1
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Andronescu LR, Richard SA, Scher AI, Lindholm DA, Mende K, Ganesan A, Huprikar N, Lalani T, Smith A, Mody RM, Jones MU, Bazan SE, Colombo RE, Colombo CJ, Ewers E, Larson DT, Maves RC, Berjohn CM, Maldonado CJ, English C, Sanchez Edwards M, Rozman JS, Rusiecki J, Byrne C, Simons MP, Tribble D, Burgess TH, Pollett SD, Agan BK. SARS-CoV-2 infection is associated with self-reported post-acute neuropsychological symptoms within six months of follow-up. PLoS One 2024; 19:e0297481. [PMID: 38626117 PMCID: PMC11020833 DOI: 10.1371/journal.pone.0297481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 01/02/2024] [Indexed: 04/18/2024] Open
Abstract
BACKGROUND Chronic neuropsychological sequelae following SARS-CoV-2 infection, including depression, anxiety, fatigue, and general cognitive difficulties, are a major public health concern. Given the potential impact of long-term neuropsychological impairment, it is important to characterize the frequency and predictors of this post-infection phenotype. METHODS The Epidemiology, Immunology, and Clinical Characteristics of Emerging Infectious Diseases with Pandemic Potential (EPICC) study is a longitudinal study assessing the impact of SARS-CoV-2 infection in U.S. Military Healthcare System (MHS) beneficiaries, i.e. those eligible for care in the MHS including active duty servicemembers, dependents, and retirees. Four broad areas of neuropsychological symptoms were assessed cross-sectionally among subjects 1-6 months post-infection/enrollment, including: depression (Patient Health Questionnaire-9), anxiety (General Anxiety Disorder-7), fatigue (PROMIS® Fatigue 7a), and cognitive function (PROMIS® Cognitive Function 8a and PROMIS® Cognitive Function abilities 8a). Multivariable Poisson regression models compared participants with and without SARS-CoV-2 infection history on these measures, adjusting for sex, ethnicity, active-duty status, age, and months post-first positive or enrollment of questionnaire completion (MPFP/E); models for fatigue and cognitive function were also adjusted for depression and anxiety scores. RESULTS The study population included 2383 participants who completed all five instruments within six MPFP/E, of whom 687 (28.8%) had at least one positive SARS-CoV-2 test. Compared to those who had never tested positive for SARS-CoV-2, the positive group was more likely to meet instrument-based criteria for depression (15.4% vs 10.3%, p<0.001), fatigue (20.1% vs 8.0%, p<0.001), impaired cognitive function (15.7% vs 8.6%, p<0.001), and impaired cognitive function abilities (24.3% vs 16.3%, p<0.001). In multivariable models, SARS-CoV-2 positive participants, assessed at an average of 2.7 months after infection, had increased risk of moderate to severe depression (RR: 1.44, 95% CI 1.12-1.84), fatigue (RR: 2.07, 95% CI 1.62-2.65), impaired cognitive function (RR: 1.64, 95% CI 1.27-2.11), and impaired cognitive function abilities (RR: 1.41, 95% CI 1.15-1.71); MPFP/E was not significant. CONCLUSIONS Participants with a history of SARS-CoV-2 infection were up to twice as likely to report cognitive impairment and fatigue as the group without prior SARS-CoV-2 infection. These findings underscore the continued importance of preventing SARS-CoV-2 infection and while time since infection/enrollment was not significant through 6 months of follow-up, this highlights the need for additional research into the long-term impacts of COVID-19 to mitigate and reverse these neuropsychological outcomes.
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Affiliation(s)
- Liana R. Andronescu
- Department of Preventive Medicine and Biostatistics, Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Bethesda, MD, United States of America
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, United States of America
| | - Stephanie A. Richard
- Department of Preventive Medicine and Biostatistics, Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Bethesda, MD, United States of America
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, United States of America
| | - Ann I. Scher
- Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD, United States of America
| | - David A. Lindholm
- Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, United States of America
- Brooke Army Medical Center, San Antonio, TX, United States of America
| | - Katrin Mende
- Department of Preventive Medicine and Biostatistics, Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Bethesda, MD, United States of America
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, United States of America
- Brooke Army Medical Center, San Antonio, TX, United States of America
| | - Anuradha Ganesan
- Department of Preventive Medicine and Biostatistics, Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Bethesda, MD, United States of America
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, United States of America
- Walter Reed National Military Medical Center, Bethesda, MD, United States of America
| | - Nikhil Huprikar
- Walter Reed National Military Medical Center, Bethesda, MD, United States of America
| | - Tahaniyat Lalani
- Department of Preventive Medicine and Biostatistics, Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Bethesda, MD, United States of America
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, United States of America
- Naval Medical Center Portsmouth, Portsmouth, VA, United States of America
| | - Alfred Smith
- Naval Medical Center Portsmouth, Portsmouth, VA, United States of America
| | - Rupal M. Mody
- William Beaumont Army Medical Center, El Paso, TX, United States of America
| | - Milissa U. Jones
- Tripler Army Medical Center, Honolulu, HI, United States of America
| | - Samantha E. Bazan
- Carl R. Darnall Army Medical Center, Fort Hood, TX, United States of America
| | - Rhonda E. Colombo
- Department of Preventive Medicine and Biostatistics, Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Bethesda, MD, United States of America
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, United States of America
- Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, United States of America
- Madigan Army Medical Center, Tacoma, WA, United States of America
| | - Christopher J. Colombo
- Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, United States of America
- Madigan Army Medical Center, Tacoma, WA, United States of America
| | - Evan Ewers
- Fort Belvoir Community Hospital, Fort Belvoir, VA, United States of America
| | - Derek T. Larson
- Fort Belvoir Community Hospital, Fort Belvoir, VA, United States of America
- Naval Medical Center San Diego, San Diego, CA, United States of America
| | - Ryan C. Maves
- Department of Preventive Medicine and Biostatistics, Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Bethesda, MD, United States of America
- Naval Medical Center San Diego, San Diego, CA, United States of America
| | - Catherine M. Berjohn
- Department of Preventive Medicine and Biostatistics, Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Bethesda, MD, United States of America
- Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, United States of America
- Naval Medical Center San Diego, San Diego, CA, United States of America
| | | | - Caroline English
- Department of Preventive Medicine and Biostatistics, Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Bethesda, MD, United States of America
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, United States of America
| | - Margaret Sanchez Edwards
- Department of Preventive Medicine and Biostatistics, Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Bethesda, MD, United States of America
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, United States of America
| | - Julia S. Rozman
- Department of Preventive Medicine and Biostatistics, Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Bethesda, MD, United States of America
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, United States of America
| | - Jennifer Rusiecki
- Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD, United States of America
| | - Celia Byrne
- Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD, United States of America
| | - Mark P. Simons
- Department of Preventive Medicine and Biostatistics, Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Bethesda, MD, United States of America
| | - David Tribble
- Department of Preventive Medicine and Biostatistics, Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Bethesda, MD, United States of America
| | - Timothy H. Burgess
- Department of Preventive Medicine and Biostatistics, Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Bethesda, MD, United States of America
| | - Simon D. Pollett
- Department of Preventive Medicine and Biostatistics, Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Bethesda, MD, United States of America
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, United States of America
| | - Brian K. Agan
- Department of Preventive Medicine and Biostatistics, Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Bethesda, MD, United States of America
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, United States of America
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Wang W, Bhushan GL, Paz S, Stauft CB, Selvaraj P, Goguet E, Bishop-Lilly KA, Subramanian R, Vassell R, Lusvarghi S, Cong Y, Agan B, Richard SA, Epsi NJ, Fries A, Fung CK, Conte MA, Holbrook MR, Wang TT, Burgess TH, Mitre E, Pollett SD, Katzelnick LC, Weiss CD. Antigenic cartography using hamster sera identifies SARS-CoV-2 JN.1 evasion seen in human XBB.1.5 booster sera. bioRxiv 2024:2024.04.05.588359. [PMID: 38712124 PMCID: PMC11071293 DOI: 10.1101/2024.04.05.588359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2024]
Abstract
Antigenic assessments of SARS-CoV-2 variants inform decisions to update COVID-19 vaccines. Primary infection sera are often used for assessments, but such sera are rare due to population immunity from SARS-CoV-2 infections and COVID-19 vaccinations. Here, we show that neutralization titers and breadth of matched human and hamster pre-Omicron variant primary infection sera correlate well and generate similar antigenic maps. The hamster antigenic map shows modest antigenic drift among XBB sub-lineage variants, with JN.1 and BA.4/BA.5 variants within the XBB cluster, but with five to six-fold antigenic differences between these variants and XBB.1.5. Compared to sera following only ancestral or bivalent COVID-19 vaccinations, or with post-vaccination infections, XBB.1.5 booster sera had the broadest neutralization against XBB sub-lineage variants, although a five-fold titer difference was still observed between JN.1 and XBB.1.5 variants. These findings suggest that antibody coverage of antigenically divergent JN.1 could be improved with a matched vaccine antigen.
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Affiliation(s)
- Wei Wang
- Office of Vaccines Research and Review, Center for Biologics Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland, USA
| | - Gitanjali L. Bhushan
- Viral Epidemiology and Immunity Unit, Laboratory of Infectious Diseases, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Stephanie Paz
- Office of Vaccines Research and Review, Center for Biologics Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland, USA
| | - Charles B. Stauft
- Office of Vaccines Research and Review, Center for Biologics Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland, USA
| | - Prabhu Selvaraj
- Office of Vaccines Research and Review, Center for Biologics Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland, USA
| | - Emilie Goguet
- Department of Microbiology and Immunology, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc. Bethesda, Maryland, USA
| | - Kimberly A. Bishop-Lilly
- Biological Defense Research Directorate, Naval Medical Research Command, Fort Detrick, Maryland, USA
| | - Rahul Subramanian
- Office of Data Science and Emerging Technologies, Office of Science Management and Operations, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Russell Vassell
- Office of Vaccines Research and Review, Center for Biologics Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland, USA
| | - Sabrina Lusvarghi
- Office of Vaccines Research and Review, Center for Biologics Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland, USA
| | - Yu Cong
- Integrated Research Facility, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Ft. Detrick, Frederick, Maryland, USA
| | - Brian Agan
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc. Bethesda, Maryland, USA
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Stephanie A. Richard
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc. Bethesda, Maryland, USA
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Nusrat J. Epsi
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc. Bethesda, Maryland, USA
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Anthony Fries
- US Air Force School of Aerospace Medicine, Dayton, Ohio, USA
| | - Christian K. Fung
- Viral Diseases Branch, Walter Reed Army Institute of Research, Silver Spring, MD, USA
| | - Matthew A. Conte
- Viral Diseases Branch, Walter Reed Army Institute of Research, Silver Spring, MD, USA
| | - Michael R. Holbrook
- Integrated Research Facility, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Ft. Detrick, Frederick, Maryland, USA
| | - Tony T. Wang
- Office of Vaccines Research and Review, Center for Biologics Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland, USA
| | - Timothy H. Burgess
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Edward Mitre
- Department of Microbiology and Immunology, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Simon D. Pollett
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc. Bethesda, Maryland, USA
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Leah C. Katzelnick
- Viral Epidemiology and Immunity Unit, Laboratory of Infectious Diseases, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Carol D. Weiss
- Office of Vaccines Research and Review, Center for Biologics Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland, USA
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3
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Richard SA, Scher AI, Rusiecki J, Byrne C, Berjohn CM, Fries AC, Lalani T, Smith AG, Mody RM, Ganesan A, Huprikar N, Colombo RE, Colombo CJ, Schofield C, Lindholm DA, Mende K, Morris MJ, Jones MU, Flanagan R, Larson DT, Ewers EC, Bazan SE, Saunders D, Maves RC, Livezey J, Maldonado CJ, Edwards MS, Rozman JS, O’Connell RJ, Simons MP, Tribble DR, Agan BK, Burgess TH, Pollett SD. Decreased Self-reported Physical Fitness Following SARS-CoV-2 Infection and the Impact of Vaccine Boosters in a Cohort Study. Open Forum Infect Dis 2023; 10:ofad579. [PMID: 38130596 PMCID: PMC10733205 DOI: 10.1093/ofid/ofad579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 11/15/2023] [Indexed: 12/23/2023] Open
Abstract
Background The long-term effects of coronavirus disease 2019 (COVID-19) on physical fitness are unclear, and the impact of vaccination on that relationship is uncertain. Methods We compared survey responses in a 1-year study of US military service members with (n = 1923) and without (n = 1591) a history of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. We fit Poisson regression models to estimate the association between history of SARS-CoV-2 infection and fitness impairment, adjusting for time since infection, demographics, and baseline health. Results The participants in this analysis were primarily young adults aged 18-39 years (75%), and 71.5% were male. Participants with a history of SARS-CoV-2 infection were more likely to report difficulty exercising (38.7% vs 18.4%; P < .01), difficulty performing daily activities (30.4% vs 12.7%; P < .01), and decreased fitness test (FT) scores (42.7% vs 26.2%; P < .01) than those without a history of infection. SARS-CoV-2-infected participants were at higher risk of these outcomes after adjusting for other factors (unvaccinated: exercising: adjusted risk ratio [aRR], 3.99; 95% CI, 3.36-4.73; activities: aRR, 5.02; 95% CI, 4.09-6.16; FT affected: aRR, 2.55; 95% CI, 2.19-2.98). Among SARS-CoV-2-positive participants, full vaccination before infection was associated with a lower risk of post-COVID-19 fitness impairment (fully vaccinated: exercise: aRR, 0.81; 95% CI, 0.70-0.95; activities: aRR, 0.76; 95% CI, 0.64-0.91; FT: aRR, 0.87; 95% CI, 0.76-1.00; boosted: exercise: aRR, 0.62; 95% CI, 0.51-0.74; activities: aRR, 0.52; 95% CI, 0.41-0.65; FT: aRR, 0.59; 95% CI, 0.49-0.70). Conclusions In this study of generally young, healthy military service members, SARS-CoV-2 infection was associated with lower self-reported fitness and exercise capacity; vaccination and boosting were associated with lower risk of self-reported fitness loss.
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Affiliation(s)
- Stephanie A Richard
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, Maryland, USA
| | - Ann I Scher
- Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Jennifer Rusiecki
- Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Celia Byrne
- Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Catherine M Berjohn
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
- Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
- Naval Medical Center San Diego, San Diego, California, USA
| | - Anthony C Fries
- US Air Force School of Aerospace Medicine, Wright-Patterson, Ohio, USA
| | - Tahaniyat Lalani
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, Maryland, USA
- Naval Medical Center Portsmouth, Portsmouth, Virginia, USA
| | - Alfred G Smith
- Naval Medical Center Portsmouth, Portsmouth, Virginia, USA
| | - Rupal M Mody
- William Beaumont Army Medical Center, El Paso, Texas, USA
| | - Anuradha Ganesan
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, Maryland, USA
- Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Nikhil Huprikar
- Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
- Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Rhonda E Colombo
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, Maryland, USA
- Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
- Madigan Army Medical Center, Joint Base Lewis McChord, Washington, USA
| | - Christopher J Colombo
- Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
- Madigan Army Medical Center, Joint Base Lewis McChord, Washington, USA
| | | | - David A Lindholm
- Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
- Brooke Army Medical Center, Joint Base San Antonio-Fort Sam Houston, Texas, USA
| | - Katrin Mende
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, Maryland, USA
- Brooke Army Medical Center, Joint Base San Antonio-Fort Sam Houston, Texas, USA
| | - Michael J Morris
- Brooke Army Medical Center, Joint Base San Antonio-Fort Sam Houston, Texas, USA
| | - Milissa U Jones
- Department of Pediatrics, Translational Medicine Unit, Uniformed Services University, Bethesda, Maryland, USA
| | - Ryan Flanagan
- Department of Pediatrics, Translational Medicine Unit, Uniformed Services University, Bethesda, Maryland, USA
| | - Derek T Larson
- Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
- Naval Medical Center San Diego, San Diego, California, USA
- Alexander T. Augusta Military Medical Center, Fort Belvoir, Virginia, USA
| | - Evan C Ewers
- Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
- Alexander T. Augusta Military Medical Center, Fort Belvoir, Virginia, USA
| | | | - David Saunders
- Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Ryan C Maves
- Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Jeffrey Livezey
- Department of Pediatrics, Clinical Pharmacology and Medical Toxicology, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | | | - Margaret Sanchez Edwards
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, Maryland, USA
| | - Julia S Rozman
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, Maryland, USA
| | - Robert J O’Connell
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Mark P Simons
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - David R Tribble
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Brian K Agan
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, Maryland, USA
| | - Timothy H Burgess
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Simon D Pollett
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, Maryland, USA
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Andronescu LR, Richard SA, Laing ED, Pisanic N, Coggins SA, Rivera MG, Kruczynski K, Saperstein AK, Modi J, Fraser JA, Shaikh S, Broder CC, Burgess TH, Heaney CD, Pollett SD, Millar E, Coles CL, Simons MP. Evaluating SARS-CoV-2 Saliva and Dried Blood Spot Surveillance Strategies in a Congregate Population. Emerg Infect Dis 2023; 29:1925-1928. [PMID: 37579513 PMCID: PMC10461675 DOI: 10.3201/eid2909.230417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/16/2023] Open
Abstract
The optimal approach to COVID-19 surveillance in congregate populations remains unclear. Our study at the US Naval Academy in Annapolis, Maryland, USA, assessed the concordance of antibody prevalence in longitudinally collected dried blood spots and saliva in a setting of frequent PCR-based testing. Our findings highlight the utility of salivary-based surveillance.
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5
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Richard SA, Pollett SD, Fries AC, Berjohn CM, Maves RC, Lalani T, Smith AG, Mody RM, Ganesan A, Colombo RE, Lindholm DA, Morris MJ, Huprikar N, Colombo CJ, Madar C, Jones M, Larson DT, Bazan SE, Mende K, Saunders D, Livezey J, Lanteri CA, Scher AI, Byrne C, Rusiecki J, Ewers E, Epsi NJ, Rozman JS, English C, Simons MP, Tribble DR, Agan BK, Burgess TH. Persistent COVID-19 Symptoms at 6 Months After Onset and the Role of Vaccination Before or After SARS-CoV-2 Infection. JAMA Netw Open 2023; 6:e2251360. [PMID: 36652247 PMCID: PMC9857077 DOI: 10.1001/jamanetworkopen.2022.51360] [Citation(s) in RCA: 24] [Impact Index Per Article: 24.0] [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: 01/19/2023] Open
Abstract
IMPORTANCE Understanding the factors associated with post-COVID conditions is important for prevention. OBJECTIVE To identify characteristics associated with persistent post-COVID-19 symptoms and to describe post-COVID-19 medical encounters. DESIGN, SETTING, AND PARTICIPANTS This cohort study used data from the Epidemiology, Immunology, and Clinical Characteristics of Emerging Infectious Diseases With Pandemic Potential (EPICC) study implemented in the US military health system (MHS); MHS beneficiaries aged 18 years or older who tested positive for SARS-CoV-2 from February 28, 2020, through December 31, 2021, were analyzed, with 1-year follow-up. EXPOSURES SARS-CoV-2 infection. MAIN OUTCOMES AND MEASURES The outcomes analyzed included survey-reported symptoms through 6 months after SARS-CoV-2 infection and International Statistical Classification of Diseases and Related Health Problems, Tenth Revision diagnosis categories reported in medical records 6 months following SARS-CoV-2 infection vs 3 months before infection. RESULTS More than half of the 1832 participants in these analyses were aged 18 to 44 years (1226 [66.9%]; mean [SD] age, 40.5 [13.7] years), were male (1118 [61.0%]), were unvaccinated at the time of their infection (1413 [77.1%]), and had no comorbidities (1290 [70.4%]). A total of 728 participants (39.7%) had illness that lasted 28 days or longer (28-89 days: 364 [19.9%]; ≥90 days: 364 [19.9%]). Participants who were unvaccinated prior to infection (risk ratio [RR], 1.39; 95% CI, 1.04-1.85), reported moderate (RR, 1.80; 95% CI, 1.47-2.22) or severe (RR, 2.25; 95% CI, 1.80-2.81) initial illnesses, had more hospitalized days (RR per each day of hospitalization, 1.02; 95% CI, 1.00-1.03), and had a Charlson Comorbidity Index score of 5 or greater (RR, 1.55; 95% CI, 1.01-2.37) were more likely to report 28 or more days of symptoms. Among unvaccinated participants, postinfection vaccination was associated with a 41% lower risk of reporting symptoms at 6 months (RR, 0.59; 95% CI, 0.40-0.89). Participants had higher risk of pulmonary (RR, 2.00; 95% CI, 1.40-2.84), diabetes (RR, 1.46; 95% CI, 1.00-2.13), neurological (RR, 1.29; 95% CI, 1.02-1.64), and mental health-related medical encounters (RR, 1.28; 95% CI, 1.01-1.62) at 6 months after symptom onset than at baseline (before SARS-CoV-2 infection). CONCLUSIONS AND RELEVANCE In this cohort study, more severe acute illness, a higher Charlson Comorbidity Index score, and being unvaccinated were associated with a higher risk of reporting COVID-19 symptoms lasting 28 days or more. Participants with COVID-19 were more likely to seek medical care for diabetes, pulmonary, neurological, and mental health-related illness for at least 6 months after onset compared with their pre-COVID baseline health care use patterns. These findings may inform the risk-benefit ratio of COVID-19 vaccination policy.
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Affiliation(s)
- Stephanie A. Richard
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc, Bethesda, Maryland
| | - Simon D. Pollett
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc, Bethesda, Maryland
| | | | - Catherine M. Berjohn
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland
- Naval Medical Center San Diego, San Diego, California
- Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Ryan C. Maves
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland
- Naval Medical Center San Diego, San Diego, California
| | - Tahaniyat Lalani
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc, Bethesda, Maryland
- Naval Medical Center Portsmouth, Portsmouth, Virginia
| | | | - Rupal M. Mody
- William Beaumont Army Medical Center, Fort Bliss, Texas
| | - Anuradha Ganesan
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc, Bethesda, Maryland
- Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Rhonda E. Colombo
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc, Bethesda, Maryland
- Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland
- Madigan Army Medical Center, Joint Base Lewis-McChord, Washington
| | - David A. Lindholm
- Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland
- Brooke Army Medical Center, Joint Base San Antonio–Fort Sam Houston, Texas
| | - Michael J. Morris
- Brooke Army Medical Center, Joint Base San Antonio–Fort Sam Houston, Texas
| | - Nikhil Huprikar
- Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland
- Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Christopher J. Colombo
- Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland
- Madigan Army Medical Center, Joint Base Lewis-McChord, Washington
| | | | - Milissa Jones
- Tripler Army Medical Center, Honolulu, Hawaii
- Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Derek T. Larson
- Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland
- Fort Belvoir Community Hospital, Fort Belvoir, Virginia
| | | | - Katrin Mende
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc, Bethesda, Maryland
- Brooke Army Medical Center, Joint Base San Antonio–Fort Sam Houston, Texas
| | - David Saunders
- Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Jeffrey Livezey
- Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Charlotte A. Lanteri
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | | | | | | | - Evan Ewers
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland
- Fort Belvoir Community Hospital, Fort Belvoir, Virginia
| | - Nusrat J. Epsi
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc, Bethesda, Maryland
| | - Julia S. Rozman
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc, Bethesda, Maryland
| | - Caroline English
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc, Bethesda, Maryland
| | - Mark P. Simons
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - David R. Tribble
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland
- Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Brian K. Agan
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc, Bethesda, Maryland
| | - Timothy H. Burgess
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland
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Richard SA, Berjohn CM, Collins L, Seshadri S, Spooner C, Campbell WR, Ganesan A, Fries AC, Hrncir D, Lalani T, Warkentien T, Markelz AE, Mende K, McClenathan B, Powers JH, Modi J, Schofield C, Williams A, Colombo RE, Burgess T. 273. Emergence of the SARS-CoV-2 Omicron Variant in the Pragmatic Assessment of Influenza Vaccine Effectiveness in the Department of Defense (PAIVED) Study. Open Forum Infect Dis 2022. [DOI: 10.1093/ofid/ofac492.351] [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
Novel SARS-CoV-2 (SCV2) variants may differ in epidemiology and clinical impact. PAIVED, a randomized trial comparing the efficacy of 3 different platforms of inactivated influenza vaccines in adult military health system beneficiaries, actively surveils participants for influenza-like illness (ILI), including COVID-19, and conducts targeted investigations among those who develop ILI. The current season (2021/22) offered an opportunity to assess symptomatology associated with emerging SCV2 variants in this prospective cohort.
Methods
Following receipt of influenza vaccine, PAIVED participants receive a weekly email or text message querying for ILI symptoms. Those who reported ILI completed a validated symptom diary (FLU-PRO Plus) daily for 7 days and collected a nasal swab. Nasal specimens underwent multiplex PCR testing, followed by SCV2 genome sequencing as applicable. PAIVED study participants from the 2021-22 influenza season who reported an ILI, had confirmed infection with SCV2 for which sequence data is available, and completed at least one FLU-PRO Plus survey were included in this analysis.
Results
To date, 293 participants (7% of active cohort; 22.5% reporting ILI) tested positive for SCV2; sequencing has identified 23 Delta and 200 Omicron variants (199 BA.1, 1 BA.2). Among the 212 participants with sequenced SCV2 and symptom data, 55% were male, 57% were white, and 85% were active-duty military (Table 1). Overall, peak symptom severity was classified as mild to moderate in 79.3% of cases, fever duration averaged 2.5±2.2 days, and there were activity limitations for a mean of 5.2±3.8 days. No differences in maximum symptom scores (total or by domain) were detected for participants infected with Omicron compared to Delta. Figure 1 depicts variation in mean symptom scores by day of ILI, grouped by variant. Table 1.Demographic characteristics of PAIVED study participants with Delta and Omicron SARS-CoV-2 variants during the 2021/22 season.Figure 1.Mean FLU-PRO Plus domain and total scores by days since identification of an influenza-like illness in participants with Omicron or Delta variants of SARS-CoV-2 in the 2021/22 season of PAIVED.
Conclusion
Omicron emerged as the predominant SCV2 variant causing ILI in our cohort this season, typically manifesting with mild symptoms. Further exploration of potential differences in ILI experience between SCV2 variants and other ILI causes, plus the impact and timing of vaccination, will add insight into the relative contribution of such factors on symptomatology.
Disclosures
John H. Powers, III, MD, Arrevus: Advisor/Consultant|Eicos: Advisor/Consultant|Evofem: Advisor/Consultant|Eyecheck: Advisor/Consultant|Gilead: Advisor/Consultant|GlaxoSmithKline: Advisor/Consultant|OPKO: Advisor/Consultant|Resolve: Advisor/Consultant|Romark: Advisor/Consultant|SpineBioPharma: Advisor/Consultant|UTIlity: Advisor/Consultant|Vir: Advisor/Consultant Jitendrakumar Modi, MD, GlaxoSmithKline: I am a paid speaker for GSK. I do not speak for their flu brand. Timothy Burgess, MD, MPH, AstraZeneca: The HJF, in support of the USU IDCRP, was funded to conduct or augment unrelated Phase III Mab and vaccine trials as part of US Govt. COVID19 response.
