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Drain PK, Dalmat RR. The elusive allure of a rapid host blood signature for tuberculosis disease. J Clin Microbiol 2024; 62:e0128923. [PMID: 38270458 PMCID: PMC10865849 DOI: 10.1128/jcm.01289-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2024] Open
Abstract
A rapid host transcriptional signature cartridge could be a major advancement for tuberculosis diagnosis and treatment monitoring. In a recent study, M. Li, Y. Qiu, M. Guo, R. Qu, et al. (J Clin Microbiol 61:e00911-23, 2023, https://doi.org/10.1128/jcm.00911-23) conducted an evaluation of the Cepheid 3-gene assay (Xpert-MTB-HR) within a diagnostic case-control study in China. While the study provides a strong contribution for determining the value of the Xpert-MTB-HR assay for diagnostic accuracy and treatment response, further assay optimization and more prospective studies are necessary before adaptation into clinical practice.
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Affiliation(s)
- Paul K. Drain
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Ronit R. Dalmat
- Department of Global Health, University of Washington, Seattle, Washington, USA
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Dalmat RR, Hao L, Prabhu R, Rechkina E, Hamilton D, Ikuma MH, Bauer M, Gale M, Cantera JL, Ball AS, Grant BD, Drain PK. Rapid Antigen and Antibody Microfluidic Immunofluorescence Assays Compared to Culture, PCR, and Laboratory Reference Tests: Performance in a Longitudinal Cohort. J Infect Dis 2023; 228:1066-1070. [PMID: 37353225 PMCID: PMC10582900 DOI: 10.1093/infdis/jiad231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 06/15/2023] [Accepted: 06/17/2023] [Indexed: 06/25/2023] Open
Abstract
We evaluated the performance of rapid antigen (RAg) and antibody (RAb) microfluidic diagnostics with serial sampling of 71 participants at 6 visits over 2 months following severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Rapid tests showed strong agreement with laboratory references (κAg = 81.0%; κAb = 87.8%). RAg showed substantial concordance to both virus growth in culture and PCR positivity 0-5 days since symptom onset (κAg-culture = 60.1% and κAg-PCR = 87.1%). PCR concordance to virus growth in culture was similar (κPCR-culture = 70.0%), although agreement between RAg and culture was better overall (κAg-culture = 45.5% vs κPCR-culture = 10.0%). Rapid antigen and antibody testing by microfluidic immunofluorescence platform are highly accurate for characterization of acute infection.
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Affiliation(s)
- Ronit R Dalmat
- International Clinical Research Center, Department of Global Health, Schools of Medicine and Public Health, University of Washington, Seattle, Washington, USA
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, Washington, USA
| | - Linhui Hao
- Division of Allergy and Infectious Diseases, Department of Medicine, School of Medicine, University of Washington, Seattle, Washington, USA
- Department of Immunology, Center for Innate Immunity and Immune Disease, University of Washington, Seattle, Washington, USA
| | - Roshni Prabhu
- International Clinical Research Center, Department of Global Health, Schools of Medicine and Public Health, University of Washington, Seattle, Washington, USA
| | - Elena Rechkina
- International Clinical Research Center, Department of Global Health, Schools of Medicine and Public Health, University of Washington, Seattle, Washington, USA
| | - Daphne Hamilton
