1
|
Dawood FS, Payne AB, McMorrow ML. Assessing the Real-World Effectiveness of Immunizations for Respiratory Syncytial Virus. JAMA 2024:2817460. [PMID: 38602685 DOI: 10.1001/jama.2024.5859] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/12/2024]
Abstract
This Viewpoint discusses recommendations from the US Centers for Disease Control and Prevention for newly licensed immunizations for respiratory syncytial virus in infants, children with high-risk conditions, and older adults.
Collapse
Affiliation(s)
- Fatimah S Dawood
- Surveillance and Prevention Branch, Coronavirus and Other Respiratory Viruses Division, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Amanda B Payne
- Surveillance and Prevention Branch, Coronavirus and Other Respiratory Viruses Division, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Meredith L McMorrow
- Surveillance and Prevention Branch, Coronavirus and Other Respiratory Viruses Division, US Centers for Disease Control and Prevention, Atlanta, Georgia
| |
Collapse
|
2
|
Chard AN, Machingaidze C, Loayza S, Gharpure R, Nogareda F, González R, Domínguez R, Tinoco YO, Dawood FS, Carreon JD, Lafond KE, Jara J, Azziz-Baumgartner E, Cozza V, Couto P, Rolfes MA, Tempia S. Estimating averted illnesses from influenza vaccination for children and pregnant women - El Salvador, Panama, and Peru, 2011-2018. Vaccine 2024:S0264-410X(24)00419-5. [PMID: 38584055 DOI: 10.1016/j.vaccine.2024.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 03/15/2024] [Accepted: 04/03/2024] [Indexed: 04/09/2024]
Abstract
BACKGROUND Estimating the burden of disease averted by vaccination can assist policymakers to implement, adjust, and communicate the value of vaccination programs. Demonstrating the use of a newly available modeling tool, we estimated the burden of influenza illnesses averted by seasonal influenza vaccination in El Salvador, Panama, and Peru during 2011-2017 among two influenza vaccine target populations: children aged 6-23 months and pregnant women. METHODS We derived model inputs, including incidence, vaccine coverage, vaccine effectiveness, and multipliers from publicly available country-level influenza surveillance data and cohort studies. We also estimated changes in illnesses averted when countries' vaccine coverage was achieved using four different vaccine deployment strategies. RESULTS Among children aged 6-23 months, influenza vaccination averted an estimated cumulative 2,161 hospitalizations, 81,907 medically-attended illnesses, and 126,987 overall illnesses during the study period, with a prevented fraction ranging from 0.3 % to 12.5 %. Among pregnant women, influenza vaccination averted an estimated cumulative 173 hospitalizations, 6,122 medically attended illnesses, and 16,412 overall illnesses, with a prevented fraction ranging from 0.2 % to 10.9 %. Compared to an influenza vaccine campaign with equal vaccine distribution during March-June, scenarios in which total cumulative coverage was achieved in March and April consistently resulted in the greatest increase in averted illness (23 %-3,129 % increase among young children and 22 %-3,260 % increase among pregnant women). DISCUSSION Influenza vaccination campaigns in El Salvador, Panama, and Peru conducted between 2011 and 2018 prevented hundreds to thousands of influenza-associated hospitalizations and illnesses in young children and pregnant women. Existing vaccination programs could prevent additional illnesses, using the same number of vaccines, by achieving the highest possible coverage within the first two months of an influenza vaccine campaign.
Collapse
Affiliation(s)
- Anna N Chard
- Influenza Division, National Center for Immunization and Respiratory Diseases, U.S. Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA 30329, United States.