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Affiliation(s)
- Stephanie A Richard
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences , Bethesda, MD, USA, Bethesda, MD
| | - Catherine M Berjohn
- Naval Medical Center San Diego Division of Infectious Diseases, Infectious Disease Clinical Research Program , San Diego, CA
| | - Limone Collins
- Immunization Healthcare Division , Defense Health Agency, Bethesda, Maryland
| | - Srihari Seshadri
- Immunization Healthcare Division , Defense Health Agency, Bethesda, Maryland
| | - Christina Spooner
- Immunization Healthcare Division , Defense Health Agency, Bethesda, Maryland
| | | | - Anuradha Ganesan
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA, Walter Reed National Military Medical Center , Bethesda, Maryland
| | | | - David Hrncir
- Carl R. Darnall Army Medical Center/Wilford Hall Ambulatory Surgical Center , Fort Hood, Texas
| | | | | | | | - Katrin Mende
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences , Bethesda, MD, USA, Bethesda, MD
| | | | | | | | - Christina Schofield
- Madigan Army Medical Center Division of Infectious Diseases, Infectious Disease Clinical Research Program , Tacoma, Washington
| | - Alan Williams
- Uniformed Services University of the Health Sciences , Bethesda, Maryland
| | - Rhonda E Colombo
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA, The Henry M. Jackson Foundation for the Advancement of Military Medicine, Madigan Army Medical Center Division of Infectious Diseases , Tacoma, Washington
| | - Timothy Burgess
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences , Bethesda, MD, USA, Bethesda, MD
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Richard SA, Scher A, Rusiecki J, Byrne C, Berjohn CM, Fries AC, Lalani T, Smith AG, Mody R, Ganesan A, Huprikar N, Colombo RE, Colombo C, Lindholm DA, Mende K, Jones M, Larson D, Ewers EC, Bazan S, Lanteri C, Saunders D, Maves RC, Livezey J, Edwards MS, Rozman JS, Tribble DR, Agan B, Pollett S, Simons MP, Burgess T. 80. SARS-CoV-2 infection is associated with decreased reported physical fitness in a US military longitudinal cohort. Open Forum Infect Dis 2022. [PMCID: PMC9751972 DOI: 10.1093/ofid/ofac492.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background COVID-19 may have deleterious effects on the fitness of active duty US military service members. We seek to understand the long-term functional consequences of SARS-CoV-2 infection in this critical population, and in other military healthcare beneficiaries. Methods The Epidemiology, Immunology, and Clinical Characteristics of Emerging Infectious Diseases with Pandemic Potential (EPICC) study is a longitudinal cohort study to describe the outcomes of SARS-CoV-2 infection in US Military Health System beneficiaries. Subjects provided information about difficulties experienced with daily activities, exercise, and physical fitness performance via electronic surveys. Subjects completed surveys at enrollment and at 1, 3, 6, 9, and 12 months. Results 5,910 subjects completed survey fitness questions, 3,244 (55%) of whom tested SARS-CoV-2 positive at least once during the period of observation. Over 75% of subjects were young adults and over half were male (Table 1). 1,093 (34.3%) of SARS-CoV-2-positive subjects reported new or increased difficulty exercising compared to 393 (14.8%) SARS-CoV-2 negative subjects (p < 0.01) (Table 2). The most commonly reported symptoms related to problems with exercise and activities were dyspnea and fatigue. Among the active-duty members who answered the question about their service-mandated physical fitness test scores, 43.2% of SARS-CoV-2-positive participants reported that their scores had worsened in the study period, compared with 24.3% of SARS-CoV-2 negative participants. Among SARS-CoV-2-positive subjects, reports of difficulty exercising and performing daily activities were highest within one month of the first positive test, decreasing in prevalence among the cohort only slightly to 24% and 18%, respectively, at 12 months (Figure 1).
Conclusion A substantial proportion of military service-members in this cohort have reported impairment of their service-mandated physical fitness scores after COVID-19; this proportion is significantly higher than those who are SARS-CoV-2 negative and persists to 12 months in many; similar complaints were reported among non-active duty. Further objective evaluation of post-COVID fitness impairment in this population is warranted. Disclosures Ryan C. Maves, MD, AiCuris: Grant/Research Support|Sound Pharmaceuticals: Grant/Research Support|Trauma Insights, LLC: Advisor/Consultant Julia S. Rozman, n/a, Astra Zeneca: The HJF, in support of the USU IDCRP, was funded to conduct or augment unrelated Phase III Mab and vaccine trials as part of US Govt. COVID19 response David R. Tribble, DrPH, AstraZeneca: The HJF, in support of the USU IDCRP, was funded to conduct or augment unrelated Phase III Mab and vaccine trials as part of US Govt. COVID19 response Simon Pollett, MBBS, Astra Zeneca: The HJF, in support of the USU IDCRP, was funded to conduct or augment unrelated Phase III Mab and vaccine trials as part of US Govt. COVID19 response Mark P. Simons, PhD, AstraZeneca: The HJF, in support of the USU IDCRP, was funded to conduct or augment unrelated Phase III Mab and vaccine trials as part of US Govt. COVID19 response Timothy Burgess, MD, MPH, AstraZeneca: The HJF, in support of the USU IDCRP, was funded to conduct or augment unrelated Phase III Mab and vaccine trials as part of US Govt. COVID19 response.
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Affiliation(s)
- Stephanie A Richard
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA, Bethesda, MD
| | - Ann Scher
- Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Jennifer Rusiecki
- Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Celia Byrne
- Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Catherine M Berjohn
- Naval Medical Center San Diego Division of Infectious Diseases, Infectious Disease Clinical Research Program, San Diego, CA
| | | | | | - Alfred G Smith
- Division of Infectious Diseases, Naval Medical Center, Portsmouth, Virginia, USA, Portsmouth, Virginia
| | - Rupal Mody
- William Beaumont Army Medical Center, El Paso, Texas
| | - Anuradha Ganesan
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA, Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Nikhil Huprikar
- Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Rhonda E Colombo
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA, The Henry M. Jackson Foundation for the Advancement of Military Medicine, Madigan Army Medical Center Division of Infectious Diseases, Tacoma, Washington
| | | | | | - Katrin Mende
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA, Bethesda, MD
| | | | - Derek Larson
- Naval Medical Center San Diego, san diego, California
| | - Evan C Ewers
- Fort Belvoir Community Hospital, Fort Belvoir, Virginia
| | | | - Charlotte Lanteri
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - David Saunders
- Uniformed Services University of the Health Sciences, Bethesda, MD, USA, Bethesda, Maryland
| | - Ryan C Maves
- Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Jeffrey Livezey
- Uniformed Services University of the Health Sciences, Bethesda, MD, USA, Bethesda, Maryland
| | - Margaret Sanchez Edwards
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health SciencesHenry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland
| | - Julia S Rozman
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA, Bethesda, MD
| | - David R Tribble
- Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Brian Agan
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA, Bethesda, MD
| | - Simon Pollett
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA, Bethesda, MD
| | - Mark P Simons
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA, Bethesda, MD
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Liberg R, Schofield C, Richard SA, Collins L, Spooner C, Seshadri S, Ganesan A, Campbell WR, Hrncir D, Lalani T, Warkentien T, Mende K, Markelz AE, Berjohn CM, McClenathan B, Modi J, Williams A, Burgess T, Colombo RE. 2200. Impact of COVID-19 Pandemic on Influenza-like Illness (ILI) Experience among Healthcare Workers in Military Treatment Facilities. Open Forum Infect Dis 2022. [PMCID: PMC9752492 DOI: 10.1093/ofid/ofac492.1819] [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 Healthcare workers (HCWs) are at heightened risk of exposure to respiratory pathogens, and occupy an important epidemiologic position in the COVID-19 pandemic. PAIVED, a multicenter, multiservice study assessing influenza vaccine effectiveness in the Department of Defense over four consecutive influenza seasons (2018-22), provides an opportunity to describe influenza like illness (ILI) experience and assess the impact of SARS-CoV-2 in HCWs compared to non-HCWs. Methods PAIVED participants were randomized to receive either egg-based, cell-based, or recombinant-derived influenza vaccine and then surveyed weekly for ILI. At enrollment, participants provided key demographic data including whether they were HCWs with direct patient contact. ILI was defined a priori as 1) having cough or sore throat plus 2) feeling feverish/having chills or having body aches/fatigue. Participants with ILI completed a symptom diary for seven days and submitted a nasal swab for pathogen detection. Study recruitment was conducted from September-January over four consecutive years. Results Of 13188 eligible participants enrolled, 4819 (36%) were HCWs. Overall, HCWs were more likely to be female (43% vs 31%), active duty military (86% vs 69%), and to identify as white (61% vs 56%). HCWs more commonly reported ILI than non-HCWs (25% vs 21%, p< 0.01). Of those experiencing ILI, SARS-CoV-2 was identified in a higher proportion of HCWs than non-HCWs (17% vs 12%, p< 0.01). Influenza was isolated in similar proportion of HCWs and non-HCWs (5% vs 4%). Each group reported similar ILI duration and severity (p< 0.01). Conclusion In a prior analysis of the 2019-20 PAIVED season, HCWs were more likely than non-HCWs to report ILI, have shorter illness duration, and isolate influenza A (H1N1). The propensity for HCWs to report ILI persisted over the four years. While SARS-CoV-2 emerged as a major pathogen in both groups, HCWs were more likely to have it identified as a cause of ILI, suggesting increased risk of symptomatic SARS-CoV-2 in our HCW population. Influenza incidence was lower than that of SARS-COV-2, and did not differ between HCWs and non-HCWs. Mean duration of illness did not differ between groups over four years; this equalization may relate to the higher incidence of SARS-CoV-2 in HCWs. Disclosures Jitendrakumar Modi, MD, GlaxoSmithKline: I am a paid speaker for GSK. I do not speak for their flu brand. Timothy Burgess, MD, MPH, AstraZeneca: The HJF, in support of the USU IDCRP, was funded to conduct or augment unrelated Phase III Mab and vaccine trials as part of US Govt. COVID19 response.
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Affiliation(s)
- Ryan Liberg
- Madigan Army Medical Center, Joint Base Lewis-McChord, Washington
| | - Christina Schofield
- Madigan Army Medical Center Division of Infectious Diseases, Infectious Disease Clinical Research Program, Tacoma, Washington
| | - Stephanie A Richard
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA, Bethesda, MD
| | - Limone Collins
- Immunization Healthcare Division, Defense Health Agency, Bethesda, Maryland
| | - Christina Spooner
- Immunization Healthcare Division, Defense Health Agency, Bethesda, Maryland
| | - Srihari Seshadri
- Immunization Healthcare Division, Defense Health Agency, Bethesda, Maryland
| | - Anuradha Ganesan
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA, Walter Reed National Military Medical Center, Bethesda, Maryland
| | | | - David Hrncir
- Carl R. Darnall Army Medical Center/Wilford Hall Ambulatory Surgical Center, Fort Hood, Texas
| | | | | | - Katrin Mende
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA, Bethesda, MD
| | | | - Catherine M Berjohn
- Naval Medical Center San Diego Division of Infectious Diseases, Infectious Disease Clinical Research Program, San Diego, CA
| | | | | | - Alan Williams
- Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Timothy Burgess
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA, Bethesda, MD
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Pollett S, Richard SA, Fries AC, Malloy AM, Ganesan A, Livezey J, Saunders D, Huprikar N, Mody R, Mende K, Lindholm DA, Berjohn CM, Rozman JS, Jones M, Colombo C, Colombo RE, Tribble D, Simons MP, Agan B, Burgess T. 1056. Correlates of Omicron SARS-CoV-2 viral load: diagnostic and clinical implications. Open Forum Infect Dis 2022. [PMCID: PMC9752607 DOI: 10.1093/ofid/ofac492.897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background Omicron SARS-CoV-2 infections are associated with less frequent olfactory sensory loss and a predominance of pharyngitis symptoms compared to prior variants, with proposed diagnostic implications. We examined whether such symptomology predicts a higher RNA abundance in the oropharynx. We further investigated how age, symptom-day, vaccination history and clinical severity correlate with viral load to inform clinical prognostication and transmission modeling. Methods The EPICC study is a longitudinal cohort of COVID-19 cases enrolled through U.S military medical treatment facilities. Demographic and clinical characteristics were measured with interviews and surveys. Nasopharyngeal (NP), oropharyngeal (OP) and nasal swabs (NS) were collected for SARS-CoV-2 qPCR and sequence genotyping. Multivariable linear regression models were fit to estimate the effect of anatomical site on SARS-CoV-2 RNA abundance (a proxy for viral load), adjusting for sampling time, vaccine history and host age. Results We analyzed 77 sequence-confirmed Omicron cases; no BA.2 cases were detected. The median age was 38.8 years. 81.8% were vaccinated and 15.6% cases were hospitalized. 80.0%, 21.8%, and 65.5% reported nasal congestion, loss of smell or taste, and sore throat, respectively. The median RNA abundance was lowest in OP swabs (p < 0.001) (Fig 1). Linear regression confirmed that OP sampling was associated with lower viral load (p < 0.001). We further noted that greater age and symptom-day were independent correlates of viral load (Table 1). By bivariate analysis there was a trend toward lower RNA abundance in vaccinated subjects (p = 0.35). RNA abundance (at any site) was substantially higher in hospitalized (10634 N2 genome equivalents [GE]/reaction) versus outpatient cases (1419 N1 GE/reaction) but this was not statistically significant (p = 0.26).
RNA abundance by upper respiratory swab anatomical location of collection (n = 142 swabs from n = 77 subjects) ![]() ![]() Conclusion We noted prevalent sore throat symptoms and infrequent sensory loss in Omicron cases. Despite this, viral load was highest in NP/NS collected swabs as has been noted in prior variants. We note an age correlation with RNA abundance, and provide a viral load decay rate which may be useful for transmission modeling. Vaccination and clinical severity may also correlate with Omicron viral load, as noted with prior SARS-CoV-2 variants. Disclosures Simon Pollett, MBBS, Astra Zeneca: The HJF, in support of the USU IDCRP, was funded to conduct or augment unrelated Phase III Mab and vaccine trials as part of US Govt. COVID19 response Julia S. Rozman, n/a, Astra Zeneca: The HJF, in support of the USU IDCRP, was funded to conduct or augment unrelated Phase III Mab and vaccine trials as part of US Govt. COVID19 response David Tribble, MD, DrPH, Astra Zeneca: The HJF, in support of the USU IDCRP, was funded to conduct or augment unrelated Phase III Mab and vaccine trials as part of US Govt. COVID19 response Mark P. Simons, PhD, AstraZeneca: The HJF, in support of the USU IDCRP, was funded to conduct or augment unrelated Phase III Mab and vaccine trials as part of US Govt. COVID19 response Timothy Burgess, MD, MPH, AstraZeneca: The HJF, in support of the USU IDCRP, was funded to conduct or augment unrelated Phase III Mab and vaccine trials as part of US Govt. COVID19 response.
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Affiliation(s)
- Simon Pollett
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA, Bethesda, Maryland
| | - Stephanie A Richard
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA, Bethesda, Maryland
| | | | - Allison M Malloy
- Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA, Bethesda, Maryland
| | - Anuradha Ganesan
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA, Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Jeffrey Livezey
- Uniformed Services University of the Health Sciences, Bethesda, MD, USA, Bethesda, Maryland
| | - David Saunders
- Uniformed Services University of the Health Sciences, Bethesda, MD, USA, Bethesda, Maryland
| | - Nikhil Huprikar
- Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Rupal Mody
- William Beaumont Army Medical Center, El Paso, Texas
| | - Katrin Mende
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA, Bethesda, Maryland
| | | | - Catherine M Berjohn
- Naval Medical Center San Diego Division of Infectious Diseases, Infectious Disease Clinical Research Program, San Diego, CA
| | - Julia S Rozman
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA, Bethesda, Maryland
| | | | | | - Rhonda E Colombo
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA, The Henry M. Jackson Foundation for the Advancement of Military Medicine, Madigan Army Medical Center Division of Infectious Diseases, Tacoma, Washington
| | - David Tribble
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA, Bethesda, Maryland
| | - Mark P Simons
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA, Bethesda, Maryland
| | - Brian Agan
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA, Bethesda, Maryland
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10
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Andronescu LR, Richard SA, Laing ED, Saperstein AK, Modi J, Heaney CD, Fraser JA, Shaikh S, Broder CC, Burgess TH, Pollett S, Millar EV, Coles CL, Simons MP. 1884. Evaluating SARS-CoV-2 Surveillance Strategies at the United States Naval Academy: A Comparison of Saliva and Dried Blood Spot Serosurveillance Against Molecular-Confirmed Case Detection. Open Forum Infect Dis 2022. [PMCID: PMC9752499 DOI: 10.1093/ofid/ofac492.1511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background Congregate military populations remain at risk of SARS-CoV-2 outbreaks and the optimal surveillance approach in such settings remains unclear. We enrolled midshipmen at the United States Naval Academy (USNA) in a setting of frequent PCR screening use of prevention strategies. Methods Dried blood spots (DBS) and saliva were collected in August 2020, December 2020, February 2021 (saliva only) and April/May 2021 to measure anti-SARS-CoV-2 spike (S) and nucleoprotein (NP) IgG. COVID-19 vaccine history and records of SARS-CoV-2 PCR tests and routine asymptomatic screening assays were obtained from the USNA Brigade Medical Clinic. Attack rates were compared with cumulative frequencies of infections. Concordance of saliva and DBS anti-NP and anti-S IgG positivity was determined using Cohen’s kappa coefficient. Results The study enrolled 181 midshipmen. COVID-19 vaccinations were administered in March/April 2021. Samples were collected for 101 participants in August, 73 in December, 57 in February (saliva only), and 63 in April/May. In August, 17 (17%) participants showed evidence of SARS-CoV-2 infection based on anti-S IgG values from DBS and/or saliva. By December 2020, anti-S seroconversion was observed for 5 more based on DBS and/or saliva. By May 2021, 100% of participants were anti-S IgG seropositive after vaccination based on DBS and/or saliva; 48% of participants had seroconverted to anti-NP IgG. Among participants with both DBS and saliva samples, a coefficient of 0.64 showed substantial agreement between anti-S IgG results in August and perfect agreement in December (Table 1). DBS and saliva results for anti-NP IgG were in perfect agreement through December and in substantial agreement in May (0.68, Table 2). Prior to vaccination in March/April 2021, 4/48 of participants had at least one documented SARS-CoV-2 PCR positive result (Table 3). Cumulative PCR test positivity concordance with DBS seroconversion was 37.5% and 60% for anti-S IgG and anti-NP IgG, respectively.
![]() ![]() ![]() Conclusion There was a substantive SARS-CoV-2 attack rate before vaccination; all vaccinees mounted an anti-S IgG response in blood. We note high agreement between DBS and saliva for IgG measurement. Serology-based surveillance identified substantially more SARS-CoV-2 infections than PCR screening.
![]() Disclosures Jitendrakumar Modi, MD, GlaxoSmithKline: I am a paid speaker for GSK. I do not speak for their flu brand. Timothy H. Burgess, MD, MPH, AstraZeneca: The HJF, in support of the USU IDCRP, was funded to conduct or augment unrelated Phase III Mab and vaccine trials as part of US Govt. COVID19 response Simon Pollett, MBBS, Astra Zeneca: The HJF, in support of the USU IDCRP, was funded to conduct or augment unrelated Phase III Mab and vaccine trials as part of US Govt. COVID19 response Mark P. Simons, PhD, AstraZeneca: The HJF, in support of the USU IDCRP, was funded to conduct or augment unrelated Phase III Mab and vaccine trials as part of US Govt. COVID19 response.
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Affiliation(s)
- Liana R Andronescu
- Henry M. Jackson Foundation for the Advancement of Military Medicine Inc., in support of the Infectious Disease Clinical Research Program, Silver Spring, Maryland
| | - Stephanie A Richard
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA, Bethesda, MD
| | - Eric D Laing
- Department of Microbiology and Immunology, Uniformed Services University, Bethesda, MD, Bethesda, Maryland
| | - Adam K Saperstein
- Department of Family Medicine, Uniformed Services University, Bethesda, MD, Annapolis, Maryland
| | | | - Christopher D Heaney
- Department of Environmental Health and Engineering, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Jamie A Fraser
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA, Bethesda, MD
| | - Saira Shaikh
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA, Bethesda, MD
| | - Christopher C Broder
- Department of Microbiology and Immunology, Uniformed Services University, Bethesda, MD, Bethesda, Maryland
| | - Timothy H Burgess
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University, Bethesda, MD, Bethesda, Maryland
| | - Simon Pollett
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA, Bethesda, MD
| | - Eugene V Millar
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University, Bethesda, MD, Bethesda, Maryland
| | - Christian L Coles
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA, Bethesda, MD
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11
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Epsi NJ, Lindholm DA, Ganesan A, Lalani T, Smith AG, Mody R, Jones M, Bazan S, Colombo RE, Colombo C, Ewers EC, Larson D, Berjohn CM, Maves RC, Fries AC, Scher A, Byrne C, Rusiecki J, Sanchez Edwards M, Rozman JS, Mende K, Simons MP, Tribble DR, Agan B, Burgess T, Pollett S, Richard SA. 1066. Precision phenotyping of “long COVID” through machine learning. Open Forum Infect Dis 2022. [DOI: 10.1093/ofid/ofac492.907] [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
Characterizing, diagnosing, and caring for “long COVID” patients has proven to be challenging due to heterogenous symptoms and broad definitions of these post-acute sequelae. Here, we take a machine learning approach to identify discrete clusters of long COVID symptoms which may define specific long COVID phenotypes.
Figure 1: (A) Principal component analysis followed by K-means clustering identified three groups of participants. (B) Heatmap depicting three distinct clusters (high values are in red and low value are in blue); Cluster 1 exhibits sensory symptoms (e.g., loss of smell and/or taste), Cluster 2 exhibits fatigue and difficulty thinking (e.g., changes in ability to think) symptoms, and Cluster 3 exhibits difficulty breathing and exercise intolerance symptoms. (C) Clinical and demographic characteristics of 97 military health system beneficiaries by identified clusters
Methods
The Epidemiology, Immunology, and Clinical Characteristics of Emerging Infectious Diseases with Pandemic Potential (EPICC) study is a longitudinal COVID-19 cohort study with data and biospecimens collected from 10 military treatment facilities and online recruitment. Demographic and clinical characteristics were collected using case report forms and surveys completed at enrollment and at 1, 3, 6, 9, and 12 months. For this analysis, we identified those who reported any moderate to severe persistent symptoms on surveys collected 6-months post-COVID-19 symptom onset. Using the survey responses, we applied principal component analysis (PCA) followed by unsupervised machine learning clustering algorithm K-means to identify groups with distinct clusters of symptoms.
Results
Of 1299 subjects with 6-month survey responses, 97 (7.47%) reported moderate to severe persistent symptoms. Among these subjects, three clusters were identified using PCA (Figure 1A). Cluster 1 is characterized by sensory symptoms (loss of taste and/or smell), Cluster 2 by fatigue and difficulty thinking, and Cluster 3 by difficulty breathing and exercise intolerance (Figure 1B). More than half of these subjects (57%) were female, 64% were 18-44 years old, and 64% had no comorbidities at enrollment (Figure 1C). Those in the sensory symptom cluster were all outpatients at the time of initial COVID-19 presentation (p < 0.01). The difficulty breathing and exercise intolerance symptom-clusters had a higher proportion of older participants (Age group ≥ 45-64) with more comorbidities (CCI ≥ 1-2).
Conclusion
We identified three distinct ‘long COVID’ phenotypes among those with moderate to severe COVID-19 symptoms at 6-months post-symptom onset. With further validation and characterization, this framework may allow more precise classification of long COVID cases, and potentially improve the diagnosis, prognosis, and treatment of post- infectious sequelae.
Disclosures
Ryan C. Maves, MD, AiCuris: Grant/Research Support|Sound Pharmaceuticals: Grant/Research Support|Trauma Insights, LLC: Advisor/Consultant Julia S. Rozman, n/a, Astra Zeneca: The HJF, in support of the USU IDCRP, was funded to conduct or augment unrelated Phase III Mab and vaccine trials as part of US Govt. COVID19 response Mark P. Simons, PhD, AstraZeneca: The HJF, in support of the USU IDCRP, was funded to conduct or augment unrelated Phase III Mab and vaccine trials as part of US Govt. COVID19 response David R. Tribble, DrPH, AstraZeneca: The HJF, in support of the USU IDCRP, was funded to conduct or augment unrelated Phase III Mab and vaccine trials as part of US Govt. COVID19 response Timothy Burgess, MD, MPH, AstraZeneca: The HJF, in support of the USU IDCRP, was funded to conduct or augment unrelated Phase III Mab and vaccine trials as part of US Govt. COVID19 response Simon Pollett, MBBS, Astra Zeneca: The HJF, in support of the USU IDCRP, was funded to conduct or augment unrelated Phase III Mab and vaccine trials as part of US Govt. COVID19 response.
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Affiliation(s)
- Nusrat J Epsi
- Uniformed Services University of the Health Sciences , Bethesda, Maryland
| | | | - Anuradha Ganesan
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA, Walter Reed National Military Medical Center , Bethesda, Maryland
| | | | - Alfred G Smith
- Division of Infectious Diseases, Naval Medical Center , Portsmouth, Virginia, USA, Portsmouth, Virginia
| | - Rupal Mody
- William Beaumont Army Medical Center , El Paso, Texas
| | | | | | - Rhonda E Colombo
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA, The Henry M. Jackson Foundation for the Advancement of Military Medicine, Madigan Army Medical Center Division of Infectious Diseases , Tacoma, Washington
| | | | - Evan C Ewers
- Fort Belvoir Community Hospital , Fort Belvoir, Virginia
| | - Derek Larson
- Naval Medical Center San Diego , san diego, California
| | - Catherine M Berjohn
- Naval Medical Center San Diego Division of Infectious Diseases, Infectious Disease Clinical Research Program , San Diego, CA
| | - Ryan C Maves
- Wake Forest University School of Medicine , Winston-Salem, North Carolina
| | | | - Ann Scher
- Uniformed Services University of the Health Sciences , Bethesda, Maryland
| | - Celia Byrne
- Uniformed Services University of the Health Sciences , Bethesda, Maryland
| | - Jennifer Rusiecki
- Uniformed Services University of the Health Sciences , Bethesda, Maryland
| | - Margaret Sanchez Edwards
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health SciencesHenry M. Jackson Foundation for the Advancement of Military Medicine , Bethesda, Maryland
| | - Julia S Rozman
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences , Bethesda, MD, USA, Bethesda, Maryland
| | - Katrin Mende
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences , Bethesda, MD, USA, Bethesda, Maryland
| | - Mark P Simons
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences , Bethesda, MD, USA, Bethesda, Maryland
| | - David R Tribble
- Uniformed Services University of the Health Sciences , Bethesda, Maryland
| | - Brian Agan
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences , Bethesda, MD, USA, Bethesda, Maryland
| | - Timothy Burgess
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences , Bethesda, MD, USA, Bethesda, Maryland
| | - Simon Pollett
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences , Bethesda, MD, USA, Bethesda, Maryland
| | - Stephanie A Richard
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences , Bethesda, MD, USA, Bethesda, Maryland
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12
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Burgess T, Richard SA, Collins L, Spooner C, Seshadri S, Schofield C, Ganesan A, Campbell WR, Hrncir D, Lalani T, Warkentien T, Mende K, Markelz AE, Berjohn CM, McClenathan B, Modi J, Williams A, Colombo RE. 2206. Pragmatic Assessment of Influenza Vaccine Effectiveness in the Department of Defense (PAIVED): Updates from Year 4 of a Multi-site Trial. Open Forum Infect Dis 2022. [PMCID: PMC9752512 DOI: 10.1093/ofid/ofac492.1825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background The effectiveness of the influenza vaccine is varies with circulating strain concordance and timing of influenza spread in a community. The Pragmatic Assessment of Influenza Vaccine Effectiveness in the DoD (PAIVED) study is a multi-year, randomized clinical trial of three FDA-licensed vaccine types (egg-based, cell-based, and recombinant), designed to determine which influenza vaccine platform is most effective among adults in a military setting.