- International Clinical Research Center, Department of Global Health, Schools of Medicine and Public Health, University of Washington, Seattle, Washington, USA
| | - Matthew H Ikuma
- International Clinical Research Center, Department of Global Health, Schools of Medicine and Public Health, University of Washington, Seattle, Washington, USA
| | - Marie Bauer
- International Clinical Research Center, Department of Global Health, Schools of Medicine and Public Health, University of Washington, Seattle, Washington, USA
| | - Michael Gale
- Department of Immunology, Center for Innate Immunity and Immune Disease, University of Washington, Seattle, Washington, USA
- Center for Emerging and Re-emerging Infectious Diseases, University of Washington, Seattle, Washington, USA
| | | | | | | | - Paul K Drain
- International Clinical Research Center, Department of Global Health, Schools of Medicine and Public Health, University of Washington, Seattle, Washington, USA
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, Washington, USA
- Division of Allergy and Infectious Diseases, Department of Medicine, School of Medicine, University of Washington, Seattle, Washington, USA
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Dalmat RR, Ziebell RA, Kamineni A, Phipps AI, Weiss NS, Breslau ES, Burnett-Hartman AN, Corley DA, Doria-Rose VP, Green BB, Halm EA, Levin TR, Schottinger JE, Chubak J. Risk of Colorectal Cancer and Colorectal Cancer Mortality Beginning One Year after a Negative Fecal Occult Blood Test, among Screen-Eligible 76- to 85-Year-Olds. Cancer Epidemiol Biomarkers Prev 2023; 32:1382-1390. [PMID: 37450838 PMCID: PMC10592334 DOI: 10.1158/1055-9965.epi-23-0265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 06/05/2023] [Accepted: 07/13/2023] [Indexed: 07/18/2023] Open
Abstract
BACKGROUND Colorectal cancer screening is universally recommended for adults ages 45 to 75 years. Noninvasive fecal occult blood tests are effective screening tests recommended by guidelines. However, empirical evidence to inform older adults' decisions about whether to continue screening is sparse, especially for individuals with prior screening. METHODS This study used a retrospective cohort of older adults at three Kaiser Permanente integrated healthcare systems (Northern California, Southern California, Washington) and Parkland Health. Beginning 1 year following a negative stool-based screening test, cumulative risks of colorectal cancer incidence, colorectal cancer mortality (accounting for deaths from other causes), and non-colorectal cancer mortality were estimated. RESULTS Cumulative incidence of colorectal cancer in screen-eligible adults ages 76 to 85 with a negative fecal occult blood test 1 year ago (N = 118,269) was 0.23% [95% confidence interval (CI), 0.20%-0.26%] after 2 years and 1.21% (95% CI, 1.13%-1.30%) after 8 years. Cumulative colorectal cancer mortality was 0.03% (95% CI, 0.02%-0.04%) after 2 years and 0.33% (95% CI, 0.28%-0.39%) after 8 years. Cumulative risk of death from non-colorectal cancer causes was 4.81% (95% CI, 4.68%-4.96%) after 2 years and 28.40% (95% CI, 27.95%-28.85%) after 8 years. CONCLUSIONS Among 76- to 85-year-olds with a recent negative stool-based test, cumulative colorectal cancer incidence and mortality estimates were low, especially within 2 years; death from other causes was over 100 times more likely than death from colorectal cancer. IMPACT These findings of low absolute colorectal cancer risk, and comparatively higher risk of death from other causes, can inform decision-making regarding whether and when to continue colorectal cancer screening beyond age 75 among screen-eligible adults.
