monroe ML, Ryan P, Reeg L, Kohrman A, Lynfield R, Bye E, Torres S, Salazar-Sanchez Y, Muse A, Barney G, Bennett NM, Bushey S, Billing L, Shiltz E, Sutton M, Abdullah N, Talbot HK, Schaffner W, Ortega J, Price A, Fry AM, Hall A, Kim L, Havers FP. Racial and Ethnic Disparities in Rates of COVID-19-Associated Hospitalization, Intensive Care Unit Admission, and In-Hospital Death in the United States From March 2020 to February 2021. JAMA Netw Open 2021; 4:e2130479. [PMID: 34673962 PMCID: PMC8531997 DOI: 10.1001/jamanetworkopen.2021.30479] [Citation(s) in RCA: 134] [Impact Index Per Article: 44.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
IMPORTANCE Racial and ethnic minority groups are disproportionately affected by COVID-19. OBJECTIVES To evaluate whether rates of severe COVID-19, defined as hospitalization, intensive care unit (ICU) admission, or in-hospital death, are higher among racial and ethnic minority groups compared with non-Hispanic White persons. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study included 99 counties within 14 US states participating in the COVID-19-Associated Hospitalization Surveillance Network. Participants were persons of all ages hospitalized with COVID-19 from March 1, 2020, to February 28, 2021. EXPOSURES Laboratory-confirmed COVID-19-associated hospitalization, defined as a positive SARS-CoV-2 test within 14 days prior to or during hospitalization. MAIN OUTCOMES AND MEASURES Cumulative age-adjusted rates (per 100 000 population) of hospitalization, ICU admission, and death by race and ethnicity. Rate ratios (RR) were calculated for each racial and ethnic group compared with White persons. RESULTS Among 153 692 patients with COVID-19-associated hospitalizations, 143 342 (93.3%) with information on race and ethnicity were included in the analysis. Of these, 105 421 (73.5%) were 50 years or older, 72 159 (50.3%) were male, 28 762 (20.1%) were Hispanic or Latino, 2056 (1.4%) were non-Hispanic American Indian or Alaska Native, 7737 (5.4%) were non-Hispanic Asian or Pacific Islander, 40 806 (28.5%) were non-Hispanic Black, and 63 981 (44.6%) were White. Compared with White persons, American Indian or Alaska Native, Latino, Black, and Asian or Pacific Islander persons were more likely to have higher cumulative age-adjusted rates of hospitalization, ICU admission, and death as follows: American Indian or Alaska Native (hospitalization: RR, 3.70; 95% CI, 3.54-3.87; ICU admission: RR, 6.49; 95% CI, 6.01-7.01; death: RR, 7.19; 95% CI, 6.47-7.99); Latino (hospitalization: RR, 3.06; 95% CI, 3.01-3.10; ICU admission: RR, 4.20; 95% CI, 4.08-4.33; death: RR, 3.85; 95% CI, 3.68-4.01); Black (hospitalization: RR, 2.85; 95% CI, 2.81-2.89; ICU admission: RR, 3.17; 95% CI, 3.09-3.26; death: RR, 2.58; 95% CI, 2.48-2.69); and Asian or Pacific Islander (hospitalization: RR, 1.03; 95% CI, 1.01-1.06; ICU admission: RR, 1.91; 95% CI, 1.83-1.98; death: RR, 1.64; 95% CI, 1.55-1.74). CONCLUSIONS AND RELEVANCE In this cross-sectional analysis, American Indian or Alaska Native, Latino, Black, and Asian or Pacific Islander persons were more likely than White persons to have a COVID-19-associated hospitalization, ICU admission, or in-hospital death during the first year of the US COVID-19 pandemic. Equitable access to COVID-19 preventive measures, including vaccination, is needed to minimize the gap in racial and ethnic disparities of severe COVID-19.
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Affiliation(s)
- Anna M. Acosta
- COVID-19-Associated Hospitalization Surveillance Network, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Shikha Garg
- COVID-19-Associated Hospitalization Surveillance Network, US Centers for Disease Control and Prevention, Atlanta, Georgia
- US Public Health Service, Rockville, Maryland
| | - Huong Pham
- COVID-19-Associated Hospitalization Surveillance Network, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Michael Whitaker
- COVID-19-Associated Hospitalization Surveillance Network, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Onika Anglin
- COVID-19-Associated Hospitalization Surveillance Network, US Centers for Disease Control and Prevention, Atlanta, Georgia
- General Dynamics Information Technology, Atlanta, Georgia
| | - Alissa O’Halloran
- COVID-19-Associated Hospitalization Surveillance Network, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jennifer Milucky
- COVID-19-Associated Hospitalization Surveillance Network, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Kadam Patel
- COVID-19-Associated Hospitalization Surveillance Network, US Centers for Disease Control and Prevention, Atlanta, Georgia
- General Dynamics Information Technology, Atlanta, Georgia
| | - Christopher Taylor
- COVID-19-Associated Hospitalization Surveillance Network, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jonathan Wortham
- COVID-19-Associated Hospitalization Surveillance Network, US Centers for Disease Control and Prevention, Atlanta, Georgia
- US Public Health Service, Rockville, Maryland
| | - Shua J. Chai
- California Emerging Infections Program, Oakland
- Career Epidemiology Field Officer, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Nisha B. Alden
- Colorado Department of Public Health and Environment, Denver
| | | | - James Meek
- Connecticut Emerging Infections Program, Yale School of Public Health, New Haven
| | | | - Evan J. Anderson
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
- Georgia Emerging Infections Program, Georgia Department of Health, Atlanta
- Atlanta Veterans Affairs Medical Center, Atlanta, Georgia
| | - Kyle P. Openo
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
- Georgia Emerging Infections Program, Georgia Department of Health, Atlanta
- Atlanta Veterans Affairs Medical Center, Atlanta, Georgia
| | | | | | | | - Libby Reeg
- Michigan Department of Health and Human Services, Lansing
| | | | | | - Erica Bye
- Minnesota Department of Health, St Paul
| | | | | | | | | | - Nancy M. Bennett
- University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Sophrena Bushey
- University of Rochester School of Medicine and Dentistry, Rochester, New York
| | | | | | | | | | - H. Keipp Talbot
- Vanderbilt University School of Medicine, Nashville, Tennessee
| | | | - Jake Ortega
- Salt Lake County Health Department, Salt Lake City, Utah
| | - Andrea Price
- Salt Lake County Health Department, Salt Lake City, Utah
| | - Alicia M. Fry
- COVID-19-Associated Hospitalization Surveillance Network, US Centers for Disease Control and Prevention, Atlanta, Georgia
- US Public Health Service, Rockville, Maryland
| | - Aron Hall
- COVID-19-Associated Hospitalization Surveillance Network, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Lindsay Kim
- COVID-19-Associated Hospitalization Surveillance Network, US Centers for Disease Control and Prevention, Atlanta, Georgia