PAIVED summary flow chart ![]() Methods Participants in the fourth year of PAIVED (2021-22 influenza season) were enrolled from September 2021 through January 2022 at 9 military facilities. Participants were asked each week about influenza-like illness (ILI) symptoms. If the participants reported ILI symptoms, research staff scheduled an acute and convalescent ILI visit. Additional details about the study are included in Figure 1. Results In year 4, 4,688 participants were enrolled, among whom 63.8% were male, 56.5% were white, and the average age was 34 years (Tables 1 and 2). As of early April, 1,297 ILIs had been reported. Most participants reported a single ILI (987 (87%)), while 140 participants reported two ILIs and 10 reported three ILIs. The mean duration of the reported ILIs was 11 days, with a mean 5 days of limited activity. Three participants were hospitalized. Among the samples processed to date, influenza has been identified in four participants. The most common pathogens in year 4 were SARS-CoV-2 and rhino/enterovirus (Figure 2). During all four years of PAIVED, we enrolled 15,449 participants, among whom 188 episodes of influenza have been identified so far (1.2%).
PAIVED summary over four seasons ![]() Demographic characteristics of PAIVED participants during four seasons ![]() Pathogens identified in ILI swabs collected in PAIVED (2021/22 season still in progress) ![]() Conclusion The fourth year of PAIVED was characterized by early (pre-enrollment) spread of influenza in some areas, as well the nationwide spread of the SARS-CoV-2 Omicron variant in December. As the swabs are processed and participants’ military health records are reviewed, we expect to identify more influenza cases; however, transmission patterns were far lower than historical averages due to pandemic precautions, making this surveillance data from identified strains more valuable. Comparative influenza vaccine effectiveness calculations will be performed to inform future vaccine purchasing decisions and we will compare serological response to the different vaccines. ![]()
Disclosures Timothy Burgess, MD, MPH, AstraZeneca: The HJF, in support of the USU IDCRP, was funded to conduct or augment unrelated Phase III Mab and vaccine trials as part of US Govt. COVID19 response Jitendrakumar Modi, MD, GlaxoSmithKline: I am a paid speaker for GSK. I do not speak for their flu brand.
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Affiliation(s)
- Timothy Burgess
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA, Bethesda, Maryland
| | - Stephanie A Richard
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA, Bethesda, Maryland
| | - Limone Collins
- Immunization Healthcare Division, Defense Health Agency, Bethesda, Maryland
| | - Christina Spooner
- Immunization Healthcare Division, Defense Health Agency, Bethesda, Maryland
| | - Srihari Seshadri
- Immunization Healthcare Division, Defense Health Agency, Bethesda, Maryland
| | - Christina Schofield
- Madigan Army Medical Center Division of Infectious Diseases, Infectious Disease Clinical Research Program, Tacoma, Washington
| | - Anuradha Ganesan
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA, Walter Reed National Military Medical Center, Bethesda, Maryland
| | | | - David Hrncir
- Carl R. Darnall Army Medical Center/Wilford Hall Ambulatory Surgical Center, Fort Hood, Texas
| | | | | | - Katrin Mende
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA, Bethesda, Maryland
| | | | - Catherine M Berjohn
- Naval Medical Center San Diego Division of Infectious Diseases, Infectious Disease Clinical Research Program, San Diego, CA
| | | | | | - Alan Williams
- Uniformed Services University of the Health Sciences, Bethesda, Maryland
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Parsons E, Richard SA, Laing ED, Fries AC, Livezey J, Jones M, Lindholm DA, Mende K, Rozman JS, Ganesan A, Huprikar N, Lalani T, Smith AG, Mody R, Bazan S, Saunders D, Colombo RE, Colombo C, Ewers EC, Larson D, Maves RC, Berjohn CM, Maldonado C, Simons MP, Tribble D, Agan B, Burgess T, Pollett S, Malloy AM. 1102. The Host Response to SARS-CoV-2 Infection Differs by Age. Open Forum Infect Dis 2022. [DOI: 10.1093/ofid/ofac492.941] [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
Infection with SARS-CoV-2 and the resulting host immune response has been primarily characterized in middle and older aged populations due to a higher incidence of symptoms in these age groups. Due to reduced severity of disease, children were poorly studied and assumed to be less frequently infected compared to older age groups. We measured the viral load and adaptive immune response across the age-spectrum to define the age-dependent viral and host responses.
Methods
From March 2020-March 2022, we enrolled individuals across the age spectrum who presented to U.S. military medical treatment facilities with COVID-19-like symptoms. In this longitudinal cohort study, demographic and clinical data were collected in addition to nasopharyngeal swabs and peripheral blood. Magnitude of viral RNA was measured by quantitative PCR (qPCR) from nasopharyngeal samples and SARS-CoV-2-specific IgG antibodies were measured from blood with multiplex microsphere immunoassays.
Results
4,768 SARS-CoV-2 positive participants were enrolled, among whom 42, 64, 89, 380, 948 and 245 individuals were in age brackets 0-4y, 5-11y, 12-17y, 18-44, 45-64y, and >65y, respectively. Viral load as measured by qPCR was determined to be similar across age groups within the first week post symptom onset. The magnitude of the IgG antibody response against the spike protein was also compared across age groups at early and convalescent time points and was higher in those over the age of 65 years.
Conclusion
Early viral load during acute infection did not correlate with age in individuals who experienced COVID-19. These findings diverge from other respiratory viruses, such as respiratory syncytial virus and influenza where children tend to have higher viral loads. In contrast, the magnitude of the antibody response against the spike protein correlated with older age at acute and convalescent time points. Together our data suggest that the host response against SAR-CoV-2 differs with age and is not associated with the acute viral load. Defining age-dependent immunity against SARS-CoV-2 has the potential to identify key immunologic responses that can be used to optimize treatment and vaccine strategies.
Disclosures
Julia S. Rozman, n/a, Astra Zeneca: The HJF, in support of the USU IDCRP, was funded to conduct or augment unrelated Phase III Mab and vaccine trials as part of US Govt. COVID19 response Ryan C. Maves, MD, AiCuris: Grant/Research Support|Sound Pharmaceuticals: Grant/Research Support|Trauma Insights, LLC: Advisor/Consultant Mark P. Simons, PhD, AstraZeneca: The HJF, in support of the USU IDCRP, was funded to conduct or augment unrelated Phase III Mab and vaccine trials as part of US Govt. COVID19 response David Tribble, MD, DrPH, Astra Zeneca: The HJF, in support of the USU IDCRP, was funded to conduct or augment unrelated Phase III Mab and vaccine trials as part of US Govt. COVID19 response Timothy Burgess, MD, MPH, AstraZeneca: The HJF, in support of the USU IDCRP, was funded to conduct or augment unrelated Phase III Mab and vaccine trials as part of US Govt. COVID19 response Simon Pollett, MBBS, Astra Zeneca: The HJF, in support of the USU IDCRP, was funded to conduct or augment unrelated Phase III Mab and vaccine trials as part of US Govt. COVID19 response.
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Affiliation(s)
| | - Stephanie A Richard
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences , Bethesda, MD, USA, Bethesda, MD
| | - Eric D Laing
- Department of Microbiology and Immunology, Uniformed Services University , Bethesda, MD, Bethesda, Maryland
| | | | - Jeffrey Livezey
- Uniformed Services University of the Health Sciences , Bethesda, MD, USA, Bethesda, Maryland
| | | | - David A Lindholm
- Uniformed Services University of the Health Sciences , San Antonio, Texas
| | - Katrin Mende
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences , Bethesda, MD, USA, Bethesda, MD
| | - Julia S Rozman
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences , Bethesda, MD, USA, Bethesda, MD
| | - Anuradha Ganesan
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA, Walter Reed National Military Medical Center , Bethesda, Maryland
| | - Nikhil Huprikar
- Walter Reed National Military Medical Center , Bethesda, Maryland
| | | | - Alfred G Smith
- Division of Infectious Diseases, Naval Medical Center , Portsmouth, Virginia, USA, Portsmouth, Virginia
| | - Rupal Mody
- William Beaumont Army Medical Center , El Paso, Texas
| | | | - David Saunders
- Uniformed Services University of the Health Sciences , Bethesda, MD, USA, Bethesda, Maryland
| | - Rhonda E Colombo
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA, The Henry M. Jackson Foundation for the Advancement of Military Medicine, Madigan Army Medical Center Division of Infectious Diseases , Tacoma, Washington
| | | | - Evan C Ewers
- Fort Belvoir Community Hospital , Fort Belvoir, Virginia
| | - Derek Larson
- Naval Medical Center San Diego , san diego, California
| | - Ryan C Maves
- Wake Forest University School of Medicine , Winston-Salem, North Carolina
| | - Catherine M Berjohn
- Naval Medical Center San Diego Division of Infectious Diseases, Infectious Disease Clinical Research Program , San Diego, CA
| | | | - Mark P Simons
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences , Bethesda, MD, USA, Bethesda, MD
| | - David Tribble
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences , Bethesda, MD, USA, Bethesda, MD
| | - Brian Agan
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences , Bethesda, MD, USA, Bethesda, MD
| | - Timothy Burgess
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences , Bethesda, MD, USA, Bethesda, MD
| | - Simon Pollett
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences , Bethesda, MD, USA, Bethesda, MD
| | - Allison M Malloy
- Department of Pediatrics, Uniformed Services University of the Health Sciences , Bethesda, MD, USA, Bethesda, Maryland
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Richard SA, Schofield C, Collins L, Spooner C, Seshadri S, Ganesan A, Campbell WR, Hrncir D, Lalani T, Warkentien T, Mende K, Markelz AE, Berjohn CM, McClenathan B, Modi J, Williams A, Burgess T, Colombo RE. 2204. Pathogen Co-infections and Trends in Influenza-like Illness in PAIVED. Open Forum Infect Dis 2022. [PMCID: PMC9752986 DOI: 10.1093/ofid/ofac492.1823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background The Pragmatic Assessment of Influenza Vaccine Effectiveness in the Department of Defense (DoD) (PAIVED) is a multicenter, multiservice study assessing influenza vaccine effectiveness in active-duty service members, retirees, and dependents. In its fourth season (2021/22), PAIVED offers a unique opportunity to examine influenza-like illness (ILI) trends prior to and during the COVID-19 pandemic in a prospectively followed, well-defined cohort. Methods Over the past 4 influenza seasons, PAIVED has enrolled DoD beneficiaries who were randomized to receive egg-based, cell-based, or recombinant-derived influenza vaccine. Participants provided some basic demographic information and were then sent a weekly text or email that inquired about ILI symptoms, defined as 1) having cough or sore throat, plus 2) feeling feverish/having chills or having body aches/fatigue. Participants with ILI completed a daily symptom diary for one week and submitted a nasal swab for PCR-based pathogen detection.
Demographic characteristics of PAIVED participants over four seasons ![]() Percent of PAIVED participants with influenza-like illness, SARS-CoV-2, influenza, and rhinovirus identified in swab samples collected over four seasons. ![]() Results Over the 4 seasons, 15,449 participants were followed for ILI (Table 1) with 3,407 participants reporting a total of 3,985 ILIs. For the 2021/22 season, ILI reports peaked in January (Figure 1). Overall, 4.7% of episodes had more than one pathogen identified (Table 2). Among the 122 coinfections identified to date, most were coinfections with rhinoviruses (91/122, 75%), including rhinovirus coinfections with seasonal coronaviruses (29, 24%), metapneumovirus (18, 15%), SARS-CoV-2 (17, 14%), and influenza (14, 11%). SARS-CoV-2 and influenza were found together in one sample. The lab data will continue to be processed for the current season (2021/22).
Pathogens identified in PAIVED nasal swabs over four seasons ![]() Conclusion ILI rates were lowest during the third year (2020/21), consistent with national influenza surveillance reports of influenza and outpatient ILI activity, suggesting that measures taken to reduce transmission of SARS-CoV-2 reduced the spread of other respiratory viruses. The emergence of the SARS-CoV-2 omicron variant in December 2021 was associated with higher ILI rates. Among those individuals for whom a sample was collected, coinfections were highest in 2018/19. Data collection and specimen analysis are ongoing for 2021/22. Disclosures Jitendrakumar Modi, MD, GlaxoSmithKline: I am a paid speaker for GSK. I do not speak for their flu brand. Timothy Burgess, MD, MPH, AstraZeneca: The HJF, in support of the USU IDCRP, was funded to conduct or augment unrelated Phase III Mab and vaccine trials as part of US Govt. COVID19 response.
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Affiliation(s)
- Stephanie A Richard
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA, Bethesda, MD
| | - Christina Schofield
- Madigan Army Medical Center Division of Infectious Diseases, Infectious Disease Clinical Research Program, Tacoma, Washington
| | - Limone Collins
- Immunization Healthcare Division, Defense Health Agency, Bethesda, Maryland
| | - Christina Spooner
- Immunization Healthcare Division, Defense Health Agency, Bethesda, Maryland
| | - Srihari Seshadri
- Immunization Healthcare Division, Defense Health Agency, Bethesda, Maryland
| | - Anuradha Ganesan
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA, Walter Reed National Military Medical Center, Bethesda, Maryland
| | | | - David Hrncir
- Carl R. Darnall Army Medical Center/Wilford Hall Ambulatory Surgical Center, Fort Hood, Texas
| | | | | | - Katrin Mende
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA, Bethesda, MD
| | | | - Catherine M Berjohn
- Naval Medical Center San Diego Division of Infectious Diseases, Infectious Disease Clinical Research Program, San Diego, CA
| | | | | | - Alan Williams
- Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Timothy Burgess
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA, Bethesda, MD
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15
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Wang W, Lusvarghi S, Subramanian R, Epsi NJ, Wang R, Goguet E, Fries AC, Echegaray F, Vassell R, Coggins SA, Richard SA, Lindholm DA, Mende K, Ewers EC, Larson DT, Colombo RE, Colombo CJ, Joseph JO, Rozman JS, Smith A, Lalani T, Berjohn CM, Maves RC, Jones MU, Mody R, Huprikar N, Livezey J, Saunders D, Hollis-Perry M, Wang G, Ganesan A, Simons MP, Broder CC, Tribble DR, Laing ED, Agan BK, Burgess TH, Mitre E, Pollett SD, Katzelnick LC, Weiss CD. Antigenic cartography of well-characterized human sera shows SARS-CoV-2 neutralization differences based on infection and vaccination history. Cell Host Microbe 2022; 30:1745-1758.e7. [PMID: 36356586 PMCID: PMC9584854 DOI: 10.1016/j.chom.2022.10.012] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [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: 07/03/2022] [Revised: 08/31/2022] [Accepted: 10/18/2022] [Indexed: 01/26/2023]
Abstract
The rapid emergence of SARS-CoV-2 variants challenges vaccination strategies. Here, we collected 201 serum samples from persons with a single infection or multiple vaccine exposures, or both. We measured their neutralization titers against 15 natural variants and 7 variants with engineered spike mutations and analyzed antigenic diversity. Antigenic maps of primary infection sera showed that Omicron sublineages BA.2, BA.4/BA.5, and BA.2.12.1 are distinct from BA.1 and more similar to Beta/Gamma/Mu variants. Three mRNA COVID-19 vaccinations increased neutralization of BA.1 more than BA.4/BA.5 or BA.2.12.1. BA.1 post-vaccination infection elicited higher neutralization titers to all variants than three vaccinations alone, although with less neutralization to BA.2.12.1 and BA.4/BA.5. Those with BA.1 infection after two or three vaccinations had similar neutralization titer magnitude and antigenic recognition. Accounting for antigenic differences among variants when interpreting neutralization titers can aid the understanding of complex patterns in humoral immunity that informs the selection of future COVID-19 vaccine strains.
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Affiliation(s)
- Wei Wang
- Center for Biologics Evaluation and Research, U.S. Food and Drug Administration, Silver Spring, MD, USA
| | - Sabrina Lusvarghi
- Center for Biologics Evaluation and Research, U.S. Food and Drug Administration, Silver Spring, MD, USA
| | - Rahul Subramanian
- Office of Data Science and Emerging Technologies, Office of Science Management and Operations, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Nusrat J Epsi
- Infectious Diseases Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA; Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, USA
| | - Richard Wang
- Center for Biologics Evaluation and Research, U.S. Food and Drug Administration, Silver Spring, MD, USA
| | - Emilie Goguet
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, USA; Department of Microbiology and Immunology, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Anthony C Fries
- U.S. Air Force School of Aerospace Medicine, Wright-Patterson Air Force Base, Fairborn, OH, USA
| | - Fernando Echegaray
- Viral Epidemiology and Immunity Unit, Laboratory of Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Russell Vassell
- Center for Biologics Evaluation and Research, U.S. Food and Drug Administration, Silver Spring, MD, USA
| | - Si'Ana A Coggins
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, USA; Department of Microbiology and Immunology, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Stephanie A Richard
- Infectious Diseases Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA; Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, USA
| | - David A Lindholm
- Brooke Army Medical Center, Joint Base San Antonio-Fort Sam Houston, San Antonio, TX, USA; Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Katrin Mende
- Infectious Diseases Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA; Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, USA
| | - Evan C Ewers
- Fort Belvoir Community Hospital, Fort Belvoir, VA, USA
| | | | - Rhonda E Colombo
- Infectious Diseases Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA; Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, USA; Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA; Madigan Army Medical Center, Tacoma, WA, USA
| | - Christopher J Colombo
- Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA; Madigan Army Medical Center, Tacoma, WA, USA
| | - Janet O Joseph
- Viral Epidemiology and Immunity Unit, Laboratory of Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Julia S Rozman
- Infectious Diseases Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA; Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, USA
| | - Alfred Smith
- Naval Medical Center Portsmouth, Portsmouth, VA, USA
| | - Tahaniyat Lalani
- Infectious Diseases Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA; Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, USA; Naval Medical Center Portsmouth, Portsmouth, VA, USA
| | - Catherine M Berjohn
- Infectious Diseases Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA; Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA; Naval Medical Center San Diego, San Diego, CA, USA
| | - Ryan C Maves
- Infectious Diseases Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA; Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA; Section of Infectious Diseases, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | | | - Rupal Mody
- William Beaumont Army Medical Center, El Paso, TX, USA
| | - Nikhil Huprikar
- Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Jeffrey Livezey
- Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - David Saunders
- Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Monique Hollis-Perry
- Clinical Trials Center, Infectious Diseases Directorate, Naval Medical Research Center, Silver Spring, MD, USA
| | - Gregory Wang
- General Dynamics Information Technology, Falls Church, VA, USA
| | - Anuradha Ganesan
- Infectious Diseases Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA; Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, USA; Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Mark P Simons
- Infectious Diseases Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Christopher C Broder
- Department of Microbiology and Immunology, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - David R Tribble
- Infectious Diseases Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Eric D Laing
- Department of Microbiology and Immunology, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Brian K Agan
- Infectious Diseases Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA; Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, USA
| | - Timothy H Burgess
- Infectious Diseases Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Edward Mitre
- Department of Microbiology and Immunology, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Simon D Pollett
- Infectious Diseases Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA; Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, USA.
| | - Leah C Katzelnick
- Viral Epidemiology and Immunity Unit, Laboratory of Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA.
| | - Carol D Weiss
- Center for Biologics Evaluation and Research, U.S. Food and Drug Administration, Silver Spring, MD, USA.
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Richard SA, Fairchok M, Coles C, Burgess TH, Colombo RE. Influenza Vaccine Effectiveness: Analysis of the Impact of Repeated Vaccinations in Military Health System Beneficiaries. Open Forum Infect Dis 2022; 9:ofac497. [PMID: 36275868 PMCID: PMC9578161 DOI: 10.1093/ofid/ofac497] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 09/26/2022] [Indexed: 10/01/2023] Open
Abstract
Background Influenza has long burdened the Military Health System (MHS). This study assesses the impact of repeated annual vaccination on influenza vaccine effectiveness (VE). Methods This retrospective, case control study using the test-negative design utilized data extracted from the MHS Data Repository (MDR). Cases had a positive influenza test and controls sought care for an influenza-like illness within 2 weeks of a case, had no positive influenza tests, and were matched by sex, race, age, and location. Vaccine effectiveness was assessed using conditional logistic regression separately for those who received inactivated and live attenuated influenza vaccines (LAIV). Results A total of 6860 cases and controls were identified in the MDR, among whom 53% were vaccinated in all 3 seasons. Among those who received inactivated influenza vaccine during the current season, VE ranged from 26% to 37% (2012/13 [A(H3N2)]: VE 26%, 95% confidence interval [CI] = 1%-45%; 2013/14 [A(H1N1)pdm09]: VE 37%, 95% CI = 18%-52%; 2014/15 [A(H3N2)]: VE 31%, 95% CI = 17%-42%). The VE ranged from 25% to 49% for those only vaccinated this season (2012/13 [A(H3N2)]: VE 38%, 95% CI = -3% to 63%; 2013/14 [A(H1N1)pdm09]: VE 49%, 95% CI = 11%-71%; 2014/15 [A(H3N2)]: VE 25%, 95% CI = -7% to 48%). The VE was more variable in those who received LAIV in the current season. No statistically significant differences in VE were observed between those frequently vaccinated and those vaccinated only during the current season. Conclusions These results underscore the value of annual influenza vaccinations for preventing infection while highlighting the need for continued improvements in influenza vaccine effectiveness.
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Affiliation(s)
- Stephanie A Richard
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, Maryland, USA
| | - Mary Fairchok
- Mary Bridge Children's Hospital, MultiCare Health System, Tacoma, Washington, USA
| | - Christian Coles
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, Maryland, USA
| | - Timothy H Burgess
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Rhonda E Colombo
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, Maryland, USA
- Madigan Army Medical Center, Tacoma, Washington, USA
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17
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Danaher PJ, Phillips M, Schmitt P, Richard SA, Millar EV, White BK, Okulicz JF, Coles CL, Burgess TH. BREATH BIOMARKERS OF INFLUENZA INFECTION. Open Forum Infect Dis 2022; 9:ofac489. [DOI: 10.1093/ofid/ofac489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 09/19/2022] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Volatile organic compounds (VOCs) are produced systemically due to varied physiological states such as oxidative stress and are excreted through the lungs. Benchtop and preliminary clinical data suggest that breath testing may be a useful diagnostic modality for viral respiratory tract infections.
Methods
Patients with influenza-like illness (ILI) presenting to a single clinic in San Antonio, TX, from 3/2017-3/2019 submitted a two-minute breath sample in addition to a nasopharyngeal swab collected for polymerase chain reaction (PCR) assay for respiratory pathogens. VOCs were assayed with gas chromatography-mass spectrometry (GC-MS) and data were analyzed to identify breath VOC biomarkers that discriminated between ILI patients with and without a PCR assay positive for influenza.
Results
Demographic, clinical, PCR and breath data were available for 237 episodes of ILI, among which 32 episodes (13.5%) were PCR positive for influenza. Twenty candidate VOCs identified patients with influenza with greater than random accuracy. A predictive algorithm using four candidate biomarkers identified this group with 78% accuracy (74% sensitivity, 70% specificity). Based on their mass spectra, most of these biomarkers were n-alkane derivatives, consistent with products of oxidative stress.
Conclusions
A breath test for VOC biomarkers accurately identified ILI patients with PCR-proven influenza. These findings bolster those of others that a rapid, accurate, universal point-of-care influenza diagnostic test based on assay of exhaled breath VOCs may be feasible. The next step will be a study of patients with ILI using a simplified method of breath collection that would facilitate translation for use in clinical practice.
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Affiliation(s)
- Patrick J Danaher
- Medicine Service, Infectious Diseases Section South Texas Veterans Health Care System San Antonio, TX 78229 , USA
| | | | | | - Stephanie A Richard
- Infectious Disease Clinical Research Program The Henry M. Jackson Foundation for the Advancement of Military Medicine Department of Preventive Medicine and Biostatistics Uniformed Services University of the Health Sciences Bethesda, MD 20814 , USA
| | - Eugene V Millar
- Infectious Disease Clinical Research Program The Henry M. Jackson Foundation for the Advancement of Military Medicine Department of Preventive Medicine and Biostatistics Uniformed Services University of the Health Sciences Bethesda, MD 20814 , USA
| | - Brian K White
- Air Force Medical Readiness Agency Defense Health Headquarters Falls Church, VA 20181 , USA
| | - Jason F Okulicz
- Department of Medicine, Infectious Diseases Service Brooke Army Medical Center San Antonio, TX 78234 , USA
| | - Christian L Coles
- Infectious Disease Clinical Research Program The Henry M. Jackson Foundation for the Advancement of Military Medicine Department of Preventive Medicine and Biostatistics Uniformed Services University of the Health Sciences Bethesda, MD 20814 , USA
| | - Timothy H Burgess
- Infectious Disease Clinical Research Program Department of Preventive Medicine and Biostatistics Uniformed Services University of the Health Sciences Bethesda, MD 20814 , USA
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18
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Scher AI, Berjohn CM, Byrne C, Colombo RE, Colombo CJ, Sanchez Edwards M, Ewers EC, Ganesan A, Jones M, Larson DT, Libraty D, Lindholm DA, Madar CS, Maldonado CJ, Maves RC, Mende K, Richard SA, Rozman JS, Rusiecki J, Smith A, Simons M, Tribble D, Agan B, Burgess TH, Pollett SD. An Analysis of SARS-CoV-2 Vaccine Reactogenicity: Variation by Type, Dose, and History, Severity, and Recency of Prior SARS-CoV-2 Infection. Open Forum Infect Dis 2022; 9:ofac314. [PMID: 35899278 PMCID: PMC9278193 DOI: 10.1093/ofid/ofac314] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 06/24/2022] [Indexed: 11/28/2022] Open
Abstract
Background There is limited information on the functional consequences of coronavirus disease 2019 (COVID-19) vaccine side effects. To support patient counseling and public health messaging, we describe the risk and correlates of COVID-19 vaccine side effects sufficient to prevent work or usual activities and/or lead to medical care (“severe” side effects). Methods The EPICC study is a longitudinal cohort study of Military Healthcare System beneficiaries including active duty service members, dependents, and retirees. We studied 2789 adults who were vaccinated between December 2020 and December 2021. Results Severe side effects were most common with the Ad26.COV2.S (Janssen/Johnson and Johnson) vaccine, followed by mRNA-1273 (Moderna) then BNT162b2 (Pfizer/BioNTech). Severe side effects were more common after the second than first dose (11% vs 4%; P < .001). First (but not second) dose side effects were more common in those with vs without prior severe acute respiratory syndrome coronavirus 2 infection (9% vs 2%; adjusted odds ratio [aOR], 5.84; 95% CI, 3.8–9.1), particularly if the prior illness was severe or critical (13% vs 2%; aOR, 10.57; 95% CI, 5.5–20.1) or resulted in inpatient care (17% vs 2%; aOR, 19.3; 95% CI, 5.1–72.5). Side effects were more common in women than men but not otherwise related to demographic factors. Conclusions Vaccine side effects sufficient to prevent usual activities were more common after the second than first dose and varied by vaccine type. First dose side effects were more likely in those with a history of COVID-19—particularly if that prior illness was severe or associated with inpatient care. These findings may assist clinicians and patients by providing a real-world evaluation of the likelihood of experiencing impactful postvaccine symptoms.