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Affiliation(s)
- Ronit R. Dalmat
- Department of Epidemiology, University of Washington, Seattle, USA
| | - Rebecca A. Ziebell
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Aruna Kamineni
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Amanda I. Phipps
- Department of Epidemiology, University of Washington, Seattle, USA
- Public Health Sciences Division, Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Noel S. Weiss
- Department of Epidemiology, University of Washington, Seattle, USA
- Public Health Sciences Division, Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Erica S. Breslau
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, USA
| | | | - Douglas A. Corley
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway Street, Oakland, CA, USA
- Department of Gastroenterology, Kaiser Permanente San Francisco Medical Center, San Francisco, CA, USA
| | - V. Paul Doria-Rose
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, USA
| | - Beverly B. Green
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
- Kaiser Permanente Bernard J Tyson School of Medicine, Department of Health Systems Science, Pasadena, CA
| | - Ethan A. Halm
- Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Theodore R. Levin
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway Street, Oakland, CA, USA
- Department of Gastroenterology, Kaiser Permanente Medical Center, Walnut Creek, CA USA
| | - Joanne E. Schottinger
- Kaiser Permanente Bernard J Tyson School of Medicine, Department of Health Systems Science, Pasadena, CA
| | - Jessica Chubak
- Department of Epidemiology, University of Washington, Seattle, USA
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
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Drain PK, Dalmat RR, Hao L, Bemer MJ, Budiawan E, Morton JF, Ireton RC, Hsiang TY, Marfatia Z, Prabhu R, Woosley C, Gichamo A, Rechkina E, Hamilton D, Montaño M, Cantera JL, Ball AS, Golez I, Smith E, Greninger AL, McElrath MJ, Thompson M, Grant BD, Meisner A, Gottlieb GS, Gale M. Duration of viral infectiousness and correlation with symptoms and diagnostic testing in non-hospitalized adults during acute SARS-CoV-2 infection: A longitudinal cohort study. J Clin Virol 2023; 161:105420. [PMID: 36913789 PMCID: PMC9981266 DOI: 10.1016/j.jcv.2023.105420] [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] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 02/07/2023] [Accepted: 02/23/2023] [Indexed: 03/06/2023]
Abstract
BACKGROUND Guidelines for SARS-CoV-2 have relied on limited data on duration of viral infectiousness and correlation with COVID-19 symptoms and diagnostic testing. METHODS We enrolled ambulatory adults with acute SARS-CoV-2 infection and performed serial measurements of COVID-19 symptoms, nasal swab viral RNA, nucleocapsid (N) and spike (S) antigens, and replication-competent SARS-CoV-2 by viral growth in culture. We determined average time from symptom onset to a first negative test result and estimated risk of infectiousness, as defined by positive viral growth in culture. RESULTS Among 95 adults, median [interquartile range] time from symptom onset to first negative test result was 9 [5] days, 13 [6] days, 11 [4] days, and >19 days for S antigen, N antigen, culture growth, and viral RNA by RT-PCR, respectively. Beyond two weeks, virus growth and N antigen titers were rarely positive, while viral RNA remained detectable among half (26/51) of participants tested 21-30 days after symptom onset. Between 6-10 days from symptom onset, N antigen was strongly associated with culture positivity (relative risk=7.61, 95% CI: 3.01-19.22), whereas neither viral RNA nor symptoms were associated with culture positivity. During the 14 days following symptom onset, the presence of N antigen remained strongly associated (adjusted relative risk=7.66, 95% CI: 3.96-14.82) with culture positivity, regardless of COVID-19 symptoms. CONCLUSIONS Most adults have replication-competent SARS-CoV-2 for 10-14 after symptom onset. N antigen testing is a strong predictor of viral infectiousness and may be a more suitable biomarker, rather than absence of symptoms or viral RNA, to discontinue isolation within two weeks from symptom onset.
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Affiliation(s)
- Paul K Drain
- International Clinical Research Center, Department of Global Health, Schools of Medicine and Public Health, University of Washington, Seattle, WA, United States; Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA, United States; Division of Allergy and Infectious Diseases, Department of Medicine, School of Medicine, University of Washington, Seattle, WA, United States.