- US Public Health Service, Rockville, Maryland
| | - Fiona P. Havers
- COVID-19-Associated Hospitalization Surveillance Network, US Centers for Disease Control and Prevention, Atlanta, Georgia
- US Public Health Service, Rockville, Maryland
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Wortham JM, Meador SA, Hadler JL, Yousey-Hindes K, See I, Whitaker M, O’Halloran A, Milucky J, Chai SJ, Reingold A, Alden NB, Kawasaki B, Anderson EJ, Openo KP, Weigel A, Monroe ML, Ryan PA, Kim S, Reeg L, Lynfield R, McMahon M, Sosin DM, Eisenberg N, Rowe A, Barney G, Bennett NM, Bushey S, Billing LM, Shiltz J, Sutton M, West N, Talbot HK, Schaffner W, McCaffrey K, Spencer M, Kambhampati AK, Anglin O, Piasecki AM, Holstein R, Hall AJ, Fry AM, Garg S, Kim L. Census tract socioeconomic indicators and COVID-19-associated hospitalization rates-COVID-NET surveillance areas in 14 states, March 1-April 30, 2020. PLoS One 2021; 16:e0257622. [PMID: 34559838 PMCID: PMC8462704 DOI: 10.1371/journal.pone.0257622] [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: 04/12/2021] [Accepted: 09/06/2021] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVES Some studies suggested more COVID-19-associated hospitalizations among racial and ethnic minorities. To inform public health practice, the COVID-19-associated Hospitalization Surveillance Network (COVID-NET) quantified associations between race/ethnicity, census tract socioeconomic indicators, and COVID-19-associated hospitalization rates. METHODS Using data from COVID-NET population-based surveillance reported during March 1-April 30, 2020 along with socioeconomic and denominator data from the US Census Bureau, we calculated COVID-19-associated hospitalization rates by racial/ethnic and census tract-level socioeconomic strata. RESULTS Among 16,000 COVID-19-associated hospitalizations, 34.8% occurred among non-Hispanic White (White) persons, 36.3% among non-Hispanic Black (Black) persons, and 18.2% among Hispanic or Latino (Hispanic) persons. Age-adjusted COVID-19-associated hospitalization rate were 151.6 (95% Confidence Interval (CI): 147.1-156.1) in census tracts with >15.2%-83.2% of persons living below the federal poverty level (high-poverty census tracts) and 75.5 (95% CI: 72.9-78.1) in census tracts with 0%-4.9% of persons living below the federal poverty level (low-poverty census tracts). Among White, Black, and Hispanic persons living in high-poverty census tracts, age-adjusted hospitalization rates were 120.3 (95% CI: 112.3-128.2), 252.2 (95% CI: 241.4-263.0), and 341.1 (95% CI: 317.3-365.0), respectively, compared with 58.2 (95% CI: 55.4-61.1), 304.0 (95%: 282.4-325.6), and 540.3 (95% CI: 477.0-603.6), respectively, in low-poverty census tracts. CONCLUSIONS Overall, COVID-19-associated hospitalization rates were highest in high-poverty census tracts, but rates among Black and Hispanic persons were high regardless of poverty level. Public health practitioners must ensure mitigation measures and vaccination campaigns address needs of racial/ethnic minority groups and people living in high-poverty census tracts.
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Affiliation(s)
- Jonathan M. Wortham
- CDC COVID-NET Team, Atlanta, GA, United States of America
- US Public Health Service, United States of America
| | - Seth A. Meador
- CDC COVID-NET Team, Atlanta, GA, United States of America
| | - James L. Hadler
- Connecticut Emerging Infections Program, Yale School of Public Health, New Haven, CT, United States of America
| | - Kimberly Yousey-Hindes
- Connecticut Emerging Infections Program, Yale School of Public Health, New Haven, CT, United States of America
| | - Isaac See
- CDC COVID-NET Team, Atlanta, GA, United States of America
- US Public Health Service, United States of America
| | | | | | | | - Shua J. Chai
- California Emerging Infections Program, Oakland, CA, United States of America
- CDC Career Epidemiology Field Officer, Oakland, CA, United States of America
| | - Arthur Reingold
- California Emerging Infections Program, Oakland, CA, United States of America
| | - Nisha B. Alden
- Colorado Department of Public Health and Environment, Denver, CO, United States of America
| | - Breanna Kawasaki
- Colorado Department of Public Health and Environment, Denver, CO, United States of America
| | - Evan J. Anderson
- Emerging Infections Program, Georgia Department of Public Health, Atlanta, GA, United States of America
- Veterans Affairs Medical Center, Atlanta, GA, United States of America
- Division of Infectious Diseases, School of Medicine, Emory University, Atlanta, GA, United States of America
| | - Kyle P. Openo
- Emerging Infections Program, Georgia Department of Public Health, Atlanta, GA, United States of America
- Veterans Affairs Medical Center, Atlanta, GA, United States of America
- Division of Infectious Diseases, School of Medicine, Emory University, Atlanta, GA, United States of America
| | - Andrew Weigel
- Iowa Department of Public Health, Des Moines, IA, United States of America
| | - Maya L. Monroe
- Maryland Department of Health, Baltimore, MD, United States of America
| | - Patricia A. Ryan
- Maryland Department of Health, Baltimore, MD, United States of America
| | - Sue Kim
- Michigan Department of Health and Human Services, Lansing, MI, United States of America
| | - Libby Reeg
- Michigan Department of Health and Human Services, Lansing, MI, United States of America
| | - Ruth Lynfield
- Minnesota Department of Health, St. Paul, MN, United States of America
| | - Melissa McMahon
- Minnesota Department of Health, St. Paul, MN, United States of America
| | - Daniel M. Sosin
- New Mexico Department of Health, Santa Fe, NM, United States of America
| | - Nancy Eisenberg
- University of New Mexico Emerging Infections Program, Albuquerque, NM, United States of America
| | - Adam Rowe
- New York State Department of Health, Albany, NY, United States of America
| | - Grant Barney
- New York State Department of Health, Albany, NY, United States of America
| | - Nancy M. Bennett
- University of Rochester School of Medicine and Dentistry, Rochester, NY, United States of America
| | - Sophrena Bushey
- University of Rochester School of Medicine and Dentistry, Rochester, NY, United States of America
| | | | - Jess Shiltz
- Ohio Department of Health, Columbus, OH, United States of America
| | - Melissa Sutton
- Public Health Division, Oregon Health Authority, Portland, OR, United States of America
| | - Nicole West
- Public Health Division, Oregon Health Authority, Portland, OR, United States of America
| | - H. Keipp Talbot
- Vanderbilt University Medical Center, Nashville, TN, United States of America
| | - William Schaffner
- Vanderbilt University Medical Center, Nashville, TN, United States of America
| | - Keegan McCaffrey