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Affiliation(s)
- Ann I Scher
- Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences , Bethesda, MD , USA
| | - Catherine M Berjohn
- Naval Medical Center San Diego , San Diego, CA , USA
- Department of Medicine, Uniformed Services University of the Health Sciences , Bethesda, MD , USA
| | - Celia Byrne
- Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences , Bethesda, MD , USA
| | - Rhonda E Colombo
- Department of Medicine, Uniformed Services University of the Health Sciences , Bethesda, MD , USA
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences , Bethesda, MD , USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc ., Bethesda, MD , USA
- Madigan Army Medical Center , Joint Base Lewis McChord, WA , USA
| | - Christopher J Colombo
- Department of Medicine, Uniformed Services University of the Health Sciences , Bethesda, MD , USA
- Madigan Army Medical Center , Joint Base Lewis McChord, WA , USA
| | - Margaret Sanchez Edwards
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences , Bethesda, MD , USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc ., Bethesda, MD , USA
| | - Evan C Ewers
- Fort Belvoir Community Hospital , Fort Belvoir, VA , USA
| | - Anuradha Ganesan
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences , Bethesda, MD , USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc ., Bethesda, MD , USA
- Walter Reed National Military Medical Center , Bethesda, MD , USA
| | | | - Derek T Larson
- Naval Medical Center San Diego , San Diego, CA , USA
- Department of Medicine, Uniformed Services University of the Health Sciences , Bethesda, MD , USA
- Fort Belvoir Community Hospital , Fort Belvoir, VA , USA
| | - Daniel Libraty
- Naval Medical Center San Diego , San Diego, CA , USA
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences , Bethesda, MD , USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc ., Bethesda, MD , USA
| | - David A Lindholm
- Department of Medicine, Uniformed Services University of the Health Sciences , Bethesda, MD , USA
- Brooke Army Medical Center , JBSA Ft Sam Houston, TX , USA
| | - Cristian S Madar
- Walter Reed National Military Medical Center , Bethesda, MD , USA
| | | | - Ryan C Maves
- Naval Medical Center San Diego , San Diego, CA , USA
- Department of Medicine, Uniformed Services University of the Health Sciences , Bethesda, MD , USA
| | - Katrin Mende
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences , Bethesda, MD , USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc ., Bethesda, MD , USA
- Brooke Army Medical Center , JBSA Ft Sam Houston, TX , USA
| | - Stephanie A Richard
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences , Bethesda, MD , USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc ., Bethesda, MD , USA
| | - Julia S Rozman
- Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences , Bethesda, MD , USA
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences , Bethesda, MD , USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc ., Bethesda, MD , USA
| | - Jennifer Rusiecki
- Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences , Bethesda, MD , USA
| | - Alfred Smith
- Naval Medical Center Portsmouth , Portsmouth, VA , USA
| | - Mark Simons
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences , Bethesda, MD , USA
| | - David Tribble
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences , Bethesda, MD , USA
| | - Brian Agan
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences , Bethesda, MD , USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc ., Bethesda, MD , USA
| | - Timothy H Burgess
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences , Bethesda, MD , USA
| | - Simon D Pollett
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences , Bethesda, MD , USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc ., Bethesda, MD , USA
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19
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Richard SA, Epsi NJ, Lindholm DA, Malloy AMW, Maves RC, Berjohn CM, Lalani T, Smith AG, Mody RM, Ganesan A, Huprikar N, Colombo RE, Colombo CJ, Madar C, Jones MU, Larson DT, Ewers EC, Bazan S, Fries AC, Maldonado CJ, Simons MP, Rozman JS, Andronescu L, Mende K, Tribble DR, Agan BK, Burgess TH, Pollett SD, Powers JH. COVID-19 patient reported symptoms using FLU-PRO Plus in a cohort study: associations with infecting genotype, vaccine history, and return-to-health. Open Forum Infect Dis 2022; 9:ofac275. [PMID: 35873301 PMCID: PMC9214183 DOI: 10.1093/ofid/ofac275] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 05/26/2022] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Patient reported outcomes of SARS-CoV-2 infection are an important measure of the full burden of COVID. Here, we examine how 1) infecting genotype and COVID-19 vaccination correlate with FLU-PRO Plus score, including by symptom domains, and 2) FLU-PRO Plus scores predict return to usual activities and health.
Methods
The EPICC study was implemented to describe the short- and long-term consequences of SARS-CoV-2 infection in a longitudinal, observational cohort. Multivariable linear regression models were run with FLU-PRO Plus scores as the outcome variable and multivariable Cox proportional hazards models evaluated effects of FLU-PRO Plus scores on return to usual health or activities.
Results
Among the 764 participants included in this analysis, 63% were 18-44 years old, 40% were female, and 51% were white. Being fully vaccinated was associated with lower total scores (β=-0.39 (95% confidence interval (CI) -0.57, -0.21)). The Delta variant was associated with higher total scores (β=0.25 (95% CI 0.05, 0.45)). Participants with higher FLU-PRO Plus scores were less likely to report returning to usual health and activities (Health: hazard ratio (HR) 0.46 (95% CI 0.37, 0.57); Activities: HR 0.56 (95% CI 0.47, 0.67)). Fully vaccinated participants were more likely to report returning to usual activities (HR 1.24 (95% CI 1.04, 1.48)).
Conclusions
Full SARS-CoV-2 vaccination is associated with decreased severity of patient-reported symptoms across multiple domains, which in turn is likely to be associated with earlier return to usual activities. In addition, infection with the Delta variant was associated with higher FLU-PRO Plus scores than previous variants, even after controlling for vaccination status.
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Affiliation(s)
- Stephanie A. Richard
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences , Bethesda, MD, USA
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc. , Bethesda, MD, USA
| | - Nusrat J. Epsi
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences , Bethesda, MD, USA
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc. , Bethesda, MD, USA
| | - David A. Lindholm
- Brooke Army Medical Center , Fort Sam Houston, TX, USA
- Uniformed Services University of the Health Sciences , Bethesda, MD, USA
| | | | - Ryan C. Maves
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences , Bethesda, MD, USA
- Naval Medical Center San Diego , San Diego, CA, USA
| | - Catherine M. Berjohn
- Uniformed Services University of the Health Sciences , Bethesda, MD, USA
- Naval Medical Center San Diego , San Diego, CA, USA
| | - Tahaniyat Lalani
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences , Bethesda, MD, USA
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc. , Bethesda, MD, USA
- Naval Medical Center Portsmouth , Portsmouth, VA, USA
| | | | - Rupal M. Mody
- William Beaumont Army Medical Center , El Paso, TX, USA
| | - Anuradha Ganesan
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences , Bethesda, MD, USA
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc. , Bethesda, MD, USA
- Walter Reed National Military Medical Center , Bethesda, MD, USA
| | - Nikhil Huprikar
- Uniformed Services University of the Health Sciences , Bethesda, MD, USA
- Walter Reed National Military Medical Center , Bethesda, MD, USA
| | - Rhonda E. Colombo
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences , Bethesda, MD, USA
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc. , Bethesda, MD, USA
- Madigan Army Medical Center , Joint Base Lewis McChord, WA, USA
| | - Christopher J. Colombo
- Uniformed Services University of the Health Sciences , Bethesda, MD, USA
- Madigan Army Medical Center , Joint Base Lewis McChord, WA, USA
| | | | - Milissa U. Jones
- Uniformed Services University of the Health Sciences , Bethesda, MD, USA
- Tripler Army Medical Center , Honolulu, HI, USA
| | - Derek T. Larson
- Naval Medical Center San Diego , San Diego, CA, USA
- Fort Belvoir Community Hospital , Fort Belvoir, VA, USA
| | - Evan C. Ewers
- Fort Belvoir Community Hospital , Fort Belvoir, VA, USA
| | - Samantha Bazan
- Carl R. Darnall Army Medical Center , Fort Hood, TX, USA
| | | | | | - Mark P. Simons
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences , Bethesda, MD, USA
| | - Julia S. Rozman
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences , Bethesda, MD, USA
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc. , Bethesda, MD, USA
| | - Liana Andronescu
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences , Bethesda, MD, USA
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc. , Bethesda, MD, USA
| | - Katrin Mende
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences , Bethesda, MD, USA
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc. , Bethesda, MD, USA
- Brooke Army Medical Center , Fort Sam Houston, TX, USA
| | - David R. Tribble
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences , Bethesda, MD, USA
| | - Brian K. Agan
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences , Bethesda, MD, USA
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc. , Bethesda, MD, USA
| | - Timothy H. Burgess
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences , Bethesda, MD, USA
| | - Simon D. Pollett
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences , Bethesda, MD, USA
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc. , Bethesda, MD, USA
| | - John H Powers
- Clinical Research Directorate, Frederick National Laboratory for Cancer Research , Frederick, MD, USA
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20
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Epsi NJ, Richard SA, Lindholm DA, Mende K, Ganesan A, Huprikar N, Lalani T, Fries AC, Maves RC, Colombo RE, Larson DT, Smith A, Chi SW, Maldonado CJ, Ewers EC, Jones MU, Berjohn CM, Libraty DH, Edwards MS, English C, Rozman JS, Mody RM, Colombo CJ, Samuels EC, Nwachukwu P, Tso MS, Scher AI, Byrne C, Rusiecki J, Simons MP, Tribble D, Broder CC, Agan BK, Burgess TH, Laing ED, Pollett SD. Understanding "Hybrid Immunity": Comparison and Predictors of Humoral Immune Responses to Severe Acute Respiratory Syndrome Coronavirus 2 Infection (SARS-CoV-2) and Coronavirus Disease 2019 (COVID-19) Vaccines. Clin Infect Dis 2022; 76:e439-e449. [PMID: 35608504 PMCID: PMC9213853 DOI: 10.1093/cid/ciac392] [Citation(s) in RCA: 10] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 04/29/2022] [Accepted: 05/17/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Comparison of humoral responses in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccinees, those with SARS-CoV-2 infection, or combinations of vaccine/ infection ("hybrid immunity") may clarify predictors of vaccine immunogenicity. METHODS We studied 2660 US Military Health System beneficiaries with a history of SARS-CoV-2 infection-alone (n = 705), vaccination-alone (n = 932), vaccine-after-infection (n = 869), and vaccine-breakthrough-infection (n = 154). Peak anti-spike-immunoglobulin G (IgG) responses through 183 days were compared, with adjustment for vaccine product, demography, and comorbidities. We excluded those with evidence of clinical or subclinical SARS-CoV-2 reinfection from all groups. RESULTS Multivariable regression results indicated that vaccine-after-infection anti-spike-IgG responses were higher than infection-alone (P < .01), regardless of prior infection severity. An increased time between infection and vaccination was associated with greater post-vaccination IgG response (P < .01). Vaccination-alone elicited a greater IgG response but more rapid waning of IgG (P < .01) compared with infection-alone (P < .01). BNT162b2 and mRNA-1273 vaccine-receipt was associated with greater IgG responses compared with JNJ-78436735 vaccine-receipt (P < .01), regardless of infection history. Those with vaccine-after-infection or vaccine-breakthrough-infection had a more durable anti-spike-IgG response compared to infection-alone (P < .01). CONCLUSIONS Vaccine-receipt elicited higher anti-spike-IgG responses than infection-alone, although IgG levels waned faster in those vaccinated (compared to infection-alone). Vaccine-after-infection elicits a greater humoral response compared with vaccine or infection alone; and the timing, but not disease severity, of prior infection predicted these post-vaccination IgG responses. While differences between groups were small in magnitude, these results offer insights into vaccine immunogenicity variations that may help inform vaccination timing strategies.
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Affiliation(s)
- Nusrat J Epsi
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA,Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc, Bethesda, Maryland, USA
| | - Stephanie A Richard
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA,Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc, Bethesda, Maryland, USA
| | - David A Lindholm
- Brooke Army Medical Center, Fort Sam Houston, Texas, USA,Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Katrin Mende
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA,Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc, Bethesda, Maryland, USA,Brooke Army Medical Center, Fort Sam Houston, Texas, USA
| | - Anuradha Ganesan
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA,Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc, Bethesda, Maryland, USA,Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Nikhil Huprikar
- Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Tahaniyat Lalani
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA,Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc, Bethesda, Maryland, USA,Naval Medical Center Portsmouth, Portsmouth, Virginia, USA
| | - Anthony C Fries
- US Air Force School of Aerospace Medicine, Dayton, Ohio, USA
| | - Ryan C Maves
- Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Rhonda E Colombo
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA,Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc, Bethesda, Maryland, USA,Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA,Madigan Army Medical Center, Joint Base Lewis McChord, Washington, USA
| | - Derek T Larson
- Fort Belvoir Community Hospital, Fort Belvoir, Virginia, USA,Naval Medical Center San Diego, San Diego, California, USA
| | - Alfred Smith
- Naval Medical Center Portsmouth, Portsmouth, Virginia, USA
| | - Sharon W Chi
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA,Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc, Bethesda, Maryland, USA,Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | | | - Evan C Ewers
- Fort Belvoir Community Hospital, Fort Belvoir, Virginia, USA
| | | | - Catherine M Berjohn
- Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA,Naval Medical Center San Diego, San Diego, California, USA
| | - Daniel H Libraty
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA,Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc, Bethesda, Maryland, USA,Naval Medical Center San Diego, San Diego, California, USA
| | - Margaret Sanchez Edwards
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA,Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc, Bethesda, Maryland, USA
| | - Caroline English
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA,Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc, Bethesda, Maryland, USA
| | - Julia S Rozman
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA,Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc, Bethesda, Maryland, USA
| | - Rupal M Mody
- William Beaumont Army Medical Center, El Paso, Texas, USA
| | - Christopher J Colombo
- Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA,Madigan Army Medical Center, Joint Base Lewis McChord, Washington, USA
| | - Emily C Samuels
- Department of Microbiology and Immunology, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Princess Nwachukwu
- Department of Microbiology and Immunology, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Marana S Tso
- Department of Microbiology and Immunology, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Ann I Scher
- Department of Preventive Medicine & Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Celia Byrne
- Department of Preventive Medicine & Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Jennifer Rusiecki
- Department of Preventive Medicine & Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Mark P Simons
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - David Tribble
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Christopher C Broder
- Department of Microbiology and Immunology, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Brian K Agan
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA,Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc, Bethesda, Maryland, USA
| | - Timothy H Burgess
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Eric D Laing
- Department of Microbiology and Immunology, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Simon D Pollett
- Correspondence: Simon Pollett, MBBS, 6720A Rockledge Drive, Suite 250, Bethesda, MD 20817, USA ()
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21
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Pollett SD, Richard SA, Fries AC, Simons MP, Mende K, Lalani T, Lee T, Chi S, Mody R, Madar C, Ganesan A, Larson DT, Colombo CJ, Colombo R, Samuels EC, Broder CC, Laing ED, Smith DR, Tribble D, Agan BK, Burgess TH. The Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) mRNA Vaccine-Breakthrough Infection Phenotype Includes Significant Symptoms, Live Virus Shedding, and Viral Genetic Diversity. Clin Infect Dis 2022; 74:897-900. [PMID: 34117878 PMCID: PMC8906702 DOI: 10.1093/cid/ciab543] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Indexed: 11/26/2022] Open
Abstract
Little is known about severe acute respiratory syndrome coronavirus 2 "vaccine-breakthrough" infections (VBIs). Here we characterize 24 VBIs in predominantly young healthy persons. While none required hospitalization, a proportion endorsed severe symptoms and shed live virus as high as 4.13 × 103 plaque-forming units/mL. Infecting genotypes included both variant-of-concern (VOC) and non-VOC strains.
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Affiliation(s)
- Simon D Pollett
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc, Bethesda, Maryland, USA
| | - Stephanie A Richard
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc, Bethesda, Maryland, USA
| | - Anthony C Fries
- US Air Force School of Aerospace Medicine, Dayton, Ohio, USA
| | - Mark P Simons
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Katrin Mende
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc, Bethesda, Maryland, USA
- Brooke Army Medical Center, Fort Sam, Houston, Texas, USA
| | - Tahaniyat Lalani
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
- Naval Medical Center Portsmouth, Portsmouth, Virginia, USA
| | - Tida Lee
- Naval Medical Center Portsmouth, Portsmouth, Virginia, USA
| | - Sharon Chi
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
- Tripler Army Medical Center, Honolulu, Hawaii, USA
| | - Rupal Mody
- William Beaumont Army Medical Center, El Paso, Texas, USA
| | | | - Anuradha Ganesan
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
- Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Derek T Larson
- Fort Belvoir Community Hospital, Fort Belvoir, Virginia, USA
| | | | - Rhonda Colombo
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc, Bethesda, Maryland, USA
- Madigan Army Medical Center, Joint Base Lewis-McChord, Washington, USA
| | - Emily C Samuels
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc, Bethesda, Maryland, USA
- Department of Microbiology and Immunology, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Christopher C Broder
- Department of Microbiology and Immunology, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Eric D Laing
- Biological Defense Research Directorate, Naval Medical Research Center, Frederick, Maryland, USA
| | - Darci R Smith
- Biological Defense Research Directorate, Naval Medical Research Center, Frederick, Maryland, USA
| | - David Tribble
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Brian K Agan
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc, Bethesda, Maryland, USA
| | - Timothy H Burgess
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
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22
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McCormick BJJ, Richard SA, Murray-Kolb LE, Kang G, Lima AAM, Mduma E, Kosek MN, Rogawski McQuade ET, Houpt ER, Bessong P, Shrestha S, Bhutta Z, Ahmed T, Caulfield LE. Full breastfeeding protection against common enteric bacteria and viruses: results from the MAL-ED cohort study. Am J Clin Nutr 2022; 115:759-769. [PMID: 34849524 PMCID: PMC8895209 DOI: 10.1093/ajcn/nqab391] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 11/19/2021] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Breastfeeding is known to reduce the risk of enteropathogen infections, but protection from specific enteropathogens is not well characterized. OBJECTIVE The aim was to estimate the association between full breastfeeding (days fed breast milk exclusively or with nonnutritive liquids) and enteropathogen detection. METHODS A total of 2145 newborns were enrolled at 8 sites, of whom 1712 had breastfeeding and key enteropathogen data through 6 mo. We focused on 11 enteropathogens: adenovirus 40/41, norovirus, sapovirus, astrovirus, and rotavirus, enterotoxigenic Escherichia coli (ETEC), Campylobacter spp., and typical enteropathogenic E. coli as well as entero-aggregative E. coli, Shigella and Cryptosporidium. Logistic regression was used to estimate the risk of enteropathogen detection in stools and survival analysis was used to estimate the timing of first detection of an enteropathogen. RESULTS Infants with 10% more days of full breastfeeding within the preceding 30 d of a stool sample were less likely to have the 3 E. coli and Campylobacter spp. detected in their stool (mean odds: 0.92-0.99) but equally likely (0.99-1.02) to have the viral pathogens detected in their stool. A 10% longer period of full breastfeeding from birth was associated with later first detection of the 3 E. coli, Campylobacter, adenovirus, astrovirus, and rotavirus (mean HRs of 0.52-0.75). The hazards declined and point estimates were not statistically significant at 3 mo. CONCLUSIONS In this large multicenter cohort study, full breastfeeding was associated with lower likelihood of detecting 4 important enteric pathogens in the first 6 mo of life. These results also show that full breastfeeding is related to delays in the first detection of some bacterial and viral pathogens in the stool. As several of these pathogens are risk factors for poor growth during childhood, this work underscores the importance of exclusive or full breastfeeding during the first 6 mo of life to optimize early health.
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Affiliation(s)
| | - Stephanie A Richard
- Fogarty International Center/National Institutes of Health, Bethesda, MD, USA
| | | | | | | | | | | | | | - Eric R Houpt
- University of Virginia, Charlottesville, VA, USA
| | | | | | | | | | - Laura E Caulfield
- The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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23
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Richard SA, Danaher PJ, White B, Mende K, Colombo RE, Burgess TH, Coles CL. Respiratory Infections Are More Common Than Healthcare Records Indicate: Results From an Anonymous Survey. Mil Med 2022; 188:usac016. [PMID: 35134203 PMCID: PMC9383359 DOI: 10.1093/milmed/usac016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 12/22/2021] [Accepted: 01/14/2022] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Influenza-like illnesses (ILIs) are common in military populations and can impair mission-readiness, particularly in the current severe acute respiratory syndrome coronavirus 2 pandemic; therefore, it is important to identify potential risk factors for infection and better understand the burden of infection. MATERIALS AND METHODS A survey was administered to military medical trainees living in a congregated setting on JBSA Fort Sam Houston, Texas, from January 2017 to February 2019. The survey included questions about ILI experience and potential ILI risk factors. RESULTS 2,121 individuals completed the survey. Respondents had a median age of 21 years, 46% were female, 32.6% were Air Force, 33.6% were Army, and 33.8% were Navy/Marines. Among the 815 (38%) who reported an ILI during training, 40% sought health care. The primary reasons for seeking healthcare included illness severity, concern about transmission, and accessibility of healthcare. Over half (54%) of the trainees who reported an ILI said the ILI had an impact on their performance, including reduced study time, missed physical training, and missed class. Multivariate model results indicate that women and younger trainees (<30 years) were more likely to report having had an ILI (women: OR 1.58, (95% CI 1.30, 1.92); age <30 years: OR 1.58, (1.06, 2.36)). In a subset analysis, those who reported washing their hands 10+ times per day were less likely to report an ILI (OR 0.61 (0.42, 0.89)). CONCLUSIONS ILIs are likely to be more common during training than healthcare records indicate and may result in decreased training effectiveness. Increasing access to handwashing facilities and education about the importance of handwashing to prevent the spread of disease will likely reduce the ILI burden in this population.
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24
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Richard SA, Pollett SD, Lanteri CA, Millar EV, Fries AC, Maves RC, Utz GC, Lalani T, Smith A, Mody RM, Ganesan A, Colombo RE, Colombo CJ, Lindholm DA, Madar C, Chi S, Huprikar N, Larson DT, Bazan SE, English C, Parmelee E, Mende K, Laing ED, Broder CC, Blair PW, Chenoweth JG, Simons MP, Tribble DR, Agan BK, Burgess TH. COVID-19 Outcomes Among US Military Health System Beneficiaries Include Complications Across Multiple Organ Systems and Substantial Functional Impairment. Open Forum Infect Dis 2021; 8:ofab556. [PMID: 34909439 PMCID: PMC8664684 DOI: 10.1093/ofid/ofab556] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 11/02/2021] [Indexed: 01/08/2023] Open
Abstract
Background We evaluated clinical outcomes, functional burden, and complications 1 month after coronavirus disease 2019 (COVID-19) infection in a prospective US Military Health System (MHS) cohort of active duty, retiree, and dependent populations using serial patient-reported outcome surveys and electronic medical record (EMR) review. Methods MHS beneficiaries presenting at 9 sites across the United States with a positive severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) test, a COVID-19-like illness, or a high-risk SARS-CoV-2 exposure were eligible for enrollment. Medical history and clinical outcomes were collected through structured interviews and International Classification of Diseases-based EMR review. Risk factors associated with hospitalization were determined by multivariate logistic regression. Results A total of 1202 participants were enrolled. There were 1070 laboratory-confirmed SARS-CoV-2 cases and 132 SARS-CoV-2-negative participants. In the first month post-symptom onset among the SARS-CoV-2-positive cases, there were 212 hospitalizations, 80% requiring oxygen, 20 ICU admissions, and 10 deaths. Risk factors for COVID-19-associated hospitalization included race (increased for Asian, Black, and Hispanic compared with non-Hispanic White), age (age 45-64 and 65+ compared with <45), and obesity (BMI≥30 compared with BMI<30). Over 2% of survey respondents reported the need for supplemental oxygen, and 31% had not returned to normal daily activities at 1 month post-symptom onset. Conclusions Older age, reporting Asian, Black, or Hispanic race/ethnicity, and obesity are associated with SARS-CoV-2 hospitalization. A proportion of acute SARS-CoV-2 infections require long-term oxygen therapy; the impact of SARS-CoV-2 infection on short-term functional status was substantial. A significant number of MHS beneficiaries had not yet returned to normal activities by 1 month.
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Affiliation(s)
- Stephanie A Richard
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, USA
| | - Simon D Pollett
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, USA
| | | | - Eugene V Millar
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, USA
| | - Anthony C Fries
- US Air Force School of Aerospace Medicine, Wright-Patterson, Ohio, USA
| | - Ryan C Maves
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA.,Naval Medical Center San Diego, San Diego, California, USA
| | - Gregory C Utz
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, USA.,Naval Medical Center San Diego, San Diego, California, USA
| | - Tahaniyat Lalani
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, USA.,Naval Medical Center Portsmouth, Portsmouth, Virginia, USA
| | - Alfred Smith
- Naval Medical Center Portsmouth, Portsmouth, Virginia, USA
| | - Rupal M Mody
- William Beaumont Army Medical Center, El Paso, Texas, USA
| | - Anuradha Ganesan
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, USA.,Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Rhonda E Colombo
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, USA.,Madigan Army Medical Center, Joint Base Lewis McChord, Washington, USA.,Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Christopher J Colombo
- Madigan Army Medical Center, Joint Base Lewis McChord, Washington, USA.,Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - David A Lindholm
- Brooke Army Medical Center, Joint Base San Antonio-Fort Sam Houston, Texas, USA.,Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | | | - Sharon Chi
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, USA.,Tripler Army Medical Center, Honolulu, Hawaii, USA
| | - Nikhil Huprikar
- Walter Reed National Military Medical Center, Bethesda, Maryland, USA.,Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Derek T Larson
- Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA.,Fort Belvoir Community Hospital, Fort Belvoir, Virginia, USA
| | | | - Caroline English
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, USA
| | - Edward Parmelee
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, USA
| | - Katrin Mende
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, USA.,Brooke Army Medical Center, Joint Base San Antonio-Fort Sam Houston, Texas, USA
| | - Eric D Laing
- Department of Microbiology and Immunology, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Christopher C Broder
- Department of Microbiology and Immunology, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Paul W Blair
- Department of Pathology, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA.,Austere environments Consortium for Enhanced Sepsis Outcomes, Henry M. Jackson Foundation, Bethesda, Maryland, USA
| | - Josh G Chenoweth
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, USA.,Austere environments Consortium for Enhanced Sepsis Outcomes, Henry M. Jackson Foundation, Bethesda, Maryland, USA
| | - Mark P Simons
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - David R Tribble
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Brian K Agan
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, USA
| | - Timothy H Burgess
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
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25
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Lu Z, Laing ED, Pena DaMata J, Pohida K, Tso MS, Samuels EC, Epsi NJ, Dorjbal B, Lake C, Richard SA, Maves RC, Lindholm DA, Rozman JS, English C, Huprikar N, Mende K, Colombo RE, Colombo CJ, Broder CC, Ganesan A, Lanteri CA, Agan BK, Tribble D, Simons MP, Dalgard CL, Blair PW, Chenoweth J, Pollett SD, Snow AL, Burgess TH, Malloy AMW. Durability of SARS-CoV-2-Specific T-Cell Responses at 12 Months Postinfection. J Infect Dis 2021; 224:2010-2019. [PMID: 34673956 PMCID: PMC8672777 DOI: 10.1093/infdis/jiab543] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 10/19/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Characterizing the longevity and quality of cellular immune responses to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) enhances understanding of coronavirus disease 2019 (COVID-19) immunity that influences clinical outcomes. Prior studies suggest SARS-CoV-2-specific T cells are present in peripheral blood 10 months after infection. Analysis of the function, durability, and diversity of cellular response long after natural infection, over a range of ages and disease phenotypes, is needed to identify preventative and therapeutic interventions. METHODS We identified participants in our multisite longitudinal, prospective cohort study 12 months after SARS-CoV-2 infection representing a range of disease severity. We investigated function, phenotypes, and frequency of T cells specific for SARS-CoV-2 using intracellular cytokine staining and spectral flow cytometry, and compared magnitude of SARS-CoV-2-specific antibodies. RESULTS SARS-CoV-2-specific antibodies and T cells were detected 12 months postinfection. Severe acute illness was associated with higher frequencies of SARS-CoV-2-specific CD4 T cells and antibodies at 12 months. In contrast, polyfunctional and cytotoxic T cells responsive to SARS-CoV-2 were identified in participants over a wide spectrum of disease severity. CONCLUSIONS SARS-CoV-2 infection induces polyfunctional memory T cells detectable at 12 months postinfection, with higher frequency noted in those who experienced severe disease.