| | - Ronit R Dalmat
- International Clinical Research Center, Department of Global Health, Schools of Medicine and Public Health, University of Washington, Seattle, WA, United States; Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA, United States
| | - Linhui Hao
- Department of Immunology, Center for Innate Immunity and Immune Disease, University of Washington, Seattle, WA, United States; Center for Emerging & Re-emerging Infectious Diseases, University of Washington, Seattle, WA, United States
| | - Meagan J Bemer
- International Clinical Research Center, Department of Global Health, Schools of Medicine and Public Health, University of Washington, Seattle, WA, United States
| | - Elvira Budiawan
- International Clinical Research Center, Department of Global Health, Schools of Medicine and Public Health, University of Washington, Seattle, WA, United States
| | - Jennifer F Morton
- International Clinical Research Center, Department of Global Health, Schools of Medicine and Public Health, University of Washington, Seattle, WA, United States
| | - Renee C Ireton
- Department of Immunology, Center for Innate Immunity and Immune Disease, University of Washington, Seattle, WA, United States; Center for Emerging & Re-emerging Infectious Diseases, University of Washington, Seattle, WA, United States
| | - Tien-Ying Hsiang
- Department of Immunology, Center for Innate Immunity and Immune Disease, University of Washington, Seattle, WA, United States; Center for Emerging & Re-emerging Infectious Diseases, University of Washington, Seattle, WA, United States
| | - Zarna Marfatia
- International Clinical Research Center, Department of Global Health, Schools of Medicine and Public Health, University of Washington, Seattle, WA, United States
| | - Roshni Prabhu
- International Clinical Research Center, Department of Global Health, Schools of Medicine and Public Health, University of Washington, Seattle, WA, United States
| | - Claire Woosley
- International Clinical Research Center, Department of Global Health, Schools of Medicine and Public Health, University of Washington, Seattle, WA, United States
| | - Adanech Gichamo
- International Clinical Research Center, Department of Global Health, Schools of Medicine and Public Health, University of Washington, Seattle, WA, United States
| | - Elena Rechkina
- International Clinical Research Center, Department of Global Health, Schools of Medicine and Public Health, University of Washington, Seattle, WA, United States
| | - Daphne Hamilton
- International Clinical Research Center, Department of Global Health, Schools of Medicine and Public Health, University of Washington, Seattle, WA, United States
| | - Michalina Montaño
- International Clinical Research Center, Department of Global Health, Schools of Medicine and Public Health, University of Washington, Seattle, WA, United States
| | | | | | - Inah Golez
- Department of Immunology, Center for Innate Immunity and Immune Disease, University of Washington, Seattle, WA, United States; Center for Emerging & Re-emerging Infectious Diseases, University of Washington, Seattle, WA, United States
| | - Elise Smith
- Department of Immunology, Center for Innate Immunity and Immune Disease, University of Washington, Seattle, WA, United States; Center for Emerging & Re-emerging Infectious Diseases, University of Washington, Seattle, WA, United States
| | - Alexander L Greninger
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA, United States
| | - M Juliana McElrath
- Division of Allergy and Infectious Diseases, Department of Medicine, School of Medicine, University of Washington, Seattle, WA, United States; Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Research Center, Seattle, WA, United States
| | - Matthew Thompson
- Department of Family Medicine, School of Medicine, University of Washington, Seattle, WA, United States
| | | | - Allison Meisner
- International Clinical Research Center, Department of Global Health, Schools of Medicine and Public Health, University of Washington, Seattle, WA, United States; Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Research Center, Seattle, WA, United States
| | - Geoffrey S Gottlieb
- Division of Allergy and Infectious Diseases, Department of Medicine, School of Medicine, University of Washington, Seattle, WA, United States; Center for Emerging & Re-emerging Infectious Diseases, University of Washington, Seattle, WA, United States; Department of Global Health, Schools of Medicine and Public Health, University of Washington, Seattle, WA, United States; Environmental Health & Safety Department, University of Washington, Seattle, WA, United States
| | - Michael Gale
