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Sternberg MR, Johnson A, King J, Ali AR, Linde L, Awofeso AO, Baker JS, Bayoumi NS, Broadway S, Busen K, Chang C, Cheng I, Cima M, Collingwood A, Dorabawila V, Drenzek C, Fleischauer A, Gent A, Hartley A, Hicks L, Hoskins M, Jara A, Jones A, Khan SI, Kamal-Ahmed I, Kangas S, Kanishka FNU, Kleppinger A, Kocharian A, León TM, Link-Gelles R, Lyons BC, Masarik J, May A, McCormick D, Meyer S, Milroy L, Morris KJ, Nelson L, Omoike E, Patel K, Pietrowski M, Pike MA, Pilishvili T, Peterson Pompa X, Powell C, Praetorius K, Rosenberg E, Schiller A, Smith-Coronado ML, Stanislawski E, Strand K, Tilakaratne BP, Vest H, Wiedeman C, Zaldivar A, Silk B, Scobie HM. Application of a life table approach to assess duration of BNT162b2 vaccine-derived immunity by age using COVID-19 case surveillance data during the Omicron variant period. PLoS One 2023; 18:e0291678. [PMID: 37729332 PMCID: PMC10511074 DOI: 10.1371/journal.pone.0291678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 09/01/2023] [Indexed: 09/22/2023] Open
Abstract
BACKGROUND SARS-CoV-2 Omicron variants have the potential to impact vaccine effectiveness and duration of vaccine-derived immunity. We analyzed U.S. multi-jurisdictional COVID-19 vaccine breakthrough surveillance data to examine potential waning of protection against SARS-CoV-2 infection for the Pfizer-BioNTech (BNT162b) primary vaccination series by age. METHODS Weekly numbers of SARS-CoV-2 infections during January 16, 2022-May 28, 2022 were analyzed by age group from 22 U.S. jurisdictions that routinely linked COVID-19 case surveillance and immunization data. A life table approach incorporating line-listed and aggregated COVID-19 case datasets with vaccine administration and U.S. Census data was used to estimate hazard rates of SARS-CoV-2 infections, hazard rate ratios (HRR) and percent reductions in hazard rate comparing unvaccinated people to people vaccinated with a Pfizer-BioNTech primary series only, by age group and time since vaccination. RESULTS The percent reduction in hazard rates for persons 2 weeks after vaccination with a Pfizer-BioNTech primary series compared with unvaccinated persons was lowest among children aged 5-11 years at 35.5% (95% CI: 33.3%, 37.6%) compared to the older age groups, which ranged from 68.7%-89.6%. By 19 weeks after vaccination, all age groups showed decreases in the percent reduction in the hazard rates compared with unvaccinated people; with the largest declines observed among those aged 5-11 and 12-17 years and more modest declines observed among those 18 years and older. CONCLUSIONS The decline in vaccine protection against SARS-CoV-2 infection observed in this study is consistent with other studies and demonstrates that national case surveillance data were useful for assessing early signals in age-specific waning of vaccine protection during the initial period of SARS-CoV-2 Omicron variant predominance. The potential for waning immunity during the Omicron period emphasizes the importance of continued monitoring and consideration of optimal timing and provision of booster doses in the future.
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Affiliation(s)
- Maya R. Sternberg
- COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Amelia Johnson
- COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Justice King
- COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Akilah R. Ali
- COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Lauren Linde
- COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Abiola O. Awofeso
- Community Health Administration, DC Department of Health, Washington, District of Columbia, United States of America
| | - Jodee S. Baker
- Division of Population Health, Utah Department of Health and Human Services, Salt Lake City, Utah, United States of America
| | - Nagla S. Bayoumi
- Communicable Disease Service, New Jersey Department of Health, Trenton, New Jersey, United States of America
| | - Steven Broadway
- Division of Disease Control and Health Protection, Florida Department of Health, Tallahassee, Florida, United States of America
| | - Katherine Busen
- Division of Communicable Disease, Michigan Department of Health and Human Services, Lansing, Michigan, United States of America
| | - Carolyn Chang
- Communicable Disease Service, New York City Department of Health and Mental Hygiene, Long Island City, New York, United States of America
| | - Iris Cheng
- Bureau of Immunization, New York City Department of Health and Mental Hygiene, Long Island City, New York, United States of America
| | - Mike Cima
- Epidemilogy, Arkansas Department of Health, Little Rock, Arkansas, United States of America
| | - Abi Collingwood
- Division of Population Health, Utah Department of Health and Human Services, Salt Lake City, Utah, United States of America
| | - Vajeera Dorabawila
- Bureau of Surveillance and Data Systems, Division of Epidemiology, Albany, New York State Department of Health, New York, NY, United States of America
| | - Cherie Drenzek
- Acute Epidemiology, Georgia Department of Public Health, Atlanta, Georgia, United States of America
| | - Aaron Fleischauer
- COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Ashley Gent
- Division of Disease Control and Health Protection, Florida Department of Health, Tallahassee, Florida, United States of America
| | - Amanda Hartley
- Communicable and Environmental Diseases and Emergency Preparedness, Nashville, Tennessee Department of Health, Nashville, Tennessee, United States of America
| | - Liam Hicks
- Bureau of Infectious Disease and Services, Arizona Department of Health Services, Phoenix, Arizona, United States of America
| | - Mikhail Hoskins
- Communicable Disease, North Carolina Department of Health and Human Services, Raleigh, North Carolina, United States of America
| | - Amanda Jara
- Acute Epidemiology, Georgia Department of Public Health, Atlanta, Georgia, United States of America
| | - Amanda Jones
- COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Saadiah I. Khan
- Communicable Disease Service, New Jersey Department of Health, Trenton, New Jersey, United States of America
| | - Ishrat Kamal-Ahmed
- Division of Public Health, Nebraska Department of Health and Human Services, Lincoln, Nebraska, United States of America
| | - Sarah Kangas
- COVID-19 Data and Surveillance Unit, Wisconsin Department of Health Services, Madison, Wisconsin, United States of America
| | - FNU Kanishka
- Division of Public Health, Nebraska Department of Health and Human Services, Lincoln, Nebraska, United States of America
| | - Alison Kleppinger
- Epidemiology and Infectious Disease Section, Connecticut Department of Public Health, Hartford, Connecticut, United States of America
| | - Anna Kocharian
- COVID-19 Data and Surveillance Unit, Wisconsin Department of Health Services, Madison, Wisconsin, United States of America
| | - Tomás M. León
- Center for Infectious Diseases, California Department of Public Health, Sacramento, California, United States of America
| | - Ruth Link-Gelles
- COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - B. Casey Lyons
- COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - John Masarik
- Community Health Administration, DC Department of Health, Washington, District of Columbia, United States of America
| | - Andrea May
- Bureau of Epidemiology and Public Health Informatics, Kansas Department of Health and Environment, Kansas, Missouri, United States of America
| | - Donald McCormick
- Epidemilogy, Arkansas Department of Health, Little Rock, Arkansas, United States of America
| | - Stephanie Meyer
- Infectious Disease Epidemiology, Prevention and Control Division, Minnesota Department of Health, Saint Paul, Minnesota, United States of America
| | - Lauren Milroy
- Disease Epidemiology and Prevention Division, Indiana Department of Health, Indianapolis, Indiana, United States of America
| | - Keeley J. Morris
- Infectious Disease Epidemiology, Prevention and Control Division, Minnesota Department of Health, Saint Paul, Minnesota, United States of America
| | - Lauren Nelson
- Center for Infectious Diseases, California Department of Public Health, Sacramento, California, United States of America
| | - Enaholo Omoike
- Division of Communicable Disease, Michigan Department of Health and Human Services, Lansing, Michigan, United States of America
| | - Komal Patel
- Acute Epidemiology, Georgia Department of Public Health, Atlanta, Georgia, United States of America
| | - Michael Pietrowski
- Division of Disease Control, Philadelphia Department of Public Health, Philadelphia, Pennsylvania, United States of America
| | - Melissa A. Pike
- Disease Control and Public Health Response Division, Colorado Department of Public Health and Environment, Denver, Colorado, United States of America
| | - Tamara Pilishvili
- COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Xandy Peterson Pompa
- Bureau of Infectious Disease and Services, Arizona Department of Health Services, Phoenix, Arizona, United States of America
| | - Charles Powell
- Epidemiology and Infectious Disease Section, Connecticut Department of Public Health, Hartford, Connecticut, United States of America
| | | | - Eli Rosenberg
- Bureau of Surveillance and Data Systems, Division of Epidemiology, Albany, New York State Department of Health, New York, NY, United States of America
| | - Adam Schiller
- COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Mayra L. Smith-Coronado
- Disease Control and Public Health Response Division, Colorado Department of Public Health and Environment, Denver, Colorado, United States of America
| | - Emma Stanislawski
- Epidemiology and Response Division, New Mexico Department of Health, Santa Fe, New Mexico, United States of America
| | - Kyle Strand
- Division of Public Health, Nebraska Department of Health and Human Services, Lincoln, Nebraska, United States of America
| | - Buddhi P. Tilakaratne
- Community Health Administration, DC Department of Health, Washington, District of Columbia, United States of America
| | - Hailey Vest
- Disease Epidemiology and Prevention Division, Indiana Department of Health, Indianapolis, Indiana, United States of America
| | - Caleb Wiedeman
- Communicable and Environmental Diseases and Emergency Preparedness, Nashville, Tennessee Department of Health, Nashville, Tennessee, United States of America
| | - Allison Zaldivar
- Bureau of Epidemiology and Public Health Informatics, Kansas Department of Health and Environment, Kansas, Missouri, United States of America
| | - Benjamin Silk
- COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Heather M. Scobie
- COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
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Johnson AG, Linde L, Ali AR, DeSantis A, Shi M, Adam C, Armstrong B, Armstrong B, Asbell M, Auche S, Bayoumi NS, Bingay B, Chasse M, Christofferson S, Cima M, Cueto K, Cunningham S, Delgadillo J, Dorabawila V, Drenzek C, Dupervil B, Durant T, Fleischauer A, Hamilton R, Harrington P, Hicks L, Hodis JD, Hoefer D, Horrocks S, Hoskins M, Husain S, Ingram LA, Jara A, Jones A, Kanishka FNU, Kaur R, Khan SI, Kirkendall S, Lauro P, Lyons S, Mansfield J, Markelz A, Masarik J, McCormick D, Mendoza E, Morris KJ, Omoike E, Patel K, Pike MA, Pilishvili T, Praetorius K, Reed IG, Severson RL, Sigalo N, Stanislawski E, Stich S, Tilakaratne BP, Turner KA, Wiedeman C, Zaldivar A, Silk BJ, Scobie HM. COVID-19 Incidence and Mortality Among Unvaccinated and Vaccinated Persons Aged ≥12 Years by Receipt of Bivalent Booster Doses and Time Since Vaccination - 24 U.S. Jurisdictions, October 3, 2021-December 24, 2022. MMWR Morb Mortal Wkly Rep 2023; 72:145-152. [PMID: 36757865 PMCID: PMC9925136 DOI: 10.15585/mmwr.mm7206a3] [Citation(s) in RCA: 21] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
On September 1, 2022, CDC recommended an updated (bivalent) COVID-19 vaccine booster to help restore waning protection conferred by previous vaccination and broaden protection against emerging variants for persons aged ≥12 years (subsequently extended to persons aged ≥6 months).* To assess the impact of original (monovalent) COVID-19 vaccines and bivalent boosters, case and mortality rate ratios (RRs) were estimated comparing unvaccinated and vaccinated persons aged ≥12 years by overall receipt of and by time since booster vaccination (monovalent or bivalent) during Delta variant and Omicron sublineage (BA.1, BA.2, early BA.4/BA.5, and late BA.4/BA.5) predominance.† During the late BA.4/BA.5 period, unvaccinated persons had higher COVID-19 mortality and infection rates than persons receiving bivalent doses (mortality RR = 14.1 and infection RR = 2.8) and to a lesser extent persons vaccinated with only monovalent doses (mortality RR = 5.4 and infection RR = 2.5). Among older adults, mortality rates among unvaccinated persons were significantly higher than among those who had received a bivalent booster (65-79 years; RR = 23.7 and ≥80 years; 10.3) or a monovalent booster (65-79 years; 8.3 and ≥80 years; 4.2). In a second analysis stratified by time since booster vaccination, there was a progressive decline from the Delta period (RR = 50.7) to the early BA.4/BA.5 period (7.4) in relative COVID-19 mortality rates among unvaccinated persons compared with persons receiving who had received a monovalent booster within 2 weeks-2 months. During the early BA.4/BA.5 period, declines in relative mortality rates were observed at 6-8 (RR = 4.6), 9-11 (4.5), and ≥12 (2.5) months after receiving a monovalent booster. In contrast, bivalent boosters received during the preceding 2 weeks-2 months improved protection against death (RR = 15.2) during the late BA.4/BA.5 period. In both analyses, when compared with unvaccinated persons, persons who had received bivalent boosters were provided additional protection against death over monovalent doses or monovalent boosters. Restored protection was highest in older adults. All persons should stay up to date with COVID-19 vaccination, including receipt of a bivalent booster by eligible persons, to reduce the risk for severe COVID-19.
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Gee JE, Bower WA, Kunkel A, Petras J, Gettings J, Bye M, Firestone M, Elrod MG, Liu L, Blaney DD, Zaldivar A, Raybern C, Ahmed FS, Honza H, Stonecipher S, O'Sullivan BJ, Lynfield R, Hunter M, Brennan S, Pavlick J, Gabel J, Drenzek C, Geller R, Lee C, Ritter JM, Zaki SR, Gulvik CA, Wilson WW, Beshearse E, Currie BJ, Webb JR, Weiner ZP, Negrón ME, Hoffmaster AR. Multistate Outbreak of Melioidosis Associated with Imported Aromatherapy Spray. N Engl J Med 2022; 386:861-868. [PMID: 35235727 DOI: 10.1056/nejmoa2116130] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Melioidosis, caused by the bacterium Burkholderia pseudomallei, is an uncommon infection that is typically associated with exposure to soil and water in tropical and subtropical environments. It is rarely diagnosed in the continental United States. Patients with melioidosis in the United States commonly report travel to regions where melioidosis is endemic. We report a cluster of four non-travel-associated cases of melioidosis in Georgia, Kansas, Minnesota, and Texas. These cases were caused by the same strain of B. pseudomallei that was linked to an aromatherapy spray product imported from a melioidosis-endemic area.