- Utah Department of Health, Salt Lake City, UT, United States of America
| | - Melanie Spencer
- Salt Lake County Health Department, Salt Lake City, UT, United States of America
| | | | - Onika Anglin
- CDC COVID-NET Team, Atlanta, GA, United States of America
| | | | | | - Aron J. Hall
- CDC COVID-NET Team, Atlanta, GA, United States of America
| | - Alicia M. Fry
- CDC COVID-NET Team, Atlanta, GA, United States of America
- US Public Health Service, United States of America
| | - Shikha Garg
- CDC COVID-NET Team, Atlanta, GA, United States of America
- US Public Health Service, United States of America
| | - Lindsay Kim
- CDC COVID-NET Team, Atlanta, GA, United States of America
- US Public Health Service, United States of America
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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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Moline HL, Whitaker M, Deng L, Rhodes JC, Milucky J, Pham H, Patel K, Anglin O, Reingold A, Chai SJ, Alden NB, Kawasaki B, Meek J, Yousey-Hindes K, Anderson EJ, Farley MM, Ryan PA, Kim S, Nunez VT, Como-Sabetti K, Lynfield R, Sosin DM, McMullen C, Muse A, Barney G, Bennett NM, Bushey S, Shiltz J, Sutton M, Abdullah N, Talbot HK, Schaffner W, Chatelain R, Ortega J, Murthy BP, Zell E, Schrag SJ, Taylor C, Shang N, Verani JR, Havers FP. Effectiveness of COVID-19 Vaccines in Preventing Hospitalization Among Adults Aged ≥65 Years - COVID-NET, 13 States, February-April 2021. MMWR Morb Mortal Wkly Rep 2021; 70:1088-1093. [PMID: 34383730 PMCID: PMC8360274 DOI: 10.15585/mmwr.mm7032e3] [Citation(s) in RCA: 103] [Impact Index Per Article: 34.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Clinical trials of COVID-19 vaccines currently authorized for emergency use in the United States (Pfizer-BioNTech, Moderna, and Janssen [Johnson & Johnson]) indicate that these vaccines have high efficacy against symptomatic disease, including moderate to severe illness (1-3). In addition to clinical trials, real-world assessments of COVID-19 vaccine effectiveness are critical in guiding vaccine policy and building vaccine confidence, particularly among populations at higher risk for more severe illness from COVID-19, including older adults. To determine the real-world effectiveness of the three currently authorized COVID-19 vaccines among persons aged ≥65 years during February 1-April 30, 2021, data on 7,280 patients from the COVID-19-Associated Hospitalization Surveillance Network (COVID-NET) were analyzed with vaccination coverage data from state immunization information systems (IISs) for the COVID-NET catchment area (approximately 4.8 million persons). Among adults aged 65-74 years, effectiveness of full vaccination in preventing COVID-19-associated hospitalization was 96% (95% confidence interval [CI] = 94%-98%) for Pfizer-BioNTech, 96% (95% CI = 95%-98%) for Moderna, and 84% (95% CI = 64%-93%) for Janssen vaccine products. Effectiveness of full vaccination in preventing COVID-19-associated hospitalization among adults aged ≥75 years was 91% (95% CI = 87%-94%) for Pfizer-BioNTech, 96% (95% CI = 93%-98%) for Moderna, and 85% (95% CI = 72%-92%) for Janssen vaccine products. COVID-19 vaccines currently authorized in the United States are highly effective in preventing COVID-19-associated hospitalizations in older adults. In light of real-world data demonstrating high effectiveness of COVID-19 vaccines among older adults, efforts to increase vaccination coverage in this age group are critical to reducing the risk for COVID-19-related hospitalization.
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Havers FP, Whitaker M, Self JL, Chai SJ, Kirley PD, Alden NB, Kawasaki B, Meek J, Yousey-Hindes K, Anderson EJ, Openo KP, Weigel A, Teno K, Monroe ML, Ryan PA, Reeg L, Kohrman A, Lynfield R, Como-Sabetti K, Poblete M, McMullen C, Muse A, Spina N, Bennett NM, Gaitán M, Billing LM, Shiltz J, Sutton M, Abdullah N, Schaffner W, Talbot HK, Crossland M, George A, Patel K, Pham H, Milucky J, Anglin O, Ujamaa D, Hall AJ, Garg S, Taylor CA. Hospitalization of Adolescents Aged 12-17 Years with Laboratory-Confirmed COVID-19 - COVID-NET, 14 States, March 1, 2020-April 24, 2021. MMWR Morb Mortal Wkly Rep 2021; 70:851-857. [PMID: 34111061 PMCID: PMC8191866 DOI: 10.15585/mmwr.mm7023e1] [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] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Most COVID-19-associated hospitalizations occur in older adults, but severe disease that requires hospitalization occurs in all age groups, including adolescents aged 12-17 years (1). On May 10, 2021, the Food and Drug Administration expanded the Emergency Use Authorization for Pfizer-BioNTech COVID-19 vaccine to include persons aged 12-15 years, and CDC's Advisory Committee on Immunization Practices recommended it for this age group on May 12, 2021.* Before that time, COVID-19 vaccines had been available only to persons aged ≥16 years. Understanding and describing the epidemiology of COVID-19-associated hospitalizations in adolescents and comparing it with adolescent hospitalizations associated with other vaccine-preventable respiratory viruses, such as influenza, offers evidence of the benefits of expanding the recommended age range for vaccination and provides a baseline and context from which to assess vaccination impact. Using the Coronavirus Disease 2019-Associated Hospitalization Surveillance Network (COVID-NET), CDC examined COVID-19-associated hospitalizations among adolescents aged 12-17 years, including demographic and clinical characteristics of adolescents admitted during January 1-March 31, 2021, and hospitalization rates (hospitalizations per 100,000 persons) among adolescents during March 1, 2020-April 24, 2021. Among 204 adolescents who were likely hospitalized primarily for COVID-19 during January 1-March 31, 2021, 31.4% were admitted to an intensive care unit (ICU), and 4.9% required invasive mechanical ventilation; there were no associated deaths. During March 1, 2020-April 24, 2021, weekly adolescent hospitalization rates peaked at 2.1 per 100,000 in early January 2021, declined to 0.6 in mid-March, and then rose to 1.3 in April. Cumulative COVID-19-associated hospitalization rates during October 1, 2020-April 24, 2021, were 2.5-3.0 times higher than were influenza-associated hospitalization rates from three recent influenza seasons (2017-18, 2018-19, and 2019-20) obtained from the Influenza Hospitalization Surveillance Network (FluSurv-NET). Recent increased COVID-19-associated hospitalization rates in March and April 2021 and the potential for severe disease in adolescents reinforce the importance of continued COVID-19 prevention measures, including vaccination and correct and consistent wearing of masks by persons not yet fully vaccinated or when required by laws, rules, or regulations.†.