- Department of Immunology, Center for Innate Immunity and Immune Disease, University of Washington, Seattle, WA, United States; Center for Emerging & Re-emerging Infectious Diseases, University of Washington, Seattle, WA, United States
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Hao L, Hsiang TY, Dalmat RR, Ireton R, Morton JF, Stokes C, Netland J, Hale M, Thouvenel C, Wald A, Franko NM, Huden K, Chu HY, Sigal A, Greninger AL, Tilles S, Barrett LK, Van Voorhis WC, Munt J, Scobey T, Baric RS, Rawlings DJ, Pepper M, Drain PK, Gale M. Dynamics of SARS-CoV-2 VOC Neutralization and Novel mAb Reveal Protection against Omicron. Viruses 2023; 15:530. [PMID: 36851745 PMCID: PMC9965505 DOI: 10.3390/v15020530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 02/06/2023] [Accepted: 02/09/2023] [Indexed: 02/17/2023] Open
Abstract
New variants of SARS-CoV-2 continue to emerge and evade immunity. We isolated SARS-CoV-2 temporally across the pandemic starting with the first emergence of the virus in the western hemisphere and evaluated the immune escape among variants. A clinic-to-lab viral isolation and characterization pipeline was established to rapidly isolate, sequence, and characterize SARS-CoV-2 variants. A virus neutralization assay was applied to quantitate humoral immunity from infection and/or vaccination. A panel of novel monoclonal antibodies was evaluated for antiviral efficacy. We directly compared all variants, showing that convalescence greater than 5 months post-symptom onset from ancestral virus provides little protection against SARS-CoV-2 variants. Vaccination enhances immunity against viral variants, except for Omicron BA.1, while a three-dose vaccine regimen provides over 50-fold enhanced protection against Omicron BA.1 compared to a two-dose. A novel Mab neutralizes Omicron BA.1 and BA.2 variants better than the clinically approved Mabs, although neither can neutralize Omicron BA.4 or BA.5. Thus, the need remains for continued vaccination-booster efforts, with innovation for vaccine and Mab improvement for broadly neutralizing activity. The usefulness of specific Mab applications links with the window of clinical opportunity when a cognate viral variant is present in the infected population.
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Affiliation(s)
- Linhui Hao
- Department of Immunology, Center for Innate Immunity and Immune Disease, University of Washington, Seattle, WA 98109, USA
- Center for Emerging & Re-Emerging Infectious Diseases, University of Washington, Seattle, WA 98109, USA
| | - Tien-Ying Hsiang
- Department of Immunology, Center for Innate Immunity and Immune Disease, University of Washington, Seattle, WA 98109, USA
- Center for Emerging & Re-Emerging Infectious Diseases, University of Washington, Seattle, WA 98109, USA
| | - Ronit R. Dalmat
- International Clinical Research Center, Department of Global Health, Schools of Medicine and Public Health, University of Washington, Seattle, WA 98104, USA
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA 98195, USA
| | - Renee Ireton
- Department of Immunology, Center for Innate Immunity and Immune Disease, University of Washington, Seattle, WA 98109, USA
- Center for Emerging & Re-Emerging Infectious Diseases, University of Washington, Seattle, WA 98109, USA
| | - Jennifer F. Morton
- International Clinical Research Center, Department of Global Health, Schools of Medicine and Public Health, University of Washington, Seattle, WA 98104, USA
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA 98195, USA
| | - Caleb Stokes
- Department of Immunology, Center for Innate Immunity and Immune Disease, University of Washington, Seattle, WA 98109, USA
- Center for Emerging & Re-Emerging Infectious Diseases, University of Washington, Seattle, WA 98109, USA
- Department of Pediatrics, School of Medicine, University of Washington, Seattle, WA 98195, USA
| | - Jason Netland
- Department of Immunology, Center for Innate Immunity and Immune Disease, University of Washington, Seattle, WA 98109, USA
| | - Malika Hale
- Department of Immunology, Center for Innate Immunity and Immune Disease, University of Washington, Seattle, WA 98109, USA
| | - Chris Thouvenel
- Department of Immunology, Center for Innate Immunity and Immune Disease, University of Washington, Seattle, WA 98109, USA
| | - Anna Wald
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA 98195, USA
- Division of Allergy and Infectious Diseases, Department of Medicine, School of Medicine, University of Washington, Seattle, WA 98195, USA
- Allergy and Infectious Diseases Division, Laboratory Medicine & Pathology, & Epidemiology, University of Washington, Seattle, WA 98195, USA
- Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Center, Seattle, WA 98109, USA
| | - Nicholas M. Franko
- Division of Allergy and Infectious Diseases, Department of Medicine, School of Medicine, University of Washington, Seattle, WA 98195, USA