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Affiliation(s)
- Jay E Gee
- From the Bacterial Special Pathogens Branch (J.E.G., W.A.B., J. Petras, M.G.E., L.L., D.D.B., C.A.G., Z.P.W., M.E.N., A.R.H.), the Poxvirus and Rabies Branch (A.K.), and the Infectious Diseases Pathology Branch (J.M.R., S.R.Z.), Division of High-Consequence Pathogens and Pathology, the Epidemic Intelligence Service (A.K., J. Petras, J. Gettings, M.F., W.W.W., E.B.), and the Prevention and Response Branch, Division of Healthcare Quality Promotion (W.W.W., E.B.), Centers for Disease Control and Prevention, the Georgia Department of Public Health (J. Gettings, S.B., J. Pavlick, J. Gabel, C.D.), and the Department of Pathology and Laboratory Medicine, Emory University School of Medicine (R.G.), Atlanta, Public Health District 1-1, Georgia Department of Public Health, Rome (M.H.), and Dekalb County Medical Examiner's Office, Decatur (R.G., C.L.) - all in Georgia; the Minnesota Department of Health, St. Paul (M.B., M.F., R.L.); the Kansas Department of Health and Environment, Topeka (A.Z., C.R., F.S.A.); Public Health Regions 2 and 3, Texas Department of State Health Services, Arlington (H.H., S.S.), and the Texas Department of State Health Services, Austin (B.J.O.); and Menzies School of Health Research, Charles Darwin University and Royal Darwin Hospital, Darwin, NT (B.J.C., J.R.W.), and the Department of Microbiology and Immunology, Peter Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, VIC (J.R.W.) - both in Australia
| | - William A Bower
- From the Bacterial Special Pathogens Branch (J.E.G., W.A.B., J. Petras, M.G.E., L.L., D.D.B., C.A.G., Z.P.W., M.E.N., A.R.H.), the Poxvirus and Rabies Branch (A.K.), and the Infectious Diseases Pathology Branch (J.M.R., S.R.Z.), Division of High-Consequence Pathogens and Pathology, the Epidemic Intelligence Service (A.K., J. Petras, J. Gettings, M.F., W.W.W., E.B.), and the Prevention and Response Branch, Division of Healthcare Quality Promotion (W.W.W., E.B.), Centers for Disease Control and Prevention, the Georgia Department of Public Health (J. Gettings, S.B., J. Pavlick, J. Gabel, C.D.), and the Department of Pathology and Laboratory Medicine, Emory University School of Medicine (R.G.), Atlanta, Public Health District 1-1, Georgia Department of Public Health, Rome (M.H.), and Dekalb County Medical Examiner's Office, Decatur (R.G., C.L.) - all in Georgia; the Minnesota Department of Health, St. Paul (M.B., M.F., R.L.); the Kansas Department of Health and Environment, Topeka (A.Z., C.R., F.S.A.); Public Health Regions 2 and 3, Texas Department of State Health Services, Arlington (H.H., S.S.), and the Texas Department of State Health Services, Austin (B.J.O.); and Menzies School of Health Research, Charles Darwin University and Royal Darwin Hospital, Darwin, NT (B.J.C., J.R.W.), and the Department of Microbiology and Immunology, Peter Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, VIC (J.R.W.) - both in Australia
| | - Amber Kunkel
- From the Bacterial Special Pathogens Branch (J.E.G., W.A.B., J. Petras, M.G.E., L.L., D.D.B., C.A.G., Z.P.W., M.E.N., A.R.H.), the Poxvirus and Rabies Branch (A.K.), and the Infectious Diseases Pathology Branch (J.M.R., S.R.Z.), Division of High-Consequence Pathogens and Pathology, the Epidemic Intelligence Service (A.K., J. Petras, J. Gettings, M.F., W.W.W., E.B.), and the Prevention and Response Branch, Division of Healthcare Quality Promotion (W.W.W., E.B.), Centers for Disease Control and Prevention, the Georgia Department of Public Health (J. Gettings, S.B., J. Pavlick, J. Gabel, C.D.), and the Department of Pathology and Laboratory Medicine, Emory University School of Medicine (R.G.), Atlanta, Public Health District 1-1, Georgia Department of Public Health, Rome (M.H.), and Dekalb County Medical Examiner's Office, Decatur (R.G., C.L.) - all in Georgia; the Minnesota Department of Health, St. Paul (M.B., M.F., R.L.); the Kansas Department of Health and Environment, Topeka (A.Z., C.R., F.S.A.); Public Health Regions 2 and 3, Texas Department of State Health Services, Arlington (H.H., S.S.), and the Texas Department of State Health Services, Austin (B.J.O.); and Menzies School of Health Research, Charles Darwin University and Royal Darwin Hospital, Darwin, NT (B.J.C., J.R.W.), and the Department of Microbiology and Immunology, Peter Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, VIC (J.R.W.) - both in Australia
| | - Julia Petras
- From the Bacterial Special Pathogens Branch (J.E.G., W.A.B., J. Petras, M.G.E., L.L., D.D.B., C.A.G., Z.P.W., M.E.N., A.R.H.), the Poxvirus and Rabies Branch (A.K.), and the Infectious Diseases Pathology Branch (J.M.R., S.R.Z.), Division of High-Consequence Pathogens and Pathology, the Epidemic Intelligence Service (A.K., J. Petras, J. Gettings, M.F., W.W.W., E.B.), and the Prevention and Response Branch, Division of Healthcare Quality Promotion (W.W.W., E.B.), Centers for Disease Control and Prevention, the Georgia Department of Public Health (J. Gettings, S.B., J. Pavlick, J. Gabel, C.D.), and the Department of Pathology and Laboratory Medicine, Emory University School of Medicine (R.G.), Atlanta, Public Health District 1-1, Georgia Department of Public Health, Rome (M.H.), and Dekalb County Medical Examiner's Office, Decatur (R.G., C.L.) - all in Georgia; the Minnesota Department of Health, St. Paul (M.B., M.F., R.L.); the Kansas Department of Health and Environment, Topeka (A.Z., C.R., F.S.A.); Public Health Regions 2 and 3, Texas Department of State Health Services, Arlington (H.H., S.S.), and the Texas Department of State Health Services, Austin (B.J.O.); and Menzies School of Health Research, Charles Darwin University and Royal Darwin Hospital, Darwin, NT (B.J.C., J.R.W.), and the Department of Microbiology and Immunology, Peter Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, VIC (J.R.W.) - both in Australia
| | - Jenna Gettings
- From the Bacterial Special Pathogens Branch (J.E.G., W.A.B., J. Petras, M.G.E., L.L., D.D.B., C.A.G., Z.P.W., M.E.N., A.R.H.), the Poxvirus and Rabies Branch (A.K.), and the Infectious Diseases Pathology Branch (J.M.R., S.R.Z.), Division of High-Consequence Pathogens and Pathology, the Epidemic Intelligence Service (A.K., J. Petras, J. Gettings, M.F., W.W.W., E.B.), and the Prevention and Response Branch, Division of Healthcare Quality Promotion (W.W.W., E.B.), Centers for Disease Control and Prevention, the Georgia Department of Public Health (J. Gettings, S.B., J. Pavlick, J. Gabel, C.D.), and the Department of Pathology and Laboratory Medicine, Emory University School of Medicine (R.G.), Atlanta, Public Health District 1-1, Georgia Department of Public Health, Rome (M.H.), and Dekalb County Medical Examiner's Office, Decatur (R.G., C.L.) - all in Georgia; the Minnesota Department of Health, St. Paul (M.B., M.F., R.L.); the Kansas Department of Health and Environment, Topeka (A.Z., C.R., F.S.A.); Public Health Regions 2 and 3, Texas Department of State Health Services, Arlington (H.H., S.S.), and the Texas Department of State Health Services, Austin (B.J.O.); and Menzies School of Health Research, Charles Darwin University and Royal Darwin Hospital, Darwin, NT (B.J.C., J.R.W.), and the Department of Microbiology and Immunology, Peter Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, VIC (J.R.W.) - both in Australia
| | - Maria Bye
- From the Bacterial Special Pathogens Branch (J.E.G., W.A.B., J. Petras, M.G.E., L.L., D.D.B., C.A.G., Z.P.W., M.E.N., A.R.H.), the Poxvirus and Rabies Branch (A.K.), and the Infectious Diseases Pathology Branch (J.M.R., S.R.Z.), Division of High-Consequence Pathogens and Pathology, the Epidemic Intelligence Service (A.K., J. Petras, J. Gettings, M.F., W.W.W., E.B.), and the Prevention and Response Branch, Division of Healthcare Quality Promotion (W.W.W., E.B.), Centers for Disease Control and Prevention, the Georgia Department of Public Health (J. Gettings, S.B., J. Pavlick, J. Gabel, C.D.), and the Department of Pathology and Laboratory Medicine, Emory University School of Medicine (R.G.), Atlanta, Public Health District 1-1, Georgia Department of Public Health, Rome (M.H.), and Dekalb County Medical Examiner's Office, Decatur (R.G., C.L.) - all in Georgia; the Minnesota Department of Health, St. Paul (M.B., M.F., R.L.); the Kansas Department of Health and Environment, Topeka (A.Z., C.R., F.S.A.); Public Health Regions 2 and 3, Texas Department of State Health Services, Arlington (H.H., S.S.), and the Texas Department of State Health Services, Austin (B.J.O.); and Menzies School of Health Research, Charles Darwin University and Royal Darwin Hospital, Darwin, NT (B.J.C., J.R.W.), and the Department of Microbiology and Immunology, Peter Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, VIC (J.R.W.) - both in Australia
| | - Melanie Firestone
- From the Bacterial Special Pathogens Branch (J.E.G., W.A.B., J. Petras, M.G.E., L.L., D.D.B., C.A.G., Z.P.W., M.E.N., A.R.H.), the Poxvirus and Rabies Branch (A.K.), and the Infectious Diseases Pathology Branch (J.M.R., S.R.Z.), Division of High-Consequence Pathogens and Pathology, the Epidemic Intelligence Service (A.K., J. Petras, J. Gettings, M.F., W.W.W., E.B.), and the Prevention and Response Branch, Division of Healthcare Quality Promotion (W.W.W., E.B.), Centers for Disease Control and Prevention, the Georgia Department of Public Health (J. Gettings, S.B., J. Pavlick, J. Gabel, C.D.), and the Department of Pathology and Laboratory Medicine, Emory University School of Medicine (R.G.), Atlanta, Public Health District 1-1, Georgia Department of Public Health, Rome (M.H.), and Dekalb County Medical Examiner's Office, Decatur (R.G., C.L.) - all in Georgia; the Minnesota Department of Health, St. Paul (M.B., M.F., R.L.); the Kansas Department of Health and Environment, Topeka (A.Z., C.R., F.S.A.); Public Health Regions 2 and 3, Texas Department of State Health Services, Arlington (H.H., S.S.), and the Texas Department of State Health Services, Austin (B.J.O.); and Menzies School of Health Research, Charles Darwin University and Royal Darwin Hospital, Darwin, NT (B.J.C., J.R.W.), and the Department of Microbiology and Immunology, Peter Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, VIC (J.R.W.) - both in Australia
| | - Mindy G Elrod
- From the Bacterial Special Pathogens Branch (J.E.G., W.A.B., J. Petras, M.G.E., L.L., D.D.B., C.A.G., Z.P.W., M.E.N., A.R.H.), the Poxvirus and Rabies Branch (A.K.), and the Infectious Diseases Pathology Branch (J.M.R., S.R.Z.), Division of High-Consequence Pathogens and Pathology, the Epidemic Intelligence Service (A.K., J. Petras, J. Gettings, M.F., W.W.W., E.B.), and the Prevention and Response Branch, Division of Healthcare Quality Promotion (W.W.W., E.B.), Centers for Disease Control and Prevention, the Georgia Department of Public Health (J. Gettings, S.B., J. Pavlick, J. Gabel, C.D.), and the Department of Pathology and Laboratory Medicine, Emory University School of Medicine (R.G.), Atlanta, Public Health District 1-1, Georgia Department of Public Health, Rome (M.H.), and Dekalb County Medical Examiner's Office, Decatur (R.G., C.L.) - all in Georgia; the Minnesota Department of Health, St. Paul (M.B., M.F., R.L.); the Kansas Department of Health and Environment, Topeka (A.Z., C.R., F.S.A.); Public Health Regions 2 and 3, Texas Department of State Health Services, Arlington (H.H., S.S.), and the Texas Department of State Health Services, Austin (B.J.O.); and Menzies School of Health Research, Charles Darwin University and Royal Darwin Hospital, Darwin, NT (B.J.C., J.R.W.), and the Department of Microbiology and Immunology, Peter Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, VIC (J.R.W.) - both in Australia
| | - Lindy Liu
- From the Bacterial Special Pathogens Branch (J.E.G., W.A.B., J. Petras, M.G.E., L.L., D.D.B., C.A.G., Z.P.W., M.E.N., A.R.H.), the Poxvirus and Rabies Branch (A.K.), and the Infectious Diseases Pathology Branch (J.M.R., S.R.Z.), Division of High-Consequence Pathogens and Pathology, the Epidemic Intelligence Service (A.K., J. Petras, J. Gettings, M.F., W.W.W., E.B.), and the Prevention and Response Branch, Division of Healthcare Quality Promotion (W.W.W., E.B.), Centers for Disease Control and Prevention, the Georgia Department of Public Health (J. Gettings, S.B., J. Pavlick, J. Gabel, C.D.), and the Department of Pathology and Laboratory Medicine, Emory University School of Medicine (R.G.), Atlanta, Public Health District 1-1, Georgia Department of Public Health, Rome (M.H.), and Dekalb County Medical Examiner's Office, Decatur (R.G., C.L.) - all in Georgia; the Minnesota Department of Health, St. Paul (M.B., M.F., R.L.); the Kansas Department of Health and Environment, Topeka (A.Z., C.R., F.S.A.); Public Health Regions 2 and 3, Texas Department of State Health Services, Arlington (H.H., S.S.), and the Texas Department of State Health Services, Austin (B.J.O.); and Menzies School of Health Research, Charles Darwin University and Royal Darwin Hospital, Darwin, NT (B.J.C., J.R.W.), and the Department of Microbiology and Immunology, Peter Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, VIC (J.R.W.) - both in Australia
| | - David D Blaney
- From the Bacterial Special Pathogens Branch (J.E.G., W.A.B., J. Petras, M.G.E., L.L., D.D.B., C.A.G., Z.P.W., M.E.N., A.R.H.), the Poxvirus and Rabies Branch (A.K.), and the Infectious Diseases Pathology Branch (J.M.R., S.R.Z.), Division of High-Consequence Pathogens and Pathology, the Epidemic Intelligence Service (A.K., J. Petras, J. Gettings, M.F., W.W.W., E.B.), and the Prevention and Response Branch, Division of Healthcare Quality Promotion (W.W.W., E.B.), Centers for Disease Control and Prevention, the Georgia Department of Public Health (J. Gettings, S.B., J. Pavlick, J. Gabel, C.D.), and the Department of Pathology and Laboratory Medicine, Emory University School of Medicine (R.G.), Atlanta, Public Health District 1-1, Georgia Department of Public Health, Rome (M.H.), and Dekalb County Medical Examiner's Office, Decatur (R.G., C.L.) - all in Georgia; the Minnesota Department of Health, St. Paul (M.B., M.F., R.L.); the Kansas Department of Health and Environment, Topeka (A.Z., C.R., F.S.A.); Public Health Regions 2 and 3, Texas Department of State Health Services, Arlington (H.H., S.S.), and the Texas Department of State Health Services, Austin (B.J.O.); and Menzies School of Health Research, Charles Darwin University and Royal Darwin Hospital, Darwin, NT (B.J.C., J.R.W.), and the Department of Microbiology and Immunology, Peter Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, VIC (J.R.W.) - both in Australia
| | - Allison Zaldivar
- From the Bacterial Special Pathogens Branch (J.E.G., W.A.B., J. Petras, M.G.E., L.L., D.D.B., C.A.G., Z.P.W., M.E.N., A.R.H.), the Poxvirus and Rabies Branch (A.K.), and the Infectious Diseases Pathology Branch (J.M.R., S.R.Z.), Division of High-Consequence Pathogens and Pathology, the Epidemic Intelligence Service (A.K., J. Petras, J. Gettings, M.F., W.W.W., E.B.), and the Prevention and Response Branch, Division of Healthcare Quality Promotion (W.W.W., E.B.), Centers for Disease Control and Prevention, the Georgia Department of Public Health (J. Gettings, S.B., J. Pavlick, J. Gabel, C.D.), and the Department of Pathology and Laboratory Medicine, Emory University School of Medicine (R.G.), Atlanta, Public Health District 1-1, Georgia Department of Public Health, Rome (M.H.), and Dekalb County Medical Examiner's Office, Decatur (R.G., C.L.) - all in Georgia; the Minnesota Department of Health, St. Paul (M.B., M.F., R.L.); the Kansas Department of Health and Environment, Topeka (A.Z., C.R., F.S.A.); Public Health Regions 2 and 3, Texas Department of State Health Services, Arlington (H.H., S.S.), and the Texas Department of State Health Services, Austin (B.J.O.); and Menzies School of Health Research, Charles Darwin University and Royal Darwin Hospital, Darwin, NT (B.J.C., J.R.W.), and the Department of Microbiology and Immunology, Peter Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, VIC (J.R.W.) - both in Australia
| | - Chelsea Raybern
- From the Bacterial Special Pathogens Branch (J.E.G., W.A.B., J. Petras, M.G.E., L.L., D.D.B., C.A.G., Z.P.W., M.E.N., A.R.H.), the Poxvirus and Rabies Branch (A.K.), and the Infectious Diseases Pathology Branch (J.M.R., S.R.Z.), Division of High-Consequence Pathogens and Pathology, the Epidemic Intelligence Service (A.K., J. Petras, J. Gettings, M.F., W.W.W., E.B.), and the Prevention and Response Branch, Division of Healthcare Quality Promotion (W.W.W., E.B.), Centers for Disease Control and Prevention, the Georgia Department of Public Health (J. Gettings, S.B., J. Pavlick, J. Gabel, C.D.), and the Department of Pathology and Laboratory Medicine, Emory University School of Medicine (R.G.), Atlanta, Public Health District 1-1, Georgia Department of Public Health, Rome (M.H.), and Dekalb County Medical Examiner's Office, Decatur (R.G., C.L.) - all in Georgia; the Minnesota Department of Health, St. Paul (M.B., M.F., R.L.); the Kansas Department of Health and Environment, Topeka (A.Z., C.R., F.S.A.); Public Health Regions 2 and 3, Texas Department of State Health Services, Arlington (H.H., S.S.), and the Texas Department of State Health Services, Austin (B.J.O.); and Menzies School of Health Research, Charles Darwin University and Royal Darwin Hospital, Darwin, NT (B.J.C., J.R.W.), and the Department of Microbiology and Immunology, Peter Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, VIC (J.R.W.) - both in Australia
| | - Farah S Ahmed