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Affiliation(s)
- Zhongyan Lu
- Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc, Bethesda, Maryland, USA
| | - Eric D Laing
- Department of Microbiology and Immunology, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Jarina Pena DaMata
- Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc, Bethesda, Maryland, USA
| | - Katherine Pohida
- Department of Pharmacology and Molecular Therapeutics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Marana S Tso
- Department of Microbiology and Immunology, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Emily C Samuels
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc, Bethesda, Maryland, USA
- Department of Microbiology and Immunology, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Nusrat J Epsi
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc, Bethesda, Maryland, USA
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Batsukh Dorjbal
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc, Bethesda, Maryland, USA
- Department of Pharmacology and Molecular Therapeutics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Camille Lake
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc, Bethesda, Maryland, USA
- Department of Pharmacology and Molecular Therapeutics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Stephanie A Richard
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc, Bethesda, Maryland, USA
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Ryan C Maves
- Naval Medical Center San Diego, San Diego, California, USA
| | - David A Lindholm
- Brooke Army Medical Center, Joint Base San Antonio-Fort Sam Houston, San Antonio, Texas, USA
| | - Julia S Rozman
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc, Bethesda, Maryland, USA
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Caroline English
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc, Bethesda, Maryland, USA
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Nikhil Huprikar
- Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Katrin Mende
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc, Bethesda, Maryland, USA
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
- Brooke Army Medical Center, Joint Base San Antonio-Fort Sam Houston, San Antonio, Texas, USA
| | - Rhonda E Colombo
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc, Bethesda, Maryland, USA
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
- Madigan Army Medical Center, Tacoma, Washington, USA
| | | | - Christopher C Broder
- Department of Microbiology and Immunology, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Anuradha Ganesan
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc, Bethesda, Maryland, USA
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
- Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Charlotte A Lanteri
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Brian K Agan
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc, Bethesda, Maryland, USA
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - David Tribble
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Mark P Simons
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Clifton L Dalgard
- Department of Anatomy, Physiology, and Genetics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Paul W Blair
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc, Bethesda, Maryland, USA
- Austere Environments Consortium for Enhanced Sepsis Outcomes, Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, Maryland, USA
| | - Josh Chenoweth
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc, Bethesda, Maryland, USA
- Austere Environments Consortium for Enhanced Sepsis Outcomes, Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, Maryland, USA
| | - Simon D Pollett
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc, Bethesda, Maryland, USA
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Andrew L Snow
- Department of Pharmacology and Molecular Therapeutics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Timothy H Burgess
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Allison M W Malloy
- Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
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26
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Richard SA, Epsi NJ, Pollett S, Lindholm DA, Malloy AMW, Maves R, Utz GC, Lalani T, Smith AG, Mody RM, Ganesan A, Colombo RE, Colombo CJ, Chi SW, Huprikar N, Larson DT, Bazan S, Madar C, Lanteri C, Rozman JS, English C, Mende K, Tribble DR, Agan BK, Burgess TH, Powers JH. Performance of the inFLUenza Patient-Reported Outcome Plus (FLU-PRO Plus) Instrument in Patients With Coronavirus Disease 2019. Open Forum Infect Dis 2021; 8:ofab517. [PMID: 34901299 DOI: 10.1093/ofid/ofab517] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 10/07/2021] [Indexed: 01/10/2023] Open
Abstract
Background The inFLUenza Patient-Reported Outcome Plus (FLU-PRO Plus) is a patient-reported outcome data collection instrument assessing symptoms of viral respiratory tract infections across 8 body systems. This study evaluated the measurement properties of FLU-PRO Plus in a study enrolling individuals with coronavirus disease 2019 (COVID-19). Methods Data from a prospective cohort study (EPICC) in US Military Health System beneficiaries evaluated for COVID-19 was utilized. Adults with symptomatic severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection with FLU-PRO Plus survey information within 1 week of symptom onset were included. Reliability of FLU-PRO Plus was estimated using intraclass correlation coefficient (ICC; 2 days' reproducibility). Known-groups validity was assessed using patient global assessment (PGA) of disease severity. Patient report of return to usual health was used to assess responsiveness (day 1-6/7). Results Two hundred twenty-six SARS-CoV-2-positive participants were included in the analysis. Reliability among those who reported no change in their symptoms from one day to the next was high for most domains (ICC range, 0.68-0.94 for day 1 to day 2). Construct validity was demonstrated by moderate to high correlation between the PGA rating of disease severity and domain and total scores (eg, total scores correlation: 0.69 [influenza-like illness severity], 0.69 [interference in daily activities], and -0.58 [physical health]). In addition, FLU-PRO Plus demonstrated good known-groups validity, with increasing domain and total scores observed with increasing severity ratings. Conclusions FLU-PRO Plus performs well in measuring signs and symptoms in SARS-CoV-2 infection with excellent construct validity, known-groups validity, and responsiveness to change. Standardized data collection instruments facilitate meta-analyses, vaccine effectiveness studies, and other COVID-19 research activities.
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Affiliation(s)
- Stephanie A Richard
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA.,The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc, Bethesda, Maryland, USA
| | - Nusrat J Epsi
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA.,The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc, Bethesda, Maryland, USA
| | - Simon Pollett
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA.,The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc, Bethesda, Maryland, USA
| | - David A Lindholm
- Brooke Army Medical Center, Fort Sam Houston, Texas, USA.,Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Allison M W Malloy
- Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Ryan Maves
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA.,Naval Medical Center San Diego, San Diego, California, USA
| | - Gregory C Utz
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA.,The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc, Bethesda, Maryland, USA.,Naval Medical Center San Diego, San Diego, California, USA
| | - Tahaniyat Lalani
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA.,The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc, Bethesda, Maryland, USA.,Naval Medical Center Portsmouth, Portsmouth, Virginia, USA
| | - Alfred G Smith
- Naval Medical Center Portsmouth, Portsmouth, Virginia, USA
| | - Rupal M Mody
- William Beaumont Army Medical Center, El Paso, Texas, USA
| | - Anuradha Ganesan
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA.,The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc, Bethesda, Maryland, USA.,Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Rhonda E Colombo
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA.,The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc, Bethesda, Maryland, USA.,Madigan Army Medical Center, Joint Base Lewis McChord, Washington, USA
| | - Christopher J Colombo
- Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA.,Madigan Army Medical Center, Joint Base Lewis McChord, Washington, USA
| | - Sharon W Chi
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA.,The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc, Bethesda, Maryland, USA.,Tripler Army Medical Center, Honolulu, Hawaii, USA
| | - Nikhil Huprikar
- Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA.,Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Derek T Larson
- Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA.,Fort Belvoir Community Hospital, Fort Belvoir, Virginia, USA
| | - Samantha Bazan
- Carl R. Darnall Army Medical Center, Fort Hood, Texas, USA
| | | | - Charlotte Lanteri
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Julia S Rozman
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA.,The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc, Bethesda, Maryland, USA
| | - Caroline English
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA.,The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc, Bethesda, Maryland, USA
| | - Katrin Mende
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA.,The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc, Bethesda, Maryland, USA.,Brooke Army Medical Center, Fort Sam Houston, Texas, USA
| | - David R Tribble
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Brian K Agan
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA.,The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc, Bethesda, Maryland, USA
| | - Timothy H Burgess
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - John H Powers
- Clinical Research Directorate, Frederick National Laboratory for Cancer Research, Frederick, Maryland, USA
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27
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Lantry FJ, Epsi N, Pollett S, Simons MP, Lindholm DA, Colombo RE, Fries AC, Maves RC, Ganesan A, Utz GC, Lalani T, Smith AG, Mody RM, Colombo CJ, Chi SW, Madar C, Huprikar N, Larson DT, Bazan S, Broder C, Laing E, English C, Lanteri C, Mende K, Tribble DR, Agan BK, Burgess TH, Richard SA. Anatomical site, viral RNA abundance, and time of sampling correlate with molecular detection of SARS-CoV-2 during infection. Open Forum Infect Dis 2021; 9:ofab623. [PMID: 35141345 PMCID: PMC8689744 DOI: 10.1093/ofid/ofab623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 12/07/2021] [Indexed: 11/18/2022] Open
Abstract
Background Nasopharyngeal (NP) swabs are the standard for SARS-CoV-2 diagnosis. If less invasive alternatives to NP swabs (eg, oropharyngeal [OP] or nasal swabs [NS]) are comparably sensitive, the use of these techniques may be preferable in terms of comfort, convenience, and safety. Methods This study compared the detection of SARS-CoV-2 in swab samples collected on the same day among participants with at least one positive PCR test. Results Overall, 755 participants had at least one set of paired swabs. Concordance between NP and other swab types was 75% (NS), 72% (OP), 54% (rectal swabs [RS]), and 78% (NS/OP combined). Kappa values were moderate for the NS, OP, and NS/OP comparisons (0.50, 0.45, and 0.54, respectively). Highest sensitivity relative to NP (0.87) was observed with a combination of NS/OP tests (positive if either NS or OP was positive). Sensitivity of the non-NP swab types was highest in the first week postsymptom onset and decreased thereafter. Similarly, virus RNA quantity was highest in the NP swabs as compared with NS, OP, and RS within two weeks postsymptom onset. OP and NS performance decreased as virus RNA quantity decreased. No differences were noted between NS specimens collected at home or in clinic. Conclusions NP swabs detected more SARS-CoV-2 cases than non-NP swabs, and the sensitivity of the non-NP swabs decreased with time postsymptom onset. While other swabs may be simpler to collect, NP swabs present the best chance of detecting SARS-CoV-2 RNA, which is essential for clinical care as well as genomic surveillance.
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Affiliation(s)
- F Julian Lantry
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
- Uniformed Services University of the Health Sciences, Bethesda, MD, USA
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, USA
| | - Nusrat Epsi
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, USA
| | - Simon Pollett
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, USA
| | - Mark P Simons
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - David A Lindholm
- Uniformed Services University of the Health Sciences, Bethesda, MD, USA
- Brooke Army Medical Center, Joint Base San Antonio-Fort Sam Houston, TX, USA
| | - Rhonda E Colombo
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, USA
- Madigan Army Medical Center, Joint Base Lewis McChord, WA, USA
| | - Anthony C Fries
- U.S. Air Force School of Aerospace Medicine, Wright-Patterson, OH, USA
| | - Ryan C Maves
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
- Naval Medical Center San Diego, San Diego, CA, USA
| | - Anuradha Ganesan
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, USA
- Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Gregory C Utz
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, USA
- Naval Medical Center San Diego, San Diego, CA, USA
| | - Tahaniyat Lalani
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, USA
- Naval Medical Center Portsmouth, Portsmouth, VA, USA
| | | | - Rupal M Mody
- William Beaumont Army Medical Center, El Paso, TX, USA
| | | | - Sharon W Chi
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, USA
- Tripler Army Medical Center, Honolulu, HI, USA
| | | | - Nikhil Huprikar
- Walter Reed National Military Medical Center, Bethesda, MD, USA
- Fort Belvoir Community Hospital, Fort Belvoir, VA, USA
| | | | | | | | - Eric Laing
- Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Caroline English
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, USA
| | - Charlotte Lanteri
- Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Katrin Mende
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, USA
- William Beaumont Army Medical Center, El Paso, TX, USA
| | - David R Tribble
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Brian K Agan
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, USA
| | - Timothy H Burgess
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Stephanie A Richard
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, USA
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Pollett S, Wier B, Richard SA, Fries AC, Maves RC, Maves RC, Utz G, Lalani T, Mody R, Ganesan A, Colombo RE, Colombo C, Lindholm DA, Lindholm DA, Madar C, Chi S, Huprikar N, Larson D, Bazan S, Scher A, Rusiecki J, Byrne C, Mende K, Simons MP, Tribble D, Agan B, Burgess T. 337. SARS-CoV-2 Viral Load Does Not Predict Incident Venous Thromboembolism in COVID-19. Open Forum Infect Dis 2021. [PMCID: PMC8690504 DOI: 10.1093/ofid/ofab466.538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background The risk factors of venous thromboembolism (VTE) in COVID-19 warrant further study. We leveraged a cohort in the Military Health System (MHS) to identify clinical and virological predictors of incident deep venous thrombosis (DVT), pulmonary embolism (PE), and other VTE within 90-days after COVID-19 onset. Methods PCR or serologically-confirmed SARS-CoV-2 infected MHS beneficiaries were enrolled via nine military treatment facilities (MTF) through April 2021. Case characteristics were derived from interview and review of the electronic medical record (EMR) through one-year follow-up in outpatients and inpatients. qPCR was performed on upper respiratory swab specimens collected post-enrollment to estimate SARS-CoV-2 viral load. The frequency of incident DVT, PE, or other VTE by 90-days post-COVID-19 onset were ascertained by ICD-10 code. Correlates of 90-day VTE were determined through multivariate logistic regression, including age and sampling-time-adjusted log10-SARS-CoV-2 GE/reaction as a priori predictors in addition to other demographic and clinical covariates which were selected through stepwise regression. Results 1473 participants with SARS-CoV-2 infection were enrolled through April 2021. 21% of study participants were inpatients; the mean age was 41 years (SD = 17.0 years). The median Charlson Comorbidity Index score was 0 (IQR = 0 - 1, range = 0 - 13). 27 (1.8%) had a prior history of VTE. Mean maximum viral load observed was 1.65 x 107 genome equivalents/reaction. 36 (2.4%) of all SARS-CoV-2 cases (including inpatients and outpatients), 29 (9.5%) of COVID-19 inpatients, and 7 (0.6%) of outpatients received an ICD-10 diagnosis of any VTE within 90 days after COVID-19 onset. Logistic regression identified hospitalization (aOR = 11.1, p = 0.003) and prior VTE (aOR = 6.2 , p = 0.009) as independent predictors of VTE within 90 days of symptom onset. Neither age (aOR = 1.0, p = 0.50), other demographic covariates, other comorbidities, nor SARS-CoV-2 viral load (aOR = 1.1, p = 0.60) were associated with 90-day VTE. Conclusion VTE was relatively frequent in this MHS cohort. SARS-CoV-2 viral load did not increase the odds of 90-day VTE. Rather, being hospitalized for SARS-CoV-2 and prior VTE history remained the strongest predictors of this complication. Disclosures Simon Pollett, MBBS, Astra Zeneca (Other Financial or Material Support, HJF, in support of USU IDCRP, funded under a CRADA to augment the conduct of an unrelated Phase III COVID-19 vaccine trial sponsored by AstraZeneca as part of USG response (unrelated work)) Ryan C. Maves, MD, EMD Serono (Advisor or Review Panel member)Heron Therapeutics (Advisor or Review Panel member) David A. Lindholm, MD, American Board of Internal Medicine (Individual(s) Involved: Self): Member of Auxiliary R&D Infectious Disease Item-Writer Task Force. No financial support received. No exam questions will be disclosed ., Other Financial or Material Support David Tribble, M.D., DrPH, Astra Zeneca (Other Financial or Material Support, HJF, in support of USU IDCRP, funded under a CRADA to augment the conduct of an unrelated Phase III COVID-19 vaccine trial sponsored by AstraZeneca as part of USG response (unrelated work))
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Affiliation(s)
- Simon Pollett
- Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Benjamin Wier
- Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Stephanie A Richard
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD and Henry M. Jackson Foundation, Bethesda, MD, Bethesda, Maryland
| | - Anthony C Fries
- United States Air Force School of Aerospace Medicine, Wright-Patterson AFB, Ohio
| | - Ryan C Maves
- Naval Medical Center San Diego, San Diego, CA and Infectious Disease Clinical Research Program, Bethesda, MD, San DIego, California
| | - Ryan C Maves
- Naval Medical Center San Diego, San Diego, CA and Infectious Disease Clinical Research Program, Bethesda, MD, San DIego, California
| | - Gregory Utz
- Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | | | | | - Anuradha Ganesan
- Infectious Disease Clinical Research Program and the Henry M. Jackson Foundation for the Advancement of Military Medicine and Walter Reed National Military Medical Center, Bethesda, MD
| | - Rhonda E Colombo
- Madigan Army Medical Center, Tacoma, WA, Infectious Disease Clinical Research Program, Bethesda, MD, and Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, Tacoma, Washington
| | - Chris Colombo
- Madigan Army Medical Center, Joint Base Lewis-McChord, Washington
| | - David A Lindholm
- Uniformed Services University of the Health Sciences; Brooke Army Medical Center, San Antonio, TX
| | - David A Lindholm
- Uniformed Services University of the Health Sciences; Brooke Army Medical Center, San Antonio, TX
| | - Cristian Madar
- Tripler Army Medical Center, Tripler Army Medical Center, Hawaii
| | - Sharon Chi
- Infectious Disease Clinical Research Program, Bethesda, Maryland
| | - Nikhil Huprikar
- Walter Reed National Military Medical Center (WRNMMC), Bethesda, Maryland
| | - Derek Larson
- Fort Belvoir Community Hospital Infectious Disease, Fort Belvoir, Virginia
| | | | - Ann Scher
- Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Jennifer Rusiecki
- Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | | | - Katrin Mende
- Infectious Disease Clinical Research Program, Bethesda, MD, The Henry M. Jackson Foundation, Bethesda, MD, and Brooke Army Medical Center, Fort Sam Houston, TX, San Antonio, TX
| | - Mark P Simons
- Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - David Tribble
- Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Brian Agan
- Infectious Disease Clinical Research Program, USU/HJF, Bethesda, Maryland
| | - Timothy Burgess
- Infectious Disease Clinical Research Program, Bethesda, Maryland
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Lu Z, Pena-DaMata J, Pohida K, Lake C, Epsi NJ, Richard SA, Agan B, Pollett S, Simons MP, Dalgard C, Blair PW, Chenoweth J, Snow AL, Burgess T, Malloy AM. 461. Classical Antigen Presenting Cell Activation Correlates with T Cell Immunity and COVID-19 Severity. Open Forum Infect Dis 2021. [PMCID: PMC8690736 DOI: 10.1093/ofid/ofab466.660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Background The initial response of immune cells against respiratory viruses often determines the severity and duration of disease. The early trajectory of the immune response during infection with SARS-CoV-2 remains poorly understood. Dysregulation of innate immune factors that facilitate viral clearance and the adaptive response, such as type I interferons, have been implicated in severe COVID-19. However, collection of biological samples during the first seven days post-symptom onset has posed a logistical challenge, limiting our knowledge surrounding the immune responses that drive protection versus immunopathology. Methods From March 2020, Military Health System beneficiaries presenting with a positive SARS-CoV-2 test, a COVID-19 like illness, or a high-risk SARS-CoV-2 exposure at nine military medical treatment facilities across the United States were eligible for enrollment in our longitudinal cohort study, which included collection of respiratory sample, sera, plasma, and peripheral blood mononuclear cells (PBMCs). Twenty-five SARS-CoV-2 infected study participants provided samples with in the first seven days of symptom onset, fifteen of whom were hospitalized with COVID-19. We employed multiparameter spectral flow cytometry to comprehensively analyze the early trajectory of the innate and adaptive immune responses. Results We discovered that early activation of critical antigen presenting cell subsets was impaired upon comparing inpatients with outpatients, correlating with decreased antigen-experienced T cell responses. Specifically, we noted reduced expression of key costimulatory molecules, CD80 and CD86, on conventional dendritic cells that are required for viral antigen-specific T cell priming. Reduction in CD38, a marker of activation was also observed on inpatient dendritic cell subsets. Conclusion Reduced antigen presenting cell activation and expression of ligands that facilitate T cell engagement may impede the efficient clearance of SARS-CoV-2, coinciding with more severe disease in our cohort. Further analysis of the functional activation of early innate immune responses triggered by SARS-CoV-2 may unveil new immune biomarkers and therapeutic targets to predict and prevent severe disease associated with inadequate T cell immunity. Disclosures Simon Pollett, MBBS, Astra Zeneca (Other Financial or Material Support, HJF, in support of USU IDCRP, funded under a CRADA to augment the conduct of an unrelated Phase III COVID-19 vaccine trial sponsored by AstraZeneca as part of USG response (unrelated work))
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Affiliation(s)
- Zhongyan Lu
- Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Jarina Pena-DaMata
- Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Katherine Pohida
- Uniformed Service University of the Health Sciences, Bethesda, Maryland
| | - Camille Lake
- Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | | | - Stephanie A Richard
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD and Henry M. Jackson Foundation, Bethesda, MD, Bethesda, Maryland
| | - Brian Agan
- Infectious Disease Clinical Research Program, USU/HJF, Bethesda, Maryland
| | - Simon Pollett
- Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Mark P Simons
- Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Clifton Dalgard
- The American Genome Center, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Paul W Blair
- Uniformed Services University, Bethesda, Maryland
| | | | - Andrew L Snow
- Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Timothy Burgess
- Infectious Disease Clinical Research Program, Bethesda, Maryland
| | - Allison M Malloy
- Uniformed Services University of the Health Sciences, Bethesda, Maryland
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Epsi NJ, Powers JH, Lindholm DA, Lindholm DA, Helfrich A, Huprikar N, Ganesan A, Lalani T, Mody R, Madar C, Bazan S, Colombo RE, Larson D, Maves RC, Maves RC, Utz G, Tribble D, Agan B, Burgess T, Malloy A, Pollett S, Richard SA. 458. A Machine Learning Approach Identifies Distinct Early-Symptom Cluster Phenotypes Which Correlate with Severe SARS-CoV-2 Outcomes. Open Forum Infect Dis 2021. [PMCID: PMC8644530 DOI: 10.1093/ofid/ofab466.657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
The novel coronavirus disease 2019 (COVID-19) pandemic remains a global challenge. Accurate COVID-19 prognosis remains an important aspect of clinical management. While many prognostic systems have been proposed, most are derived from analyses of individual symptoms or biomarkers. Here, we take a machine learning approach to first identify discrete clusters of early stage-symptoms which may delineate groups with distinct symptom phenotypes. We then sought to identify whether these groups correlate with subsequent disease severity.
Methods
The Epidemiology, Immunology, and Clinical Characteristics of Emerging Infectious Diseases with Pandemic Potential (EPICC) study is a longitudinal cohort study with data and biospecimens collected from nine military treatment facilities over 1 year of follow-up. Demographic and clinical characteristics were measured with interviews and electronic medical record review. Early symptoms by organ-domain were measured by FLU-PRO-plus surveys collected for 14 days post-enrollment, with surveys completed a median 14.5 (Interquartile Range, IQR = 13) days post-symptom onset. Using these FLU-PRO-plus responses, we applied principal component analysis followed by unsupervised machine learning algorithm k-means to identify groups with distinct clusters of symptoms. We then fit multivariate logistic regression models to determine how these early-symptom clusters correlated with hospitalization risk after controlling for age, sex, race, and obesity.
Results
Using SARS-CoV-2 positive participants (n = 1137) from the EPICC cohort (Figure 1), we transformed reported symptoms into domains and identified three groups of participants with distinct clusters of symptoms. Logistic regression demonstrated that cluster-2 was associated with an approximately three-fold increased odds [3.01 (95% CI: 2-4.52); P < 0.001] of hospitalization which remained significant after controlling for other factors [2.97 (95% CI: 1.88-4.69); P < 0.001].
(A) Baseline characteristics of SARS-CoV-2 positive participants. (B) Heatmap comparing FLU-PRO response in each participant. (C) Principal component analysis followed by k-means clustering identified three groups of participants. (D) Crude and adjusted association of identified cluster with hospitalization.
Conclusion
Our findings have identified three distinct groups with early-symptom phenotypes. With further validation of the clusters’ significance, this tool could be used to improve COVID-19 prognosis in a precision medicine framework and may assist in patient triaging and clinical decision-making.