| | - Chiedza Machingaidze
- Global Influenza Programme, World Health Organization, Av. Appia 20, 1202 Geneva, Switzerland
| | - Sergio Loayza
- Pan American Health Organization, 525 23rd St NW, Washington, DC 20037, United States
| | - Radhika Gharpure
- Influenza Division, National Center for Immunization and Respiratory Diseases, U.S. Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA 30329, United States
| | - Francisco Nogareda
- Pan American Health Organization, 525 23rd St NW, Washington, DC 20037, United States
| | - Rosalba González
- Gorgas Memorial Institute of Health Studies, Ave. Justo Arosemena, Calle 35, Panama City, Panama
| | - Rhina Domínguez
- National Institute of Health of El Salvador, C. Gabriela Mistral 211, San Salvador, El Salvador
| | - Yeny O Tinoco
- U.S. Naval Medical Research Unit SOUTH, Av. Venezuela. Cuadra 36 s/n. Bellavista. Callao, Lima, Peru
| | - Fatimah S Dawood
- Influenza Division, National Center for Immunization and Respiratory Diseases, U.S. Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA 30329, United States
| | - Joseph Daniel Carreon
- Influenza Division, National Center for Immunization and Respiratory Diseases, U.S. Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA 30329, United States
| | - Kathryn E Lafond
- Influenza Division, National Center for Immunization and Respiratory Diseases, U.S. Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA 30329, United States
| | - Jorge Jara
- Pan American Health Organization, 525 23rd St NW, Washington, DC 20037, United States
| | - Eduardo Azziz-Baumgartner
- Influenza Division, National Center for Immunization and Respiratory Diseases, U.S. Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA 30329, United States
| | - Vanessa Cozza
- Global Influenza Programme, World Health Organization, Av. Appia 20, 1202 Geneva, Switzerland
| | - Paula Couto
- Pan American Health Organization, 525 23rd St NW, Washington, DC 20037, United States
| | - Melissa A Rolfes
- Influenza Division, National Center for Immunization and Respiratory Diseases, U.S. Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA 30329, United States; Global Influenza Programme, World Health Organization, Av. Appia 20, 1202 Geneva, Switzerland
| | - Stefano Tempia
- Global Influenza Programme, World Health Organization, Av. Appia 20, 1202 Geneva, Switzerland
| |
Collapse
|
3
|
Cohen C, Kleynhans J, von Gottberg A, McMorrow ML, Wolter N, Bhiman JN, Moyes J, du Plessis M, Carrim M, Buys A, Martinson NA, Kahn K, Tollman S, Lebina L, Wafawanaka F, du Toit J, Gómez-Olivé FX, Dawood FS, Mkhencele T, Tempia S. Characteristics of infections with ancestral, Beta and Delta variants of SARS-CoV-2 in the PHIRST-C community cohort study, South Africa, 2020-2021. BMC Infect Dis 2024; 24:336. [PMID: 38515050 PMCID: PMC10956206 DOI: 10.1186/s12879-024-09209-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 03/08/2024] [Indexed: 03/23/2024] Open
Abstract
BACKGROUND Data on the characteristics of individuals with mild and asymptomatic infections with different SARS-CoV-2 variants are limited. We therefore compared the characteristics of individuals infected with ancestral, Beta and Delta SARS-CoV-2 variants in South Africa. METHODS We conducted a prospective cohort study in a rural and an urban site during July 2020-August 2021. Mid-turbinate nasal swabs were collected twice-weekly from household members irrespective of symptoms and tested for SARS-CoV-2 using real-time reverse transcription polymerase chain reaction (rRT-PCR). Differences in demographic and clinical characteristics, shedding and cycle threshold (Ct) value of infection episodes by variant were evaluated using multinomial regression. Overall and age-specific incidence rates of infection were compared by variant. RESULTS We included 1200 individuals from 222 households and 648 rRT-PCR-confirmed infection episodes (66, 10% ancestral, 260, 40% Beta, 322, 50% Delta). Symptomatic proportion was similar for ancestral (7, 11%), Beta (44, 17%), and Delta (46, 14%) infections (p=0.4). After accounting for previous infection, peak incidence shifted to younger age groups in successive waves (40-59 years ancestral, 19-39 years Beta, 13-18 years Delta). On multivariable analysis, compared to ancestral, Beta infection was more common in individuals aged 5-12 years (vs 19-39)(adjusted odds ratio (aOR) 2.6, 95% confidence interval (CI)1.1-6.6) and PCR cycle threshold (Ct) value <30 (vs >35)(aOR 3.2, 95%CI 1.3-7.9), while Delta was more common in individuals aged <5 (aOR 6.7, 95%CI1.4-31.2) and 5-12 years (aOR 6.6 95%CI2.6-16.7)(vs 19-39) and Ct value <30 (aOR 4.5, 95%CI 1.3-15.5) and 30-35 (aOR 6.0, 95%CI 2.3-15.7)(vs >35). CONCLUSIONS Consecutive SARS-CoV-2 waves with Beta and Delta variants were associated with a shift to younger individuals. Beta and Delta infections were associated with higher peak viral loads, potentially increasing infectiousness.
