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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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Murthy NC, Holland DP, Chamberlain AT, Smith S, Callahan J, Smith W. The 6 E Framework of Public Health Preparedness for Mass Gatherings-Lessons Learned From Super Bowl LIII, Fulton County, Georgia, 2019. J Public Health Manag Pract 2021; 27:E197-E204. [PMID: 32833878 PMCID: PMC8291143 DOI: 10.1097/phh.0000000000001237] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
CONTEXT On February 3, 2019, Atlanta, Georgia, hosted Super Bowl LIII, which is classified as a National Special Security Event. The festivities comprising this major sporting event brought approximately half a million people to Atlanta, which posed significant challenges to the local public health community. As the lead local agency for public health planning, preparedness, and response efforts, Fulton County Board of Health (FCBOH) needed to address multiple specific tasks based on core functional areas outlined in the Emergency Support Function (ESF) 8 (eg, bioterrorism preparedness and epidemiological surveillance). PROGRAM To prepare for the Super Bowl, FCBOH developed a systematic approach to ensure community-wide public health preparedness for mass gatherings. This approach came to be known as the 6 E framework, which consists of (1) engaging stakeholders, (2) examining current capabilities and identifying gaps, (3) establishing roles and responsibilities, (4) executing plans to fill gaps, (5) exercising plans, and (6) evaluating impact. IMPLEMENTATION We define each step of the 6 E framework and present practical examples of how FCBOH implemented each step when preparing for the Super Bowl. Challenges that FCBOH faced and the lessons learned in the process are illustrated. The 6 E framework provides a systematic approach to community preparedness and allows local health departments to tailor the approach to serve local public health needs. EVALUATION The successful implementation of the 6 E framework allowed for stakeholders at the federal, state, and local levels (including law enforcement) to effectively coordinate an epidemiological investigation and response when 4 staff members reported gastrointestinal symptoms after eating at a feeding station. DISCUSSION Preparation for the Super Bowl required months of diligent cross-sectoral and cross-jurisdictional partnership building, and the 6 E framework can help other local public health jurisdictions prepare to host major mass gatherings.
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Affiliation(s)
- Neil C. Murthy
- Preventive Medicine Residency Program, Division of Scientific Education and Professional Development, Centers for Disease Control and Prevention, Atlanta, Georgia (Dr Murthy); Office of Medical and Preventive Services (Dr Holland), Office of Epidemiology (Dr Chamberlain and Ms Sasha Smith), and Office of Emergency Preparedness (Mr Callahan and Ms Wendy Smith), Fulton County Board of Health, Atlanta, Georgia; Department of Medicine, Division of Infectious Diseases (Dr Holland), and Department of Epidemiology, Rollins School of Public Health (Dr Chamberlain), Emory University, Atlanta, Georgia
| | - David P. Holland
- Preventive Medicine Residency Program, Division of Scientific Education and Professional Development, Centers for Disease Control and Prevention, Atlanta, Georgia (Dr Murthy); Office of Medical and Preventive Services (Dr Holland), Office of Epidemiology (Dr Chamberlain and Ms Sasha Smith), and Office of Emergency Preparedness (Mr Callahan and Ms Wendy Smith), Fulton County Board of Health, Atlanta, Georgia; Department of Medicine, Division of Infectious Diseases (Dr Holland), and Department of Epidemiology, Rollins School of Public Health (Dr Chamberlain), Emory University, Atlanta, Georgia
| | - Allison T. Chamberlain
- Preventive Medicine Residency Program, Division of Scientific Education and Professional Development, Centers for Disease Control and Prevention, Atlanta, Georgia (Dr Murthy); Office of Medical and Preventive Services (Dr Holland), Office of Epidemiology (Dr Chamberlain and Ms Sasha Smith), and Office of Emergency Preparedness (Mr Callahan and Ms Wendy Smith), Fulton County Board of Health, Atlanta, Georgia; Department of Medicine, Division of Infectious Diseases (Dr Holland), and Department of Epidemiology, Rollins School of Public Health (Dr Chamberlain), Emory University, Atlanta, Georgia
| | - Sasha Smith
- Preventive Medicine Residency Program, Division of Scientific Education and Professional Development, Centers for Disease Control and Prevention, Atlanta, Georgia (Dr Murthy); Office of Medical and Preventive Services (Dr Holland), Office of Epidemiology (Dr Chamberlain and Ms Sasha Smith), and Office of Emergency Preparedness (Mr Callahan and Ms Wendy Smith), Fulton County Board of Health, Atlanta, Georgia; Department of Medicine, Division of Infectious Diseases (Dr Holland), and Department of Epidemiology, Rollins School of Public Health (Dr Chamberlain), Emory University, Atlanta, Georgia