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Kim L, Garg S, O'Halloran A, Whitaker M, Pham H, Anderson EJ, Armistead I, Bennett NM, Billing L, Como-Sabetti K, Hill M, Kim S, Monroe ML, Muse A, Reingold AL, Schaffner W, Sutton M, Talbot HK, Torres SM, Yousey-Hindes K, Holstein R, Cummings C, Brammer L, Hall AJ, Fry AM, Langley GE. Risk Factors for Intensive Care Unit Admission and In-hospital Mortality Among Hospitalized Adults Identified through the US Coronavirus Disease 2019 (COVID-19)-Associated Hospitalization Surveillance Network (COVID-NET). Clin Infect Dis 2021; 72:e206-e214. [PMID: 32674114 PMCID: PMC7454425 DOI: 10.1093/cid/ciaa1012] [Citation(s) in RCA: 373] [Impact Index Per Article: 124.3] [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: 06/01/2020] [Accepted: 07/14/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Currently, the United States has the largest number of reported coronavirus disease 2019 (COVID-19) cases and deaths globally. Using a geographically diverse surveillance network, we describe risk factors for severe outcomes among adults hospitalized with COVID-19. METHODS We analyzed data from 2491 adults hospitalized with laboratory-confirmed COVID-19 between 1 March-2 May 2020, as identified through the Coronavirus Disease 2019-Associated Hospitalization Surveillance Network, which comprises 154 acute-care hospitals in 74 counties in 13 states. We used multivariable analyses to assess associations between age, sex, race and ethnicity, and underlying conditions with intensive care unit (ICU) admission and in-hospital mortality. RESULTS The data show that 92% of patients had ≥1 underlying condition; 32% required ICU admission; 19% required invasive mechanical ventilation; and 17% died. Independent factors associated with ICU admission included ages 50-64, 65-74, 75-84, and ≥85 years versus 18-39 years (adjusted risk ratios [aRRs], 1.53, 1.65, 1.84, and 1.43, respectively); male sex (aRR, 1.34); obesity (aRR, 1.31); immunosuppression (aRR, 1.29); and diabetes (aRR, 1.13). Independent factors associated with in-hospital mortality included ages 50-64, 65-74, 75-84, and ≥ 85 years versus 18-39 years (aRRs, 3.11, 5.77, 7.67, and 10.98, respectively); male sex (aRR, 1.30); immunosuppression (aRR, 1.39); renal disease (aRR, 1.33); chronic lung disease (aRR 1.31); cardiovascular disease (aRR, 1.28); neurologic disorders (aRR, 1.25); and diabetes (aRR, 1.19). CONCLUSIONS In-hospital mortality increased markedly with increasing age. Aggressive implementation of prevention strategies, including social distancing and rigorous hand hygiene, may benefit the population as a whole, as well as those at highest risk for COVID-19-related complications.
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Affiliation(s)
- Lindsay Kim
- Coronavirus Disease 2019 (COVID-19) Associated Hospitalization Surveillance Network (COVID-NET) Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.,US Public Health Service, Rockville, Maryland, USA
| | - Shikha Garg
- Coronavirus Disease 2019 (COVID-19) Associated Hospitalization Surveillance Network (COVID-NET) Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.,US Public Health Service, Rockville, Maryland, USA
| | - Alissa O'Halloran
- Coronavirus Disease 2019 (COVID-19) Associated Hospitalization Surveillance Network (COVID-NET) Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Michael Whitaker
- Coronavirus Disease 2019 (COVID-19) Associated Hospitalization Surveillance Network (COVID-NET) Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.,Eagle Global Scientific, Atlanta, Georgia, USA
| | - Huong Pham
- Coronavirus Disease 2019 (COVID-19) Associated Hospitalization Surveillance Network (COVID-NET) Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Evan J Anderson
- Department of Medicine and Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA.,Emerging Infections Program, Georgia Department of Health, Atlanta, Georgia, USA.,Veterans Affairs Medical Center, Atlanta, Georgia, USA
| | - Isaac Armistead
- University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Nancy M Bennett
- University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | | | | | - Mary Hill
- Salt Lake County Health Department, Salt Lake City, Utah, USA
| | - Sue Kim
- Michigan Department of Health and Human Services, Lansing, Michigan, USA
| | - Maya L Monroe
- Maryland Department of Health, Baltimore, Maryland, USA
| | - Alison Muse
- New York State Department of Health, Albany, New York, USA
| | | | | | | | - H Keipp Talbot
- Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | | | - Kimberly Yousey-Hindes
- Connecticut Emerging Infections Program, Yale School of Public Health, New Haven, Connecticut, USA
| | - Rachel Holstein
- Coronavirus Disease 2019 (COVID-19) Associated Hospitalization Surveillance Network (COVID-NET) Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.,Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee, USA
| | - Charisse Cummings
- Coronavirus Disease 2019 (COVID-19) Associated Hospitalization Surveillance Network (COVID-NET) Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.,Chickasaw Nation Industries, Norman, Oklahoma, USA
| | - Lynnette Brammer
- Coronavirus Disease 2019 (COVID-19) Associated Hospitalization Surveillance Network (COVID-NET) Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Aron J Hall
- Coronavirus Disease 2019 (COVID-19) Associated Hospitalization Surveillance Network (COVID-NET) Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Alicia M Fry
- Coronavirus Disease 2019 (COVID-19) Associated Hospitalization Surveillance Network (COVID-NET) Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Gayle E Langley
- Coronavirus Disease 2019 (COVID-19) Associated Hospitalization Surveillance Network (COVID-NET) Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Holmen JE, Kim L, Cikesh B, Kirley PD, Chai SJ, Bennett NM, Felsen CB, Ryan P, Monroe M, Anderson EJ, Openo KP, Como-Sabetti K, Bye E, Talbot HK, Schaffner W, Muse A, Barney GR, Whitaker M, Ahern J, Rowe C, Langley G, Reingold A. Relationship between neighborhood census-tract level socioeconomic status and respiratory syncytial virus-associated hospitalizations in U.S. adults, 2015-2017. BMC Infect Dis 2021; 21:293. [PMID: 33757443 PMCID: PMC7986301 DOI: 10.1186/s12879-021-05989-w] [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: 11/12/2020] [Accepted: 03/15/2021] [Indexed: 02/06/2023] Open
Abstract
Background Respiratory syncytial virus (RSV) infection causes substantial morbidity and mortality in children and adults. Socioeconomic status (SES) is known to influence many health outcomes, but there have been few studies of the relationship between RSV-associated illness and SES, particularly in adults. Understanding this association is important in order to identify and address disparities and to prioritize resources for prevention. Methods Adults hospitalized with a laboratory-confirmed RSV infection were identified through population-based surveillance at multiple sites in the U.S. The incidence of RSV-associated hospitalizations was calculated by census-tract (CT) poverty and crowding, adjusted for age. Log binomial regression was used to evaluate the association between Intensive Care Unit (ICU) admission or death and CT poverty and crowding. Results Among the 1713 cases, RSV-associated hospitalization correlated with increased CT level poverty and crowding. The incidence rate of RSV-associated hospitalization was 2.58 (CI 2.23, 2.98) times higher in CTs with the highest as compared to the lowest percentages of individuals living below the poverty level (≥ 20 and < 5%, respectively). The incidence rate of RSV-associated hospitalization was 1.52 (CI 1.33, 1.73) times higher in CTs with the highest as compared to the lowest levels of crowding (≥5 and < 1% of households with > 1 occupant/room, respectively). Neither CT level poverty nor crowding had a correlation with ICU admission or death. Conclusions Poverty and crowding at CT level were associated with increased incidence of RSV-associated hospitalization, but not with more severe RSV disease. Efforts to reduce the incidence of RSV disease should consider SES. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-021-05989-w.