Disclaimer
Disclosures
David A. Lindholm, MD, American Board of Internal Medicine (Individual(s) Involved: Self): Member of Auxiliary R&D Infectious Disease Item-Writer Task Force. No financial support received. No exam questions will be disclosed ., Other Financial or Material Support Ryan C. Maves, MD, EMD Serono (Advisor or Review Panel member)Heron Therapeutics (Advisor or Review Panel member) Simon Pollett, MBBS, Astra Zeneca (Other Financial or Material Support, HJF, in support of USU IDCRP, funded under a CRADA to augment the conduct of an unrelated Phase III COVID-19 vaccine trial sponsored by AstraZeneca as part of USG response (unrelated work))
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Affiliation(s)
| | - John H Powers
- Support to National Institute of Allergy and Infectious Disease, Bethesda, MD
| | - David A Lindholm
- Uniformed Services University of the Health Sciences; Brooke Army Medical Center, San Antonio, TX
| | - David A Lindholm
- Uniformed Services University of the Health Sciences; Brooke Army Medical Center, San Antonio, TX
| | - Alison Helfrich
- Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Nikhil Huprikar
- Walter Reed National Military Medical Center (WRNMMC), Bethesda, Maryland
| | - Anuradha Ganesan
- Infectious Disease Clinical Research Program and the Henry M. Jackson Foundation for the Advancement of Military Medicine and Walter Reed National Military Medical Center, Bethesda, MD
| | - Tahaniyat Lalani
- Infectious Disease Clinical Research Program, Bethesda, MD, The Henry M. Jackson Foundation, Bethesda, MD, and Naval Medical Center Portsmouth, VA, Portsmouth, Virginia
| | - Rupal Mody
- William Beaumont Army Medical Center, El Paso, Texas
| | - Cristian Madar
- Tripler Army Medical Center, Tripler Army Medical Center, Hawaii
| | | | - Rhonda E Colombo
- Madigan Army Medical Center, Tacoma, WA, Infectious Disease Clinical Research Program, Bethesda, MD, and Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, Tacoma, Washington
| | - Derek Larson
- Fort Belvoir Community Hospital Infectious Disease, Fort Belvoir, Virginia
| | - Ryan C Maves
- Naval Medical Center San Diego, San Diego, CA and Infectious Disease Clinical Research Program, Bethesda, MD, San DIego, California
| | - Ryan C Maves
- Naval Medical Center San Diego, San Diego, CA and Infectious Disease Clinical Research Program, Bethesda, MD, San DIego, California
| | - Gregory Utz
- Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | | | - Brian Agan
- Infectious Disease Clinical Research Program, USU/HJF, Bethesda, Maryland
| | - Timothy Burgess
- Infectious Disease Clinical Research Program, Bethesda, Maryland
| | - Allison Malloy
- Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Simon Pollett
- Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Stephanie A Richard
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD and Henry M. Jackson Foundation, Bethesda, MD, Bethesda, Maryland
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Cooper E, Lee T, Laing E, Ritter A, Lee M, Baker M, Baldino T, Mcadoo T, Nguyen H, Broder CC, Epsi NJ, Richard SA, Warkentien T, Millar E, Burgess T, Kronmann K, Lalani T. 385. SARS-CoV-2 Infections Among Military Personnel Deployed on the USNS COMFORT to New York City During the COVID-19 Pandemic and One-Year Follow-Up. Open Forum Infect Dis 2021. [PMCID: PMC8643885 DOI: 10.1093/ofid/ofab466.586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background The USNS COMFORT deployed to New York City to augment the inpatient health care capacity in March 2020. The aim of this study was to determine the prevalence of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection among US Navy personnel upon return from deployment, and to identify incident cases of SARS-CoV-2 infection during 1 year of follow-up. Methods Crewmembers, the majority of whom were health care workers (HCW), were enrolled following deployment, in May 2020. PCR results from symptomatic crewmembers during deployment, and Day 0 and Day 14 post-deployment screening swabs conducted on all crewmembers, per military order, were abstracted. A questionnaire and serum were collected on Day 14 post-deployment. SARS-CoV-2 infection was defined as a positive SARS-CoV-2 spike glycoprotein immunoglobulin G antibody (IgG) or PCR. COVID-19 related medical encounters, PCR and antibody testing results within 1 year following deployment were abstracted from the Military Health System Data Repository (MDR). There was adequate provision of personal protective equipment (PPE) in the hospital and the COVID-19 vaccine roll-out for HCW began in December 2020. Results Of the 1200 crewmembers, 449 were enrolled and completed the questionnaire and screening swabs, and 432 (96.2%) completed the Day 14 blood draw (Table 1). The cumulative prevalence of SARS-CoV-2 infection was 3.01% (13/432; 95% CI, 1.61%–5.09%). One of 17 subjects did not complete the blood draw and was PCR positive on Day 14. 433/449 (96.4%) had a PCR performed during the follow-up period (i.e. after the Day 14 post-deployment visit until Feb 2021), for HCW screening or symptomatic illness (median number of tests: 2 [IQR: 1, 2; range: 1,6]). 25 of 433 (5.8%) were PCR positive (Fig 1). 19 (76.0%) occurred in corpsmen, 23 (92.0%) were symptomatic and none were hospitalized. One asymptomatic re-infection occurred in a crewmember who was PCR negative and IgG positive at Day 14 post-deployment. Table 1. Characteristics of the overall cohort and by SARS-CoV-2 infection ![]()
Figure 1. Number of PCR tests (bar graph) and positivity rate (red line) by month in 449 USNS COMFORT crewmembers during 1-year follow-up after return from deployment ![]()
Conclusion The post-deployment prevalence of SARS-CoV-2 infection was low. A high proportion of HCW underwent PCR testing during 1-year follow-up but a low incidence of infection was observed. This was likely from community transmission as nosocomial transmission was mitigated by adequate PPE and vaccine roll-out. Disclosures All Authors: No reported disclosures
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Affiliation(s)
| | - Tida Lee
- Naval Medical Center Portsmouth, Portsmouth, Virginia
| | - Eric Laing
- Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Andrew Ritter
- Naval Medical Center Portsmouth, Portsmouth, Virginia
| | - Melissa Lee
- Naval Medical Center Portsmouth, Portsmouth, Virginia
| | - Matthew Baker
- Naval Medical Center Portsmouth, Portsmouth, Virginia
| | - Tyler Baldino
- Naval Medical Center Portsmouth, Portsmouth, Virginia
| | | | - Huy Nguyen
- Naval Medical Center Portsmouth, Portsmouth, Virginia
| | | | | | - Stephanie A Richard
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD and Henry M. Jackson Foundation, Bethesda, MD, Bethesda, Maryland
| | | | - Eugene Millar
- Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Timothy Burgess
- Infectious Disease Clinical Research Program, Bethesda, Maryland
| | | | - Tahaniyat Lalani
- Infectious Disease Clinical Research Program, Bethesda, MD, The Henry M. Jackson Foundation, Bethesda, MD, and Naval Medical Center Portsmouth, VA, Portsmouth, Virginia
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Kautz M, Epsi NJ, Richard SA, Colombo RE, Ganesan A, Collins L, Burgess T, Maves RC, Maves RC, Markelz AE, Geaney C, Seshadri S, Utz G, Mende K, Hrncir D, Modi J, Fries AC, McClenathan B, Schofield C, Montgomery JR, Skerrett C, Spooner C, Coles CL, Lalani T. 677. Compliance and Performance Characteristics of Subject Collected Versus Health-care Worker Collected Nasal Swabs for Respiratory Viral Surveillance. Open Forum Infect Dis 2021. [DOI: 10.1093/ofid/ofab466.874] [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: 11/13/2022] Open
Abstract
Abstract
Background
Self-collection of mid-nasal swabs (SCNS) at home is a convenient alternative to health-care worker-collected nasal swabs (HCWC) for determining the pathogen-specific epidemiology of influenza-like illness (ILI). We evaluated the compliance and performance characteristics of SCNS vs. HCWC for respiratory pathogens during 2019-2020 flu season.
Methods
Adult Military Health System (MHS) beneficiaries were enrolled in an influenza vaccine effectiveness trial (PAIVED). Following vaccination, subjects were instructed on SCNS and completion of a symptom diary and were contacted weekly to ascertain ILI symptoms (fever, sore throat, and/or cough). In the event of an ILI, subjects completed the symptom diary and SCNS and were scheduled a clinic visit for HCWC. Swabs were tested with the Luminex NxTAG® Respiratory Pathogen Panel. We evaluated compliance with swab collection, positive percent agreement (PPA) of SCNS using PCR detection from either HCWC or SCNS as the reference standard, and agreement between paired swabs using the Cohen Kappa coefficient (Κ).
Results
1808 ILI were reported by 972 participants enrolled during the study period. Compliance with HCWC was higher than SCNS (58% [1042] vs. 42% [766]; p< 0.001). SCNS were associated with a shorter interval from symptom onset (median: 4 days [IQR:2-6 days] vs. clinic collect: 7 days [IQR:4-9 days]; p < 0.001). 663 paired swabs were available for 609 participants (Table 1). The overall detection rate was higher in SCNS (36%) than HCWC (26%; p< 0.001) (Figure 1). The overall PPA was 85.7% and a PPA of approximately 80% of greater was observed for influenza, rhino/enterovirus, parainfluenza and respiratory syncytial virus. Agreement between paired swabs was poor due to the lower detection rates in HCWC.
Table 1. Demographics and swab collection data for 609 participants who provided 663 paired swabs
Figure 1. Detection by pathogen in 663 paired swabs
Conclusion
SCNS were associated with higher detection rates compared to HCWC, likely due to the shorter interval between symptom onset and swab collection. Strategies to improve compliance with SCNS and minimize the interval between symptom onset and swab collection are needed to optimize detection of respiratory pathogens in this MHS cohort.
Disclosures
Ryan C. Maves, MD, EMD Serono (Advisor or Review Panel member)Heron Therapeutics (Advisor or Review Panel member) Jitu Modi, MD, GSK (Speaker's Bureau)
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Affiliation(s)
| | | | - Stephanie A Richard
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD and Henry M. Jackson Foundation, Bethesda, Maryland
| | - Rhonda E Colombo
- Madigan Army Medical Center, Tacoma, WA, Infectious Disease Clinical Research Program, Bethesda, MD, and Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Tacoma, Washington
| | - Anuradha Ganesan
- Infectious Disease Clinical Research Program and the Henry M. Jackson Foundation for the Advancement of Military Medicine and Walter Reed National Military Medical Center, Bethesda, MD
| | - Limone Collins
- Immunization Health Branch, Defense Health Agency, Falls Church, VA
| | - Timothy Burgess
- Infectious Disease Clinical Research Program, Bethesda, Maryland
| | - Ryan C Maves
- Naval Medical Center San Diego, San Diego, CAand Infectious Disease Clinical Research Program, Bethesda, MD
| | - Ryan C Maves
- Naval Medical Center San Diego, San Diego, CAand Infectious Disease Clinical Research Program, Bethesda, MD
| | | | - Casey Geaney
- Walter Reed National Military Medical Center, Bethesda, MD
| | - Srihari Seshadri
- Immunization Health Branch, Defense Health Agency, Falls Church, VA
| | - Gregory Utz
- Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Katrin Mende
- Infectious Disease Clinical Research Program, Bethesda, MD, The Henry M. Jackson Foundation, Bethesda, MD, and Brooke Army Medical Center, Fort Sam Houston, TX
| | - David Hrncir
- Lackland Air Force Base & Carl R. Darnall Army Medical Center, San Antonio, Texas
| | - Jitu Modi
- Naval Health Clinic Annapolis, Laurel, Maryland
| | - Anthony C Fries
- United States Air Force School of Aerospace Medicine, Wright-Patterson AFB, Ohio
| | | | | | | | | | | | - Christian L Coles
- Infectious Disease Clinical Research Program, Bethesda, MD, The Henry M. Jackson Foundation, Bethesda, MD
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Burgess T, Richard SA, Collins L, Colombo RE, Ganesan A, Geaney C, Hrncir D, Lalani T, Markelz AE, Maves RC, Maves RC, McClenathan B, Mende K, Modi J, Montgomery JR, Schofield C, Seshadri S, Skerrett C, Spooner C, Utz G, Warkentien T, Williams A, Coles CL. 05. Pragmatic Assessment of Influenza Vaccine Effectiveness in the DoD (PAIVED): Updates from Year 3 of Multi-Site Trial. Open Forum Infect Dis 2021. [PMCID: PMC8644712 DOI: 10.1093/ofid/ofab466.208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Background The SARS-CoV-2 pandemic has spotlighted respiratory infections and the value of effective vaccines. The SARS-CoV-2 vaccine has been remarkably effective; however, influenza vaccine effectiveness has been reported to be lower among active duty military populations than in the general public (18% vs 36%). The Pragmatic Assessment of Influenza Vaccine Effectiveness in the DoD (PAIVED) study compares 3 FDA-licensed influenza vaccine types (egg-based, cell-based, and recombinant) to assess differences in immunogenicity and effectiveness in adults. Methods Participants in the 3rd year of PAIVED (2020/21 influenza season) were enrolled from October 2020 through January 2021. Participants received weekly surveys about influenza-like-illnesses (ILI) experienced in the past week; if they reported an ILI, they were queried about symptom duration and severity, and asked to self-collect a nasal swab and dried blood sample. Four weeks later, more information about symptom duration and illness burden was obtained via telephone interview, and the participant collected a second blood sample. Results PAIVED year 3 enrolled 3,269 participants (Table 1). 278 participants reported 1 ILI , while 60 reported 2 ILIs, and 18 reported 3 ILIs. No pathogen was identified for most processed ILI samples (78%); the most common viruses were SARS-CoV-2 (25, 12%), rhinovirus (24, 12%), and seasonal coronaviruses (4, 2%). No influenza has been identified thus far. Among those participants who had convalescent ILI visits (275), the median duration of the reported ILIs was 9 days (IQR 5, 15), with a median of 4 days (IQR 2, 7) of limited activity, and 2 days (IQR 0, 3) with fever. Three individuals were hospitalized. ![]()
Conclusion There have been relatively low rates of ILI identified in this study during this season, with only 11% of the participants reporting an ILI so far, consistent with low rates of non-COVID-19 ILI reported elsewhere during the current pandemic. We anticipate some influenza cases may be identified as more samples are processed. Planned analyses include calculating comparative influenza vaccine effectiveness to inform future vaccine purchasing decisions, as well as comparing serological response to the different vaccines. ![]()
Disclosures Ryan C. Maves, MD, EMD Serono (Advisor or Review Panel member)Heron Therapeutics (Advisor or Review Panel member) Jitu Modi, MD, GSK (Speaker’s Bureau)
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Affiliation(s)
- Timothy Burgess
- Infectious Disease Clinical Research Program, Bethesda, Maryland
| | - Stephanie A Richard
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD and Henry M. Jackson Foundation, Bethesda, MD, Bethesda, Maryland
| | - Limone Collins
- Immunization Health Branch, Defense Health Agency Bethesda, MD, Falls Church, VA, San Diego, CA, Falls Church, VA
| | - Rhonda E Colombo
- Madigan Army Medical Center, Tacoma, WA, Infectious Disease Clinical Research Program, Bethesda, MD, and Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, Tacoma, Washington
| | - Anuradha Ganesan
- Infectious Disease Clinical Research Program and the Henry M. Jackson Foundation for the Advancement of Military Medicine and Walter Reed National Military Medical Center, Bethesda, MD
| | - Casey Geaney
- Walter Reed National Military Medical Center, Bethesda, MD
| | - David Hrncir
- Lackland Air Force Base & Carl R. Darnall Army Medical Center, San Antonio, Texas
| | - Tahaniyat Lalani
- Infectious Disease Clinical Research Program, Bethesda, MD, The Henry M. Jackson Foundation, Bethesda, MD, and Naval Medical Center Portsmouth, VA, Portsmouth, Virginia
| | | | - Ryan C Maves
- Naval Medical Center San Diego, San Diego, CA and Infectious Disease Clinical Research Program, Bethesda, MD, San DIego, California
| | - Ryan C Maves
- Naval Medical Center San Diego, San Diego, CA and Infectious Disease Clinical Research Program, Bethesda, MD, San DIego, California
| | - Bruce McClenathan
- Womack Army Medical Center, Fort Bragg, NC 28310, Fort Bragg, North Carolina
| | - Katrin Mende
- Infectious Disease Clinical Research Program, Bethesda, MD, The Henry M. Jackson Foundation, Bethesda, MD, and Brooke Army Medical Center, Fort Sam Houston, TX, San Antonio, TX
| | - Jitu Modi
- Naval Health Clinic Annapolis, Laurel, Maryland
| | | | | | - Srihari Seshadri
- Immunization Health Branch, Defense Health Agency, Falls Church, VA
| | | | | | - Gregory Utz
- Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | | | | | - Christian L Coles
- Infectious Disease Clinical Research Program, Bethesda, MD, The Henry M. Jackson Foundation, Bethesda, MD, Bethesda, MD
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Blair PW, Brandsma J, Epsi NJ, Richard SA, Striegel D, Chenoweth J, Mehta R, Clemens E, Malloy A, Lanteri C, Dumler JS, Tribble D, Burgess T, Pollett S, Agan B, Clark D. 438. Phenotypic Differences Between Distinct Immune Biomarker Clusters During the ‘Hyperinflammatory’ Middle-Phase of COVID-19. Open Forum Infect Dis 2021. [PMCID: PMC8644901 DOI: 10.1093/ofid/ofab466.637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections peak during an inflammatory ‘middle’ phase and lead to severe illness predominately among those with certain comorbid noncommunicable diseases (NCDs). We used network machine learning to identify inflammation biomarker patterns associated with COVID-19 among those with NCDs. Methods SARS-CoV-2 RT-PCR positive subjects who had specimens available within 15-28 days post-symptom onset were selected from the DoD/USU EPICC COVID-19 cohort study. Plasma levels of 15 inflammation protein biomarkers were measured using a broad dynamic range immunoassay on samples collected from individuals with COVID-19 at 8 military hospitals across the United States. A network machine learning algorithm, topological data analysis (TDA), was performed using results from the ‘hyperinflammatory’ middle phase. Backward selection stepwise logistic regression was used to identify analytes associated with each cluster. NCDs with a significant association (0.05 significance level) across clusters using Fisher’s exact test were further evaluated comparing the NCD frequency in each cluster against all other clusters using a Kruskal-Wallis test. A sensitivity analysis excluding mild disease was also performed. Results The analysis population (n=129, 33.3% female, median 41.3 years of age) included 77 ambulatory, 31 inpatient, 16 ICU-level, and 5 fatal cases. TDA identified 5 unique clusters (Figure 1). Stepwise regression with a Bonferroni-corrected cutoff adjusted for severity identified representative analytes for each cluster (Table 1). The frequency of diabetes (p=0.01), obesity (p< 0.001), and chronic pulmonary disease (p< 0.001) differed among clusters. When restricting to hospitalized patients, obesity (8 of 11), chronic pulmonary disease (6 of 11), and diabetes (6 of 11) were more prevalent in cluster C than all other clusters. ![]()
Cluster differences in comorbid diseases and severity by cluster. 1A: bar plot of diabetes prevalence; 1B: bar plot of chronic lung disease ; 1C: bar plot of obesity prevalence; 1D: prevalence of steroid treatment ; 1E: Topologic data analysis network with clusters labeled; 1F: Bar plot of ordinal levels of severity. ![]()
Conclusion Machine learning clustering methods are promising analytical tools for identifying inflammation marker patterns associated with baseline risk factors and severe illness due to COVID-19. These approaches may offer new insights for COVID19 prognosis, therapy, and prevention. Disclosures Simon Pollett, MBBS, Astra Zeneca (Other Financial or Material Support, HJF, in support of USU IDCRP, funded under a CRADA to augment the conduct of an unrelated Phase III COVID-19 vaccine trial sponsored by AstraZeneca as part of USG response (unrelated work))
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Affiliation(s)
- Paul W Blair
- Uniformed Services University, Bethesda, Maryland
| | | | | | - Stephanie A Richard
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD and Henry M. Jackson Foundation, Bethesda, MD, Bethesda, Maryland
| | | | | | | | | | - Allison Malloy
- Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Charlotte Lanteri
- Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Boyds, Maryland
| | - J Stephen Dumler
- Uniformed Services University of the Health Sciences, Bethesda, MD
| | | | - Timothy Burgess
- Infectious Disease Clinical Research Program, Bethesda, Maryland
| | - Simon Pollett
- Uniformed Services University of the Health Sciences, Bethesda, MD
| | - Brian Agan
- Infectious Disease Clinical Research Program, USU/HJF, Bethesda, Maryland
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Richard SA, Pollett S, Epsi NJ, Maves RC, Maves RC, Utz G, Lalani T, Mody R, Ganesan A, Colombo RE, Colombo C, Lindholm DA, Lindholm DA, Madar C, Chi S, Huprikar N, Larson D, Bazan S, Byrne C, English CE, Parmelee E, Mende K, Simons M, Burgess T, Tribble D, Agan B. 34. Long-term clinical outcomes following SARS-CoV-2 infection include persistent symptoms and cardiovascular disease beyond 3 months post-infection. Open Forum Infect Dis 2021. [PMCID: PMC8644356 DOI: 10.1093/ofid/ofab466.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Background The long-term health effects after SARS-CoV-2 infection remain poorly understood. We evaluated health and healthcare usage after SARS-CoV-2 infection via surveys and longitudinal electronic medical record (EMR) review within the Military Health System (MHS). Methods We studied MHS beneficiaries enrolled in the Epidemiology, Immunology, and Clinical Characteristics of Emerging Infectious Diseases with Pandemic Potential (EPICC) cohort from March to December 2020. COVID-19 illness symptom severity and duration were derived from surveys initiated in late 2020. In addition, multi-year healthcare encounter history before and after onset of COVID-19 symptoms was collected from the MHS EMR. Odds of organ-system clinical diagnoses within the 3 months pre- and post-symptom onset were calculated using generalized linear models, controlling for age, sex, and race, and including participant as a random effect. Results 1,015 participants were included who were SARS-CoV-2 positive, symptomatic, and had 3-month follow-up data available in the EMR (Table 1). 625 of these participants had survey data collected more than 28 days post-symptom onset, among whom 17% and 6% reported persistent symptoms at 28-84 days, and 85+ days, respectively. 9.6% had not resumed normal activities by one month. The most frequently reported symptoms persisting beyond 28 days were dyspnea, loss of smell and/or taste, fatigue, and exercise intolerance (Figure 1A). When compared with the period 61 to 90 days prior to symptom onset, the first month post-symptom onset period was associated with increases of pulmonary (aOR = 57, 95% CI 28-112), renal (aOR = 29, 95% CI 10-84), cardiovascular (aOR = 7, 95% CI 5-11), and neurological diagnoses (aOR = 3, 95% CI 2-4) (Figures 1B and 1C). Cardiovascular disease diagnoses remained elevated through 3 months (aOR = 2, 95% CI 1-3). Table 1. Characteristics of SARS-CoV-2+ EPICC participants, and illness duration among those with 28+ days post-symptom onset survey data collection. ![]()
Figure 1 ![]()
Fig1A. Symptoms reported by EPICC participants with illnesses longer than 28 days; 1B. Percent of participants with organ system specific diagnoses on each day, 90 days pre- and post-symptom onset; 1C. Odds of organ system specific diagnoses within each month, +/- 3 months of symptom onset, were calculated using generalized linear models, controlling for age, sex, and race and included participants as a random effect. Odds shown are relative to the earliest period included in the model, 61-90 days before onset. Conclusion In this MHS cohort, a significant proportion of participants had persistent symptoms and cardiovascular disease diagnoses 3 months after COVID-19 illness onset. These findings emphasize the long-term morbidity of COVID-19 and the importance of mitigating SARS-CoV-2 infections. Further analyses will evaluate demographic, clinical, and biomarker predictors of medium-to-long term organ-specific post-acute sequelae. Disclosures Simon Pollett, MBBS, Astra Zeneca (Other Financial or Material Support, HJF, in support of USU IDCRP, funded under a CRADA to augment the conduct of an unrelated Phase III COVID-19 vaccine trial sponsored by AstraZeneca as part of USG response (unrelated work)) Ryan C. Maves, MD, EMD Serono (Advisor or Review Panel member)Heron Therapeutics (Advisor or Review Panel member) David A. Lindholm, MD, American Board of Internal Medicine (Individual(s) Involved: Self): Member of Auxiliary R&D Infectious Disease Item-Writer Task Force. No financial support received. No exam questions will be disclosed ., Other Financial or Material Support
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Affiliation(s)
- Stephanie A Richard
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD and Henry M. Jackson Foundation, Bethesda, MD, Bethesda, Maryland
| | - Simon Pollett
- Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | | | - Ryan C Maves
- Naval Medical Center San Diego, San Diego, CA and Infectious Disease Clinical Research Program, Bethesda, MD, San DIego, California
| | - Ryan C Maves
- Naval Medical Center San Diego, San Diego, CA and Infectious Disease Clinical Research Program, Bethesda, MD, San DIego, California
| | - Gregory Utz
- Naval Medical Center San Diego, Infectious Disease Clinical Research Program, Bethesda, MD, and Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, San Diego, California
| | - Tahaniyat Lalani
- Infectious Disease Clinical Research Program, Bethesda, MD, The Henry M. Jackson Foundation, Bethesda, MD, and Naval Medical Center Portsmouth, VA, Portsmouth, Virginia
| | | | - Anuradha Ganesan
- Infectious Disease Clinical Research Program and the Henry M. Jackson Foundation for the Advancement of Military Medicine and Walter Reed National Military Medical Center, Bethesda, MD
| | - Rhonda E Colombo
- Madigan Army Medical Center, Tacoma, WA, Infectious Disease Clinical Research Program, Bethesda, MD, and Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, Tacoma, Washington
| | - Chris Colombo
- Madigan Army Medical Center, Joint Base Lewis-McChord, Washington
| | - David A Lindholm
- Uniformed Services University of the Health Sciences; Brooke Army Medical Center, San Antonio, TX
| | - David A Lindholm
- Uniformed Services University of the Health Sciences; Brooke Army Medical Center, San Antonio, TX
| | - Cristian Madar
- Tripler Army Medical Center, Tripler Army Medical Center, Hawaii
| | | | - Nikhil Huprikar
- Walter Reed National Military Medical Center (WRNMMC), Bethesda, Maryland
| | - Derek Larson
- Fort Belvoir Community Hospital Infectious Disease, Fort Belvoir, Virginia
| | | | | | - Caroline E English
- Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Edward Parmelee
- Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Rockville, Maryland
| | - Katrin Mende
- Infectious Disease Clinical Research Program, Bethesda, MD, The Henry M. Jackson Foundation, Bethesda, MD, and Brooke Army Medical Center, Fort Sam Houston, TX, San Antonio, TX
| | | | - Timothy Burgess
- Infectious Disease Clinical Research Program, Bethesda, Maryland
| | | | - Brian Agan
- Infectious Disease Clinical Research Program, USU/HJF, Bethesda, Maryland
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Colombo RE, Richard SA, Schofield C, Collins L, Ganesan A, Geaney C, Hrncir D, Lalani T, Markelz AE, Maves RC, Maves RC, McClenathan B, Mende K, Modi J, Montgomery JR, Seshadri S, Skerrett C, Spooner C, Utz G, Williams A, Burgess T, Coles CL. 1338. Before and After: The Impact of the COVID-19 Pandemic on Influenza-Like Illness Trends in PAIVED. Open Forum Infect Dis 2021. [PMCID: PMC8689775 DOI: 10.1093/ofid/ofab466.1530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
The Pragmatic Assessment of Influenza Vaccine Effectiveness in the DoD (PAIVED) is a multicenter study assessing influenza vaccine effectiveness in active duty service members, retirees, and dependents. PAIVED recently completed its third year and offers a unique opportunity to examine influenza-like illness (ILI) trends prior to and during the COVID-19 pandemic in a prospective, well-defined cohort.
Methods
During the 2018-19, 2019-20, and 2020-21 influenza seasons, PAIVED enrolled DoD beneficiaries presenting for annual influenza vaccination. After collecting baseline demographic data, participants were randomized to receive egg-based, cell-based, or recombinant-derived influenza vaccine. Weekly throughout the influenza season of enrollment, participants were surveyed electronically for ILI, defined as (1) having cough or sore throat, plus (2) feeling feverish/having chills or having body aches/fatigue. Participants with ILI completed a daily symptom diary for seven days and submitted a nasal swab for pathogen detection.
Results
Over the three seasons, there were 10,656 PAIVED participants: 1514 (14.2%) in 2018-19, 5876 (55.1%) in 2019-20, and 3266 (30.6%) in 2020-21. The majority were male (68-73% per year) with a mean age of 34±14.8 years at enrollment. 2266 participants reported a total of 2673 unique ILIs. The highest percentage of participants with ILI was in 2019-20 (28.2%), versus 19.6% in 2018-19 and 9.6% in 2020-21. Figure 1 depicts the percent of individuals reporting ILI by week of the season for each of the PAIVED seasons. Notably, after March 21, 2020, the weekly incidence of participants reporting ILI never exceeded 1%.
Figure 1. Percent of PAIVED participants reporting ILI by week of season.
Conclusion
The low incidence of reported ILI in PAIVED participants during the COVID-19 pandemic is consistent with national influenza surveillance reports of influenza and outpatient ILI activity, suggesting that mitigation measures taken to reduce transmission of SARS-CoV-2 reduced the spread of other respiratory viruses.