- From the Bacterial Special Pathogens Branch (J.E.G., W.A.B., J. Petras, M.G.E., L.L., D.D.B., C.A.G., Z.P.W., M.E.N., A.R.H.), the Poxvirus and Rabies Branch (A.K.), and the Infectious Diseases Pathology Branch (J.M.R., S.R.Z.), Division of High-Consequence Pathogens and Pathology, the Epidemic Intelligence Service (A.K., J. Petras, J. Gettings, M.F., W.W.W., E.B.), and the Prevention and Response Branch, Division of Healthcare Quality Promotion (W.W.W., E.B.), Centers for Disease Control and Prevention, the Georgia Department of Public Health (J. Gettings, S.B., J. Pavlick, J. Gabel, C.D.), and the Department of Pathology and Laboratory Medicine, Emory University School of Medicine (R.G.), Atlanta, Public Health District 1-1, Georgia Department of Public Health, Rome (M.H.), and Dekalb County Medical Examiner's Office, Decatur (R.G., C.L.) - all in Georgia; the Minnesota Department of Health, St. Paul (M.B., M.F., R.L.); the Kansas Department of Health and Environment, Topeka (A.Z., C.R., F.S.A.); Public Health Regions 2 and 3, Texas Department of State Health Services, Arlington (H.H., S.S.), and the Texas Department of State Health Services, Austin (B.J.O.); and Menzies School of Health Research, Charles Darwin University and Royal Darwin Hospital, Darwin, NT (B.J.C., J.R.W.), and the Department of Microbiology and Immunology, Peter Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, VIC (J.R.W.) - both in Australia
| | - Heidi Honza
- From the Bacterial Special Pathogens Branch (J.E.G., W.A.B., J. Petras, M.G.E., L.L., D.D.B., C.A.G., Z.P.W., M.E.N., A.R.H.), the Poxvirus and Rabies Branch (A.K.), and the Infectious Diseases Pathology Branch (J.M.R., S.R.Z.), Division of High-Consequence Pathogens and Pathology, the Epidemic Intelligence Service (A.K., J. Petras, J. Gettings, M.F., W.W.W., E.B.), and the Prevention and Response Branch, Division of Healthcare Quality Promotion (W.W.W., E.B.), Centers for Disease Control and Prevention, the Georgia Department of Public Health (J. Gettings, S.B., J. Pavlick, J. Gabel, C.D.), and the Department of Pathology and Laboratory Medicine, Emory University School of Medicine (R.G.), Atlanta, Public Health District 1-1, Georgia Department of Public Health, Rome (M.H.), and Dekalb County Medical Examiner's Office, Decatur (R.G., C.L.) - all in Georgia; the Minnesota Department of Health, St. Paul (M.B., M.F., R.L.); the Kansas Department of Health and Environment, Topeka (A.Z., C.R., F.S.A.); Public Health Regions 2 and 3, Texas Department of State Health Services, Arlington (H.H., S.S.), and the Texas Department of State Health Services, Austin (B.J.O.); and Menzies School of Health Research, Charles Darwin University and Royal Darwin Hospital, Darwin, NT (B.J.C., J.R.W.), and the Department of Microbiology and Immunology, Peter Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, VIC (J.R.W.) - both in Australia
| | - Shelley Stonecipher
- From the Bacterial Special Pathogens Branch (J.E.G., W.A.B., J. Petras, M.G.E., L.L., D.D.B., C.A.G., Z.P.W., M.E.N., A.R.H.), the Poxvirus and Rabies Branch (A.K.), and the Infectious Diseases Pathology Branch (J.M.R., S.R.Z.), Division of High-Consequence Pathogens and Pathology, the Epidemic Intelligence Service (A.K., J. Petras, J. Gettings, M.F., W.W.W., E.B.), and the Prevention and Response Branch, Division of Healthcare Quality Promotion (W.W.W., E.B.), Centers for Disease Control and Prevention, the Georgia Department of Public Health (J. Gettings, S.B., J. Pavlick, J. Gabel, C.D.), and the Department of Pathology and Laboratory Medicine, Emory University School of Medicine (R.G.), Atlanta, Public Health District 1-1, Georgia Department of Public Health, Rome (M.H.), and Dekalb County Medical Examiner's Office, Decatur (R.G., C.L.) - all in Georgia; the Minnesota Department of Health, St. Paul (M.B., M.F., R.L.); the Kansas Department of Health and Environment, Topeka (A.Z., C.R., F.S.A.); Public Health Regions 2 and 3, Texas Department of State Health Services, Arlington (H.H., S.S.), and the Texas Department of State Health Services, Austin (B.J.O.); and Menzies School of Health Research, Charles Darwin University and Royal Darwin Hospital, Darwin, NT (B.J.C., J.R.W.), and the Department of Microbiology and Immunology, Peter Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, VIC (J.R.W.) - both in Australia
| | - Briana J O'Sullivan
- From the Bacterial Special Pathogens Branch (J.E.G., W.A.B., J. Petras, M.G.E., L.L., D.D.B., C.A.G., Z.P.W., M.E.N., A.R.H.), the Poxvirus and Rabies Branch (A.K.), and the Infectious Diseases Pathology Branch (J.M.R., S.R.Z.), Division of High-Consequence Pathogens and Pathology, the Epidemic Intelligence Service (A.K., J. Petras, J. Gettings, M.F., W.W.W., E.B.), and the Prevention and Response Branch, Division of Healthcare Quality Promotion (W.W.W., E.B.), Centers for Disease Control and Prevention, the Georgia Department of Public Health (J. Gettings, S.B., J. Pavlick, J. Gabel, C.D.), and the Department of Pathology and Laboratory Medicine, Emory University School of Medicine (R.G.), Atlanta, Public Health District 1-1, Georgia Department of Public Health, Rome (M.H.), and Dekalb County Medical Examiner's Office, Decatur (R.G., C.L.) - all in Georgia; the Minnesota Department of Health, St. Paul (M.B., M.F., R.L.); the Kansas Department of Health and Environment, Topeka (A.Z., C.R., F.S.A.); Public Health Regions 2 and 3, Texas Department of State Health Services, Arlington (H.H., S.S.), and the Texas Department of State Health Services, Austin (B.J.O.); and Menzies School of Health Research, Charles Darwin University and Royal Darwin Hospital, Darwin, NT (B.J.C., J.R.W.), and the Department of Microbiology and Immunology, Peter Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, VIC (J.R.W.) - both in Australia
| | - Ruth Lynfield
- From the Bacterial Special Pathogens Branch (J.E.G., W.A.B., J. Petras, M.G.E., L.L., D.D.B., C.A.G., Z.P.W., M.E.N., A.R.H.), the Poxvirus and Rabies Branch (A.K.), and the Infectious Diseases Pathology Branch (J.M.R., S.R.Z.), Division of High-Consequence Pathogens and Pathology, the Epidemic Intelligence Service (A.K., J. Petras, J. Gettings, M.F., W.W.W., E.B.), and the Prevention and Response Branch, Division of Healthcare Quality Promotion (W.W.W., E.B.), Centers for Disease Control and Prevention, the Georgia Department of Public Health (J. Gettings, S.B., J. Pavlick, J. Gabel, C.D.), and the Department of Pathology and Laboratory Medicine, Emory University School of Medicine (R.G.), Atlanta, Public Health District 1-1, Georgia Department of Public Health, Rome (M.H.), and Dekalb County Medical Examiner's Office, Decatur (R.G., C.L.) - all in Georgia; the Minnesota Department of Health, St. Paul (M.B., M.F., R.L.); the Kansas Department of Health and Environment, Topeka (A.Z., C.R., F.S.A.); Public Health Regions 2 and 3, Texas Department of State Health Services, Arlington (H.H., S.S.), and the Texas Department of State Health Services, Austin (B.J.O.); and Menzies School of Health Research, Charles Darwin University and Royal Darwin Hospital, Darwin, NT (B.J.C., J.R.W.), and the Department of Microbiology and Immunology, Peter Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, VIC (J.R.W.) - both in Australia
| | - Melissa Hunter
- From the Bacterial Special Pathogens Branch (J.E.G., W.A.B., J. Petras, M.G.E., L.L., D.D.B., C.A.G., Z.P.W., M.E.N., A.R.H.), the Poxvirus and Rabies Branch (A.K.), and the Infectious Diseases Pathology Branch (J.M.R., S.R.Z.), Division of High-Consequence Pathogens and Pathology, the Epidemic Intelligence Service (A.K., J. Petras, J. Gettings, M.F., W.W.W., E.B.), and the Prevention and Response Branch, Division of Healthcare Quality Promotion (W.W.W., E.B.), Centers for Disease Control and Prevention, the Georgia Department of Public Health (J. Gettings, S.B., J. Pavlick, J. Gabel, C.D.), and the Department of Pathology and Laboratory Medicine, Emory University School of Medicine (R.G.), Atlanta, Public Health District 1-1, Georgia Department of Public Health, Rome (M.H.), and Dekalb County Medical Examiner's Office, Decatur (R.G., C.L.) - all in Georgia; the Minnesota Department of Health, St. Paul (M.B., M.F., R.L.); the Kansas Department of Health and Environment, Topeka (A.Z., C.R., F.S.A.); Public Health Regions 2 and 3, Texas Department of State Health Services, Arlington (H.H., S.S.), and the Texas Department of State Health Services, Austin (B.J.O.); and Menzies School of Health Research, Charles Darwin University and Royal Darwin Hospital, Darwin, NT (B.J.C., J.R.W.), and the Department of Microbiology and Immunology, Peter Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, VIC (J.R.W.) - both in Australia
| | - Skyler Brennan
- From the Bacterial Special Pathogens Branch (J.E.G., W.A.B., J. Petras, M.G.E., L.L., D.D.B., C.A.G., Z.P.W., M.E.N., A.R.H.), the Poxvirus and Rabies Branch (A.K.), and the Infectious Diseases Pathology Branch (J.M.R., S.R.Z.), Division of High-Consequence Pathogens and Pathology, the Epidemic Intelligence Service (A.K., J. Petras, J. Gettings, M.F., W.W.W., E.B.), and the Prevention and Response Branch, Division of Healthcare Quality Promotion (W.W.W., E.B.), Centers for Disease Control and Prevention, the Georgia Department of Public Health (J. Gettings, S.B., J. Pavlick, J. Gabel, C.D.), and the Department of Pathology and Laboratory Medicine, Emory University School of Medicine (R.G.), Atlanta, Public Health District 1-1, Georgia Department of Public Health, Rome (M.H.), and Dekalb County Medical Examiner's Office, Decatur (R.G., C.L.) - all in Georgia; the Minnesota Department of Health, St. Paul (M.B., M.F., R.L.); the Kansas Department of Health and Environment, Topeka (A.Z., C.R., F.S.A.); Public Health Regions 2 and 3, Texas Department of State Health Services, Arlington (H.H., S.S.), and the Texas Department of State Health Services, Austin (B.J.O.); and Menzies School of Health Research, Charles Darwin University and Royal Darwin Hospital, Darwin, NT (B.J.C., J.R.W.), and the Department of Microbiology and Immunology, Peter Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, VIC (J.R.W.) - both in Australia
| | - Jessica Pavlick
- From the Bacterial Special Pathogens Branch (J.E.G., W.A.B., J. Petras, M.G.E., L.L., D.D.B., C.A.G., Z.P.W., M.E.N., A.R.H.), the Poxvirus and Rabies Branch (A.K.), and the Infectious Diseases Pathology Branch (J.M.R., S.R.Z.), Division of High-Consequence Pathogens and Pathology, the Epidemic Intelligence Service (A.K., J. Petras, J. Gettings, M.F., W.W.W., E.B.), and the Prevention and Response Branch, Division of Healthcare Quality Promotion (W.W.W., E.B.), Centers for Disease Control and Prevention, the Georgia Department of Public Health (J. Gettings, S.B., J. Pavlick, J. Gabel, C.D.), and the Department of Pathology and Laboratory Medicine, Emory University School of Medicine (R.G.), Atlanta, Public Health District 1-1, Georgia Department of Public Health, Rome (M.H.), and Dekalb County Medical Examiner's Office, Decatur (R.G., C.L.) - all in Georgia; the Minnesota Department of Health, St. Paul (M.B., M.F., R.L.); the Kansas Department of Health and Environment, Topeka (A.Z., C.R., F.S.A.); Public Health Regions 2 and 3, Texas Department of State Health Services, Arlington (H.H., S.S.), and the Texas Department of State Health Services, Austin (B.J.O.); and Menzies School of Health Research, Charles Darwin University and Royal Darwin Hospital, Darwin, NT (B.J.C., J.R.W.), and the Department of Microbiology and Immunology, Peter Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, VIC (J.R.W.) - both in Australia
| | - Julie Gabel
- From the Bacterial Special Pathogens Branch (J.E.G., W.A.B., J. Petras, M.G.E., L.L., D.D.B., C.A.G., Z.P.W., M.E.N., A.R.H.), the Poxvirus and Rabies Branch (A.K.), and the Infectious Diseases Pathology Branch (J.M.R., S.R.Z.), Division of High-Consequence Pathogens and Pathology, the Epidemic Intelligence Service (A.K., J. Petras, J. Gettings, M.F., W.W.W., E.B.), and the Prevention and Response Branch, Division of Healthcare Quality Promotion (W.W.W., E.B.), Centers for Disease Control and Prevention, the Georgia Department of Public Health (J. Gettings, S.B., J. Pavlick, J. Gabel, C.D.), and the Department of Pathology and Laboratory Medicine, Emory University School of Medicine (R.G.), Atlanta, Public Health District 1-1, Georgia Department of Public Health, Rome (M.H.), and Dekalb County Medical Examiner's Office, Decatur (R.G., C.L.) - all in Georgia; the Minnesota Department of Health, St. Paul (M.B., M.F., R.L.); the Kansas Department of Health and Environment, Topeka (A.Z., C.R., F.S.A.); Public Health Regions 2 and 3, Texas Department of State Health Services, Arlington (H.H., S.S.), and the Texas Department of State Health Services, Austin (B.J.O.); and Menzies School of Health Research, Charles Darwin University and Royal Darwin Hospital, Darwin, NT (B.J.C., J.R.W.), and the Department of Microbiology and Immunology, Peter Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, VIC (J.R.W.) - both in Australia
| | - Cherie Drenzek
- From the Bacterial Special Pathogens Branch (J.E.G., W.A.B., J. Petras, M.G.E., L.L., D.D.B., C.A.G., Z.P.W., M.E.N., A.R.H.), the Poxvirus and Rabies Branch (A.K.), and the Infectious Diseases Pathology Branch (J.M.R., S.R.Z.), Division of High-Consequence Pathogens and Pathology, the Epidemic Intelligence Service (A.K., J. Petras, J. Gettings, M.F., W.W.W., E.B.), and the Prevention and Response Branch, Division of Healthcare Quality Promotion (W.W.W., E.B.), Centers for Disease Control and Prevention, the Georgia Department of Public Health (J. Gettings, S.B., J. Pavlick, J. Gabel, C.D.), and the Department of Pathology and Laboratory Medicine, Emory University School of Medicine (R.G.), Atlanta, Public Health District 1-1, Georgia Department of Public Health, Rome (M.H.), and Dekalb County Medical Examiner's Office, Decatur (R.G., C.L.) - all in Georgia; the Minnesota Department of Health, St. Paul (M.B., M.F., R.L.); the Kansas Department of Health and Environment, Topeka (A.Z., C.R., F.S.A.); Public Health Regions 2 and 3, Texas Department of State Health Services, Arlington (H.H., S.S.), and the Texas Department of State Health Services, Austin (B.J.O.); and Menzies School of Health Research, Charles Darwin University and Royal Darwin Hospital, Darwin, NT (B.J.C., J.R.W.), and the Department of Microbiology and Immunology, Peter Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, VIC (J.R.W.) - both in Australia
| | - Rachel Geller
- From the Bacterial Special Pathogens Branch (J.E.G., W.A.B., J. Petras, M.G.E., L.L., D.D.B., C.A.G., Z.P.W., M.E.N., A.R.H.), the Poxvirus and Rabies Branch (A.K.), and the Infectious Diseases Pathology Branch (J.M.R., S.R.Z.), Division of High-Consequence Pathogens and Pathology, the Epidemic Intelligence Service (A.K., J. Petras, J. Gettings, M.F., W.W.W., E.B.), and the Prevention and Response Branch, Division of Healthcare Quality Promotion (W.W.W., E.B.), Centers for Disease Control and Prevention, the Georgia Department of Public Health (J. Gettings, S.B., J. Pavlick, J. Gabel, C.D.), and the Department of Pathology and Laboratory Medicine, Emory University School of Medicine (R.G.), Atlanta, Public Health District 1-1, Georgia Department of Public Health, Rome (M.H.), and Dekalb County Medical Examiner's Office, Decatur (R.G., C.L.) - all in Georgia; the Minnesota Department of Health, St. Paul (M.B., M.F., R.L.); the Kansas Department of Health and Environment, Topeka (A.Z., C.R., F.S.A.); Public Health Regions 2 and 3, Texas Department of State Health Services, Arlington (H.H., S.S.), and the Texas Department of State Health Services, Austin (B.J.O.); and Menzies School of Health Research, Charles Darwin University and Royal Darwin Hospital, Darwin, NT (B.J.C., J.R.W.), and the Department of Microbiology and Immunology, Peter Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, VIC (J.R.W.) - both in Australia
| | - Crystal Lee
- From the Bacterial Special Pathogens Branch (J.E.G., W.A.B., J. Petras, M.G.E., L.L., D.D.B., C.A.G., Z.P.W., M.E.N., A.R.H.), the Poxvirus and Rabies Branch (A.K.), and the Infectious Diseases Pathology Branch (J.M.R., S.R.Z.), Division of High-Consequence Pathogens and Pathology, the Epidemic Intelligence Service (A.K., J. Petras, J. Gettings, M.F., W.W.W., E.B.), and the Prevention and Response Branch, Division of Healthcare Quality Promotion (W.W.W., E.B.), Centers for Disease Control and Prevention, the Georgia Department of Public Health (J. Gettings, S.B., J. Pavlick, J. Gabel, C.D.), and the Department of Pathology and Laboratory Medicine, Emory University School of Medicine (R.G.), Atlanta, Public Health District 1-1, Georgia Department of Public Health, Rome (M.H.), and Dekalb County Medical Examiner's Office, Decatur (R.G., C.L.) - all in Georgia; the Minnesota Department of Health, St. Paul (M.B., M.F., R.L.); the Kansas Department of Health and Environment, Topeka (A.Z., C.R., F.S.A.); Public Health Regions 2 and 3, Texas Department of State Health Services, Arlington (H.H., S.S.), and the Texas Department of State Health Services, Austin (B.J.O.); and Menzies School of Health Research, Charles Darwin University and Royal Darwin Hospital, Darwin, NT (B.J.C., J.R.W.), and the Department of Microbiology and Immunology, Peter Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, VIC (J.R.W.) - both in Australia
| | - Jana M Ritter
- From the Bacterial Special Pathogens Branch (J.E.G., W.A.B., J. Petras, M.G.E., L.L., D.D.B., C.A.G., Z.P.W., M.E.N., A.R.H.), the Poxvirus and Rabies Branch (A.K.), and the Infectious Diseases Pathology Branch (J.M.R., S.R.Z.), Division of High-Consequence Pathogens and Pathology, the Epidemic Intelligence Service (A.K., J. Petras, J. Gettings, M.F., W.W.W., E.B.), and the Prevention and Response Branch, Division of Healthcare Quality Promotion (W.W.W., E.B.), Centers for Disease Control and Prevention, the Georgia Department of Public Health (J. Gettings, S.B., J. Pavlick, J. Gabel, C.D.), and the Department of Pathology and Laboratory Medicine, Emory University School of Medicine (R.G.), Atlanta, Public Health District 1-1, Georgia Department of Public Health, Rome (M.H.), and Dekalb County Medical Examiner's Office, Decatur (R.G., C.L.) - all in Georgia; the Minnesota Department of Health, St. Paul (M.B., M.F., R.L.); the Kansas Department of Health and Environment, Topeka (A.Z., C.R., F.S.A.); Public Health Regions 2 and 3, Texas Department of State Health Services, Arlington (H.H., S.S.), and the Texas Department of State Health Services, Austin (B.J.O.); and Menzies School of Health Research, Charles Darwin University and Royal Darwin Hospital, Darwin, NT (B.J.C., J.R.W.), and the Department of Microbiology and Immunology, Peter Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, VIC (J.R.W.) - both in Australia