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Affiliation(s)
- Jenna E Holmen
- UCSF Benioff Children's Hospital, 747 52nd St, Oakland, CA, 94609, USA.
| | - Lindsay Kim
- Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA.,US Public Health Service, Atlanta, GA, USA
| | - Bryanna Cikesh
- Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | | | - Shua J Chai
- Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA.,California Emerging Infections Program, Oakland, CA, USA
| | - Nancy M Bennett
- University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Christina B Felsen
- University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | | | - Maya Monroe
- Maryland Department of Health, Baltimore, MD, USA
| | - Evan J Anderson
- Departments of Medicine and Pediatrics, Emory University School of Medicine, Atlanta, GA, USA.,Emerging Infections Program, Georgia Department of Health, Atlanta, GA, USA.,Veterans Affairs Medical Center, Atlanta, GA, USA
| | - Kyle P Openo
- Emerging Infections Program, Georgia Department of Health, Atlanta, GA, USA.,Veterans Affairs Medical Center, Atlanta, GA, USA.,Foundation for Atlanta Veterans Education and Research, Decatur, GA, USA
| | | | - Erica Bye
- Minnesota Department of Health, St. Paul, MN, USA
| | - H Keipp Talbot
- Vanderbilt University Medical Center, Nashville, TN, USA
| | | | - Alison Muse
- New York State Department of Health, Albany, NY, USA
| | | | - Michael Whitaker
- Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | - Jennifer Ahern
- Division of Epidemiology, School of Public Health, University of California, Berkeley, CA, USA
| | - Christopher Rowe
- Division of Epidemiology, School of Public Health, University of California, Berkeley, CA, USA.,San Francisco Department of Public Health, San Francisco, CA, USA
| | - Gayle Langley
- Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | - Art Reingold
- Division of Epidemiology, School of Public Health, University of California, Berkeley, CA, USA
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Owusu D, Kim L, O'Halloran A, Whitaker M, Piasecki AM, Reingold A, Alden NB, Maslar A, Anderson EJ, Ryan PA, Kim S, Como-Sabetti K, Hancock EB, Muse A, Bennett NM, Billing LM, Sutton M, Talbot HK, Ortega J, Brammer L, Fry AM, Hall AJ, Garg S. Characteristics of Adults Aged 18-49 Years Without Underlying Conditions Hospitalized With Laboratory-Confirmed Coronavirus Disease 2019 in the United States: COVID-NET-March-August 2020. Clin Infect Dis 2021; 72:e162-e166. [PMID: 33270136 PMCID: PMC7799269 DOI: 10.1093/cid/ciaa1806] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 12/01/2020] [Indexed: 12/19/2022] Open
Abstract
Among 513 adults aged 18-49 years without underlying medical conditions hospitalized with coronavirus disease 2019 (COVID-19) during March 2020-August 2020, 22% were admitted to an intensive care unit, 10% required mechanical ventilation, and 3 patients died (0.6%). These data demonstrate that healthy younger adults can develop severe COVID-19.
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Affiliation(s)
- Daniel Owusu
- CDC COVID-NET Team.,Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Lindsay Kim
- CDC COVID-NET Team.,US Public Health Service, Rockville, Maryland, USA
| | | | | | | | - Arthur Reingold
- California Emerging Infections Program, Oakland, California, USA.,School of Public Health, University of California, Berkeley, Berkeley, California, USA
| | - Nisha B Alden
- Colorado Department of Public Health and Environment, Denver, Colorado, USA
| | - Amber Maslar
- Connecticut Emerging Infections Program, Yale School of Public Health, New Haven, Connecticut, USA
| | - Evan J Anderson
- Departments of Pediatrics and Medicine, Emory University School of Medicine, Atlanta, Georgia, USA.,Emerging Infections Program, Atlanta Veterans Affairs Medical Center, Atlanta, Georgia, USA
| | | | - Sue Kim
- Michigan Department of Health and Human Services, Lansing, Michigan, USA
| | | | - Emily B Hancock
- New Mexico Emerging Infections Program, Santa Fe, New Mexico, USA
| | - Alison Muse
- New York State Department of Health, Albany, New York, USA
| | - Nancy M Bennett
- University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | | | | | - H Keipp Talbot
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Jake Ortega
- Salt Lake County Health Department, Salt Lake City, Utah, USA
| | | | - Alicia M Fry
- CDC COVID-NET Team.,US Public Health Service, Rockville, Maryland, USA
| | | | - Shikha Garg
- CDC COVID-NET Team.,US Public Health Service, Rockville, Maryland, USA
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Holmen J, Reingold A, Bye E, Kim L, Anderson EJ, Bennett NM, Chai S, Kirley PD, Muse A, Talbot H, Monroe M, Rothrock G, Whitaker M, Bryanna C. 1717. Relationship between Neighborhood Census-tract Level Poverty and Respiratory Syncytial Virus (RSV)-associated Hospitalizations in U.S. adults, 2015-2017. Open Forum Infect Dis 2020. [PMCID: PMC7777680 DOI: 10.1093/ofid/ofaa439.1895] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
In the U.S., RSV is increasingly recognized as a cause of hospitalization for adults with respiratory illness. In adults > 50 years of age, it accounts for up to 12% of medically-attended acute respiratory illnesses and has a case fatality proportion of ~ 6–8%. Poverty can have important influences on health on both the individual level as well as the community level. Few studies have evaluated the relationship of RSV and poverty level, and no identified studies have evaluated this relationship among adults. We evaluated the incidence of RSV-associated hospitalizations in adults across multiple sites in the U.S. by census-tract (CT) level poverty.
Methods
Medical record data abstraction was conducted for all adults with a laboratory-confirmed RSV infection admitted to a hospital within the Centers for Disease Control and Prevention’s Emerging Infections Program catchment areas within California, Georgia, Maryland, Minnesota, New York, and Tennessee during the 2015–2017 RSV seasons (October-April). Patient addresses were geocoded to their corresponding CT. CTs were divided into four levels of poverty, as selected in prior publications, based on American Community Survey data of percentage of people living below the poverty level: 0–4.9%, 5–9.9%, 10-19.9%, and ³20%. Incidence rates were calculated by dividing the number of RSV cases in each CT poverty-level (numerator) by the number of adults living in each CT poverty level (denominator), as determined from the 2010 US census, and standardized for age.
Results
There were 1713 RSV case-patients with demographic characteristics (Table 1). The incidence of RSV-associated hospitalizations of adults increased with increasing CT level poverty (Figure 1 and Table 2). The risk of RSV-associated hospitalization was 2.58 times higher in census tracts with the highest (20%) versus the lowest (< 5%) percentages of individuals living below the poverty level.
Table 1: Demographic characteristics of adults with an RSV-associated hospitalization, 2015-2017.
Figure 1. Age-adjusted incidence rate of RSV-associated hospitalizations of adults by census-tract poverty level, 2015-2017
Table 2. Incidence rate ratios for RSV-associated hospitalizations of adults by census-tract poverty level, 2015-2017.
Conclusion
The incidence rate of RSV-associated hospitalization in adults appears to have a positive association with increasing CT level of poverty; however, this trend reached significance only among cases living in CTs with higher percentages of poverty (≥ 10%).