| | - Kristen Huden
- Division of Allergy and Infectious Diseases, Department of Medicine, School of Medicine, University of Washington, Seattle, WA 98195, USA
| | - Helen Y. Chu
- Division of Allergy and Infectious Diseases, Department of Medicine, School of Medicine, University of Washington, Seattle, WA 98195, USA
| | - Alex Sigal
- Africa Health Research Institute, Durban 4001, South Africa
- School of Laboratory Medicine and Medical Sciences, University of KwaZulu-Natal, Mayville 4058, South Africa
- Centre for the AIDS Program of Research in South Africa, Congella 4013, South Africa
| | - Alex L. Greninger
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA 98195, USA
| | - Sasha Tilles
- Center for Emerging & Re-Emerging Infectious Diseases, University of Washington, Seattle, WA 98109, USA
- Division of Allergy and Infectious Diseases, Department of Medicine, School of Medicine, University of Washington, Seattle, WA 98195, USA
| | - Lynn K. Barrett
- Center for Emerging & Re-Emerging Infectious Diseases, University of Washington, Seattle, WA 98109, USA
- Division of Allergy and Infectious Diseases, Department of Medicine, School of Medicine, University of Washington, Seattle, WA 98195, USA
| | - Wesley C. Van Voorhis
- Center for Emerging & Re-Emerging Infectious Diseases, University of Washington, Seattle, WA 98109, USA
- Division of Allergy and Infectious Diseases, Department of Medicine, School of Medicine, University of Washington, Seattle, WA 98195, USA
| | - Jennifer Munt
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC 27695, USA
| | - Trevor Scobey
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC 27695, USA
| | - Ralph S. Baric
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC 27695, USA
| | - David J. Rawlings
- Department of Immunology, Center for Innate Immunity and Immune Disease, University of Washington, Seattle, WA 98109, USA
| | - Marion Pepper
- Department of Immunology, Center for Innate Immunity and Immune Disease, University of Washington, Seattle, WA 98109, USA
| | - Paul K. Drain
- International Clinical Research Center, Department of Global Health, Schools of Medicine and Public Health, University of Washington, Seattle, WA 98104, USA
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA 98195, USA
- Division of Allergy and Infectious Diseases, Department of Medicine, School of Medicine, University of Washington, Seattle, WA 98195, USA
| | - Michael Gale
- Department of Immunology, Center for Innate Immunity and Immune Disease, University of Washington, Seattle, WA 98109, USA
- Center for Emerging & Re-Emerging Infectious Diseases, University of Washington, Seattle, WA 98109, USA
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Dalmat RR, Ziebell RA, Kamineni A, Phipps AI, Weiss NS, Breslau ES, Corley DA, Green BB, Halm EA, Levin TR, Schottinger JE, Chubak J. Risk of Colorectal Cancer and Colorectal Cancer Mortality Beginning Ten Years after a Negative Colonoscopy, among Screen-Eligible Adults 76 to 85 Years Old. Cancer Epidemiol Biomarkers Prev 2023; 32:37-45. [PMID: 36099431 PMCID: PMC9839620 DOI: 10.1158/1055-9965.epi-22-0581] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 08/18/2022] [Accepted: 09/06/2022] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Few empirical data are available to inform older adults' decisions about whether to screen or continue screening for colorectal cancer based on their prior history of screening, particularly among individuals with a prior negative exam. METHODS Using a retrospective cohort of older adults receiving healthcare at three Kaiser Permanente integrated healthcare systems in Northern California (KPNC), Southern California (KPSC), and Washington (KPWA), we estimated the cumulative risk of colorectal cancer incidence and mortality among older adults who had a negative colonoscopy 10 years earlier, accounting for death from other causes. RESULTS Screen-eligible adults ages 76 to 85 years who had a negative colonoscopy 10 years earlier were found to be at a low risk of colorectal cancer diagnosis, with a cumulative incidence of 0.39% [95% CI, 0.31%-0.48%) at 2 years that increased to 1.29% (95% CI, 1.02%-1.61%) at 8 years. Cumulative mortality from colorectal cancer was 0.04% (95% CI, 0.02%-0.08%) at 2 years and 0.46% (95% CI, 0.30%-0.70%) at 8 years. CONCLUSIONS These low estimates of cumulative colorectal cancer incidence and mortality occurred in the context of much higher risk of death from other causes. IMPACT Knowledge of these results could bear on older adults' decision to undergo or not undergo further colorectal cancer screening, including choice of modality, should they decide to continue screening. See related commentary by Lieberman, p. 6.