| | - Sherif R Zaki
- From the Bacterial Special Pathogens Branch (J.E.G., W.A.B., J. Petras, M.G.E., L.L., D.D.B., C.A.G., Z.P.W., M.E.N., A.R.H.), the Poxvirus and Rabies Branch (A.K.), and the Infectious Diseases Pathology Branch (J.M.R., S.R.Z.), Division of High-Consequence Pathogens and Pathology, the Epidemic Intelligence Service (A.K., J. Petras, J. Gettings, M.F., W.W.W., E.B.), and the Prevention and Response Branch, Division of Healthcare Quality Promotion (W.W.W., E.B.), Centers for Disease Control and Prevention, the Georgia Department of Public Health (J. Gettings, S.B., J. Pavlick, J. Gabel, C.D.), and the Department of Pathology and Laboratory Medicine, Emory University School of Medicine (R.G.), Atlanta, Public Health District 1-1, Georgia Department of Public Health, Rome (M.H.), and Dekalb County Medical Examiner's Office, Decatur (R.G., C.L.) - all in Georgia; the Minnesota Department of Health, St. Paul (M.B., M.F., R.L.); the Kansas Department of Health and Environment, Topeka (A.Z., C.R., F.S.A.); Public Health Regions 2 and 3, Texas Department of State Health Services, Arlington (H.H., S.S.), and the Texas Department of State Health Services, Austin (B.J.O.); and Menzies School of Health Research, Charles Darwin University and Royal Darwin Hospital, Darwin, NT (B.J.C., J.R.W.), and the Department of Microbiology and Immunology, Peter Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, VIC (J.R.W.) - both in Australia
| | - Christopher A Gulvik
- From the Bacterial Special Pathogens Branch (J.E.G., W.A.B., J. Petras, M.G.E., L.L., D.D.B., C.A.G., Z.P.W., M.E.N., A.R.H.), the Poxvirus and Rabies Branch (A.K.), and the Infectious Diseases Pathology Branch (J.M.R., S.R.Z.), Division of High-Consequence Pathogens and Pathology, the Epidemic Intelligence Service (A.K., J. Petras, J. Gettings, M.F., W.W.W., E.B.), and the Prevention and Response Branch, Division of Healthcare Quality Promotion (W.W.W., E.B.), Centers for Disease Control and Prevention, the Georgia Department of Public Health (J. Gettings, S.B., J. Pavlick, J. Gabel, C.D.), and the Department of Pathology and Laboratory Medicine, Emory University School of Medicine (R.G.), Atlanta, Public Health District 1-1, Georgia Department of Public Health, Rome (M.H.), and Dekalb County Medical Examiner's Office, Decatur (R.G., C.L.) - all in Georgia; the Minnesota Department of Health, St. Paul (M.B., M.F., R.L.); the Kansas Department of Health and Environment, Topeka (A.Z., C.R., F.S.A.); Public Health Regions 2 and 3, Texas Department of State Health Services, Arlington (H.H., S.S.), and the Texas Department of State Health Services, Austin (B.J.O.); and Menzies School of Health Research, Charles Darwin University and Royal Darwin Hospital, Darwin, NT (B.J.C., J.R.W.), and the Department of Microbiology and Immunology, Peter Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, VIC (J.R.W.) - both in Australia
| | - W Wyatt Wilson
- From the Bacterial Special Pathogens Branch (J.E.G., W.A.B., J. Petras, M.G.E., L.L., D.D.B., C.A.G., Z.P.W., M.E.N., A.R.H.), the Poxvirus and Rabies Branch (A.K.), and the Infectious Diseases Pathology Branch (J.M.R., S.R.Z.), Division of High-Consequence Pathogens and Pathology, the Epidemic Intelligence Service (A.K., J. Petras, J. Gettings, M.F., W.W.W., E.B.), and the Prevention and Response Branch, Division of Healthcare Quality Promotion (W.W.W., E.B.), Centers for Disease Control and Prevention, the Georgia Department of Public Health (J. Gettings, S.B., J. Pavlick, J. Gabel, C.D.), and the Department of Pathology and Laboratory Medicine, Emory University School of Medicine (R.G.), Atlanta, Public Health District 1-1, Georgia Department of Public Health, Rome (M.H.), and Dekalb County Medical Examiner's Office, Decatur (R.G., C.L.) - all in Georgia; the Minnesota Department of Health, St. Paul (M.B., M.F., R.L.); the Kansas Department of Health and Environment, Topeka (A.Z., C.R., F.S.A.); Public Health Regions 2 and 3, Texas Department of State Health Services, Arlington (H.H., S.S.), and the Texas Department of State Health Services, Austin (B.J.O.); and Menzies School of Health Research, Charles Darwin University and Royal Darwin Hospital, Darwin, NT (B.J.C., J.R.W.), and the Department of Microbiology and Immunology, Peter Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, VIC (J.R.W.) - both in Australia
| | - Elizabeth Beshearse
- From the Bacterial Special Pathogens Branch (J.E.G., W.A.B., J. Petras, M.G.E., L.L., D.D.B., C.A.G., Z.P.W., M.E.N., A.R.H.), the Poxvirus and Rabies Branch (A.K.), and the Infectious Diseases Pathology Branch (J.M.R., S.R.Z.), Division of High-Consequence Pathogens and Pathology, the Epidemic Intelligence Service (A.K., J. Petras, J. Gettings, M.F., W.W.W., E.B.), and the Prevention and Response Branch, Division of Healthcare Quality Promotion (W.W.W., E.B.), Centers for Disease Control and Prevention, the Georgia Department of Public Health (J. Gettings, S.B., J. Pavlick, J. Gabel, C.D.), and the Department of Pathology and Laboratory Medicine, Emory University School of Medicine (R.G.), Atlanta, Public Health District 1-1, Georgia Department of Public Health, Rome (M.H.), and Dekalb County Medical Examiner's Office, Decatur (R.G., C.L.) - all in Georgia; the Minnesota Department of Health, St. Paul (M.B., M.F., R.L.); the Kansas Department of Health and Environment, Topeka (A.Z., C.R., F.S.A.); Public Health Regions 2 and 3, Texas Department of State Health Services, Arlington (H.H., S.S.), and the Texas Department of State Health Services, Austin (B.J.O.); and Menzies School of Health Research, Charles Darwin University and Royal Darwin Hospital, Darwin, NT (B.J.C., J.R.W.), and the Department of Microbiology and Immunology, Peter Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, VIC (J.R.W.) - both in Australia
| | - Bart J Currie
- From the Bacterial Special Pathogens Branch (J.E.G., W.A.B., J. Petras, M.G.E., L.L., D.D.B., C.A.G., Z.P.W., M.E.N., A.R.H.), the Poxvirus and Rabies Branch (A.K.), and the Infectious Diseases Pathology Branch (J.M.R., S.R.Z.), Division of High-Consequence Pathogens and Pathology, the Epidemic Intelligence Service (A.K., J. Petras, J. Gettings, M.F., W.W.W., E.B.), and the Prevention and Response Branch, Division of Healthcare Quality Promotion (W.W.W., E.B.), Centers for Disease Control and Prevention, the Georgia Department of Public Health (J. Gettings, S.B., J. Pavlick, J. Gabel, C.D.), and the Department of Pathology and Laboratory Medicine, Emory University School of Medicine (R.G.), Atlanta, Public Health District 1-1, Georgia Department of Public Health, Rome (M.H.), and Dekalb County Medical Examiner's Office, Decatur (R.G., C.L.) - all in Georgia; the Minnesota Department of Health, St. Paul (M.B., M.F., R.L.); the Kansas Department of Health and Environment, Topeka (A.Z., C.R., F.S.A.); Public Health Regions 2 and 3, Texas Department of State Health Services, Arlington (H.H., S.S.), and the Texas Department of State Health Services, Austin (B.J.O.); and Menzies School of Health Research, Charles Darwin University and Royal Darwin Hospital, Darwin, NT (B.J.C., J.R.W.), and the Department of Microbiology and Immunology, Peter Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, VIC (J.R.W.) - both in Australia
| | - Jessica R Webb
- From the Bacterial Special Pathogens Branch (J.E.G., W.A.B., J. Petras, M.G.E., L.L., D.D.B., C.A.G., Z.P.W., M.E.N., A.R.H.), the Poxvirus and Rabies Branch (A.K.), and the Infectious Diseases Pathology Branch (J.M.R., S.R.Z.), Division of High-Consequence Pathogens and Pathology, the Epidemic Intelligence Service (A.K., J. Petras, J. Gettings, M.F., W.W.W., E.B.), and the Prevention and Response Branch, Division of Healthcare Quality Promotion (W.W.W., E.B.), Centers for Disease Control and Prevention, the Georgia Department of Public Health (J. Gettings, S.B., J. Pavlick, J. Gabel, C.D.), and the Department of Pathology and Laboratory Medicine, Emory University School of Medicine (R.G.), Atlanta, Public Health District 1-1, Georgia Department of Public Health, Rome (M.H.), and Dekalb County Medical Examiner's Office, Decatur (R.G., C.L.) - all in Georgia; the Minnesota Department of Health, St. Paul (M.B., M.F., R.L.); the Kansas Department of Health and Environment, Topeka (A.Z., C.R., F.S.A.); Public Health Regions 2 and 3, Texas Department of State Health Services, Arlington (H.H., S.S.), and the Texas Department of State Health Services, Austin (B.J.O.); and Menzies School of Health Research, Charles Darwin University and Royal Darwin Hospital, Darwin, NT (B.J.C., J.R.W.), and the Department of Microbiology and Immunology, Peter Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, VIC (J.R.W.) - both in Australia
| | - Zachary P Weiner
- From the Bacterial Special Pathogens Branch (J.E.G., W.A.B., J. Petras, M.G.E., L.L., D.D.B., C.A.G., Z.P.W., M.E.N., A.R.H.), the Poxvirus and Rabies Branch (A.K.), and the Infectious Diseases Pathology Branch (J.M.R., S.R.Z.), Division of High-Consequence Pathogens and Pathology, the Epidemic Intelligence Service (A.K., J. Petras, J. Gettings, M.F., W.W.W., E.B.), and the Prevention and Response Branch, Division of Healthcare Quality Promotion (W.W.W., E.B.), Centers for Disease Control and Prevention, the Georgia Department of Public Health (J. Gettings, S.B., J. Pavlick, J. Gabel, C.D.), and the Department of Pathology and Laboratory Medicine, Emory University School of Medicine (R.G.), Atlanta, Public Health District 1-1, Georgia Department of Public Health, Rome (M.H.), and Dekalb County Medical Examiner's Office, Decatur (R.G., C.L.) - all in Georgia; the Minnesota Department of Health, St. Paul (M.B., M.F., R.L.); the Kansas Department of Health and Environment, Topeka (A.Z., C.R., F.S.A.); Public Health Regions 2 and 3, Texas Department of State Health Services, Arlington (H.H., S.S.), and the Texas Department of State Health Services, Austin (B.J.O.); and Menzies School of Health Research, Charles Darwin University and Royal Darwin Hospital, Darwin, NT (B.J.C., J.R.W.), and the Department of Microbiology and Immunology, Peter Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, VIC (J.R.W.) - both in Australia
| | - María E Negrón
- From the Bacterial Special Pathogens Branch (J.E.G., W.A.B., J. Petras, M.G.E., L.L., D.D.B., C.A.G., Z.P.W., M.E.N., A.R.H.), the Poxvirus and Rabies Branch (A.K.), and the Infectious Diseases Pathology Branch (J.M.R., S.R.Z.), Division of High-Consequence Pathogens and Pathology, the Epidemic Intelligence Service (A.K., J. Petras, J. Gettings, M.F., W.W.W., E.B.), and the Prevention and Response Branch, Division of Healthcare Quality Promotion (W.W.W., E.B.), Centers for Disease Control and Prevention, the Georgia Department of Public Health (J. Gettings, S.B., J. Pavlick, J. Gabel, C.D.), and the Department of Pathology and Laboratory Medicine, Emory University School of Medicine (R.G.), Atlanta, Public Health District 1-1, Georgia Department of Public Health, Rome (M.H.), and Dekalb County Medical Examiner's Office, Decatur (R.G., C.L.) - all in Georgia; the Minnesota Department of Health, St. Paul (M.B., M.F., R.L.); the Kansas Department of Health and Environment, Topeka (A.Z., C.R., F.S.A.); Public Health Regions 2 and 3, Texas Department of State Health Services, Arlington (H.H., S.S.), and the Texas Department of State Health Services, Austin (B.J.O.); and Menzies School of Health Research, Charles Darwin University and Royal Darwin Hospital, Darwin, NT (B.J.C., J.R.W.), and the Department of Microbiology and Immunology, Peter Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, VIC (J.R.W.) - both in Australia
| | - Alex R Hoffmaster
- From the Bacterial Special Pathogens Branch (J.E.G., W.A.B., J. Petras, M.G.E., L.L., D.D.B., C.A.G., Z.P.W., M.E.N., A.R.H.), the Poxvirus and Rabies Branch (A.K.), and the Infectious Diseases Pathology Branch (J.M.R., S.R.Z.), Division of High-Consequence Pathogens and Pathology, the Epidemic Intelligence Service (A.K., J. Petras, J. Gettings, M.F., W.W.W., E.B.), and the Prevention and Response Branch, Division of Healthcare Quality Promotion (W.W.W., E.B.), Centers for Disease Control and Prevention, the Georgia Department of Public Health (J. Gettings, S.B., J. Pavlick, J. Gabel, C.D.), and the Department of Pathology and Laboratory Medicine, Emory University School of Medicine (R.G.), Atlanta, Public Health District 1-1, Georgia Department of Public Health, Rome (M.H.), and Dekalb County Medical Examiner's Office, Decatur (R.G., C.L.) - all in Georgia; the Minnesota Department of Health, St. Paul (M.B., M.F., R.L.); the Kansas Department of Health and Environment, Topeka (A.Z., C.R., F.S.A.); Public Health Regions 2 and 3, Texas Department of State Health Services, Arlington (H.H., S.S.), and the Texas Department of State Health Services, Austin (B.J.O.); and Menzies School of Health Research, Charles Darwin University and Royal Darwin Hospital, Darwin, NT (B.J.C., J.R.W.), and the Department of Microbiology and Immunology, Peter Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, VIC (J.R.W.) - both in Australia
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Johnson AG, Amin AB, Ali AR, Hoots B, Cadwell BL, Arora S, Avoundjian T, Awofeso AO, Barnes J, Bayoumi NS, Busen K, Chang C, Cima M, Crockett M, Cronquist A, Davidson S, Davis E, Delgadillo J, Dorabawila V, Drenzek C, Eisenstein L, Fast HE, Gent A, Hand J, Hoefer D, Holtzman C, Jara A, Jones A, Kamal-Ahmed I, Kangas S, Kanishka FNU, Kaur R, Khan S, King J, Kirkendall S, Klioueva A, Kocharian A, Kwon FY, Logan J, Lyons BC, Lyons S, May A, McCormick D, Mendoza E, Milroy L, O’Donnell A, Pike M, Pogosjans S, Saupe A, Sell J, Smith E, Sosin DM, Stanislawski E, Steele MK, Stephenson M, Stout A, Strand K, Tilakaratne BP, Turner K, Vest H, Warner S, Wiedeman C, Zaldivar A, Silk BJ, Scobie HM. COVID-19 Incidence and Death Rates Among Unvaccinated and Fully Vaccinated Adults with and Without Booster Doses During Periods of Delta and Omicron Variant Emergence - 25 U.S. Jurisdictions, April 4-December 25, 2021. MMWR Morb Mortal Wkly Rep 2022; 71:132-138. [PMID: 35085223 PMCID: PMC9351531 DOI: 10.15585/mmwr.mm7104e2] [Citation(s) in RCA: 197] [Impact Index Per Article: 98.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Paz-Bailey G, Sternberg M, Kugeler K, Hoots B, Amin AB, Johnson AG, Barbeau B, Bayoumi NS, Bertolino D, Boulton R, Brown CM, Busen K, Cima M, Drenzek C, Gent A, Haney G, Hicks L, Hook S, Jara A, Jones A, Kamal-Ahmed I, Kangas S, Kanishka FNU, Khan SI, Kirkendall SK, Kocharian A, Lyons BC, Lauro P, McCormick D, McMullen C, Milroy L, Reese HE, Sell J, Sierocki A, Smith E, Sosin D, Stanislawski E, Strand K, Troelstrup T, Turner KA, Vest H, Warner S, Wiedeman C, Silk B, Scobie HM. Covid-19 Rates by Time since Vaccination during Delta Variant Predominance. NEJM Evid 2022; 1:10.1056/evidoa2100057. [PMID: 37207114 PMCID: PMC10193243 DOI: 10.1056/evidoa2100057] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
BACKGROUND With the emergence of the delta variant, the United States experienced a rapid increase in Covid-19 cases in 2021. We estimated the risk of breakthrough infection and death by month of vaccination as a proxy for waning immunity during a period of delta variant predominance. METHODS Covid-19 case and death data from 15 U.S. jurisdictions during January 3 to September 4, 2021 were used to estimate weekly hazard rates among fully vaccinated persons, stratified by age group and vaccine product. Case and death rates during August 1 to September 4, 2021 were presented across four cohorts defined by month of vaccination. Poisson models were used to estimate adjusted rate ratios comparing the earlier cohorts to July rates. RESULTS During August 1 to September 4, 2021, case rates per 100,000 person-weeks among all vaccine recipients for the January to February, March to April, May to June, and July cohorts were 168.8 (95% confidence interval [CI], 167.5 to 170.1), 123.5 (95% CI, 122.8 to 124.1), 83.6 (95% CI, 82.9 to 84.3), and 63.1 (95% CI, 61.6 to 64.6), respectively. Similar trends were observed by age group for BNT162b2 (Pfizer-BioNTech) and mRNA-1273 (Moderna) vaccine recipients. Rates for the Ad26.COV2.S (Janssen-Johnson & Johnson) vaccine were higher; however, trends were inconsistent. BNT162b2 vaccine recipients 65 years of age or older had higher death rates among those vaccinated earlier in the year. Protection against death was sustained for the mRNA-1273 vaccine recipients. Across age groups and vaccine types, people who were vaccinated 6 months ago or longer (January-February) were 3.44 (3.36 to 3.53) times more likely to be infected and 1.70 (1.29 to 2.23) times more likely to die from COVID-19 than people vaccinated recently in July 2021. CONCLUSIONS Our study suggests that protection from SARS-CoV-2 infection among all ages or death among older adults waned with increasing time since vaccination during a period of delta predominance. These results add to the evidence base that supports U.S. booster recommendations, especially for older adults vaccinated with BNT162b2 and recipients of the Ad26.COV2.S vaccine. (Funded by the Centers for Disease Control and Prevention.).