Disclosures
Evan J. Anderson, MD, Sanofi Pasteur (Scientific Research Study Investigator)
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Affiliation(s)
- Jenna Holmen
- UCSF Benioff Children’s Hospital Oakland, Oakland, CA
| | - Art Reingold
- University of California, Berkeley, Berkeley, CA
| | - Erica Bye
- Minnesota Department of Health, St. Paul, Minnesota
| | - Lindsey Kim
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Evan J Anderson
- Emory University, Atlanta VA Medical Center, Atlanta, Georgia
| | - Nancy M Bennett
- University of Rochester School of Medicine and Dentistry, Rochester, NY
| | - Shua Chai
- California Department of Public Health, Oakland, CA
| | | | - Alison Muse
- New York State Department of Health, Albany, New York
| | | | - Maya Monroe
- Maryland Department of Health and Mental Hygiene, Baltimore, Maryland
| | | | | | - Cikesh Bryanna
- Center’s for Disease Control and Prevention, Atlanta, Georgia
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Kambhampati AK, O’Halloran AC, Whitaker M, Magill SS, Chea N, Chai SJ, Daily Kirley P, Herlihy RK, Kawasaki B, Meek J, Yousey-Hindes K, Anderson EJ, Openo KP, Monroe ML, Ryan PA, Kim S, Reeg L, Como-Sabetti K, Danila R, Davis SS, Torres S, Barney G, Spina NL, Bennett NM, Felsen CB, Billing LM, Shiltz J, Sutton M, West N, Schaffner W, Talbot HK, Chatelain R, Hill M, Brammer L, Fry AM, Hall AJ, Wortham JM, Garg S, Kim L. COVID-19-Associated Hospitalizations Among Health Care Personnel - COVID-NET, 13 States, March 1-May 31, 2020. MMWR Morb Mortal Wkly Rep 2020; 69:1576-1583. [PMID: 33119554 PMCID: PMC7659917 DOI: 10.15585/mmwr.mm6943e3] [Citation(s) in RCA: 81] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Health care personnel (HCP) can be exposed to SARS-CoV-2, the virus that causes coronavirus disease 2019 (COVID-19), both within and outside the workplace, increasing their risk for infection. Among 6,760 adults hospitalized during March 1-May 31, 2020, for whom HCP status was determined by the COVID-19-Associated Hospitalization Surveillance Network (COVID-NET), 5.9% were HCP. Nursing-related occupations (36.3%) represented the largest proportion of HCP hospitalized with COVID-19. Median age of hospitalized HCP was 49 years, and 89.8% had at least one underlying medical condition, of which obesity was most commonly reported (72.5%). A substantial proportion of HCP with COVID-19 had indicators of severe disease: 27.5% were admitted to an intensive care unit (ICU), 15.8% required invasive mechanical ventilation, and 4.2% died during hospitalization. HCP can have severe COVID-19-associated illness, highlighting the need for continued infection prevention and control in health care settings as well as community mitigation efforts to reduce transmission.
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Delahoy MJ, Whitaker M, O’Halloran A, Chai SJ, Kirley PD, Alden N, Kawasaki B, Meek J, Yousey-Hindes K, Anderson EJ, Openo KP, Monroe ML, Ryan PA, Fox K, Kim S, Lynfield R, Siebman S, Davis SS, Sosin DM, Barney G, Muse A, Bennett NM, Felsen CB, Billing LM, Shiltz J, Sutton M, West N, Schaffner W, Talbot HK, George A, Spencer M, Ellington S, Galang RR, Gilboa SM, Tong VT, Piasecki A, Brammer L, Fry AM, Hall AJ, Wortham JM, Kim L, Garg S. Characteristics and Maternal and Birth Outcomes of Hospitalized Pregnant Women with Laboratory-Confirmed COVID-19 - COVID-NET, 13 States, March 1-August 22, 2020. MMWR Morb Mortal Wkly Rep 2020; 69:1347-1354. [PMID: 32970655 PMCID: PMC7727497 DOI: 10.15585/mmwr.mm6938e1] [Citation(s) in RCA: 239] [Impact Index Per Article: 59.8] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Kim L, Whitaker M, O’Halloran A, Kambhampati A, Chai SJ, Reingold A, Armistead I, Kawasaki B, Meek J, Yousey-Hindes K, Anderson EJ, Openo KP, Weigel A, Ryan P, Monroe ML, Fox K, Kim S, Lynfield R, Bye E, Shrum Davis S, Smelser C, Barney G, Spina NL, Bennett NM, Felsen CB, Billing LM, Shiltz J, Sutton M, West N, Talbot HK, Schaffner W, Risk I, Price A, Brammer L, Fry AM, Hall AJ, Langley GE, Garg S. Hospitalization Rates and Characteristics of Children Aged <18 Years Hospitalized with Laboratory-Confirmed COVID-19 - COVID-NET, 14 States, March 1-July 25, 2020. MMWR Morb Mortal Wkly Rep 2020; 69:1081-1088. [PMID: 32790664 PMCID: PMC7440125 DOI: 10.15585/mmwr.mm6932e3] [Citation(s) in RCA: 373] [Impact Index Per Article: 93.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Most reported cases of coronavirus disease 2019 (COVID-19) in children aged <18 years appear to be asymptomatic or mild (1). Less is known about severe COVID-19 illness requiring hospitalization in children. During March 1-July 25, 2020, 576 pediatric COVID-19 cases were reported to the COVID-19-Associated Hospitalization Surveillance Network (COVID-NET), a population-based surveillance system that collects data on laboratory-confirmed COVID-19-associated hospitalizations in 14 states (2,3). Based on these data, the cumulative COVID-19-associated hospitalization rate among children aged <18 years during March 1-July 25, 2020, was 8.0 per 100,000 population, with the highest rate among children aged <2 years (24.8). During March 21-July 25, weekly hospitalization rates steadily increased among children (from 0.1 to 0.4 per 100,000, with a weekly high of 0.7 per 100,000). Overall, Hispanic or Latino (Hispanic) and non-Hispanic black (black) children had higher cumulative rates of COVID-19-associated hospitalizations (16.4 and 10.5 per 100,000, respectively) than did non-Hispanic white (white) children (2.1). Among 208 (36.1%) hospitalized children with complete medical chart reviews, 69 (33.2%) were admitted to an intensive care unit (ICU); 12 of 207 (5.8%) required invasive mechanical ventilation, and one patient died during hospitalization. Although the cumulative rate of pediatric COVID-19-associated hospitalization remains low (8.0 per 100,000 population) compared with that among adults (164.5),* weekly rates increased during the surveillance period, and one in three hospitalized children were admitted to the ICU, similar to the proportion among adults. Continued tracking of SARS-CoV-2 infections among children is important to characterize morbidity and mortality. Reinforcement of prevention efforts is essential in congregate settings that serve children, including childcare centers and schools.