Collapse
Affiliation(s)
- Cheryl Cohen
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa.
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
| | - Jackie Kleynhans
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Anne von Gottberg
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa
- School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Meredith L McMorrow
- Centers for Disease Control and Prevention (CDC) COVID-19 Response, Atlanta, Georgia, United States of America
| | - Nicole Wolter
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa
- School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Jinal N Bhiman
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa
- School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Jocelyn Moyes
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Mignon du Plessis
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa
- School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Maimuna Carrim
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa
- School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Amelia Buys
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa
| | - Neil A Martinson
- Perinatal HIV Research Unit, University of the Witwatersrand, Johannesburg, South Africa
- DST/NRF Centre of Excellence for Biomedical Tuberculosis Research, University of the Witwatersrand, Johannesburg, South Africa
- Johns Hopkins University Center for TB Research, Baltimore, Maryland, United States of America
| | - Kathleen Kahn
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Stephen Tollman
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Limakatso Lebina
- Perinatal HIV Research Unit, University of the Witwatersrand, Johannesburg, South Africa
- Africa Health Research Institute, Mtubatuba, KwaZulu-Natal, South Africa
| | - Floidy Wafawanaka
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Jacques du Toit
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Francesc Xavier Gómez-Olivé
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Fatimah S Dawood
- Centers for Disease Control and Prevention (CDC) COVID-19 Response, Atlanta, Georgia, United States of America
| | - Thulisa Mkhencele
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa
| | - Stefano Tempia
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Centers for Disease Control and Prevention (CDC) COVID-19 Response, Atlanta, Georgia, United States of America
| |
Collapse
|
4
|
Moline HL, Tannis A, Toepfer AP, Williams JV, Boom JA, Englund JA, Halasa NB, Staat MA, Weinberg GA, Selvarangan R, Michaels MG, Sahni LC, Klein EJ, Stewart LS, Schlaudecker EP, Szilagyi PG, Schuster JE, Goldstein L, Musa S, Piedra PA, Zerr DM, Betters KA, Rohlfs C, Albertin C, Banerjee D, McKeever ER, Kalman C, Clopper BR, McMorrow ML, Dawood FS. Early Estimate of Nirsevimab Effectiveness for Prevention of Respiratory Syncytial Virus-Associated Hospitalization Among Infants Entering Their First Respiratory Syncytial Virus Season - New Vaccine Surveillance Network, October 2023-February 2024. MMWR Morb Mortal Wkly Rep 2024; 73:209-214. [PMID: 38457312 PMCID: PMC10932582 DOI: 10.15585/mmwr.mm7309a4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/10/2024]
Abstract
Respiratory syncytial virus (RSV) is the leading cause of hospitalization among infants in the United States. In August 2023, CDC's Advisory Committee on Immunization Practices recommended nirsevimab, a long-acting monoclonal antibody, for infants aged <8 months to protect against RSV-associated lower respiratory tract infection during their first RSV season and for children aged 8-19 months at increased risk for severe RSV disease. In phase 3 clinical trials, nirsevimab efficacy against RSV-associated lower respiratory tract infection with hospitalization was 81% (95% CI = 62%-90%) through 150 days after receipt; post-introduction effectiveness has not been assessed in the United States. In this analysis, the New Vaccine Surveillance Network evaluated nirsevimab effectiveness against RSV-associated hospitalization among infants in their first RSV season during October 1, 