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Affiliation(s)
- Gabriela Paz-Bailey
- Epidemiology Task Force, COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta
| | - Maya Sternberg
- Epidemiology Task Force, COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta
| | - Kiersten Kugeler
- Epidemiology Task Force, COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta
| | - Brooke Hoots
- Epidemiology Task Force, COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta
| | - Avnika B Amin
- Epidemiology Task Force, COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta
| | - Amelia G Johnson
- Epidemiology Task Force, COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta
| | | | | | - Daniel Bertolino
- New York City Department of Health and Mental Hygiene, Long Island City
| | | | | | | | | | | | | | | | - Liam Hicks
- Arizona Department of Health Services, Phoenix
| | - Sarah Hook
- Epidemiology Task Force, COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta
| | | | - Amanda Jones
- Center for Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention, Atlanta
| | | | - Sarah Kangas
- Wisconsin Department of Health Services, Madison
| | - F N U Kanishka
- Nebraska Department of Health and Human Services, Lincoln
| | | | | | | | - B Casey Lyons
- Data Analytics and Visualization Task Force, COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta
| | | | | | | | | | - Heather E Reese
- Epidemiology Task Force, COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta
| | - Jessica Sell
- New York City Department of Health and Mental Hygiene, Long Island City
| | | | | | | | | | - Kyle Strand
- Nebraska Department of Health and Human Services, Lincoln
| | | | | | | | - Sydni Warner
- Wisconsin Department of Health Services, Madison
| | | | - Benjamin Silk
- Epidemiology Task Force, COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta
| | - Heather M Scobie
- Epidemiology Task Force, COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta
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Gopalsamy SN, Ramakrishnan A, Shariff MM, Gabel J, Brennan S, Drenzek C, Farley MM, Gaynes RP, Cartwright EJ. Brucellosis Initially Misidentified as Ochrobactrum anthropi Bacteremia: A Case Report and Review of the Literature. Open Forum Infect Dis 2021; 8:ofab473. [PMID: 34660837 PMCID: PMC8514177 DOI: 10.1093/ofid/ofab473] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 09/23/2021] [Indexed: 11/20/2022] Open
Abstract
Automated identification systems may misidentify Brucella, the causative agent of brucellosis, which may be re-emerging in the United States as the result of an expanding feral swine population. We present a case of Brucella suis likely associated with feral swine exposure that was misidentified as Ochrobactrum anthropi, a phylogenetic relative.
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Affiliation(s)
| | - Aditi Ramakrishnan
- Division of Infectious Diseases, Department of Medicine, Emory University, Atlanta, Georgia, USA
| | - Mustaf M Shariff
- Department of Medicine, Northside Hospital Gwinnett, Lawrenceville, Georgia, USA
| | - Julie Gabel
- Georgia Department of Public Health, Atlanta, Georgia, USA
| | - Skyler Brennan
- Georgia Department of Public Health, Atlanta, Georgia, USA
| | - Cherie Drenzek
- Georgia Department of Public Health, Atlanta, Georgia, USA
| | - Monica M Farley
- Division of Infectious Diseases, Department of Medicine, Emory University, Atlanta, Georgia, USA.,Atlanta VA Medical Center, Decatur, Georgia, USA
| | - Robert P Gaynes
- Division of Infectious Diseases, Department of Medicine, Emory University, Atlanta, Georgia, USA.,Atlanta VA Medical Center, Decatur, Georgia, USA
| | - Emily J Cartwright
- Division of Infectious Diseases, Department of Medicine, Emory University, Atlanta, Georgia, USA.,Atlanta VA Medical Center, Decatur, Georgia, USA
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Chamberlain AT, Toomey KE, Bradley H, Hall EW, Fahimi M, Lopman BA, Luisi N, Sanchez T, Drenzek C, Shioda K, Siegler AJ, Sullivan PS. Cumulative incidence of SARS-CoV-2 infections among adults in Georgia, USA, August-December 2020. J Infect Dis 2021; 225:396-403. [PMID: 34662409 PMCID: PMC8807152 DOI: 10.1093/infdis/jiab522] [Citation(s) in RCA: 6] [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: 05/07/2021] [Accepted: 10/15/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Reported COVID-19 cases underestimate true SARS-CoV-2 infections. Data on all infections, including asymptomatic infections, are needed to guide programs. To minimize biases in estimates from reported cases and seroprevalence surveys, we conducted a household-based probability survey in Georgia and estimated cumulative incidence of SARS-CoV-2 infections adjusted for antibody waning. METHODS From August to December 2020, we mailed specimen collection kits (nasal swabs and blood spots) to a random sample of Georgia addresses. One household adult completed a survey and returned specimens for virus and antibody testing. We estimated cumulative incidence of SARS-CoV-2 infections adjusted for waning antibodies, reported fraction, and infection fatality ratio (IFR). Differences in seropositivity among demographic, geographic and clinical subgroups were explored with weighted prevalence ratios (PR). RESULTS Among 1,370 participants, adjusted cumulative incidence of SARS-CoV-2 was 16.1% (95% credible interval (CrI): 13.5-19.2%) as of November 16, 2020. The reported fraction was 26.6% and IFR was 0.78%. Non-Hispanic Black (PR: 2.03, CI 1.0, 4.1) and Hispanic adults (PR: 1.98, CI 0.74, 5.31) were more likely than non-Hispanic White adults to be seropositive. CONCLUSIONS As of mid-November 2020, one in 6 adults in Georgia had been infected with SARS-CoV-2. The COVID-19 epidemic in Georgia is likely substantially underestimated by reported cases.
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Affiliation(s)
- Allison T Chamberlain
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | | | - Heather Bradley
- Department of Population Health Sciences, Georgia State University School of Public Health, Atlanta, GA, USA
| | - Eric W Hall
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | | | - Benjamin A Lopman
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Nicole Luisi
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Travis Sanchez
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | | | - Kayoko Shioda
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Aaron J Siegler
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Patrick Sean Sullivan
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
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Tinker SC, Szablewski CM, Litvintseva AP, Drenzek C, Voccio GE, Hunter MA, Briggs S, Heida DE, Folster J, Shewmaker PL, Medrzycki M, Bowen MD, Bohannon C, Bagarozzi D, Petway M, Rota PA, Kuhnert-Tallman W, Thornburg N, Prince-Guerra JL, Barrios LC, Tamin A, Harcourt JL, Honein MA. Point-of-Care Antigen Test for SARS-CoV-2 in Asymptomatic College Students. Emerg Infect Dis 2021; 27:2662-2665. [PMID: 34399086 PMCID: PMC8462309 DOI: 10.3201/eid2710.210080] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
We used the BinaxNOW COVID-19 Ag Card to screen 1,540 asymptomatic college students for severe acute respiratory syndrome coronavirus 2 in a low-prevalence setting. Compared with reverse transcription PCR, BinaxNOW showed 20% overall sensitivity; among participants with culturable virus, sensitivity was 60%. BinaxNOW provides point-of-care screening but misses many infections.
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9
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Gettings J, Czarnik M, Morris E, Haller E, Thompson-Paul AM, Rasberry C, Lanzieri TM, Smith-Grant J, Aholou TM, Thomas E, Drenzek C, MacKellar D. Mask Use and Ventilation Improvements to Reduce COVID-19 Incidence in Elementary Schools - Georgia, November 16-December 11, 2020. MMWR Morb Mortal Wkly Rep 2021; 70:779-784. [PMID: 34043610 PMCID: PMC8158891 DOI: 10.15585/mmwr.mm7021e1] [Citation(s) in RCA: 76] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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10
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Gettings JR, Gold JAW, Kimball A, Forsberg K, Scott C, Uehara A, Tong S, Hast M, Swanson MR, Morris E, Oraka E, Almendares O, Thomas ES, Mehari L, McCloud J, Roberts G, Crosby D, Balajee A, Burnett E, Chancey RJ, Cook P, Donadel M, Espinosa C, Evans ME, Fleming-Dutra KE, Forero C, Kukielka EA, Li Y, Marcet PL, Mitruka K, Nakayama JY, Nakazawa Y, O'Hegarty M, Pratt C, Rice ME, Rodriguez Stewart RM, Sabogal R, Sanchez E, Velasco-Villa A, Weng MK, Zhang J, Rivera G, Parrott T, Franklin R, Memark J, Drenzek C, Hall AJ, Kirking HL, Tate JE, Vallabhaneni S. SARS-CoV-2 transmission in a Georgia school district - United States, December 2020-January 2021. Clin Infect Dis 2021; 74:319-326. [PMID: 33864375 PMCID: PMC8083290 DOI: 10.1093/cid/ciab332] [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] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND To inform prevention strategies, we assessed the extent of SARS-CoV-2 transmission and settings in which transmission occurred in a Georgia public school district. METHODS During December 1, 2020-January 22, 2021, SARS-CoV-2-infected index cases and their close contacts in schools were identified by school and public health officials. For in-school contacts, we assessed symptoms and offered SARS-CoV-2 RT-PCR testing; performed epidemiologic investigations and whole-genome sequencing to identify in-school transmission; and calculated secondary attack rate (SAR) by school setting (e.g., sports, elementary school classroom), index case role (i.e., staff, student), and index case symptomatic status. RESULTS We identified 86 index cases and 1,119 contacts, 688 (63.1%) of whom received testing. Fifty-nine (8.7%) of 679 contacts tested positive; 15 (17.4%) of 86 index cases resulted in ≥2 positive contacts. Among 55 persons testing positive with available symptom data, 31 (56.4%) were asymptomatic. Highest SAR were in indoor, high-contact sports settings (23.8%, 95% confidence interval [CI] 12.7, 33.3), staff meetings/lunches (18.2%, CI 4.5-31.8), and elementary school classrooms (9.5%, CI 6.5-12.5). SAR was higher for staff (13.1%, CI 9.0-17.2) versus student index cases (5.8%, CI 3.6-8.0) and for symptomatic (10.9%, CI 8.1-13.9) versus asymptomatic index cases (3.0%, CI 1.0-5.5). CONCLUSIONS Indoor sports may pose a risk to the safe operation of in-person learning. Preventing infection in staff members, through measures that include COVID-19 vaccination, is critical to reducing in-school transmission. Because many positive contacts were asymptomatic, contact tracing should be paired with testing, regardless of symptoms.
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Affiliation(s)
- Jenna R Gettings
- Georgia Department of Public Health, Atlanta, GA, USA.,COVID-19 Response, CDC, Atlanta, GA, USA.,Epidemic Intelligence Service, CDC, Atlanta, GA, USA
| | - Jeremy A W Gold
- COVID-19 Response, CDC, Atlanta, GA, USA.,Epidemic Intelligence Service, CDC, Atlanta, GA, USA
| | - Anne Kimball
- COVID-19 Response, CDC, Atlanta, GA, USA.,Epidemic Intelligence Service, CDC, Atlanta, GA, USA
| | | | | | | | | | | | | | | | - Emeka Oraka
- COVID-19 Response, CDC, Atlanta, GA, USA.,General Dynamics Information Technology, Falls Church, VA, USA
| | | | | | | | | | | | | | - Abirami Balajee
- COVID-19 Response, CDC, Atlanta, GA, USA.,Maximus Federal, Reston, VA, USA
| | | | | | - Peter Cook
- COVID-19 Response, CDC, Atlanta, GA, USA
| | | | | | | | | | | | - Esther A Kukielka
- COVID-19 Response, CDC, Atlanta, GA, USA.,Epidemic Intelligence Service, CDC, Atlanta, GA, USA
| | - Yan Li
- COVID-19 Response, CDC, Atlanta, GA, USA
| | | | | | - Jasmine Y Nakayama
- COVID-19 Response, CDC, Atlanta, GA, USA.,Epidemic Intelligence Service, CDC, Atlanta, GA, USA
| | | | | | - Caroline Pratt
- COVID-19 Response, CDC, Atlanta, GA, USA.,Epidemic Intelligence Service, CDC, Atlanta, GA, USA
| | | | | | | | | | | | | | - Jing Zhang
- COVID-19 Response, CDC, Atlanta, GA, USA
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11
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McGovern OL, Kobayashi M, Shaw KA, Szablewski C, Gabel J, Holsinger C, Drenzek C, Brennan S, Milucky J, Farrar JL, Wolff BJ, Benitez AJ, Thurman KA, Diaz MH, Winchell JM, Schrag S. Use of Real-Time PCR for Chlamydia psittaci Detection in Human Specimens During an Outbreak of Psittacosis - Georgia and Virginia, 2018. MMWR Morb Mortal Wkly Rep 2021; 70:505-509. [PMID: 33830980 PMCID: PMC8030988 DOI: 10.15585/mmwr.mm7014a1] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Psittacosis is typically a mild febrile respiratory illness caused by infection with the bacterium Chlamydia psittaci and usually transmitted to humans by infected birds (1). On average, 11 psittacosis cases per year were reported in the United States during 2000-2017. During August-October 2018, the largest U.S. psittacosis outbreak in 30 years (82 cases identified*) occurred in two poultry slaughter plants, one each in Virginia and Georgia, that shared source farms (2). CDC used C. psittaci real-time polymerase chain reaction (PCR) to test 54 human specimens from this outbreak. This was the largest number of human specimens from a single outbreak ever tested for C. psittaci using real-time PCR, which is faster and more sensitive than commercially available serologic tests. This represented a rare opportunity to assess the utility of multiple specimen types for real-time PCR detection of C. psittaci. C. psittaci was detected more frequently in lower respiratory specimens (59% [10 of 17]) and stool (four of five) than in upper respiratory specimens (7% [two of 28]). Among six patients with sputum and nasopharyngeal swabs tested, C. psittaci was detected only in sputum in five patients. Cycle threshold (Ct) values suggested bacterial load was higher in lower respiratory specimens than in nasopharyngeal swabs. These findings support prioritizing lower respiratory specimens for real-time PCR detection of C. psittaci. Stool specimens might also have utility for diagnosis of psittacosis.
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12
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Pettrone K, Burnett E, Link-Gelles R, Haight SC, Schrodt C, England L, Gomes DJ, Shamout M, O'Laughlin K, Kimball A, Blau EF, Ladva CN, Szablewski CM, Tobin-D'Angelo M, Oosmanally N, Drenzek C, Browning SD, Bruce BB, da Silva J, Gold JAW, Jackson BR, Morris SB, Natarajan P, Fanfair RN, Patel PR, Rogers-Brown J, Rossow J, Wong KK, Murphy DJ, Blum JM, Hollberg J, Lefkove B, Brown FW, Shimabukuro T, Midgley CM, Tate JE, Killerby ME. Characteristics and Risk Factors of Hospitalized and Nonhospitalized COVID-19 Patients, Atlanta, Georgia, USA, March-April 2020. Emerg Infect Dis 2021; 27:1164-1168. [PMID: 33754981 PMCID: PMC8007327 DOI: 10.3201/eid2704.204709] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
We compared the characteristics of hospitalized and nonhospitalized patients who had coronavirus disease in Atlanta, Georgia, USA. We found that risk for hospitalization increased with a patient’s age and number of concurrent conditions. We also found a potential association between hospitalization and high hemoglobin A1c levels in persons with diabetes.
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13
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Szablewski CM, Chang KT, McDaniel CJ, Chu VT, Yousaf AR, Schwartz NG, Brown M, Winglee K, Paul P, Cui Z, Slayton RB, Tong S, Li Y, Uehara A, Zhang J, Sharkey SM, Kirking HL, Tate JE, Dirlikov E, Fry AM, Hall AJ, Rose DA, Villanueva J, Drenzek C, Stewart RJ, Lanzieri TM. SARS-CoV-2 Transmission Dynamics in a Sleep-Away Camp. Pediatrics 2021; 147:peds.2020-046524. [PMID: 33504612 PMCID: PMC8982574 DOI: 10.1542/peds.2020-046524] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/15/2021] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES In late June 2020, a large outbreak of coronavirus disease 2019 (COVID-19) occurred at a sleep-away youth camp in Georgia, affecting primarily persons ≤21 years. We conducted a retrospective cohort study among campers and staff (attendees) to determine the extent of the outbreak and assess factors contributing to transmission. METHODS Attendees were interviewed to ascertain demographic characteristics, known exposures to COVID-19 and community exposures, and mitigation measures before, during, and after attending camp. COVID-19 case status was determined for all camp attendees on the basis of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) test results and reported symptoms. We calculated attack rates and instantaneous reproduction numbers and sequenced SARS-CoV-2 viral genomes from the outbreak. RESULTS Among 627 attendees, the median age was 15 years (interquartile range: 12-16 years); 56% (351 of 627) of attendees were female. The attack rate was 56% (351 of 627) among all attendees. On the basis of date of illness onset or first positive test result on a specimen collected, 12 case patients were infected before arriving at camp and 339 case patients were camp associated. Among 288 case patients with available symptom information, 45 (16%) were asymptomatic. Despite cohorting, 50% of attendees reported direct contact with people outside their cabin cohort. On the first day of camp session, the instantaneous reproduction number was 10. Viral genomic diversity was low. CONCLUSIONS Few introductions of SARS-CoV-2 into a youth congregate setting resulted in a large outbreak. Testing strategies should be combined with prearrival quarantine, routine symptom monitoring with appropriate isolation and quarantine, cohorting, social distancing, mask wearing, and enhanced disinfection and hand hygiene. Promotion of mitigation measures among younger populations is needed.