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Affiliation(s)
- Ronit R. Dalmat
- Department of Epidemiology, University of Washington, Seattle, USA
| | - Rebecca A. Ziebell
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Aruna Kamineni
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Amanda I. Phipps
- Department of Epidemiology, University of Washington, Seattle, USA.,Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Noel S. Weiss
- Department of Epidemiology, University of Washington, Seattle, USA.,Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Erica S. Breslau
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, USA
| | - Douglas A. Corley
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway Street, Oakland, CA, USA.,Department of Gastroenterology, Kaiser Permanente San Francisco Medical Center, San Francisco, CA, USA
| | - Beverly B. Green
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Ethan A. Halm
- Department of Medicine, Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Theodore R. Levin
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway Street, Oakland, CA, USA.,Department of Gastroenterology, Kaiser Permanente San Francisco Medical Center, San Francisco, CA, USA
| | - Joanne E. Schottinger
- Kaiser Permanente Bernard J Tyson School of Medicine, Department of Health Systems Science, Pasadena, CA
| | - Jessica Chubak
- Department of Epidemiology, University of Washington, Seattle, USA.,Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
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Chubak J, Dalmat RR, Weiss NS, Doria-Rose VP, Corley DA, Kamineni A. Informative Presence in Electronic Health Record Data: A Challenge in Implementing Study Exclusion Criteria. Epidemiology 2023; 34:29-32. [PMID: 36125348 PMCID: PMC9722536 DOI: 10.1097/ede.0000000000001542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- Jessica Chubak
- Kaiser Permanente Washington Health Research Institute, Seattle, WA
- University of Washington, Department of Epidemiology, Seattle, WA
| | - Ronit R. Dalmat
- University of Washington, Department of Epidemiology, Seattle, WA
| | - Noel S. Weiss
- University of Washington, Department of Epidemiology, Seattle, WA
| | - V. Paul Doria-Rose
- Healthcare Delivery Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD
| | | | - Aruna Kamineni
- Kaiser Permanente Washington Health Research Institute, Seattle, WA
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Hao L, Hsiang TY, Dalmat RR, Ireton R, Morton J, Stokes C, Netland J, Hale M, Thouvenel C, Wald A, Franko NM, Huden K, Chu H, Greninger A, Tilles S, Barrett LK, Van Voorhis WC, Munt J, Scobey T, Baric RS, Rawlings D, Pepper M, Drain PK, Gale M. Dynamics of SARS-CoV-2 VOC neutralization and novel mAb reveal protection against Omicron. medRxiv 2022:2022.08.12.22278720. [PMID: 36032965 PMCID: PMC9413723 DOI: 10.1101/2022.08.12.22278720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
To evaluate SARS-CoV-2 variants we isolated SARS-CoV-2 temporally during the pandemic starting with first appearance of virus in the Western hemisphere near Seattle, WA, USA, and isolated each known major variant class, revealing the dynamics of emergence and complete take-over of all new cases by current Omicron variants. We assessed virus neutralization in a first-ever full comparison across variants and evaluated a novel monoclonal antibody (Mab). We found that convalescence greater than 5-months provides little-to-no protection against SARS-CoV-2 variants, vaccination enhances immunity against variants with the exception of Omicron BA.1, and paired testing of vaccine sera against ancestral virus compared to Omicron BA.1 shows that 3-dose vaccine regimen provides over 50-fold enhanced protection against Omicron BA.1 compared to a 2-dose regimen. We also reveal a novel Mab that effectively neutralizes Omicron BA.1 and BA.2 variants over clinically-approved Mabs. Our observations underscore the need for continued vaccination efforts, with innovation for vaccine and Mab improvement, for protection against variants of SARS-CoV-2. Summary We isolated SARS-CoV-2 temporally starting with emergence of virus in the Western hemisphere. Neutralization analyses across all variant lineages show that vaccine-boost regimen provides protection against Omicron BA.1. We reveal a Mab that protects against Omicron BA.1 and BA.2 variants.