Disclaimer
Disclosures
Ryan C. Maves, MD, EMD Serono (Advisor or Review Panel member)Heron Therapeutics (Advisor or Review Panel member) Jitu Modi, MD, GSK (Speaker’s Bureau)
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Affiliation(s)
- Rhonda E Colombo
- Madigan Army Medical Center, Tacoma, WA, Infectious Disease Clinical Research Program, Bethesda, MD, and Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, Tacoma, Washington
| | - Stephanie A Richard
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD and Henry M. Jackson Foundation, Bethesda, MD, Bethesda, Maryland
| | | | - Limone Collins
- Immunization Health Branch, Defense Health Agency Bethesda, MD, Falls Church, VA, San Diego, CA, Falls Church, VA
| | - Anuradha Ganesan
- Infectious Disease Clinical Research Program and the Henry M. Jackson Foundation for the Advancement of Military Medicine and Walter Reed National Military Medical Center, Bethesda, MD
| | - Casey Geaney
- Walter Reed National Military Medical Center, Bethesda, MD
| | - David Hrncir
- Lackland Air Force Base & Carl R. Darnall Army Medical Center, San Antonio, Texas
| | | | | | - Ryan C Maves
- Naval Medical Center San Diego, San Diego, CA and Infectious Disease Clinical Research Program, Bethesda, MD, San DIego, California
| | - Ryan C Maves
- Naval Medical Center San Diego, San Diego, CA and Infectious Disease Clinical Research Program, Bethesda, MD, San DIego, California
| | - Bruce McClenathan
- Womack Army Medical Center, Fort Bragg, NC 28310, Fort Bragg, North Carolina
| | - Katrin Mende
- Infectious Disease Clinical Research Program, Bethesda, MD, The Henry M. Jackson Foundation, Bethesda, MD, and Brooke Army Medical Center, Fort Sam Houston, TX, San Antonio, TX
| | - Jitu Modi
- Naval Health Clinic Annapolis, Laurel, Maryland
| | | | - Srihari Seshadri
- Immunization Health Branch, Defense Health Agency, Falls Church, VA
| | | | | | - Gregory Utz
- Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | | | - Timothy Burgess
- Infectious Disease Clinical Research Program, Bethesda, Maryland
| | - Christian L Coles
- Infectious Disease Clinical Research Program, Bethesda, MD, The Henry M. Jackson Foundation, Bethesda, MD, Bethesda, MD
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Yee D, Tso M, Shaw E, Rosen LB, Samuels E, Bastard P, Casanova JL, Holland SM, Su HC, Richard SA, Mende K, Lalani T, Lindholm DA, Lindholm DA, Simons MP, Tribble D, Malloy A, Laing E, Agan B, Pollett S, Burgess T, Snow AL. 450. Type I Interferon Autoantibodies Are Detected in Those with Critical COVID-19, Including a Young Female Patient. Open Forum Infect Dis 2021. [PMCID: PMC8690641 DOI: 10.1093/ofid/ofab466.649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background Approximately 10-20% of patients with critical COVID-19 harbor neutralizing autoantibodies (auto-Abs) that target type I interferons (IFN), a family of cytokines that induce critical innate immune defense mechanisms upon viral infection. Studies to date indicate that these auto-Abs are mostly detected in men over age 65. Methods We screened for type I IFN serum auto-Abs in sera collected < 21 days post-symptom onset in a subset of 103 COVID-19 inpatients and 24 outpatients drawn from a large prospective cohort study of SARS-CoV-2 infected patients enrolled across U.S. Military Treatment Facilities. The mean age of this n = 127 subset of study participants was 55.2 years (SD = 15.2 years, range 7.7 – 86.2 years), and 86/127 (67.7%) were male. Results Among those hospitalized 49/103 (47.6%) had severe COVID-19 (required at least high flow oxygen), and nine subjects died. We detected neutralizing auto-Abs against IFN-α, IFN-ω, or both, in four inpatients (3.9%, 8.2% of severe cases), with no auto-Abs detected in outpatients. Three of these patients were white males over the age of 62, all with multiple comorbidities; two of whom died and the third requiring high flow oxygen therapy. The fourth patient was a 36-year-old Hispanic female with a history of obesity who required mechanical ventilation during her admission for COVID-19. Conclusion These findings support the association between type I IFN auto-antibody production and life-threatening COVID-19. With further validation, reliable high-throughput screening for type I IFN auto-Abs may inform diagnosis, pathogenesis and treatment strategies for COVID-19, particularly in older males. Our finding of type I IFN auto-Ab production in a younger female prompts further study of this autoimmune phenotype in a broader population. Disclosures David A. Lindholm, MD, American Board of Internal Medicine (Individual(s) Involved: Self): Member of Auxiliary R&D Infectious Disease Item-Writer Task Force. No financial support received. No exam questions will be disclosed ., Other Financial or Material Support David Tribble, M.D., DrPH, Astra Zeneca (Other Financial or Material Support, HJF, in support of USU IDCRP, funded under a CRADA to augment the conduct of an unrelated Phase III COVID-19 vaccine trial sponsored by AstraZeneca as part of USG response (unrelated work)) Simon Pollett, MBBS, Astra Zeneca (Other Financial or Material Support, HJF, in support of USU IDCRP, funded under a CRADA to augment the conduct of an unrelated Phase III COVID-19 vaccine trial sponsored by AstraZeneca as part of USG response (unrelated work))
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Affiliation(s)
- Debra Yee
- Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Marana Tso
- Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Elana Shaw
- National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health, Bethesda, Maryland
| | - Lindsey B Rosen
- National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health, Bethesda, Maryland
| | - Emily Samuels
- Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | | | | | - Steven M Holland
- Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
| | - Helen C Su
- Immune Deficiency Genetics Section, Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
| | | | - Katrin Mende
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences and Brooke Army Medical Center, JBSA Fort Sam Houston, TX, San Antonio, TX
| | - Tahaniyat Lalani
- Infectious Disease Clinical Research Program, Bethesda, MD, The Henry M. Jackson Foundation, Bethesda, MD, and Naval Medical Center Portsmouth, VA, Portsmouth, Virginia
| | - David A Lindholm
- Uniformed Services University of the Health Sciences; Brooke Army Medical Center, San Antonio, TX
| | - David A Lindholm
- Uniformed Services University of the Health Sciences; Brooke Army Medical Center, San Antonio, TX
| | - Mark P Simons
- Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - David Tribble
- Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Allison Malloy
- Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Eric Laing
- Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Brian Agan
- Infectious Disease Clinical Research Program, USU/HJF, Bethesda, Maryland
| | - Simon Pollett
- Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Timothy Burgess
- Infectious Disease Clinical Research Program, Bethesda, Maryland
| | - Andrew L Snow
- Uniformed Services University of the Health Sciences, Bethesda, Maryland
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Maves RC, Richard SA, Lindholm DA, Epsi N, Larson DT, Conlon C, Everson K, Lis S, Blair PW, Chi S, Ganesan A, Pollett S, Burgess TH, Agan BK, Colombo RE, Colombo CJ. Predictive Value of an Age-Based Modification of the National Early Warning System in Hospitalized Patients With COVID-19. Open Forum Infect Dis 2021; 8:ofab421. [PMID: 34877361 PMCID: PMC8643671 DOI: 10.1093/ofid/ofab421] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 07/29/2021] [Accepted: 08/06/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Early recognition of high-risk patients with coronavirus disease 2019 (COVID-19) may improve outcomes. Although many predictive scoring systems exist, their complexity may limit utility in COVID-19. We assessed the prognostic performance of the National Early Warning Score (NEWS) and an age-based modification (NEWS+age) among hospitalized COVID-19 patients enrolled in a prospective, multicenter US Military Health System (MHS) observational cohort study. METHODS Hospitalized adults with confirmed COVID-19 not requiring invasive mechanical ventilation at admission and with a baseline NEWS were included. We analyzed each scoring system's ability to predict key clinical outcomes, including progression to invasive ventilation or death, stratified by baseline severity (low [0-3], medium [4-6], and high [≥7]). RESULTS Among 184 included participants, those with low baseline NEWS had significantly shorter hospitalizations (P < .01) and lower maximum illness severity (P < .001). Most (80.2%) of low NEWS vs 15.8% of high NEWS participants required no or at most low-flow oxygen supplementation. Low NEWS (≤3) had a negative predictive value of 97.2% for progression to invasive ventilation or death; a high NEWS (≥7) had high specificity (93.1%) but low positive predictive value (42.1%) for such progression. NEWS+age performed similarly to NEWS at predicting invasive ventilation or death (NEWS+age: area under the receiver operating characteristics curve [AUROC], 0.69; 95% CI, 0.65-0.73; NEWS: AUROC, 0.70; 95% CI, 0.66-0.75). CONCLUSIONS NEWS and NEWS+age showed similar test characteristics in an MHS COVID-19 cohort. Notably, low baseline scores had an excellent negative predictive value. Given their easy applicability, these scoring systems may be useful in resource-limited settings to identify COVID-19 patients who are unlikely to progress to critical illness.
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Affiliation(s)
- Ryan C Maves
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
- Naval Medical Center San Diego, San Diego, California, USA
- Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Stephanie A Richard
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, Maryland, USA
| | - David A Lindholm
- Brooke Army Medical Center, Joint Base San Antonio, Fort Sam Houston, Texas, USA
- Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Nusrat Epsi
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, Maryland, USA
| | - Derek T Larson
- Fort Belvoir Community Hospital, Fort Belvoir, Virginia, USA
| | - Christian Conlon
- Madigan Army Medical Center, Joint Base Lewis-McChord, Washington, USA
| | - Kyle Everson
- Madigan Army Medical Center, Joint Base Lewis-McChord, Washington, USA
| | - Steffen Lis
- Madigan Army Medical Center, Joint Base Lewis-McChord, Washington, USA
| | - Paul W Blair
- Austere Environments Consortium for Enhanced Sepsis Outcomes, Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, Maryland, USA
- Department of Pathology, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Sharon Chi
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, Maryland, USA
- Tripler Army Medical Center, Honolulu, Hawaii, USA
| | - Anuradha Ganesan
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, Maryland, USA
- Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Simon Pollett
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, Maryland, USA
| | - Timothy H Burgess
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Brian K Agan
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, Maryland, USA
| | - Rhonda E Colombo
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, Maryland, USA
- Madigan Army Medical Center, Joint Base Lewis-McChord, Washington, USA
| | - Christopher J Colombo
- Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
- Madigan Army Medical Center, Joint Base Lewis-McChord, Washington, USA
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Epsi NJ, Richard SA, Laing ED, Fries AC, Millar E, Simons MP, English C, Colombo CJ, Colombo RE, Lindholm DA, Ganesan A, Maves RC, Huprikar N, Larson D, Mende K, Chi SW, Madar C, Lalani T, Broder CC, Tribble D, Agan BK, Burgess TH, Pollett SD. Clinical, immunological and virological SARS-CoV-2 phenotypes in obese and non-obese military health system beneficiaries. J Infect Dis 2021; 224:1462-1472. [PMID: 34331541 PMCID: PMC8385847 DOI: 10.1093/infdis/jiab396] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 07/30/2021] [Indexed: 11/25/2022] Open
Abstract
Background The mechanisms underlying the association between obesity and coronavirus disease 2019 (COVID-19) severity remain unclear. After verifying that obesity was a correlate of severe COVID-19 in US Military Health System (MHS) beneficiaries, we compared immunological and virological phenotypes of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in both obese and nonobese participants. Methods COVID-19–infected MHS beneficiaries were enrolled, and anthropometric, clinical, and demographic data were collected. We compared the SARS-CoV-2 peak IgG humoral response and reverse-transcription polymerase chain reaction viral load in obese and nonobese patients, stratified by hospitalization, utilizing logistic regression models. Results Data from 511 COVID-19 patients were analyzed, among whom 24% were obese and 14% severely obese. Obesity was independently associated with hospitalization (adjusted odds ratio [aOR], 1.91; 95% confidence interval [CI], 1.15–3.18) and need for oxygen therapy (aOR, 3.39; 95% CI, 1.61–7.11). In outpatients, severely obese had a log10 (1.89) higher nucleocapsid (N1) genome equivalents (GE)/reaction and log10 (2.62) higher N2 GE/reaction than nonobese (P = 0.03 and P < .001, respectively). We noted a correlation between body mass index and peak anti-spike protein IgG in inpatients and outpatients (coefficient = 5.48, P < .001). Conclusions Obesity is a strong correlate of COVID-19 severity in MHS beneficiaries. These findings offer new pathophysiological insights into the relationship between obesity and COVID-19 severity.
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Affiliation(s)
- Nusrat J Epsi
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD USA
| | - Stephanie A Richard
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD USA
| | - Eric D Laing
- Department of Microbiology and Immunology, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Anthony C Fries
- U.S. Air Force School of Aerospace Medicine, Dayton, Ohio, USA
| | - Eugene Millar
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD USA
| | - Mark P Simons
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Caroline English
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD USA
| | - Christopher J Colombo
- Madigan Army Medical Center, Joint Base Lewis McChord, WA, USA.,Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Rhonda E Colombo
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD USA.,Madigan Army Medical Center, Joint Base Lewis McChord, WA, USA
| | | | - Anuradha Ganesan
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD USA.,Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Ryan C Maves
- Naval Medical Center San Diego, San Diego, CA, USA
| | - Nikhil Huprikar
- Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Derek Larson
- Fort Belvoir Community Hospital, Fort Belvoir, VA, USA
| | - Katrin Mende
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD USA.,Brooke Army Medical Center, Fort Sam Houston, TX, USA
| | - Sharon W Chi
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD USA.,Tripler Army Medical Center, Honolulu, HI, USA
| | | | - Tahaniyat Lalani
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD USA.,Naval Medical Center Portsmouth, Portsmouth, VA, USA
| | - Christopher C Broder
- Department of Microbiology and Immunology, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - David Tribble
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Brian K Agan
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD USA
| | - Timothy H Burgess
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Simon D Pollett
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD USA
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Richard SA, McCormick BJJ, Murray-Kolb LE, Bessong P, Shrestha SK, Mduma E, Ahmed T, Kang G, Lee GO, Seidman JC, Svensen E, Kosek MN, Caulfield LE. Influences on catch-up growth using relative versus absolute metrics: evidence from the MAL-ED cohort study. BMC Public Health 2021; 21:1246. [PMID: 34187407 PMCID: PMC8240385 DOI: 10.1186/s12889-021-11120-0] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 05/24/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Poor growth in early childhood has been considered irreversible after 2-3 years of age and has been associated with morbidity and mortality over the short-term and with poor economic and cognitive outcomes over the long-term. The MAL-ED cohort study was performed in eight low-income settings with the goal of evaluating relationships between the child's environment and experience (dietary, illness, and pathogen exposure, among others) and their growth and development. The goal of this analysis is to determine whether there are differences in the factors associated with growth from 24 to 60 months using two different metrics. METHODS Across six MAL-ED sites, 942 children had anthropometry data at 24 and 60 months, as well as information about socioeconomic status, maternal height, gut permeability (lactulose-mannitol z-score (LMZ)), dietary intake from 9 to 24 months, and micronutrient status. Anthropometric changes were in height- or weight-for-age z-score (HAZ, WAZ), their absolute difference from the growth standard median (HAD (cm), WAD (kg)), as well as recovery from stunting/underweight. Outcomes were modeled using multivariate regression. RESULTS At 24 months, almost half of the cohort was stunted (45%) and 21% were underweight. Among those who were stunted at 24 months (n = 426), 185 (43%) were no longer stunted at 60 months. Most children increased their HAZ from 24 to 60 months (81%), whereas fewer (33%) had positive changes in their HAD. Linear regression models indicate that girls improved less than boys from 24 to 60 months (HAZ: -0.21 (95% CI -0.27, -0.15); HAD: -0.75 (-1.07, -0.43)). Greater intestinal permeability (higher LMZ) at 0-24 months was associated with lower relative and absolute changes from 24 to 60 months (HAZ: -0.10 (-0.16, -0.04); HAD: -0.47 (-0.73, -0.21)). Maternal height (per 10 cm) was positively associated with changes (HAZ: 0.09 (0.03, 0.15); HAD: 0.45 (0.15, 0.75)). Similar relationships were identified for changes in WAZ and WAD. CONCLUSIONS The study children demonstrated improved growth from 24 to 60 months of age, but only a subset had positive changes in HAD and WAD. The same environmental factors were associated with growth from 24 to 60 months regardless of metric used (change in HAZ or HAD, or WAZ and WAD).
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Affiliation(s)
| | | | | | | | - Sanjaya K. Shrestha
- Walter Reed, Armed Forces Research Institute of Medical Sciences (AFRIMS) Research Unit, Nepal, (WARUN), Kathmandu, Nepal
| | | | | | - Gagandeep Kang
- Division of Gastrointestinal Sciences, Christian Medical College, Vellore, Tamil Nadu India
| | - Gwenyth O. Lee
- The Johns Hopkins University, 615 North Wolfe Street, Room W2041, Baltimore, MD 21205 USA
| | - Jessica C. Seidman
- Fogarty International Center/National Institutes of Health, Bethesda, MD USA
| | | | | | - Laura E. Caulfield
- The Johns Hopkins University, 615 North Wolfe Street, Room W2041, Baltimore, MD 21205 USA
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41
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Colombo RE, Schofield C, Richard SA, Fairchok M, Chen WJ, Danaher PJ, Lalani TN, Ridoré M, Maves RC, Arnold JC, Ganesan A, Agan B, Millar EV, Coles C, Burgess TH. Effects of human immunodeficiency virus status on symptom severity in influenza-like illness in an otherwise healthy adult outpatient cohort. J Investig Med 2021; 69:1230-1237. [PMID: 33893210 PMCID: PMC8319060 DOI: 10.1136/jim-2020-001694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/31/2021] [Indexed: 11/25/2022]
Abstract
The impact of HIV on influenza-like illness (ILI) has been incompletely described in the era of combination antiretroviral therapy, particularly in the post-H1N1 pandemic period. This analysis informs on ILI in an otherwise healthy, predominantly outpatient cohort of adults with HIV in the USA. From September 2010 to March 2015, this multisite observational cohort study enrolled otherwise healthy adults presenting to a participating US military medical center with ILI, a subset of whom were HIV positive. Demographics, clinical data, and self-reported symptom severity were ascertained, and enrollees completed a daily symptom diary for up to 10 days. 510 men were included in the analysis; 50 (9.8%) were HIV positive. Subjects with HIV were older and less likely to be on active duty. Rhinovirus and influenza A were the most commonly identified pathogens. Moderate–severe diarrhea (p<0.001) and fatigue (p=0.01) were more frequently reported by HIV-positive men. HIV positivity was associated with higher gastrointestinal scores, but not other measures of ILI symptom severity, after controlling for age, race, military status, and influenza season. Few were hospitalized. HIV-positive subjects had more influenza B (p=0.04) and were more likely to receive antivirals (32% vs 6%, p<0.01). Antiviral use was not significantly associated with symptom scores when accounting for potential confounders. In this predominantly outpatient cohort of adult men, HIV had minimal impact on ILI symptom severity. Despite similar illness severity, a higher percentage of subjects with HIV reported undergoing antiviral treatment for ILI, likely reflecting differences in prescribing practices.Trial registration number: NCT01021098.
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Affiliation(s)
- Rhonda E Colombo
- Department of Medicine, Madigan Army Medical Center, Tacoma, Washington, USA .,Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Infectious Disease Clinical Research Program, Bethesda, Maryland, USA.,Henry M Jackson Foundation for the Advancement of Military Medicine Inc, Bethesda, Maryland, USA
| | - Christina Schofield
- Department of Medicine, Madigan Army Medical Center, Tacoma, Washington, USA .,Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Infectious Disease Clinical Research Program, Bethesda, Maryland, USA
| | - Stephanie A Richard
- Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Infectious Disease Clinical Research Program, Bethesda, Maryland, USA.,Henry M Jackson Foundation for the Advancement of Military Medicine Inc, Bethesda, Maryland, USA
| | - Mary Fairchok
- Department of Medicine, Madigan Army Medical Center, Tacoma, Washington, USA.,Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Infectious Disease Clinical Research Program, Bethesda, Maryland, USA.,Henry M Jackson Foundation for the Advancement of Military Medicine Inc, Bethesda, Maryland, USA
| | - Wei-Ju Chen
- Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Infectious Disease Clinical Research Program, Bethesda, Maryland, USA.,Henry M Jackson Foundation for the Advancement of Military Medicine Inc, Bethesda, Maryland, USA
| | - Patrick J Danaher
- Department of Medicine, Brooke Army Medical Center, San Antonio, Texas, USA
| | - Tahaniyat N Lalani
- Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Infectious Disease Clinical Research Program, Bethesda, Maryland, USA.,Henry M Jackson Foundation for the Advancement of Military Medicine Inc, Bethesda, Maryland, USA.,Infectious Disease Department, Naval Medical Center Portsmouth, Portsmouth, Virginia, USA
| | - Michelande Ridoré
- Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Infectious Disease Clinical Research Program, Bethesda, Maryland, USA.,Henry M Jackson Foundation for the Advancement of Military Medicine Inc, Bethesda, Maryland, USA
| | - Ryan C Maves
- Department of Medicine, Naval Medical Center San Diego, San Diego, California, USA
| | - John C Arnold
- Department of Pediatrics, Naval Medical Center San Diego, San Diego, California, USA
| | - Anuradha Ganesan
- Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Infectious Disease Clinical Research Program, Bethesda, Maryland, USA.,Henry M Jackson Foundation for the Advancement of Military Medicine Inc, Bethesda, Maryland, USA.,Department of Medicine, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Brian Agan
- Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Infectious Disease Clinical Research Program, Bethesda, Maryland, USA.,Henry M Jackson Foundation for the Advancement of Military Medicine Inc, Bethesda, Maryland, USA
| | - Eugene V Millar
- Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Infectious Disease Clinical Research Program, Bethesda, Maryland, USA.,Henry M Jackson Foundation for the Advancement of Military Medicine Inc, Bethesda, Maryland, USA
| | - Christian Coles
- Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Infectious Disease Clinical Research Program, Bethesda, Maryland, USA.,Henry M Jackson Foundation for the Advancement of Military Medicine Inc, Bethesda, Maryland, USA
| | - Timothy H Burgess
- Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Infectious Disease Clinical Research Program, Bethesda, Maryland, USA
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Schofield C, Colombo RE, Richard SA, Chen WJ, Fairchok MP, Maves RC, Arnold JC, Danaher PJ, Deiss RG, Lalani T, Rajnik M, Millar EV, Coles CL, Burgess TH. Comparable Disease Severity by Influenza Virus Subtype in the Acute Respiratory Infection Consortium Natural History Study. Mil Med 2021; 185:e1008-e1015. [PMID: 32588899 DOI: 10.1093/milmed/usaa120] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 12/13/2019] [Accepted: 01/07/2020] [Indexed: 12/30/2022] Open
Abstract
INTRODUCTION Since the influenza A/H1N1 pandemic of 2009 to 2010, numerous studies have described the clinical course and outcome of the different subtypes of influenza (A/H1N1, A/H3N2, and B). A recent systematic literature review concluded that there were no appreciable differences in either clinical presentation or disease severity among these subtypes, but study parameters limit the applicability of these results to military populations. We sought to evaluate differences in disease severity among influenza subtypes in a cohort of healthy, primarily outpatient adult U.S. Department of Defense beneficiaries. MATERIALS AND METHODS From 2009 to 2014, we enrolled otherwise healthy adults age 18 to 65 years with influenza-like illness in an observational cohort study based in 5 U.S. military medical centers. Serial nasopharyngeal swabs were collected for determination of etiology and viral shedding by polymerase chain reaction. The presence and severity of symptoms was assessed by interview and patient diary. RESULTS Over a 5-year period, a total of 157 adults with laboratory-confirmed influenza and influenza subtype were enrolled. Of these, 69 (44%) were positive for influenza A(H1N1), 69 (44%) for influenza A(H3N2), and 19 (12%) for influenza B. About 61% were male, 64% were active duty military personnel, and 72% had received influenza vaccine in the past 8 months. Almost 10% were hospitalized with influenza. Seasonal influenza virus distribution among enrollees mirrored that of nationwide trends each year of study. Individuals with A/H1N1 had upper respiratory composite scores that were lower than those with A/H3N2. Multivariate models indicated that individuals with A(H1N1) and B had increased lower respiratory symptom scores when compared to influenza A(H3N2) (A[H1N1]: 1.51 [95% CI 0.47, 2.55]; B: 1.46 [95% CI 0.09, 2.83]), whereas no other differences in symptom severity scores among influenza A(H1N1), influenza A(H3N2), and influenza B infection were observed. Overall, influenza season (maximum in 2012-2013 season) and female sex of the participant were found to be associated with increased influenza symptom severity. CONCLUSIONS Our study of influenza in a cohort of otherwise healthy, outpatient adult Department of Defense beneficiaries over 5 influenza seasons revealed few differences between influenza A(H1N1), influenza A(H3N2), and influenza B infection with respect to self-reported disease severity or clinical outcomes. This study highlights the importance of routine, active, and laboratory-based surveillance to monitor ongoing trends and severity of influenza in various populations to inform prevention measures.
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Affiliation(s)
- Christina Schofield
- Infectious Disease Service, Madigan Army Medical Center, 9040 Jackson Ave, Fort Lewis, Washington, Washington DC 98431
| | - Rhonda E Colombo
- Infectious Disease Service, Madigan Army Medical Center, 9040 Jackson Ave, Fort Lewis, Washington, Washington DC 98431.,Infectious Diseases Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD 2088.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD 2088
| | - Stephanie A Richard
- Infectious Diseases Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD 2088.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD 2088
| | - Wei-Ju Chen
- Infectious Diseases Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD 2088.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD 2088
| | - Mary P Fairchok
- Infectious Disease Service, Madigan Army Medical Center, 9040 Jackson Ave, Fort Lewis, Washington, Washington DC 98431.,Infectious Diseases Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD 2088.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD 2088
| | - Ryan C Maves
- Division of Infectious Disease, Naval Medical Center San Diego, 34800 Bob Wilson Dr, San Diego, CA 92134
| | - John C Arnold
- Division of Infectious Disease, Naval Medical Center San Diego, 34800 Bob Wilson Dr, San Diego, CA 92134
| | - Patrick J Danaher
- Infectious Disease Service, San Antonio Military Medical Center, 3551 Roger Brooke Dr, San Antonio, TX 78234
| | - Robert G Deiss
- Infectious Diseases Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD 2088.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD 2088.,Division of Infectious Disease, Naval Medical Center San Diego, 34800 Bob Wilson Dr, San Diego, CA 92134
| | - Tahaniyat Lalani
- Infectious Diseases Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD 2088.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD 2088.,Infectious Disease Division, Naval Medical Center Portsmouth, 620 John Paul Jones Cir, Portsmouth, VA 23708
| | - Michael Rajnik
- Division of Infectious Disease, Walter Reed National Military Medical Center, 4494 Palm Rd N, Bethesda, MD 20889
| | - Eugene V Millar
- Infectious Diseases Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD 2088.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD 2088
| | - Christian L Coles
- Infectious Diseases Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD 2088.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD 2088
| | - Timothy H Burgess
- Infectious Diseases Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD 2088
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Richard SA, McCormick BJJ, Murray-Kolb LE, Patil CL, Chandyo RK, Mahopo C, Maciel BL, Bose A, Mahfuz M, Ambikapathi R, Olortegui MP, Caulfield LE. Characteristics associated with the transition to partial breastfeeding prior to 6 months of age: Data from seven sites in a birth cohort study. Matern Child Nutr 2021; 17:e13166. [PMID: 33660928 PMCID: PMC8189203 DOI: 10.1111/mcn.13166] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 01/31/2021] [Accepted: 02/02/2021] [Indexed: 11/30/2022]
Abstract
The WHO recommends exclusive breastfeeding for the first 6 months of life. However, the transition of the infants' diet to partial breastfeeding with the addition of animal milks and/or solids typically occurs earlier than this. Here, we explored factors associated with the timing of an early transition to partial breastfeeding across seven sites of a birth cohort study in which twice weekly information on infant feeding practices was collected. Infant (size, sex, illness and temperament), maternal (age, education, parity and depressive symptoms), breastfeeding initiation practices (time of initiation, colostrum and pre‐lacteal feeding) and household factors (food security, crowding, assets, income and resources) were considered. Three consecutive caregiver reports of feeding animal milks and/or solids (over a 10‐day period) were characterized as a transition to partial breastfeeding, and Cox proportional hazard models with time (in days) to partial breastfeeding were used to evaluate associations with both fixed and time‐varying characteristics. Overall, 1470 infants were included in this analysis. Median age of transition to partial breastfeeding ranged from 59 days (South Africa and Tanzania) to 178 days (Bangladesh). Overall, higher weight‐for‐length z‐scores were associated with later transitions to partial breastfeeding, as were food insecurity, and infant cough in the past 30 days. Maternal depressive symptoms (evaluated amongst 1227 infants from six sites) were associated with an earlier transition to partial breastfeeding. Relative thinness or heaviness within each site was related to breastfeeding transitions, as opposed to absolute z‐scores. Further research is needed to understand relationships between local perceptions of infant body size and decisions about breastfeeding.