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Affiliation(s)
| | - Karen T. Chang
- COVID-19 Response Team, CDC, Atlanta, GA,Epidemic Intelligence Service, Atlanta, GA
| | | | - Victoria T. Chu
- COVID-19 Response Team, CDC, Atlanta, GA,Epidemic Intelligence Service, Atlanta, GA
| | - Anna R. Yousaf
- COVID-19 Response Team, CDC, Atlanta, GA,Epidemic Intelligence Service, Atlanta, GA
| | - Noah G. Schwartz
- COVID-19 Response Team, CDC, Atlanta, GA,Epidemic Intelligence Service, Atlanta, GA
| | - Marie Brown
- Georgia Department of Public Health, Atlanta, GA
| | | | | | | | | | | | - Yan Li
- COVID-19 Response Team, CDC, Atlanta, GA
| | | | - Jing Zhang
- COVID-19 Response Team, CDC, Atlanta, GA
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14
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Gold JAW, Gettings JR, Kimball A, Franklin R, Rivera G, Morris E, Scott C, Marcet PL, Hast M, Swanson M, McCloud J, Mehari L, Thomas ES, Kirking HL, Tate JE, Memark J, Drenzek C, Vallabhaneni S. Clusters of SARS-CoV-2 Infection Among Elementary School Educators and Students in One School District - Georgia, December 2020-January 2021. MMWR Morb Mortal Wkly Rep 2021; 70:289-292. [PMID: 33630823 PMCID: PMC8344983 DOI: 10.15585/mmwr.mm7008e4] [Citation(s) in RCA: 53] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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15
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da Silva JF, Hernandez-Romieu AC, Browning SD, Bruce BB, Natarajan P, Morris SB, Gold JAW, Neblett Fanfair R, Rogers-Brown J, Rossow J, Szablewski CM, Oosmanally N, D’Angelo MT, Drenzek C, Murphy DJ, Hollberg J, Blum JM, Jansen R, Wright DW, Sewell W, Owens J, Lefkove B, Brown FW, Burton DC, Uyeki TM, Patel PR, Jackson BR, Wong KK. COVID-19 Clinical Phenotypes: Presentation and Temporal Progression of Disease in a Cohort of Hospitalized Adults in Georgia, United States. Open Forum Infect Dis 2021; 8:ofaa596. [PMID: 33537363 PMCID: PMC7798484 DOI: 10.1093/ofid/ofaa596] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 12/03/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND The epidemiological features and outcomes of hospitalized adults with coronavirus disease 2019 (COVID-19) have been described; however, the temporal progression and medical complications of disease among hospitalized patients require further study. Detailed descriptions of the natural history of COVID-19 among hospitalized patients are paramount to optimize health care resource utilization, and the detection of different clinical phenotypes may allow tailored clinical management strategies. METHODS This was a retrospective cohort study of 305 adult patients hospitalized with COVID-19 in 8 academic and community hospitals. Patient characteristics included demographics, comorbidities, medication use, medical complications, intensive care utilization, and longitudinal vital sign and laboratory test values. We examined laboratory and vital sign trends by mortality status and length of stay. To identify clinical phenotypes, we calculated Gower's dissimilarity matrix between each patient's clinical characteristics and clustered similar patients using the partitioning around medoids algorithm. RESULTS One phenotype of 6 identified was characterized by high mortality (49%), older age, male sex, elevated inflammatory markers, high prevalence of cardiovascular disease, and shock. Patients with this severe phenotype had significantly elevated peak C-reactive protein creatinine, D-dimer, and white blood cell count and lower minimum lymphocyte count compared with other phenotypes (P < .01, all comparisons). CONCLUSIONS Among a cohort of hospitalized adults, we identified a severe phenotype of COVID-19 based on the characteristics of its clinical course and poor prognosis. These findings need to be validated in other cohorts, as improved understanding of clinical phenotypes and risk factors for their development could help inform prognosis and tailored clinical management for COVID-19.
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Affiliation(s)
- Juliana F da Silva
- CDC COVID-19 Emergency Response, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Alfonso C Hernandez-Romieu
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- United States Public Health Service
| | - Sean D Browning
- CDC COVID-19 Emergency Response, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Beau B Bruce
- CDC COVID-19 Emergency Response, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Pavithra Natarajan
- CDC COVID-19 Emergency Response, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Sapna B Morris
- CDC COVID-19 Emergency Response, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- United States Public Health Service
| | - Jeremy A W Gold
- CDC COVID-19 Emergency Response, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Robyn Neblett Fanfair
- CDC COVID-19 Emergency Response, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- United States Public Health Service
| | - Jessica Rogers-Brown
- CDC COVID-19 Emergency Response, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - John Rossow
- CDC COVID-19 Emergency Response, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- United States Public Health Service
| | - Christine M Szablewski
- CDC COVID-19 Emergency Response, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- Georgia Department of Public Health, Atlanta, Georgia, USA
| | | | | | - Cherie Drenzek
- Georgia Department of Public Health, Atlanta, Georgia, USA
| | - David J Murphy
- Emory University School of Medicine, Atlanta, Georgia, USA
| | - Julie Hollberg
- Emory University School of Medicine, Atlanta, Georgia, USA
| | - James M Blum
- Emory University School of Medicine, Atlanta, Georgia, USA
- Georgia Clinical & Translational Science Alliance, Atlanta, Georgia, USA
| | | | - David W Wright
- Georgia Clinical & Translational Science Alliance, Atlanta, Georgia, USA
- Grady Health System, Atlanta, Georgia, USA
| | | | - Jack Owens
- Phoebe Putney Memorial Hospital, Albany, Georgia, USA
| | | | - Frank W Brown
- Georgia Clinical & Translational Science Alliance, Atlanta, Georgia, USA
- Emory Decatur Hospital, Decatur, Georgia, USA
| | - Deron C Burton
- CDC COVID-19 Emergency Response, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- United States Public Health Service
| | - Timothy M Uyeki
- CDC COVID-19 Emergency Response, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- United States Public Health Service
| | - Priti R Patel
- CDC COVID-19 Emergency Response, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- United States Public Health Service
| | - Brendan R Jackson
- CDC COVID-19 Emergency Response, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- United States Public Health Service
| | - Karen K Wong
- CDC COVID-19 Emergency Response, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- United States Public Health Service
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16
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Bajema KL, Dahlgren FS, Lim TW, Bestul N, Biggs HM, Tate JE, Owusu C, Szablewski CM, Drenzek C, Drobeniuc J, Semenova V, Li H, Browning P, Desai R, Epperson M, Jia LT, Thornburg NJ, Edens C, Fry AM, Hall AJ, Schiffer J, Havers FP. Comparison of Estimated SARS-CoV-2 Seroprevalence through Commercial Laboratory Residual Sera Testing and a Community Survey. Clin Infect Dis 2020; 73:e3120-e3123. [PMID: 33300579 PMCID: PMC7799302 DOI: 10.1093/cid/ciaa1804] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Indexed: 12/02/2022] Open
Abstract
We compared severe acute respiratory syndrome–related coronavirus-2 seroprevalence estimated from commercial laboratory residual sera and a community household survey in metropolitan Atlanta during April-May 2020 and found these two estimates to be similar (4.94% versus 3.18%). Compared with more representative surveys, commercial sera can provide an approximate measure of seroprevalence.
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Affiliation(s)
- Kristina L Bajema
- CDC COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, GA
| | - F Scott Dahlgren
- CDC COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, GA
| | - Travis W Lim
- CDC COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, GA
| | - Nicolette Bestul
- CDC COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, GA
| | - Holly M Biggs
- CDC COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, GA
| | - Jacqueline E Tate
- CDC COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, GA
| | - Claudio Owusu
- CDC COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, GA
| | - Christine M Szablewski
- CDC COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, GA.,Georgia Department of Public Health, Atlanta, GA
| | | | - Jan Drobeniuc
- CDC COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, GA
| | - Vera Semenova
- CDC COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, GA
| | - Han Li
- CDC COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, GA
| | - Peter Browning
- CDC COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, GA
| | - Rita Desai
- CDC COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, GA
| | - Monica Epperson
- CDC COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, GA
| | - Lily T Jia
- CDC COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, GA
| | - Natalie J Thornburg
- CDC COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, GA
| | - Chris Edens
- CDC COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, GA
| | - Alicia M Fry
- CDC COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, GA
| | - Aron J Hall
- CDC COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, GA
| | - Jarad Schiffer
- CDC COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, GA
| | - Fiona P Havers
- CDC COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, GA
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17
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Schwartz NG, Moorman AC, Makaretz A, Chang KT, Chu VT, Szablewski CM, Yousaf AR, Brown MM, Clyne A, DellaGrotta A, Drobeniuc J, Korpics J, Muir A, Drenzek C, Bandy U, Kirking HL, Tate JE, Hall AJ, Lanzieri TM, Stewart RJ. Adolescent with COVID-19 as the Source of an Outbreak at a 3-Week Family Gathering - Four States, June-July 2020. MMWR Morb Mortal Wkly Rep 2020; 69:1457-1459. [PMID: 33031365 PMCID: PMC7561219 DOI: 10.15585/mmwr.mm6940e2] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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18
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Jackson BR, Gold JAW, Natarajan P, Rossow J, Neblett Fanfair R, da Silva J, Wong KK, Browning SD, Bamrah Morris S, Rogers-Brown J, Hernandez-Romieu AC, Szablewski CM, Oosmanally N, Tobin-D'Angelo M, Drenzek C, Murphy DJ, Hollberg J, Blum JM, Jansen R, Wright DW, SeweSll WM, Owens JD, Lefkove B, Brown FW, Burton DC, Uyeki TM, Bialek SR, Patel PR, Bruce BB. Predictors at admission of mechanical ventilation and death in an observational cohort of adults hospitalized with COVID-19. Clin Infect Dis 2020; 73:e4141-e4151. [PMID: 32971532 PMCID: PMC7543323 DOI: 10.1093/cid/ciaa1459] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Indexed: 01/08/2023] Open
Abstract
Background Coronavirus disease (COVID-19) can cause severe illness and death. Predictors of poor outcome collected on hospital admission may inform clinical and public health decisions. Methods We conducted a retrospective observational cohort investigation of 297 adults admitted to eight academic and community hospitals in Georgia, United States, during March 2020. Using standardized medical record abstraction, we collected data on predictors including admission demographics, underlying medical conditions, outpatient antihypertensive medications, recorded symptoms, vital signs, radiographic findings, and laboratory values. We used random forest models to calculate adjusted odds ratios (aORs) and 95% confidence intervals (CI) for predictors of invasive mechanical ventilation (IMV) and death. Results Compared with age <45 years, ages 65–74 years and ≥75 years were predictors of IMV (aOR 3.12, CI 1.47–6.60; aOR 2.79, CI 1.23–6.33) and the strongest predictors for death (aOR 12.92, CI 3.26–51.25; aOR 18.06, CI 4.43–73.63). Comorbidities associated with death (aORs from 2.4 to 3.8, p <0.05) included end-stage renal disease, coronary artery disease, and neurologic disorders, but not pulmonary disease, immunocompromise, or hypertension. Pre-hospital use vs. non-use of angiotensin receptor blockers (aOR 2.02, CI 1.03–3.96) and dihydropyridine calcium channel blockers (aOR 1.91, CI 1.03–3.55) were associated with death. Conclusions After adjustment for patient and clinical characteristics, older age was the strongest predictor of death, exceeding comorbidities, abnormal vital signs, and laboratory test abnormalities. That coronary artery disease, but not chronic lung disease, was associated with death among hospitalized patients warrants further investigation, as do associations between certain antihypertensive medications and death.
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Affiliation(s)
| | - Jeremy A W Gold
- CDC COVID-19 Emergency Response.,Epidemic Intelligence Service, CDC
| | | | - John Rossow
- CDC COVID-19 Emergency Response.,U.S. Public Health Service.,Epidemic Intelligence Service, CDC
| | | | | | - Karen K Wong
- CDC COVID-19 Emergency Response.,U.S. Public Health Service
| | - Sean D Browning
- CDC COVID-19 Emergency Response.,Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee
| | | | - Jessica Rogers-Brown
- CDC COVID-19 Emergency Response.,Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee
| | - Alfonso C Hernandez-Romieu
- CDC COVID-19 Emergency Response.,U.S. Public Health Service.,Epidemic Intelligence Service, CDC.,Emory University School of Medicine
| | - Christine M Szablewski
- CDC COVID-19 Emergency Response.,U.S. Public Health Service.,Epidemic Intelligence Service, CDC.,Georgia Department of Public Health, Atlanta, Georgia
| | | | | | | | | | | | - James M Blum
- Emory University School of Medicine.,Georgia Clinical & Translational Science Alliance, Atlanta, Georgia
| | | | - David W Wright
- Emory University School of Medicine.,Grady Health System, Atlanta, Georgia
| | | | - Jack D Owens
- Phoebe Putney Memorial Hospital, Albany, Georgia
| | | | - Frank W Brown
- Emory University School of Medicine.,Emory Decatur Hospital, Decatur, Georgia
| | - Deron C Burton
- CDC COVID-19 Emergency Response.,U.S. Public Health Service
| | | | | | - Priti R Patel
- CDC COVID-19 Emergency Response.,U.S. Public Health Service
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19
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Bixler D, Miller AD, Mattison CP, Taylor B, Komatsu K, Peterson Pompa X, Moon S, Karmarkar E, Liu CY, Openshaw JJ, Plotzker RE, Rosen HE, Alden N, Kawasaki B, Siniscalchi A, Leapley A, Drenzek C, Tobin-D'Angelo M, Kauerauf J, Reid H, Hawkins E, White K, Ahmed F, Hand J, Richardson G, Sokol T, Eckel S, Collins J, Holzbauer S, Kollmann L, Larson L, Schiffman E, Kittle TS, Hertin K, Kraushaar V, Raman D, LeGarde V, Kinsinger L, Peek-Bullock M, Lifshitz J, Ojo M, Arciuolo RJ, Davidson A, Huynh M, Lash MK, Latash J, Lee EH, Li L, McGibbon E, McIntosh-Beckles N, Pouchet R, Ramachandran JS, Reilly KH, Dufort E, Pulver W, Zamcheck A, Wilson E, de Fijter S, Naqvi O, Nalluswami K, Waller K, Bell LJ, Burch AK, Radcliffe R, Fiscus MD, Lewis A, Kolsin J, Pont S, Salinas A, Sanders K, Barbeau B, Althomsons S, Atti S, Brown JS, Chang A, Clarke KR, Datta SD, Iskander J, Leitgeb B, Pindyck T, Priyamvada L, Reagan-Steiner S, Scott NA, Viens LJ, Zhong J, Koumans EH. SARS-CoV-2-Associated Deaths Among Persons Aged <21 Years - United States, February 12-July 31, 2020. MMWR Morb Mortal Wkly Rep 2020; 69:1324-1329. [PMID: 32941417 DOI: 10.15585/mmwr.mm6937e4] [Citation(s) in RCA: 108] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Since February 12, 2020, approximately 6.5 million cases of SARS-CoV-2 infection, the cause of coronavirus disease 2019 (COVID-19), and 190,000 SARS-CoV-2-associated deaths have been reported in the United States (1,2). Symptoms associated with SARS-CoV-2 infection are milder in children compared with adults (3). Persons aged <21 years constitute 26% of the U.S. population (4), and this report describes characteristics of U.S. persons in that population who died in association with SARS-CoV-2 infection, as reported by public health jurisdictions. Among 121 SARS-CoV-2-associated deaths reported to CDC among persons aged <21 years in the United States during February 12-July 31, 2020, 63% occurred in males, 10% of decedents were aged <1 year, 20% were aged 1-9 years, 70% were aged 10-20 years, 45% were Hispanic persons, 29% were non-Hispanic Black (Black) persons, and 4% were non-Hispanic American Indian or Alaska Native (AI/AN) persons. Among these 121 decedents, 91 (75%) had an underlying medical condition,* 79 (65%) died after admission to a hospital, and 39 (32%) died at home or in the emergency department (ED).† These data show that nearly three quarters of SARS-CoV-2-associated deaths among infants, children, adolescents, and young adults have occurred in persons aged 10-20 years, with a disproportionate percentage among young adults aged 18-20 years and among Hispanics, Blacks, AI/ANs, and persons with underlying medical conditions. Careful monitoring of SARS-CoV-2 infections, deaths, and other severe outcomes among persons aged <21 years remains particularly important as schools reopen in the United States. Ongoing evaluation of effectiveness of prevention and control strategies will also be important to inform public health guidance for schools and parents and other caregivers.
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Szablewski CM, Chang KT, Brown MM, Chu VT, Yousaf AR, Anyalechi N, Aryee PA, Kirking HL, Lumsden M, Mayweather E, McDaniel CJ, Montierth R, Mohammed A, Schwartz NG, Shah JA, Tate JE, Dirlikov E, Drenzek C, Lanzieri TM, Stewart RJ. SARS-CoV-2 Transmission and Infection Among Attendees of an Overnight Camp - Georgia, June 2020. MMWR Morb Mortal Wkly Rep 2020; 69:1023-1025. [PMID: 32759921 PMCID: PMC7454898 DOI: 10.15585/mmwr.mm6931e1] [Citation(s) in RCA: 171] [Impact Index Per Article: 42.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Limited data are available about transmission of SARS-CoV-2, the virus that causes coronavirus disease 2019 (COVID-19), among youths. During June 17-20, an overnight camp in Georgia (camp A) held orientation for 138 trainees and 120 staff members; staff members remained for the first camp session, scheduled during June 21-27, and were joined by 363 campers and three senior staff members on June 21. Camp A adhered to the measures in Georgia's Executive Order* that allowed overnight camps to operate beginning on May 31, including requiring all trainees, staff members, and campers to provide documentation of a negative viral SARS-CoV-2 test ≤12 days before arriving. Camp A adopted most† components of CDC's Suggestions for Youth and Summer Camps§ to minimize the risk for SARS-CoV-2 introduction and transmission. Measures not implemented were cloth masks for campers and opening windows and doors for increased ventilation in buildings. Cloth masks were required for staff members. Camp attendees were cohorted by cabin and engaged in a variety of indoor and outdoor activities, including daily vigorous singing and cheering. On June 23, a teenage staff member left camp A after developing chills the previous evening. The staff member was tested and reported a positive test result for SARS-CoV-2 the following day (June 24). Camp A officials began sending campers home on June 24 and closed the camp on June 27. On June 25, the Georgia Department of Public Health (DPH) was notified and initiated an investigation. DPH recommended that all attendees be tested and self-quarantine, and isolate if they had a positive test result.