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Garg S, Kim L, Whitaker M, O’Halloran A, Cummings C, Holstein R, Prill M, Chai SJ, Kirley PD, Alden NB, Kawasaki B, Yousey-Hindes K, Niccolai L, Anderson EJ, Openo KP, Weigel A, Monroe ML, Ryan P, Henderson J, Kim S, Como-Sabetti K, Lynfield R, Sosin D, Torres S, Muse A, Bennett NM, Billing L, Sutton M, West N, Schaffner W, Talbot HK, Aquino C, George A, Budd A, Brammer L, Langley G, Hall AJ, Fry A. Hospitalization Rates and Characteristics of Patients Hospitalized with Laboratory-Confirmed Coronavirus Disease 2019 - COVID-NET, 14 States, March 1-30, 2020. MMWR Morb Mortal Wkly Rep 2020; 69:458-464. [PMID: 32298251 PMCID: PMC7755063 DOI: 10.15585/mmwr.mm6915e3] [Citation(s) in RCA: 1633] [Impact Index Per Article: 408.3] [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: 02/06/2023]
Abstract
Since SARS-CoV-2, the novel coronavirus that causes coronavirus disease 2019 (COVID-19), was first detected in December 2019 (1), approximately 1.3 million cases have been reported worldwide (2), including approximately 330,000 in the United States (3). To conduct population-based surveillance for laboratory-confirmed COVID-19-associated hospitalizations in the United States, the COVID-19-Associated Hospitalization Surveillance Network (COVID-NET) was created using the existing infrastructure of the Influenza Hospitalization Surveillance Network (FluSurv-NET) (4) and the Respiratory Syncytial Virus Hospitalization Surveillance Network (RSV-NET). This report presents age-stratified COVID-19-associated hospitalization rates for patients admitted during March 1-28, 2020, and clinical data on patients admitted during March 1-30, 2020, the first month of U.S. surveillance. Among 1,482 patients hospitalized with COVID-19, 74.5% were aged ≥50 years, and 54.4% were male. The hospitalization rate among patients identified through COVID-NET during this 4-week period was 4.6 per 100,000 population. Rates were highest (13.8) among adults aged ≥65 years. Among 178 (12%) adult patients with data on underlying conditions as of March 30, 2020, 89.3% had one or more underlying conditions; the most common were hypertension (49.7%), obesity (48.3%), chronic lung disease (34.6%), diabetes mellitus (28.3%), and cardiovascular disease (27.8%). These findings suggest that older adults have elevated rates of COVID-19-associated hospitalization and the majority of persons hospitalized with COVID-19 have underlying medical conditions. These findings underscore the importance of preventive measures (e.g., social distancing, respiratory hygiene, and wearing face coverings in public settings where social distancing measures are difficult to maintain)† to protect older adults and persons with underlying medical conditions, as well as the general public. In addition, older adults and persons with serious underlying medical conditions should avoid contact with persons who are ill and immediately contact their health care provider(s) if they have symptoms consistent with COVID-19 (https://www.cdc.gov/coronavirus/2019-ncov/symptoms-testing/symptoms.html) (5). Ongoing monitoring of hospitalization rates, clinical characteristics, and outcomes of hospitalized patients will be important to better understand the evolving epidemiology of COVID-19 in the United States and the clinical spectrum of disease, and to help guide planning and prioritization of health care system resources.
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Scheyett A, Bayakly R, Whitaker M. Characteristics and contextual stressors in farmer and agricultural worker suicides in Georgia from 2008–2015. ACTA ACUST UNITED AC 2019. [DOI: 10.1037/rmh0000114] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Nielsen Moody A, Bull J, Culpan AM, Munyombwe T, Sharma N, Whitaker M, Wolstenhulme S. Preoperative sentinel lymph node identification, biopsy and localisation using contrast enhanced ultrasound (CEUS) in patients with breast cancer: a systematic review and meta-analysis. Clin Radiol 2017; 72:959-971. [DOI: 10.1016/j.crad.2017.06.121] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Revised: 06/11/2017] [Accepted: 06/26/2017] [Indexed: 01/08/2023]
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Charlton WS, LeBouf RF, Gariazzo C, Ford DG, Beard C, Landsberger S, Whitaker M. Proliferation Resistance Assessment Methodology for Nuclear Fuel Cycles. NUCL TECHNOL 2017. [DOI: 10.13182/nt07-a3809] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- William S. Charlton
- Texas A&M University Nuclear Engineering Department, College Station, Texas 77843-3133
| | - Ryan F. LeBouf
- University of Texas, Nuclear Engineering Teaching Laboratory, Austin, Texas 78758
| | - Claudio Gariazzo
- University of Texas, Nuclear Engineering Teaching Laboratory, Austin, Texas 78758
| | - D. Grant Ford
- University of Texas, Nuclear Engineering Teaching Laboratory, Austin, Texas 78758
| | - Carl Beard
- BWXT-Pantex, Technology Development and Deployment Applied Technology Division, Amarillo, Texas
| | - Sheldon Landsberger
- University of Texas, Nuclear Engineering Teaching Laboratory, Austin, Texas 78758
| | - Michael Whitaker
- Oak Ridge National Laboratory Nuclear Science and Technology Division, Oak Ridge, Tennessee 37831
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Perinelli DR, Cespi M, Bonacucina G, Naylor A, Whitaker M, Lam JKW, Howdle SM, Casettari L, Palmieri GF. PEGylated Biodegradable Polyesters for PGSS Microparticles Formulation: Processability, Physical and Release Properties. Curr Drug Deliv 2017; 13:673-81. [PMID: 26674199 DOI: 10.2174/1567201813666151207111034] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Revised: 11/24/2015] [Accepted: 12/12/2015] [Indexed: 11/22/2022]
Abstract
BACKGROUND Particles from Gas Saturated Solution (PGSS) is an emergent method that employs supercritical carbon dioxide (scCO2) to produce microparticles. It is suitable for encapsulating biologically active compounds including therapeutic peptides and proteins. Poly(lactide acid) (PLA) and/or poly(lactic-coglycolic acid) (PLGA) are the most commonly used materials in PGSS, due to their good processability in scCO2. Previous studies demonstrated that the properties of the microparticles can be modulated by adding polyethylene glycol (PEG) or tri-block PEGylated copolymers. OBJECTIVE In the present work, the effect of the addition of biodegradable PEGylated di-block copolymers on the physical properties and drug release performance of microparticles prepared by PGSS technique was evaluated. METHOD mPEG5kDa-P(L)LA and mPEG5kDa-P(L)LGA with similar molecular weights were synthesized and their behaviour, when exposed to supercritical CO2, was investigated. Different microparticle formulations, composed of a high (81%) or low (9%) percentage of the synthesized copolymers were prepared and compared in terms of particle size distribution, morphology, yield and protein release. Drug release studies were performed using bovine serum albumin (BSA) as a model protein. RESULTS PEGylated copolymers showed good processability in PGSS without significant changes to the physical properties of the microparticles. However, the addition of PEG exerted a modulating effect on the microparticle drug dissolution behaviour, increasing the rate of BSA release as a function of its content in the formulation. CONCLUSION This study demonstrated the feasibility of producing microparticles by using PEGylated di-block copolymers through a PGSS technique at mild operating conditions (low operating pressure and temperature).
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Affiliation(s)
| | | | | | | | | | | | | | - L Casettari
- Department of Biomolecular Sciences, University of Urbino, Piazza Rinascimento, 6, Urbino (PU) 61029, Italy.