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Affiliation(s)
- Stephanie A Richard
- Fogarty International Center, National Institutes of Health, Bethesda, Maryland, USA.,Infectious Disease Clinical Research Program, Henry M Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, USA
| | - Benjamin J J McCormick
- Fogarty International Center, National Institutes of Health, Bethesda, Maryland, USA.,Science Fish Limited, Insch, UK
| | - Laura E Murray-Kolb
- Department of Nutritional Sciences, The Pennsylvania State University, State College, PA, USA
| | - Crystal L Patil
- Department of Human Development and Nursing Science, University of Illinois, Chicago, Illinois, USA
| | | | - Cloupas Mahopo
- Department of Nutrition, University of Venda, Thohoyandou, South Africa
| | - Bruna L Maciel
- Department of Nutrition, Federal University of Rio Grande do Norte, Natal, Brazil
| | - Anuradha Bose
- Division of Gastrointestinal Sciences, Christian Medical College, Vellore, India
| | - Mustafa Mahfuz
- Nutrition and Clinical Services Division, icddr,b, Dhaka, Bangladesh
| | - Ramya Ambikapathi
- Fogarty International Center, National Institutes of Health, Bethesda, Maryland, USA.,Department of Public Health, Purdue University, West Lafayette, Indiana, USA
| | | | - Laura E Caulfield
- The Department of International Health, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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Laing ED, Sterling SL, Richard SA, Epsi NJ, Coggins S, Samuels EC, Phogat S, Yan L, Moreno N, Coles CL, Drew M, Mehalko J, English CE, Merritt S, Mende K, Munster VJ, de Wit E, Chung KK, Millar EV, Tribble DR, Simons MP, Pollett SD, Agan BK, Esposito D, Lanteri C, Clifton GT, Mitre E, Burgess TH, Broder CC. Antigen-based multiplex strategies to discriminate SARS-CoV-2 natural and vaccine induced immunity from seasonal human coronavirus humoral responses. medRxiv 2021:2021.02.10.21251518. [PMID: 33594376 PMCID: PMC7885935 DOI: 10.1101/2021.02.10.21251518] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Sensitive and specific SARS-CoV-2 antibody assays remain critical for community and hospital-based SARS-CoV-2 sero-surveillance. With the rollout of SARS-CoV-2 vaccines, such assays must be able to distinguish vaccine from natural immunity to SARS-CoV-2 and related human coronaviruses. Here, we developed and implemented multiplex microsphere-based immunoassay strategies for COVD-19 antibody studies that incorporates spike protein trimers of SARS-CoV-2 and the endemic seasonal human coronaviruses (HCoV), enabling high throughout measurement of pre-existing cross-reactive antibodies. We varied SARS-CoV-2 antigen compositions within the multiplex assay, allowing direct comparisons of the effects of spike protein, receptor-binding domain protein (RBD) and nucleocapsid protein (NP) based SARS-CoV-2 antibody detection. Multiplex immunoassay performance characteristics are antigen-dependent, and sensitivities and specificities range 92-99% and 94-100%, respectively, for human subject samples collected as early as 7-10 days from symptom onset. SARS-CoV-2 spike and RBD had a strong correlative relationship for the detection of IgG. Correlation between detectable IgG reactive with spike and NP also had strong relationship, however, several PCR-positive and spike IgG-positive serum samples were NP IgG-negative. This spike and NP multiplex immunoassay has the potential to be useful for differentiation between vaccination and natural infection induced antibody responses. We also assessed the induction of de novo SARS-CoV-2 IgG cross reactions with SARS-CoV and MERS-CoV spike proteins. Furthermore, multiplex immunoassays that incorporate spike proteins of SARS-CoV-2 and HCoVs will permit investigations into the influence of HCoV antibodies on COVID-19 clinical outcomes and SARS-CoV-2 antibody durability.
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Affiliation(s)
- Eric D. Laing
- Department of Microbiology and Immunology, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Spencer L. Sterling
- Department of Microbiology and Immunology, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD USA
| | - Stephanie A. Richard
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD USA
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Nusrat J. Epsi
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD USA
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Si’Ana Coggins
- Department of Microbiology and Immunology, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD USA
| | - Emily C. Samuels
- Department of Microbiology and Immunology, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD USA
| | - Shreshta Phogat
- Department of Microbiology and Immunology, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD USA
| | - Lianying Yan
- Department of Microbiology and Immunology, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD USA
| | - Nicole Moreno
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD USA
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Christian L. Coles
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD USA
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Matthew Drew
- Protein Expression Laboratory, National Cancer Institute RAS Initiative, Frederick National Laboratory for Cancer Research, Frederick, MD, USA
| | - Jennifer Mehalko
- Protein Expression Laboratory, National Cancer Institute RAS Initiative, Frederick National Laboratory for Cancer Research, Frederick, MD, USA
| | - Caroline E. English
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD USA
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Scott Merritt
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD USA
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
- Brooke Army Medical Center, JBSA Fort Sam Houston, TX, USA
| | - Katrin Mende
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD USA
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
- Brooke Army Medical Center, JBSA Fort Sam Houston, TX, USA
| | - Vincent J. Munster
- Laboratory of Virology, Rocky Mountain Laboratories, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Hamilton, MT, USA
| | - Emmie de Wit
- Laboratory of Virology, Rocky Mountain Laboratories, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Hamilton, MT, USA
| | - Kevin K. Chung
- Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Eugene V. Millar
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD USA
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - David R. Tribble
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Mark P. Simons
- Department of Microbiology and Immunology, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Simon D. Pollett
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD USA
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Brian K. Agan
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD USA
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Dominic Esposito
- Protein Expression Laboratory, National Cancer Institute RAS Initiative, Frederick National Laboratory for Cancer Research, Frederick, MD, USA
| | - Charlotte Lanteri
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD USA
| | | | - Edward Mitre
- Department of Microbiology and Immunology, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Timothy H. Burgess
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD USA
| | - Christopher C. Broder
- Department of Microbiology and Immunology, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
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Lalani T, Lee TK, Laing ED, Ritter A, Cooper E, Lee M, Baker M, Baldino T, Mcadoo T, Phogat S, Samuels E, Nguyen H, Broder CC, Epsi N, Richard SA, Warkentien TE, Millar EV, Burgess T, Kronmann KC. SARS-CoV-2 Infections and Serologic Responses Among Military Personnel Deployed on the USNS COMFORT to New York City During the COVID-19 Pandemic. Open Forum Infect Dis 2021; 8:ofaa654. [PMID: 33553482 PMCID: PMC7856331 DOI: 10.1093/ofid/ofaa654] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 12/29/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) presents a unique challenge to United States Navy hospital ships. The aim of this study was to determine the prevalence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection among US Navy personnel deployed on the USNS COMFORT to augment the inpatient health care capacity in New York City. METHODS This was a cross-sectional study conducted on USNS COMFORT crewmembers returning to Norfolk, Virginia, following deployment. Participants completed an electronic questionnaire and provided a serum sample at Day 14 post-deployment. Polymerase chain reaction (PCR) results from testing of symptomatic crewmembers during deployment and Day 0 and Day 14 post-deployment screening swabs conducted on all crewmembers, per military order, were abstracted. SARS-CoV-2 infection was defined as a positive SARS-CoV-2 spike glycoprotein immunoglobulin G antibody or PCR result. RESULTS Of the ship's total complement of 1200 crewmembers, 450 were enrolled: 432 (96.0%) completed the questionnaire and provided a serum sample. The median age of participants (interquartile range) was 30 (24-39) years, 50.8% were female, 58.6% were White, and 14.0% were Black; 80.1% had a clinical role during deployment. The cumulative prevalence of SARS-CoV-2 infection was 3.01% (13/432; 95% CI, 1.61%-5.09%). Twelve of 13 infections occurred in health care providers, and 8 of 13 were asymptomatic. The antibody profile of infected crewmembers varied by suspected timing of infection. CONCLUSIONS We observed a low prevalence of SARS-CoV-2 infection among USNS COMFORT crewmembers despite the inherent risk of a shipboard deployment to an area with high rates of community transmission. Our findings suggest that early infection control measures mitigated the spread of SARS-CoV-2 among crewmembers.
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Affiliation(s)
- Tahaniyat Lalani
- Infectious Disease Clinical Research Program, Uniformed Services University, Bethesda, Maryland, USA
- Henry M Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, Maryland, USA
- Naval Medical Center Portsmouth, Portsmouth, Virginia, USA
| | - Tida K Lee
- Naval Medical Center Portsmouth, Portsmouth, Virginia, USA
- Department of Medicine, Uniformed Services University, Bethesda, Maryland, USA
| | - Eric D Laing
- Department of Microbiology and Immunology, Uniformed Services University, Bethesda, Maryland, USA
| | - Andrew Ritter
- Naval Medical Center Portsmouth, Portsmouth, Virginia, USA
| | | | - Melissa Lee
- Naval Medical Center Portsmouth, Portsmouth, Virginia, USA
| | - Matthew Baker
- Naval Medical Center Portsmouth, Portsmouth, Virginia, USA
| | - Tyler Baldino
- Naval Medical Center Portsmouth, Portsmouth, Virginia, USA
| | | | - Shreshta Phogat
- Department of Microbiology and Immunology, Uniformed Services University, Bethesda, Maryland, USA
| | - Emily Samuels
- Department of Microbiology and Immunology, Uniformed Services University, Bethesda, Maryland, USA
| | - Huy Nguyen
- Naval Medical Center Portsmouth, Portsmouth, Virginia, USA
| | - Christopher C Broder
- Department of Microbiology and Immunology, Uniformed Services University, Bethesda, Maryland, USA
| | - Nusrat Epsi
- Infectious Disease Clinical Research Program, Uniformed Services University, Bethesda, Maryland, USA
- Henry M Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, Maryland, USA
| | - Stephanie A Richard
- Infectious Disease Clinical Research Program, Uniformed Services University, Bethesda, Maryland, USA
- Henry M Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, Maryland, USA
| | | | - Eugene V Millar
- Infectious Disease Clinical Research Program, Uniformed Services University, Bethesda, Maryland, USA
- Henry M Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, Maryland, USA
| | - Timothy Burgess
- Infectious Disease Clinical Research Program, Uniformed Services University, Bethesda, Maryland, USA
| | - Karl C Kronmann
- Naval Medical Center Portsmouth, Portsmouth, Virginia, USA
- Department of Medicine, Uniformed Services University, Bethesda, Maryland, USA
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Richard SA, Schofield C, Colombo R, Fairchok MP, Maves RC, Arnold J, Danaher P, Deiss R, Lalani T, Rajnik M, Millar G, Coles CL, Burgess T. 1512. Influenza vaccine effectiveness wanes over the influenza season: results from five military treatment facilities. Open Forum Infect Dis 2020. [PMCID: PMC7777829 DOI: 10.1093/ofid/ofaa439.1693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Background
Influenza vaccination can reduce influenza burden, but questions have arisen about the duration of vaccine protection. While the timing of vaccination varies, annual receipt of influenza vaccine is mandated for active duty military personnel. The goal of this analysis is to determine if influenza vaccine effectiveness decreases over time. A secondary goal of this analysis is to determine if repeated influenza vaccination is associated with risk for influenza.
Methods
Otherwise healthy individuals presenting for treatment of acute respiratory infections at 5 military treatment facilities from 2009 to 2018 were enrolled in the Acute Respiratory Infection Consortium (ARIC) study. Individuals with complete demographics, influenza vaccination in the two years prior to illness, and influenza laboratory results were included in this analysis (n=1,273). Multivariate logistic regression was used to calculate the odds of an influenza diagnosis according to time since influenza vaccination, categorized in 90-day periods. The model also included age, race, month of diagnosis, influenza season, and whether the participant received 4+ influenza vaccinations in the past 5 years.
Results
One hundred and ninety-two individuals (15%) had laboratory confirmed influenza (Table 1). Participants were mostly active duty, male, and white. Over half of the participants received 4+ influenza vaccinations in the past 5 years. Participants who were vaccinated 90-179 and 180+ days ago had greater odds of being diagnosed with influenza than did individuals who were vaccinated < 90 days prior to illness onset (Table 2). Participants who were 18-24 years old had lower odds of influenza than individuals in other age groups. Vaccine experience (vaccinated against influenza for at least four of the past five years), race, and ethnicity were not statistically significantly associated with influenza diagnosis.
Table 1. Characteristics of individuals included in the analysis of waning influenza vaccine effectiveness in the ARIC study
Table 2. Multivariate logistic regression results from model using influenza diagnosis as the outcome variable. Also included in the model are season and month of diagnosis.
Conclusion
Influenza vaccination was most effective 14-89 days post-vaccination and effectiveness decreased thereafter. Repeat influenza vaccination, however, was not significantly associated with greater odds of influenza. The waning effectiveness of influenza vaccination indicates additional consideration be given to the timing of vaccination.
Disclaimer
Disclosures
All Authors: No reported disclosures
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Affiliation(s)
| | | | - Rhonda Colombo
- Madigan Army Medical Center, Tacoma, WA, Infectious Disease Clinical Research Program, Bethesda, MD, and Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, Tacoma, Washington
| | | | - Ryan C Maves
- Naval Medical Center San Diego, San Diego, CA and Infectious Disease Clinical Research Program, Bethesda, MD, San DIego, California
| | | | | | | | - Tahaniyat Lalani
- Infectious Disease Clinical Research Program, Bethesda, MD, The Henry M. Jackson Foundation, Bethesda, MD, and Naval Medical Center Portsmouth, VA, Portsmouth, Virginia
| | - Michael Rajnik
- Uniformed Services University of the Health Sciences, Bethesda, MD
| | - Gene Millar
- Infectious Disease Clinical Research Program, USU, Rockville, Maryland
| | - Christian L Coles
- Infectious Disease Clinical Research Program, Bethesda, MD, The Henry M. Jackson Foundation, Bethesda, MD, Bethesda, MD
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Richard SA, Burgess T, Burgess T, Collins L, Colombo R, Ganesan A, Geaney C, Hrncir D, Lalani T, Markelz AE, Maves RC, McClenathan B, Mende K, Modi J, Montgomery JR, Schofield C, Seshadri S, Skerrett C, Spooner C, Utz G, Warkentien T, Coles CL. 1501. Pragmatic Assessment of Influenza Vaccine Effectiveness in the DoD (PAIVED): Updates from Year 2 of multi-site trial. Open Forum Infect Dis 2020. [PMCID: PMC7777763 DOI: 10.1093/ofid/ofaa439.1682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background Despite nearly universal influenza vaccination for active duty military personnel, breakthrough influenza infections occur. We are reporting on the second year of the Pragmatic Assessment of Influenza Vaccine Effectiveness in the DoD (PAIVED), comparing three FDA-licensed influenza vaccine types (egg-based, cell -based, and recombinant) to assess differences in immunogenicity and effectiveness. Methods Participants in the second year of PAIVED were enrolled from Oct 2019 through Jan 2020 at 9 military facilities. Participants received weekly inquiries about influenza-like-illnesses (ILI) experienced in the past week, and if the participant reported having a cough or sore throat and a) muscle/body aches or fatigue and/or b) being feverish or having chills, they were scheduled for a clinic visit. During this visit, a blood sample and a nasal swab were collected, as well as information about symptom duration and severity. A second (convalescent) visit was conducted approximately 4 weeks later, which involved collecting additional information about the duration of symptoms and illness burden, as well as a second blood draw. Due to the COVID-19 pandemic, acute and convalescent visits were disrupted at most sites in March and April due to COVID-19 precautions. Results PAIVED year 2 enrolled 5,892 participants who completed demographic forms (Table 1). Among those who reported any ILIs, most reported one ILI (1,345), while 264 reported two ILIs, and 42 reported three ILIs. Nasal swabs were processed from 273 ILIs at four sites (Fig 1), and 14 cases of influenza were identified thus far. The median duration of ILIs was ten days, with a median of three days of limited activity, and two days with fever. Nine individuals were hospitalized. Table 1. Demographic characteristics of individuals enrolled in PAIVED 2019/20 ![]()
Figure 1. Lab results as of 5/15 (N=273 samples) ![]()
Conclusion Over 25% of participants reported an ILI, and 5% of the nasal swabs that have been tested thus far have been positive for influenza. While most samples have not yet been analyzed, we have identified some breakthrough cases of influenza among vaccinated participants. Planned analyses include comparative vaccine effectiveness in order to inform future vaccine purchasing decisions. Disclaimer ![]()
Disclosures All Authors: No reported disclosures
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Affiliation(s)
| | - Timothy Burgess
- Infectious Disease Clinical Research Program, Bethesda, MD, Bethesda, Maryland
| | - Timothy Burgess
- Infectious Disease Clinical Research Program, Bethesda, MD, Bethesda, Maryland
| | - Limone Collins
- Immunization Health Branch, Defense Health Agency Bethesda, MD, Falls Church, VA, San Diego, CA, Falls Church, VA
| | - Rhonda Colombo
- Madigan Army Medical Center, Tacoma, WA, Infectious Disease Clinical Research Program, Bethesda, MD, and Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, Tacoma, Washington
| | - Anuradha Ganesan
- Infectious Disease Clinical Research Program and the Henry M. Jackson Foundation for the Advancement of Military Medicine and Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Casey Geaney
- Walter Reed National Military Medical Center, Bethesda, MD
| | - David Hrncir
- Lackland Air Force Base & Carl R. Darnall Army Medical Center, San Antonio, Texas
| | - Tahaniyat Lalani
- Infectious Disease Clinical Research Program, Bethesda, MD, The Henry M. Jackson Foundation, Bethesda, MD, and Naval Medical Center Portsmouth, VA, Portsmouth, Virginia
| | | | - Ryan C Maves
- Naval Medical Center San Diego, San Diego, CA and Infectious Disease Clinical Research Program, Bethesda, MD, San DIego, California
| | - Bruce McClenathan
- Womack Army Medical Center, Fort Bragg, NC 28310, Fort Bragg, North Carolina
| | - Katrin Mende
- Infectious Disease Clinical Research Program, Bethesda, MD, The Henry M. Jackson Foundation, Bethesda, MD, and Brooke Army Medical Center, Fort Sam Houston, TX, San Antonio, TX
| | | | | | | | - Srihari Seshadri
- Immunization Health Branch, Defense Health Agency, Falls Church, VA
| | | | | | - Gregory Utz
- Naval Medical Center San Diego, Infectious Disease Clinical Research Program, Bethesda, MD, and Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, San Diego, California
| | | | - Christian L Coles
- Infectious Disease Clinical Research Program, Bethesda, MD, The Henry M. Jackson Foundation, Bethesda, MD, Bethesda, MD
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Lewis FI, Guga G, Mdoe P, Mduma E, Mahopo C, Bessong P, Richard SA, McCormick BJJ. Introducing a drift and diffusion framework for childhood growth research. Gates Open Res 2020; 4:71. [PMID: 33490877 PMCID: PMC7791186 DOI: 10.12688/gatesopenres.13123.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/18/2020] [Indexed: 11/24/2022] Open
Abstract
Background: Growth trajectories are highly variable between children, making epidemiological analyses challenging both to the identification of malnutrition interventions at the population level and also risk assessment at individual level. We introduce stochastic differential equation (SDE) models into child growth research. SDEs describe flexible dynamic processes comprising: drift - gradual smooth changes - such as physiology or gut microbiome, and diffusion - sudden perturbations, such as illness or infection. Methods: We present a case study applying SDE models to child growth trajectory data from the Haydom, Tanzania and Venda, South Africa sites within the MAL-ED cohort. These data comprise n=460 children aged 0-24 months. A comparison with classical curve fitting (linear mixed models) is also presented. Results: The SDE models offered a wide range of new flexible shapes and parameterizations compared to classical additive models, with performance as good or better than standard approaches. The predictions from the SDE models suggest distinct longitudinal clusters that form distinct 'streams' hidden by the large between-child variability. Conclusions: Using SDE models to predict future growth trajectories revealed new insights in the observed data, where trajectories appear to cluster together in bands, which may have a future risk assessment application. SDEs offer an attractive approach for child growth modelling and potentially offer new insights.
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Affiliation(s)
| | | | | | - Esto Mduma
- Haydom Lutheran Hospital, Haydom, Tanzania
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Laing ED, Sterling SL, Richard SA, Phogat S, Samuels EC, Epsi NJ, Yan L, Moreno N, Coles C, Mehalko J, Drew M, English C, Chung KK, Clifton GT, Munster VJ, de Wit E, Tribble D, Agan BK, Esposito D, Lanteri C, Mitre E, Burgess TH, Broder CC. A betacoronavirus multiplex microsphere immunoassay detects early SARS-CoV-2 seroconversion and controls for pre-existing seasonal human coronavirus antibody cross-reactivity. medRxiv 2020:2020.10.14.20207050. [PMID: 33083807 PMCID: PMC7574255 DOI: 10.1101/2020.10.14.20207050] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
With growing concern of persistent or multiple waves of SARS-CoV-2 in the United States, sensitive and specific SARS-CoV-2 antibody assays remain critical for community and hospital-based SARS-CoV-2 surveillance. Here, we describe the development and application of a multiplex microsphere-based immunoassay (MMIA) for COVD-19 antibody studies, utilizing serum samples from non-human primate SARS-CoV-2 infection models, an archived human sera bank and subjects enrolled at five U.S. military hospitals. The MMIA incorporates prefusion stabilized spike glycoprotein trimers of SARS-CoV-2, SARS-CoV-1, MERS-CoV, and the seasonal human coronaviruses HCoV-HKU1 and HCoV-OC43, into a multiplexing system that enables simultaneous measurement of off-target pre-existing cross-reactive antibodies. We report the sensitivity and specificity performances for this assay strategy at 98% sensitivity and 100% specificity for subject samples collected as early as 10 days after the onset of symptoms. In archival sera collected prior to 2019 and serum samples from subjects PCR negative for SARS-CoV-2, we detected seroprevalence of 72% and 98% for HCoV-HKU1 and HCoV-0C43, respectively. Requiring only 1.25 μL of sera, this approach permitted the simultaneous identification of SARS-CoV-2 seroconversion and polyclonal SARS-CoV-2 IgG antibody responses to SARS-CoV-1 and MERS-CoV, further demonstrating the presence of conserved epitopes in the spike glycoprotein of zoonotic betacoronaviruses. Application of this serology assay in observational studies with serum samples collected from subjects before and after SARS-CoV-2 infection will permit an investigation of the influences of HCoV-induced antibodies on COVID-19 clinical outcomes.
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Affiliation(s)
- Eric D. Laing
- Department of Microbiology and Immunology, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Spencer L. Sterling
- Department of Microbiology and Immunology, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD USA
| | - Stephanie A. Richard
- Infectious Diseases Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD USA
| | - Shreshta Phogat
- Department of Microbiology and Immunology, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD USA
| | - Emily C. Samuels
- Department of Microbiology and Immunology, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD USA
| | - Nusrat J. Epsi
- Infectious Diseases Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD USA
| | - Lianying Yan
- Department of Microbiology and Immunology, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD USA
| | - Nicole Moreno
- Infectious Diseases Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD USA
| | - Christian Coles
- Infectious Diseases Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD USA
| | - Jennifer Mehalko
- Protein Expression Laboratory, National Cancer Institute RAS Initiative, Frederick National Laboratory for Cancer Research, Frederick, MD, USA
| | - Matthew Drew
- Protein Expression Laboratory, National Cancer Institute RAS Initiative, Frederick National Laboratory for Cancer Research, Frederick, MD, USA
| | - Caroline English
- Infectious Diseases Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD USA
| | - Kevin K. Chung
- Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | | | - Vincent J. Munster
- Laboratory of Virology, Rocky Mountain Laboratories, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Hamilton, MT, USA
| | - Emmie de Wit
- Laboratory of Virology, Rocky Mountain Laboratories, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Hamilton, MT, USA
| | - David Tribble
- Infectious Diseases Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Brian K. Agan
- Infectious Diseases Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD USA
| | - Dominic Esposito
- Protein Expression Laboratory, National Cancer Institute RAS Initiative, Frederick National Laboratory for Cancer Research, Frederick, MD, USA
| | - Charlotte Lanteri
- Infectious Diseases Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Edward Mitre
- Department of Microbiology and Immunology, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Timothy H. Burgess
- Infectious Diseases Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Christopher C. Broder
- Department of Microbiology and Immunology, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
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Laing ED, Sterling SL, Richard SA, Phogat S, Samuels EC, Epsi NJ, Yan L, Moreno N, Coles C, Mehalko J, Drew M, English C, Chung KK, Clifton GT, Munster V, de Wit E, Tribble D, Agan B, Esposito D, Lanteri C, Mitre E, Burgess TH, Broder CC. A betacoronavirus multiplex microsphere immunoassay detects early SARS-CoV-2 seroconversion and controls for pre-existing seasonal human coronavirus antibody cross-reactivity. medRxiv 2020. [PMID: 33083807 DOI: 10.1101/2020.05.21.20108985v2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
Abstract
With growing concern of persistent or multiple waves of SARS-CoV-2 in the United States, sensitive and specific SARS-CoV-2 antibody assays remain critical for community and hospital-based SARS-CoV-2 surveillance. Here, we describe the development and application of a multiplex microsphere-based immunoassay (MMIA) for COVD-19 antibody studies, utilizing serum samples from non-human primate SARS-CoV-2 infection models, an archived human sera bank and subjects enrolled at five U.S. military hospitals. The MMIA incorporates prefusion stabilized spike glycoprotein trimers of SARS-CoV-2, SARS-CoV-1, MERS-CoV, and the seasonal human coronaviruses HCoV-HKU1 and HCoV-OC43, into a multiplexing system that enables simultaneous measurement of off-target pre-existing cross-reactive antibodies. We report the sensitivity and specificity performances for this assay strategy at 98% sensitivity and 100% specificity for subject samples collected as early as 10 days after the onset of symptoms. In archival sera collected prior to 2019 and serum samples from subjects PCR negative for SARS-CoV-2, we detected seroprevalence of 72% and 98% for HCoV-HKU1 and HCoV-0C43, respectively. Requiring only 1.25 uL of sera, this approach permitted the simultaneous identification of SARS-CoV-2 seroconversion and polyclonal SARS-CoV-2 IgG antibody responses to SARS-CoV-1 and MERS-CoV, further demonstrating the presence of conserved epitopes in the spike glycoprotein of zoonotic betacoronaviruses. Application of this serology assay in observational studies with serum samples collected from subjects before and after SARS-CoV-2 infection will permit an investigation of the influences of HCoV-induced antibodies on COVID-19 clinical outcomes.
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