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21
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Biggs HM, Harris JB, Breakwell L, Dahlgren FS, Abedi GR, Szablewski CM, Drobeniuc J, Bustamante ND, Almendares O, Schnall AH, Gilani Z, Smith T, Gieraltowski L, Johnson JA, Bajema KL, McDavid K, Schafer IJ, Sullivan V, Punkova L, Tejada-Strop A, Amiling R, Mattison CP, Cortese MM, Ford SE, Paxton LA, Drenzek C, Tate JE. Estimated Community Seroprevalence of SARS-CoV-2 Antibodies - Two Georgia Counties, April 28-May 3, 2020. MMWR Morb Mortal Wkly Rep 2020; 69:965-970. [PMID: 32701941 PMCID: PMC7377817 DOI: 10.15585/mmwr.mm6929e2] [Citation(s) in RCA: 89] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
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22
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Killerby ME, Link-Gelles R, Haight SC, Schrodt CA, England L, Gomes DJ, Shamout M, Pettrone K, O'Laughlin K, Kimball A, Blau EF, Burnett E, Ladva CN, Szablewski CM, Tobin-D'Angelo M, Oosmanally N, Drenzek C, Murphy DJ, Blum JM, Hollberg J, Lefkove B, Brown FW, Shimabukuro T, Midgley CM, Tate JE. Characteristics Associated with Hospitalization Among Patients with COVID-19 - Metropolitan Atlanta, Georgia, March-April 2020. MMWR Morb Mortal Wkly Rep 2020; 69:790-794. [PMID: 32584797 PMCID: PMC7316317 DOI: 10.15585/mmwr.mm6925e1] [Citation(s) in RCA: 251] [Impact Index Per Article: 62.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The first reported U.S. case of coronavirus disease 2019 (COVID-19) was detected in January 2020 (1). As of June 15, 2020, approximately 2 million cases and 115,000 COVID-19-associated deaths have been reported in the United States.* Reports of U.S. patients hospitalized with SARS-CoV-2 infection (the virus that causes COVID-19) describe high proportions of older, male, and black persons (2-4). Similarly, when comparing hospitalized patients with catchment area populations or nonhospitalized COVID-19 patients, high proportions have underlying conditions, including diabetes mellitus, hypertension, obesity, cardiovascular disease, chronic kidney disease, or chronic respiratory disease (3,4). For this report, data were abstracted from the medical records of 220 hospitalized and 311 nonhospitalized patients aged ≥18 years with laboratory-confirmed COVID-19 from six acute care hospitals and associated outpatient clinics in metropolitan Atlanta, Georgia. Multivariable analyses were performed to identify patient characteristics associated with hospitalization. The following characteristics were independently associated with hospitalization: age ≥65 years (adjusted odds ratio [aOR] = 3.4), black race (aOR = 3.2), having diabetes mellitus (aOR = 3.1), lack of insurance (aOR = 2.8), male sex (aOR = 2.4), smoking (aOR = 2.3), and obesity (aOR = 1.9). Infection with SARS-CoV-2 can lead to severe outcomes, including death, and measures to protect persons from infection, such as staying at home, social distancing (5), and awareness and management of underlying conditions should be emphasized for those at highest risk for hospitalization with COVID-19. Measures that prevent the spread of infection to others, such as wearing cloth face coverings (6), should be used whenever possible to protect groups at high risk. Potential barriers to the ability to adhere to these measures need to be addressed.
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23
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Gold JAW, Wong KK, Szablewski CM, Patel PR, Rossow J, da Silva J, Natarajan P, Morris SB, Fanfair RN, Rogers-Brown J, Bruce BB, Browning SD, Hernandez-Romieu AC, Furukawa NW, Kang M, Evans ME, Oosmanally N, Tobin-D'Angelo M, Drenzek C, Murphy DJ, Hollberg J, Blum JM, Jansen R, Wright DW, Sewell WM, Owens JD, Lefkove B, Brown FW, Burton DC, Uyeki TM, Bialek SR, Jackson BR. Characteristics and Clinical Outcomes of Adult Patients Hospitalized with COVID-19 - Georgia, March 2020. MMWR Morb Mortal Wkly Rep 2020; 69:545-550. [PMID: 32379729 PMCID: PMC7737948 DOI: 10.15585/mmwr.mm6918e1] [Citation(s) in RCA: 325] [Impact Index Per Article: 81.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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24
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Shaw KA, Szablewski CM, Kellner S, Kornegay L, Bair P, Brennan S, Kunkes A, Davis M, McGovern OL, Winchell J, Kobayashi M, Burton N, de Perio MA, Gabel J, Drenzek C, Murphy J, Holsinger C, Forlano L. Psittacosis Outbreak among Workers at Chicken Slaughter Plants, Virginia and Georgia, USA, 2018. Emerg Infect Dis 2020; 25:2143-2145. [PMID: 31625859 PMCID: PMC6810211 DOI: 10.3201/eid2511.190703] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
During August–October, 2018, an outbreak of severe respiratory illness was reported among poultry slaughter plant workers in Virginia and Georgia, USA. A multiorganizational team investigated the cause and extent of illness, determined that the illness was psittacosis, and evaluated and recommended controls for health hazards in the workplace to prevent additional cases.
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25
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Harvey RR, Cooper R, Bennett S, Richardson M, Duke D, Stoughton C, Smalligan R, Gaul L, Drenzek C, Griffin PM, Geissler A, Rao AK. Outbreak of Foodborne Botulism in an Immigrant Community: Overcoming Delayed Disease Recognition, Ambiguous Epidemiologic Links, and Cultural Barriers to Identify the Cause. Clin Infect Dis 2019; 66:S82-S84. [PMID: 29293929 DOI: 10.1093/cid/cix817] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
We describe a botulism outbreak involving 4 Middle Eastern men complicated by delayed diagnosis, ambiguous epidemiologic links among patients, and illness onset dates inconsistent with a point-source exposure. Homemade turshi, a fermented vegetable dish, was the likely cause. Patients ate turshi at 2 locations on different days over 1 month.
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Affiliation(s)
- R Reid Harvey
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia.,Enteric Diseases Epidemiology Branch, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Robert Cooper
- Texas Tech University Health Sciences Center, Amarillo
| | - Sarah Bennett
- Enteric Diseases Epidemiology Branch, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Deree Duke
- Amarillo Environmental Health Department, Amarillo
| | | | - Roger Smalligan
- Potter and Randall Counties Public Health Authority, Amarillo
| | - Linda Gaul
- Texas Department of State Health Services, Austin
| | | | - Patricia M Griffin
- Enteric Diseases Epidemiology Branch, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Aimee Geissler
- Enteric Diseases Epidemiology Branch, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Agam K Rao
- Enteric Diseases Epidemiology Branch, Centers for Disease Control and Prevention, Atlanta, Georgia
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26
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Davis VN, Ido M, Evans A, Bayakly R, Drenzek C. Abstract WP232: Targeted Mass Stroke Education Improves Knowledge of Stroke Signs in Georgia. Stroke 2019. [DOI: 10.1161/str.50.suppl_1.wp232] [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: 11/16/2022]
Abstract
Introduction:
Acute stroke patients must be transported to stroke-ready facilities swiftly for better patient outcomes. Public knowledge of stroke signs and the need to call emergency medical services (EMS) is critical to ensure that stroke patients get to hospital timely. This study assesses the impact of a targeted stroke awareness campaign launched by the Georgia Department of Public Health (DPH) in 2017.
Method:
From May to September 2017, the Georgia DPH launched a multipronged public stroke education campaign involving public service announcements, posters on mass transport systems, billboards on highways, and digital displays at sport events. The campaign targeted African-Americans because of their higher risk for stroke. Four questions about stroke signs (facial droop, arm weakness and slurred speech) and the importance of calling 911 were added to the 2017 Georgia Behavioral Risk Factor Surveillance System (BRFSS) survey. The pre and post-campaign levels of knowledge of stroke signs, as determined by answers to BRFSS questions, were compared among different race groups using SAS-callable SUDDAN software and applying logistic regressions for model adjusted prevalence differences.
Results:
In general, a 3.8% to a 5.5% improvement in knowledge was documented for each sign of stroke. The proportion of adult Georgians who knew all three signs of stroke included in the campaign and the importance of calling 911 increased from 49.9% pre-campaign to 56.0% post-campaign. However, the improvement was significant and more pronounced among African Americans (16%, SE=7%) than among Whites (1%, SE=4%), and Hispanics (3%, SE=10%) controlling for other potential predictors. Moreover, relatively fewer Hispanics (29%; 95%CI: 19%, 41%) provided the correct answers to the four questions than African-Americans (58%; 95%CI: 51%, 64%) and Whites (62%, 95%CI: 58%, 67%) post-campaign.
Conclusion:
The Georgia DPH’s targeted mass educational campaign was effective in improving the knowledge of stroke signs among the public and the need to call EMS. The Department must continue its education effort to improve public’s knowledge with emphasis on reaching the Hispanic population.
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Affiliation(s)
| | - Moges Ido
- Georgia Dept of Public Health, Atlanta, GA
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27
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Raabe V, O'Neal JP, Drenzek C, Kraft CS. Reply to Nicastri et al. Clin Infect Dis 2018; 66:638-639. [PMID: 29186318 DOI: 10.1093/cid/cix865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Vanessa Raabe
- Division of Infectious Diseases, Emory University, Atlanta, Georgia
| | - J Patrick O'Neal
- Georgia Department of Public Health, Emory University, Atlanta, Georgia
| | - Cherie Drenzek
- Georgia Department of Public Health, Emory University, Atlanta, Georgia
| | - Colleen S Kraft
- Division of Infectious Diseases, Emory University, Atlanta, Georgia.,Department of Pathology and Laboratory Medicine, Emory University, Atlanta, Georgia
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28
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Edison L, Erickson A, Smith S, Lopez G, Hon S, King A, Nydam N, O’Neal JP, Drenzek C. Notes from the Field: Counterfeit Percocet-Related Overdose Cluster - Georgia, June 2017. MMWR Morb Mortal Wkly Rep 2017; 66:1119-1120. [PMID: 29049275 PMCID: PMC5689089 DOI: 10.15585/mmwr.mm6641a6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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29
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Hatzenbuehler LA, Tobin-D'Angelo M, Drenzek C, Peralta G, Cranmer LC, Anderson EJ, Milla SS, Abramowicz S, Yi J, Hilinski J, Rajan R, Whitley MK, Gower V, Berkowitz F, Shapiro CA, Williams JK, Harmon P, Shane AL. Pediatric Dental Clinic-Associated Outbreak of Mycobacterium abscessus Infection. J Pediatric Infect Dis Soc 2017; 6:e116-e122. [PMID: 28903524 DOI: 10.1093/jpids/pix065] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2017] [Accepted: 07/11/2017] [Indexed: 11/12/2022]
Abstract
BACKGROUND Mycobacterium abscessus is an uncommon cause of invasive odontogenic infection. METHODS M abscessus-associated odontogenic infections occurred in a group of children after they each underwent a pulpotomy. A probable case-child was defined as a child with facial or neck swelling and biopsy-confirmed granulomatous inflammation after a pulpotomy between October 1, 2013, and September 30, 2015. M abscessus was isolated by culture in confirmed case-children. Clinical presentation, management, and outcomes were determined by medical record abstraction. RESULTS Among 24 children, 14 (58%) were confirmed case-children. Their median age was 7.3 years (interquartile range, 5.8-8.2 years), and the median time from pulpotomy to symptom onset was 74 days (range, 14-262 days). Clinical diagnoses included cervical lymphadenitis (24 [100%] of 24), mandibular or maxillary osteomyelitis (11 [48%] of 23), and pulmonary nodules (7 [37%] of 19). Each child had ≥1 hospitalization and a median of 2 surgeries (range, 1-6). Of the 24 children, 12 (50%) had surgery alone and 11 (46%) received intravenous (IV) antibiotics. Nineteen of the 24 (79%) children experienced complications, including vascular access malfunction (7 [64%] of 11), high-frequency hearing loss (5 [56%] of 9), permanent tooth loss (11 [48%] of 23), facial nerve palsy (7 [29%] of 24), urticarial rash (3 [25%] of 12), elevated liver enzyme levels (1 [20%] of 5), acute kidney injury (2 [18%] of 11), incision dehiscence/fibrosis (3 [13%] of 24), and neutropenia (1 [9%] of 11). CONCLUSIONS M abscessus infection was associated with significant medical morbidity and treatment complications. Unique manifestations included extranodal mandibular or maxillary osteomyelitis and pulmonary nodules. Challenges in the identification of case-children resulted from an extended incubation period and various clinical manifestations. Clinicians should consider the association between M abscessus infection and pulpotomy in children who present with subacute cervical lymphadenitis. The use of treated/sterile water during pulpotomy might prevent further outbreaks.
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Affiliation(s)
- Lindsay A Hatzenbuehler
- Division of Pediatric Infectious Diseases.,Department of Pediatrics.,Baylor College of Medicine, Houston, Texas
| | | | | | | | - Lisa C Cranmer
- Division of Pediatric Infectious Diseases.,Department of Pediatrics.,Emory School of Medicine, Atlanta.,Children's Healthcare of Atlanta, Georgia
| | - Evan J Anderson
- Division of Pediatric Infectious Diseases.,Department of Pediatrics.,Emory School of Medicine, Atlanta.,Children's Healthcare of Atlanta, Georgia.,Division of Infectious Diseases.,Department of Medicine
| | - Sarah S Milla
- Emory School of Medicine, Atlanta.,Children's Healthcare of Atlanta, Georgia.,Department of Pediatric Radiology
| | - Shelly Abramowicz
- Emory School of Medicine, Atlanta.,Children's Healthcare of Atlanta, Georgia.,Department of Pediatric Oral and Maxillofacial Surgery
| | - Jumi Yi
- Division of Pediatric Infectious Diseases.,Department of Pediatrics.,Emory School of Medicine, Atlanta.,Children's Healthcare of Atlanta, Georgia
| | - Joseph Hilinski
- Department of Pediatrics.,St. Luke's Children's Hospital, Boise, Idaho
| | - Roy Rajan
- Emory School of Medicine, Atlanta.,Children's Healthcare of Atlanta, Georgia.,Department of Pediatric Otolaryngology-Head & Neck Surgery
| | - Matthew K Whitley
- Children's Healthcare of Atlanta, Georgia.,Pediatric Ear, Nose and Throat of Atlanta
| | - Verlia Gower
- Children's Healthcare of Atlanta, Georgia.,Pediatric Ear, Nose and Throat of Atlanta
| | - Frank Berkowitz
- Division of Pediatric Infectious Diseases.,Department of Pediatrics.,Emory School of Medicine, Atlanta.,Children's Healthcare of Atlanta, Georgia
| | - Craig A Shapiro
- Division of Pediatric Infectious Diseases.,Department of Pediatrics.,Emory School of Medicine, Atlanta.,Children's Healthcare of Atlanta, Georgia
| | - Joseph K Williams
- Children's Healthcare of Atlanta, Georgia.,Department of Pediatric Plastic and Reconstructive Surgery
| | - Paula Harmon
- Children's Healthcare of Atlanta, Georgia.,Pediatric Ear, Nose and Throat of Atlanta
| | - Andi L Shane
- Division of Pediatric Infectious Diseases.,Department of Pediatrics.,Emory School of Medicine, Atlanta.,Children's Healthcare of Atlanta, Georgia
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30
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Machado FR, Tuttle J, Drenzek C. Effect of Medicaid Status on up-to-date Vaccination Rates Among two-year-old Children in Georgia, 2015. JGPHA 2017. [DOI: 10.21633/jgpha.7.139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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31
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Kumar GS, Bryan M, Bayakly R, Drenzek C, Merlo C, Perry GS. Reported Motivations for and Locations of Healthy Eating Among Georgia High School Students. J Sch Health 2017; 87:353-362. [PMID: 28382665 PMCID: PMC8951171 DOI: 10.1111/josh.12503] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Revised: 08/19/2016] [Accepted: 10/14/2016] [Indexed: 06/07/2023]
Abstract
BACKGROUND Understanding how youth perceive eating healthy foods can inform programs and policies that aim to improve healthy eating. We assessed the reasons for and the most common locations of eating healthy foods among Georgia's (GA) high school (HS) students. METHODS Using the 2013 GA HS Youth Risk Behavior Survey, we examined motivations for and locations of eating healthy foods by sociodemographic characteristics and daily fruit and vegetable intake. Weighted chi-square tests were used to examine differences in responses for each perception. RESULTS Nineteen percent of GA HS students consumed fruit ≥3 times/day and 11% consumed vegetables ≥3 times/day. The most frequently chosen response to motivations for eating healthy foods was the desire to be healthy (42%), followed by enjoying their taste (18%). The most likely location to eat healthy foods was at home (80%), followed by at school (13%). CONCLUSIONS GA HS students are most motivated to eat healthy foods by the desire to be healthy and their enjoyment of the taste of healthy foods. Incorporating messages that align with students' motivations to eat healthy foods could be considered when developing promotional programs/policies targeting healthy eating.