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Dalmat RR, Mooney SJ, Hurvitz PM, Zhou C, Moudon AV, Saelens BE. Walkability measures to predict the likelihood of walking in a place: A classification and regression tree analysis. Health Place 2021; 72:102700. [PMID: 34700066 PMCID: PMC8627829 DOI: 10.1016/j.healthplace.2021.102700] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 10/15/2021] [Accepted: 10/15/2021] [Indexed: 10/20/2022]
Abstract
Walkability is a popular and ubiquitous term at the intersection of urban planning and public health. As the number of potential walkability measures grows in the literature, there is a need to compare their relative importance for specific research objectives. This study demonstrates a classification and regression tree (CART) model to compare five familiar measures of walkability from the literature for their relative ability to predict whether or not walking occurs in a dataset of objectively measured locations. When analyzed together, the measures had moderate-to-high accuracy (87.8% agreement: 65.6% of true walking GPS-measured points classified as walking and 93.4% of non-walking points as non-walking). On its own, the most well-known composite measure, Walk Score, performed only slightly better than measures of the built environment composed of a single variable (transit ridership, employment density, and residential density).Thus there may be contexts where transparent and longitudinally available measures of urban form are worth a marginal tradeoff in prediction accuracy. This comparison of walkability measures using CART highlights the importance for public health and urban design researchers to think carefully about how and why particular walkability measures are used.
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Affiliation(s)
- Ronit R Dalmat
- Department of Epidemiology, University of Washington, 1959 NE Pacific Street, Seattle, USA.
| | - Stephen J Mooney
- Department of Epidemiology, University of Washington, 1959 NE Pacific Street, Seattle, USA
| | - Philip M Hurvitz
- Department of Urban Design and Planning and Urban Form Laboratory, University of Washington, 4333 Brooklyn Ave NE, Seattle, USA; Center for Studies in Demography and Ecology, University of Washington, Seattle, USA
| | - Chuan Zhou
- Seattle Children's Research Institute, 2001 Eighth Ave. Seattle, USA; Department of Pediatrics, University of Washington, Seattle, USA
| | - Anne V Moudon
- Department of Urban Design and Planning and Urban Form Laboratory, University of Washington, 4333 Brooklyn Ave NE, Seattle, USA
| | - Brian E Saelens
- Seattle Children's Research Institute, 2001 Eighth Ave. Seattle, USA; Department of Pediatrics, University of Washington, Seattle, USA
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Schwartz NRM, Dalmat RR. Letter to the editor concerning Kuksis et al. Neuro Oncol 2021; 23:1404-1405. [PMID: 33982751 DOI: 10.1093/neuonc/noab050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Naomi R M Schwartz
- Comparative Health Outcomes, Policy & Economics (CHOICE) Institute, School of Pharmacy, University of Washington, Seattle, Washington, USA
| | - Ronit R Dalmat
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, Washington, USA
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