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Butson M, Pope D, Whitaker M. SU-E-T-475: Improvements to Total Body Irradiation Dosimetry Efficiency with EBT3 Radiochromic Film and a Template System. Med Phys 2015. [DOI: 10.1118/1.4924837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Butson M, Pope D, Whitaker M. SU-E-T-275: Dose Build Up and Bolusing Characteristics for Total Body Irradiation Dosimetry. Med Phys 2015. [DOI: 10.1118/1.4924637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Butson M, Carroll S, Whitaker M, Odgers D, Martin D, Hinds S, Kader J, Ho K, Amos S, Toohey J. SU-E-T-373: Evaluation and Reduction of Contralateral Skin /subcutaneous Dose for Tangential Breast Irradiation. Med Phys 2015. [DOI: 10.1118/1.4924734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Whitaker M, Spivey MH. Delayed ICU discharges and medical follow-up: a cause of increased mortality? Crit Care 2015. [PMCID: PMC4470665 DOI: 10.1186/cc14591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Hancock S, Whitaker M. SU-E-T-33: An EPID-Based Method for Testing Absolute Leaf Position for MLC Without Backup Jaws. Med Phys 2014. [DOI: 10.1118/1.4888363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Perinelli DR, Bonacucina G, Cespi M, Naylor A, Whitaker M, Palmieri GF, Giorgioni G, Casettari L. Evaluation of P(L)LA-PEG-P(L)LA as processing aid for biodegradable particles from gas saturated solutions (PGSS) process. Int J Pharm 2014; 468:250-7. [PMID: 24746690 DOI: 10.1016/j.ijpharm.2014.04.031] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [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: 02/07/2014] [Revised: 04/10/2014] [Accepted: 04/14/2014] [Indexed: 12/01/2022]
Abstract
A series of biodegradable P(L)LA-PEG1.5 kDa-P(L)LA copolymers have been synthesized and compared as processing aid versus Poloxamer 407 (PEO-PPO-PEO), in the formulation of protein encapsulated microparticles, using supercritical carbon dioxide (scCO2). Bovine serum albumin (BSA) loaded microcarriers were prepared applying the particles from the gas saturated solutions (PGSS) technique using scCO2 and thus, avoiding the standard practice of organic solvent encapsulation. Four triblock copolymers were synthesized and characterized, particularly in terms of thermal properties and behaviour when exposed to scCO2. The effects of the inclusion of these copolymers in the formulation of poly(α-hydroxy acids) based microparticles - e.g. poly(D,L-lactic-co-glycolic acid) (PLGA) and poly(D,L-lactide) (PLA) - were analysed in terms of yield, particle size, morphology and drug release. The use of P(L)LA-PEG1.5 kDa-P(L)LA triblock copolymers were found to increase the yield of the PGSS-based process and to decrease the size of the microparticles produced, in comparison with the formulation containing the Poloxamer 407. Moreover the microparticles formulated with the triblock copolymers possessing the higher hydrophobic character were able to maintain a controlled drug release profile.
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Affiliation(s)
- D R Perinelli
- School of Pharmacy, University of Camerino, Via Sant'Agostino 1, Camerino, MC 62032, Italy
| | - G Bonacucina
- School of Pharmacy, University of Camerino, Via Sant'Agostino 1, Camerino, MC 62032, Italy
| | - M Cespi
- School of Pharmacy, University of Camerino, Via Sant'Agostino 1, Camerino, MC 62032, Italy
| | - A Naylor
- Critical Pharmaceuticals Limited BioCity, Pennyfoot Street, Nottingham NG1 1GF, United Kingdom
| | - M Whitaker
- Critical Pharmaceuticals Limited BioCity, Pennyfoot Street, Nottingham NG1 1GF, United Kingdom
| | - G F Palmieri
- School of Pharmacy, University of Camerino, Via Sant'Agostino 1, Camerino, MC 62032, Italy
| | - G Giorgioni
- School of Pharmacy, University of Camerino, Via Sant'Agostino 1, Camerino, MC 62032, Italy
| | - L Casettari
- Department of Biomolecular Sciences, University of Urbino, Piazza Rinascimento 6, Urbino, PU 61029, Italy.
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Levasseur M, Dumollard R, Chambon JP, Hebras C, Sinclair M, Whitaker M, McDougall A. Release from meiotic arrest in ascidian eggs requires the activity of two phosphatases but not CaMKII. Development 2014; 140:4583-93. [PMID: 24194472 DOI: 10.1242/dev.096578] [Citation(s) in RCA: 15] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The fertilising sperm triggers a transient Ca(2+) increase that releases eggs from cell cycle arrest in the vast majority of animal eggs. In vertebrate eggs, Erp1, an APC/C(cdc20) inhibitor, links release from metaphase II arrest with the Ca(2+) transient and its degradation is triggered by the Ca(2+)-induced activation of CaMKII. By contrast, many invertebrate groups have mature eggs that arrest at metaphase I, and these species do not possess the CaMKII target Erp1 in their genomes. As a consequence, it is unknown exactly how cell cycle arrest at metaphase I is achieved and how the fertilisation Ca(2+) transient overcomes the arrest in the vast majority of animal species. Using live-cell imaging with a novel cyclin reporter to study cell cycle arrest and its release in urochordate ascidians, the closest living invertebrate group to the vertebrates, we have identified a new signalling pathway for cell cycle resumption in which CaMKII plays no part. Instead, we find that the Ca(2+)-activated phosphatase calcineurin (CN) is required for egg activation. Moreover, we demonstrate that parthenogenetic activation of metaphase I-arrested eggs by MEK inhibition, independent of a Ca(2+) increase, requires the activity of a second egg phosphatase: PP2A. Furthermore, PP2A activity, together with CN, is required for normal egg activation during fertilisation. As ascidians are a sister group of the vertebrates, we discuss these findings in relation to cell cycle arrest and egg activation in chordates.
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Affiliation(s)
- Mark Levasseur
- Institute for Cell and Molecular Biosciences, The Medical School, Newcastle University, Newcastle upon Tyne NE2 4HH, UK
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Levasseur M, Dumollard R, Chambon JP, Hebras C, Sinclair M, Whitaker M, McDougall A. Release from meiotic arrest in ascidian eggs requires the activity of two phosphatases but not CaMKII. J Cell Sci 2013. [DOI: 10.1242/jcs.145144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Dardick C, Callahan A, Horn R, Ruiz KB, Zhebentyayeva T, Hollender C, Whitaker M, Abbott A, Scorza R. PpeTAC1 promotes the horizontal growth of branches in peach trees and is a member of a functionally conserved gene family found in diverse plants species. Plant J 2013; 75:618-30. [PMID: 23663106 DOI: 10.1111/tpj.12234] [Citation(s) in RCA: 100] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/26/2013] [Revised: 04/08/2013] [Accepted: 04/26/2013] [Indexed: 05/18/2023]
Abstract
Trees are capable of tremendous architectural plasticity, allowing them to maximize their light exposure under highly competitive environments. One key component of tree architecture is the branch angle, yet little is known about the molecular basis for the spatial patterning of branches in trees. Here, we report the identification of a candidate gene for the br mutation in Prunus persica (peach) associated with vertically oriented growth of branches, referred to as 'pillar' or 'broomy'. Ppa010082, annotated as hypothetical protein in the peach genome sequence, was identified as a candidate gene for br using a next generation sequence-based mapping approach. Sequence similarity searches identified rice TAC1 (tiller angle control 1) as a putative ortholog, and we thus named it PpeTAC1. In monocots, TAC1 is known to lead to less compact growth by increasing the tiller angle. In Arabidopsis, an attac1 mutant showed more vertical branch growth angles, suggesting that the gene functions universally to promote the horizontal growth of branches. TAC1 genes belong to a gene family (here named IGT for a shared conserved motif) found in all plant genomes, consisting of two clades: one containing TAC1-like genes; the other containing LAZY1, which contains an EAR motif, and promotes vertical shoot growth in Oryza sativa (rice) and Arabidopsis through influencing polar auxin transport. The data suggest that IGT genes are ancient, and play conserved roles in determining shoot growth angles in plants. Understanding how IGT genes modulate branch angles will provide insights into how different architectural growth habits evolved in terrestrial plants.
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Affiliation(s)
- Chris Dardick
- USDA-ARS Appalachian Fruit Research Station, Kearneysville, WV 25430, USA.
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