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Affiliation(s)
- Gayathri S. Kumar
- Centers for Disease Control and Prevention, 4770 Buford Highway, Atlanta, Georgia 30341
| | - Michael Bryan
- Georgia Department of Public Health, 2 Peachtree Street NW, Atlanta, Georgia 30303
| | - Rana Bayakly
- Georgia Department of Public Health, 2 Peachtree Street NW, Atlanta, Georgia 30303
| | - Cherie Drenzek
- Georgia Department of Public Health, 2 Peachtree Street NW, Atlanta, Georgia 30303
| | - Caitlin Merlo
- Centers for Disease Control and Prevention, 4770 Buford Highway, Atlanta, Georgia 30341
| | - Geraldine S. Perry
- Centers for Disease Control and Prevention, 4770 Buford Highway, Atlanta, Georgia 30341
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32
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Hatzenbuehler L, Drenzek C, Tobin-D'Angelo M, Peralta G, Anderson EJ, Yi J, Shapiro C, Abramowicz S, Cranmer L, Shore S, Statham M, Hilinski J, Harmon P, Baktha S, Williams J, Berkowitz F, Milla S, Gower V, Whitley M, Shane AL. Pediatric Dental Clinic-Associated Outbreak of Mycobacterium abscessus Infections. Open Forum Infect Dis 2016. [DOI: 10.1093/ofid/ofw194.140] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - Cherie Drenzek
- Georgia Department of Community Health, Atlanta, Georgia
| | | | - Gianna Peralta
- Georgia Department of Community Health, Atlanta, Georgia
| | - Evan J. Anderson
- Pediatrics and Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Jumi Yi
- Pediatrics, Emory University School of Medicine, Atlanta, Georgia
| | - Craig Shapiro
- Pediatrics, Emory University School of Medicine, Atlanta, Georgia
| | - Shelly Abramowicz
- Oral and Maxillofacial Surgery, Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Lisa Cranmer
- Pediatrics, Emory University School of Medicine, Atlanta, Georgia
| | - Steve Shore
- Pediatric Infectious Disease, Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Melissa Statham
- Ear, Nose and Throat, Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Joseph Hilinski
- Pediatrics, Emory University School of Medicine, Atlanta, Georgia
| | - Paula Harmon
- Ear, Nose and Throat, Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Sivi Baktha
- Ear, Nose and Throat, Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Joseph Williams
- Plastic and Craniofacial Surgery, Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Frank Berkowitz
- Pediatrics, Emory University School of Medicine, Atlanta, Georgia
| | - Sarah Milla
- Radiology, Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Verlia Gower
- Ear, Nose and Throat, Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Matthew Whitley
- Ear, Nose and Throat, Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Andi L. Shane
- Pediatrics, Emory University School of Medicine, Atlanta, Georgia
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33
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Peralta G, Tobin-D’Angelo M, Parham A, Edison L, Lorentzson L, Smith C, Drenzek C. Notes from the Field: Mycobacterium abscessusInfections Among Patients of a Pediatric Dentistry Practice — Georgia, 2015. MMWR Morb Mortal Wkly Rep 2016; 65:355-6. [DOI: 10.15585/mmwr.mm6513a5] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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34
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Kwit N, Nelson C, Kugeler K, Petersen J, Plante L, Yaglom H, Kramer V, Schwartz B, House J, Colton L, Feldpausch A, Drenzek C, Baumbach J, DiMenna M, Fisher E, Debess E, Buttke D, Weinburke M, Percy C, Schriefer M, Gage K, Mead P. Human Plague — United States, 2015. MMWR Morb Mortal Wkly Rep 2015; 64:918-9. [DOI: 10.15585/mmwr.mm6433a6] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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Parham M, Edison L, Soetebier K, Feldpausch A, Kunkes A, Smith W, Guffey T, Fetherolf R, Sanlis K, Gabel J, Cowell A, Drenzek C. Ebola active monitoring system for travelers returning from West Africa—Georgia, 2014-2015. MMWR Morb Mortal Wkly Rep 2015; 64:347-50. [PMID: 25856255 PMCID: PMC4584625] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
The Ebola virus disease (Ebola) epidemic in West Africa has so far produced approximately 25,000 cases, more than 40 times the number in any previously documented Ebola outbreak. Because of the risk for imported disease from infected travelers, in October 2014 CDC recommended that all travelers to the United States from Ebola-affected countries receive enhanced entry screening and postarrival active monitoring for Ebola signs or symptoms until 21 days after their departure from an Ebola-affected country. The state of Georgia began its active monitoring program on October 25, 2014. The Georgia Department of Public Health (DPH) modified its existing, web-based electronic notifiable disease reporting system to create an Ebola Active Monitoring System (EAMS). DPH staff members developed EAMS from conceptualization to implementation in 6 days. In accordance with CDC recommendations, "low (but not zero) risk" travelers are required to report their daily health status to DPH, and the EAMS dashboard enables DPH epidemiologists to track symptoms and compliance with active monitoring. Through March 31, 2015, DPH monitored 1,070 travelers, and 699 (65%) used their EAMS traveler login instead of telephone or e-mail to report their health status. Medical evaluations were performed on 30 travelers, of whom three were tested for Ebola. EAMS has enabled two epidemiologists to monitor approximately 100 travelers daily, and to rapidly respond to travelers reporting signs and symptoms of potential Ebola virus infection. Similar electronic tracking systems might be useful for other jurisdictions.
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Affiliation(s)
- Mary Parham
- Center for Surveillance, Epidemiology and Laboratory Services, CDC
| | - Laura Edison
- Georgia Department of Public Health
- Division of State and Local Readiness, CDC
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Edison L, Knust B, Petersen B, Gabel J, Manning C, Drenzek C, Ströher U, Rollin PE, Thoroughman D, Nichol ST. Trace-forward investigation of mice in response to lymphocytic choriomeningitis virus outbreak. Emerg Infect Dis 2014; 20:291-5. [PMID: 24447898 PMCID: PMC3901476 DOI: 10.3201/eid2010.130861] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
During follow-up of a 2012 US outbreak of lymphocytic choriomeningitis virus (LCMV), we conducted a trace-forward investigation. LCMV-infected feeder mice originating from a US rodent breeding facility had been distributed to >500 locations in 21 states. All mice from the facility were euthanized, and no additional persons tested positive for LCMV infection.
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Pillai SK, Noe RS, Murphy MW, Vaidyanathan A, Young R, Kieszak S, Freymann G, Smith W, Drenzek C, Lewis L, Wolkin AF. Heat Illness: Predictors of Hospital Admissions Among Emergency Department Visits—Georgia, 2002–2008. J Community Health 2013; 39:90-8. [DOI: 10.1007/s10900-013-9743-4] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Tobin-D’Angelo M, Martyn A, Moore A, Dishman H, Drenzek C. Mycoplasma pneumoniae outbreak at a university - Georgia, 2012. MMWR Morb Mortal Wkly Rep 2013; 62:603-6. [PMID: 23903594 PMCID: PMC4604853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
On October 17, 2012, the Georgia Department of Public Health (DPH) was notified by the Fulton County Department of Health and Wellness that a local university, the Georgia Institute of Technology, was experiencing a pneumonia outbreak among students. DPH epidemiologists investigated to identify the etiology, find additional cases, and recommend control measures. Respiratory swabs collected from students with pneumonia and tested at CDC using a quantitative real-time polymerase chain reaction (qPCR) assay were positive for Mycoplasma pneumoniae. The university alerted students, faculty, and staff members to the outbreak and recommended prevention measures by e-mail, social media, and posters. A survey administered to students assessed illness prevention behaviors, outbreak awareness, and communication preferences. Eighty-three cases were diagnosed among students during September 1-December 4, 2012, making this outbreak the largest reported at a U.S. university in 35 years. No cases were reported among faculty or staff members. Of the 83 patients, 19 had specimens tested by qPCR, of which 12 (63%) were positive for M. pneumoniae. Despite university communication efforts, approximately half of students surveyed were unaware of the outbreak when surveyed in December. DPH recommendations included implementing university policies that facilitate students staying home and seeking medical care when ill and refining health messages and communication methods to improve awareness of disease outbreaks among students.
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Spaulding AC, McCallum VA, Walker D, Reeves A, Drenzek C, Lewis S, Bailey E, Buehler JW, Spotts Whitney EA, Berkelman RL. How Public Health and Prisons Can Partner for Pandemic Influenza Preparedness: A Report From Georgia. Journal of Correctional Health Care 2009; 15:118-28; quiz 159. [DOI: 10.1177/1078345808330056] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Anne C. Spaulding
- Rollins School of Public Health, Emory University, Atlanta, Georgia
- Georgia Correctional Healthcare, Augusta, Georgia
| | | | - Dawn Walker
- Division of Public Health, Georgia Department of Human Resources, Atlanta, Georgia
| | - Ariane Reeves
- Notifiable Diseases Epidemiology Section, Division of Public Health, Georgia Department of Human Resources, Atlanta, Georgia
| | - Cherie Drenzek
- Notifiable Diseases Epidemiology Section, Division of Public Health, Georgia Department of Human Resources, Atlanta, Georgia
| | | | - Ed Bailey
- Georgia Correctional Healthcare, Augusta, Georgia
| | - James W. Buehler
- Rollins School of Public Health, Emory University, Atlanta, Georgia
- Division of Public Health, Georgia Department of Human Resources, Atlanta, Georgia
| | | | - Ruth L. Berkelman
- Center for Public Health Preparedness and Research, Atlanta, Georgia
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Sheth AN, Wiersma P, Atrubin D, Dubey V, Zink D, Skinner G, Doerr F, Juliao P, Gonzalez G, Burnett C, Drenzek C, Shuler C, Austin J, Ellis A, Maslanka S, Sobel J. International outbreak of severe botulism with prolonged toxemia caused by commercial carrot juice. Clin Infect Dis 2008; 47:1245-51. [PMID: 18834318 DOI: 10.1086/592574] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND On 8 September 2006, 3 Georgia residents presented with symptoms of food-borne botulism, a potentially fatal illness caused by Clostridium botulinum neurotoxins. METHODS Investigators reviewed medical records and interviewed patients and family members. Foods from patients' homes and samples of the implicated commercial beverage were tested for botulinum toxin and C. botulinum by standard methods. RESULTS The patients presented with cranial neuropathies and flaccid paralysis; all patients required mechanical ventilation. The 3 Georgia patients had consumed carrot juice from the same bottle before illness onset. An additional case in Florida and 2 in Ontario, Canada, were subsequently identified in patients who had consumed carrot juice. Serum samples obtained from 5 patients tested positive for botulinum toxin type A-in one patient, 12 days after illness onset, and in another patient, 25 days after illness onset. Carrot juice produced by 1 manufacturer, recovered from patients' homes in Georgia, Florida, and Ontario, yielded type A toxin. The juice contained no added sugar, salt, or preservative; inappropriate refrigeration likely resulted in botulinum toxin production. CONCLUSION This outbreak was caused by commercially produced, internationally distributed carrot juice that was contaminated with botulinum toxin. When toxemia persists, treatment for botulism should be considered even if diagnosed weeks after illness onset. The implicated pasteurized carrot juice had no barriers to growth of C. botulinum other than refrigeration; additional protective measures for carrot juice are needed to prevent future outbreaks. The US Food and Drug Administration has since issued industry guidance to reduce the risk of C. botulinum intoxication from low-acid refrigerated juices.
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Affiliation(s)
- Anandi N Sheth
- Enteric Diseases Epidemiology Branch, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA.
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Cookson ST, Soetebier K, Murray EL, Fajardo GC, Cowell A, Drenzek C, Hanzlick R. Internet-based morbidity and mortality surveillance among Hurricane Katrina evacuees in Georgia. Prev Chronic Dis 2008; 5:A133. [PMID: 18793521 PMCID: PMC2578770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION The Internet has revolutionized the way public health surveillance is conducted. Georgia has used it for notifiable disease reporting, electronic outbreak management, and early event detection. We used it in our public health response to the 125,000 Hurricane Katrina evacuees who came to Georgia. METHODS We developed Internet-based surveillance forms for evacuation shelters and an Internet-based death registry. District epidemiologists, hospital-based physicians, and medical examiners/coroners electronically completed the forms. We analyzed these data and data from emergency departments used by the evacuees. RESULTS Shelter residents and patients who visited emergency departments reported primarily chronic diseases. Among 33 evacuee deaths, only 2 were from infectious diseases, and 1 was indirectly related to the hurricane. CONCLUSION The Internet was essential to collect health data from multiple locations, by many different people, and for multiple types of health encounters during Georgia's Hurricane Katrina public health response.
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Affiliation(s)
- Susan T Cookson
- Centers for Disease Control and Prevention. Dr Cookson is also affiliated with the Georgia Division of Public Health
| | | | | | - Geroncio C Fajardo
- Georgia Division of Public Health, Atlanta, Georgia. Fulton County Medical Examiner’s Office, Atlanta, Georgia
| | - Alex Cowell
- Georgia Division of Public Health, Atlanta, Georgia
| | | | - Randy Hanzlick
- Fulton County Medical Examiner’s Office, Atlanta, Georgia
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Cohen AL, Shuler C, McAllister S, Fosheim GE, Brown MG, Abercrombie D, Anderson K, McDougal LK, Drenzek C, Arnold K, Jernigan D, Gorwitz R. Methamphetamine use and methicillin-resistant Staphylococcus aureus skin infections. Emerg Infect Dis 2008; 13:1707-13. [PMID: 18217555 PMCID: PMC3375784 DOI: 10.3201/eid1311.070148] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Methicillin-resistant Staphylococcus aureus (MRSA) infections and methamphetamine use are emerging public health problems. We conducted a case-control investigation to determine risk factors for MRSA skin and soft tissue infections (SSTIs) in residents of a largely rural southeastern community in the United States. Case-patients were persons >12 years old who had culturable SSTIs; controls had no SSTIs. Of 119 SSTIs identified, 81 (68.1%) were caused by MRSA. Methamphetamine use was reported in 9.9% of case-patients and 1.8% of controls. After we adjusted for age, sex, and race, patients with MRSA SSTIs were more likely than controls to have recently used methamphetamine (odds ratio 5.10, 95% confidence interval 1.55-16.79). MRSA caused most SSTIs in this population. Transmission of MRSA may be occurring among methamphetamine users in this community.
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Affiliation(s)
- Adam L Cohen
- Respiratory Diseases Brabch, Division of Bacterial Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA.
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Abstract
OBJECTIVE Shigella infection is highly communicable; however, outbreaks associated with swimming in recreational fresh water are rarely identified. MATERIALS AND METHODS A cohort study of lake visitors was performed. RESULTS Seventeen (24.6%) case patients among 69 persons who visited the lake over the holiday weekend were identified. Attack rates increased with increasing exposure to lake water; the risk of illness was greatest among swimmers who reported getting lake water in their mouths (relative risk = 5.37, 95% confidence interval = 2.2, 13.3). Shigella sonnei was isolated from stool samples of four of eight swimmers tested. CONCLUSIONS The outbreak likely was caused by fecal contamination of lake water by an infected swimmer; there was no evidence of sewage contamination into the lake. Fresh water is a potential source of infection in patients with acute gastroenteritis and recent exposure. Since testing and chlorination of lake water is impractical, prevention relies on avoidance of fecal contamination and/or minimizing ingestion of the water.
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Affiliation(s)
- Martha Iwamoto
- Epidemic Intelligence Service, Epidemiology Program Office, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
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Affiliation(s)
| | - Thomas Gomez
- U.S. Department of Agriculture, Riverdale, Maryland, USA
| | - Cherie Drenzek
- Georgia Department of Human Resources, Atlanta, Georgia, USA
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Mahon BE, Slutsker L, Hutwagner L, Drenzek C, Maloney K, Toomey K, Griffin PM. Consequences in Georgia of a nationwide outbreak of Salmonella infections: what you don't know might hurt you. Am J Public Health 1999; 89:31-5. [PMID: 9987461 PMCID: PMC1508495 DOI: 10.2105/ajph.89.1.31] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES This study assessed the impact in Georgia of a nationwide salmonellosis outbreak caused by ice cream products and the effectiveness of the subsequent warning against eating the implicated products. METHODS A telephone survey of 250 randomly selected Georgia customers of the ice cream producer was conducted 13 to 17 days after the warning. RESULTS Respondents from 179 households representing 628 persons were interviewed. The median date of first hearing the warning was 5 days after it was issued, and 16 respondents (9%) had not heard it. Among those who had heard the warning, 42 (26%) did not initially believe the products were unsafe. In 22 (31%) of the 72 households that had the implicated ice cream when the respondent heard the warning, someone subsequently ate the ice cream. Diarrhea was reported in 26% (121/463) of persons who had eaten the products but in only 5% (8/152) who had not (odds ratio [controlling for household clustering] = 3.8; 95% confidence interval = 2.0, 7.5). We estimate this outbreak caused 11,000 cases of diarrhea in Georgia, 1760 (16%) with exposure after the warning. CONCLUSIONS A large outbreak occurred in Georgia, much of which might have been prevented by a more timely and convincing warning.
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Affiliation(s)
- B E Mahon
- Foodborne and Diarrheal Diseases Branch, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
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Childs JE, Colby L, Krebs JW, Strine T, Feller M, Noah D, Drenzek C, Smith JS, Rupprecht CE. Surveillance and spatiotemporal associations of rabies in rodents and lagomorphs in the United States, 1985-1994. J Wildl Dis 1997; 33:20-7. [PMID: 9027687 DOI: 10.7589/0090-3558-33.1.20] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Between 1985 and 1994, 368 cases of rabies in rodents (95% of reports) and lagomorphs (5%) were reported to the Centers for Disease Control and Prevention, Atlanta, Georgia (USA), from 22 states. This was a 354% increase from the period 1971 to 1984. Most reports were cases of rabies in woodchucks (Marmota monax) (n = 317), primarily from the eastern United States, which has been recently experiencing an epizootic of raccoon (Procyon lotor) rabies. Cases of rabies in woodchucks were temporally and spatially associated with reports of raccoon rabies. Antigenic or genetic characterization of variants of rabies viruses from rodents and woodchucks corresponded to the variants associated with the major terrestrial wildlife reservoir within the geographic region of specimen origin. Although rodents and lagomorphs are infrequently infected with rabies and human contact with these animals rarely requires postexposure treatment, appropriate health authorities need to evaluate individual circumstances surrounding potential exposures.
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Affiliation(s)
- J E Childs
- Division of Viral and Rickettsial Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
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