| | - John Callahan
- Preventive Medicine Residency Program, Division of Scientific Education and Professional Development, Centers for Disease Control and Prevention, Atlanta, Georgia (Dr Murthy); Office of Medical and Preventive Services (Dr Holland), Office of Epidemiology (Dr Chamberlain and Ms Sasha Smith), and Office of Emergency Preparedness (Mr Callahan and Ms Wendy Smith), Fulton County Board of Health, Atlanta, Georgia; Department of Medicine, Division of Infectious Diseases (Dr Holland), and Department of Epidemiology, Rollins School of Public Health (Dr Chamberlain), Emory University, Atlanta, Georgia
| | - Wendy Smith
- Preventive Medicine Residency Program, Division of Scientific Education and Professional Development, Centers for Disease Control and Prevention, Atlanta, Georgia (Dr Murthy); Office of Medical and Preventive Services (Dr Holland), Office of Epidemiology (Dr Chamberlain and Ms Sasha Smith), and Office of Emergency Preparedness (Mr Callahan and Ms Wendy Smith), Fulton County Board of Health, Atlanta, Georgia; Department of Medicine, Division of Infectious Diseases (Dr Holland), and Department of Epidemiology, Rollins School of Public Health (Dr Chamberlain), Emory University, Atlanta, Georgia
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Lehnert JD, Moulia DL, Murthy NC, Fiebelkorn AP, Vagi SJ, Dopson SA, Graitcer SB. Key Elements for Conducting Vaccination Exercises for Pandemic Influenza Preparedness. Am J Public Health 2018; 108:S194-S195. [PMID: 30192669 DOI: 10.2105/ajph.2018.304473] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Jonathan D Lehnert
- Jonathan D. Lehnert and Danielle L. Moulia are with IHRC, Inc., Atlanta, GA. Neil C. Murthy is with the Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta. Amy Parker Fiebelkorn and Samuel B. Graitcer are with the Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta. Sara J. Vagi and Stephanie A. Dopson are with the Division of State and Local Readiness, Office of Public Health Preparedness and Response, Centers for Disease Control and Prevention, Atlanta
| | - Danielle L Moulia
- Jonathan D. Lehnert and Danielle L. Moulia are with IHRC, Inc., Atlanta, GA. Neil C. Murthy is with the Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta. Amy Parker Fiebelkorn and Samuel B. Graitcer are with the Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta. Sara J. Vagi and Stephanie A. Dopson are with the Division of State and Local Readiness, Office of Public Health Preparedness and Response, Centers for Disease Control and Prevention, Atlanta
| | - Neil C Murthy
- Jonathan D. Lehnert and Danielle L. Moulia are with IHRC, Inc., Atlanta, GA. Neil C. Murthy is with the Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta. Amy Parker Fiebelkorn and Samuel B. Graitcer are with the Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta. Sara J. Vagi and Stephanie A. Dopson are with the Division of State and Local Readiness, Office of Public Health Preparedness and Response, Centers for Disease Control and Prevention, Atlanta
| | - Amy Parker Fiebelkorn
- Jonathan D. Lehnert and Danielle L. Moulia are with IHRC, Inc., Atlanta, GA. Neil C. Murthy is with the Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta. Amy Parker Fiebelkorn and Samuel B. Graitcer are with the Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta. Sara J. Vagi and Stephanie A. Dopson are with the Division of State and Local Readiness, Office of Public Health Preparedness and Response, Centers for Disease Control and Prevention, Atlanta
| | - Sara J Vagi
- Jonathan D. Lehnert and Danielle L. Moulia are with IHRC, Inc., Atlanta, GA. Neil C. Murthy is with the Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta. Amy Parker Fiebelkorn and Samuel B. Graitcer are with the Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta. Sara J. Vagi and Stephanie A. Dopson are with the Division of State and Local Readiness, Office of Public Health Preparedness and Response, Centers for Disease Control and Prevention, Atlanta
| | - Stephanie A Dopson
- Jonathan D. Lehnert and Danielle L. Moulia are with IHRC, Inc., Atlanta, GA. Neil C. Murthy is with the Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta. Amy Parker Fiebelkorn and Samuel B. Graitcer are with the Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta. Sara J. Vagi and Stephanie A. Dopson are with the Division of State and Local Readiness, Office of Public Health Preparedness and Response, Centers for Disease Control and Prevention, Atlanta
| | - Samuel B Graitcer
- Jonathan D. Lehnert and Danielle L. Moulia are with IHRC, Inc., Atlanta, GA. Neil C. Murthy is with the Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta. Amy Parker Fiebelkorn and Samuel B. Graitcer are with the Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta. Sara J. Vagi and Stephanie A. Dopson are with the Division of State and Local Readiness, Office of Public Health Preparedness and Response, Centers for Disease Control and Prevention, Atlanta
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