2023-February 29, 2024. Among 699 infants hospitalized with acute respiratory illness, 59 (8%) received nirsevimab ≥7 days before symptom onset. Nirsevimab effectiveness was 90% (95% CI = 75%-96%) against RSV-associated hospitalization with a median time from receipt to symptom onset of 45 days (IQR = 19-76 days). The number of infants who received nirsevimab was too low to stratify by duration from receipt; however, nirsevimab effectiveness is expected to decrease with increasing time after receipt because of antibody decay. Although nirsevimab uptake and the interval from receipt of nirsevimab were limited in this analysis, this early estimate supports the current nirsevimab recommendation for the prevention of severe RSV disease in infants. Infants should be protected by maternal RSV vaccination or infant receipt of nirsevimab.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - New Vaccine Surveillance Network Product Effectiveness Collaborators
- Coronavirus and Other Respiratory Viruses Division, National Center for Immunization and Respiratory Diseases, CDC; UPMC Children’s Hospital of Pittsburgh, Pittsburgh, Pennsylvania; Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; Texas Children’s Hospital, Houston, Texas; Baylor College of Medicine, Houston, Texas; Department of Pediatrics, Seattle Children’s Hospital, Seattle, Washington; Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee; Division of Infectious Diseases, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio; Department of Pediatrics, University of Rochester Medical Center and University of Rochester–Golisano Children’s Hospital, Rochester, New York; Department of Pathology and Laboratory Medicine, Children’s Mercy Hospital, Kansas City, Missouri; Department of Pediatrics Children’s Mercy Hospital, Kansas City, Missouri
| | | | | |
Collapse
|
5
|
Kenmoe S, Chu HY, Dawood FS, Milucky J, Kittikraisak W, Matthewson H, Kulkarni D, Suntarattiwong P, Frivold C, Mohanty S, Havers F, Li Y, Nair H. Burden of Respiratory Syncytial Virus-Associated Acute Respiratory Infections During Pregnancy. J Infect Dis 2024; 229:S51-S60. [PMID: 37824420 DOI: 10.1093/infdis/jiad449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 10/04/2023] [Accepted: 10/10/2023] [Indexed: 10/14/2023] Open
Abstract
BACKGROUND With the licensure of maternal respiratory syncytial virus (RSV) vaccines in Europe and the United States, data are needed to better characterize the burden of RSV-associated acute respiratory infections (ARI) in pregnancy. The current study aimed to determine among pregnant individuals the proportion of ARI testing positive for RSV and the RSV incidence rate, RSV-associated hospitalizations, deaths, and perinatal outcomes. METHODS We conducted a systematic review, following PRISMA 2020 guidelines, using 5 databases (Medline, Embase, Global Health, Web of Science, and Global Index Medicus), and including additional unpublished data. Pregnant individuals with ARI who had respiratory samples tested for RSV were included. We used a random-effects meta-analysis to generate overall proportions and rate estimates across studies. RESULTS Eleven studies with pregnant individuals recruited between 2010 and 2022 were identified, most of which recruited pregnant individuals in community, inpatient and outpatient settings. Among 8126 pregnant individuals, the proportion with ARI that tested positive for RSV ranged from 0.9% to 10.7%, with a meta-estimate of 3.4% (95% confidence interval [CI], 1.9%-54%). The pooled incidence rate of RSV among pregnant individuals was 26.0 (95% CI, 15.8-36.2) per 1000 person-years. RSV hospitalization rates reported in 2 studies were 2.4 and 3.0 per 1000 person-years. In 5 studies that ascertained RSV-associated deaths among 4708 pregnant individuals, no deaths were reported. Three studies comparing RSV-positive and RSV-negative pregnant individuals found no difference in the odds of miscarriage, stillbirth, low birth weight, and small size for gestational age. RSV-positive pregnant individuals had higher odds of preterm delivery (odds ratio, 3.6 [95% CI, 1.3-10.3]). CONCLUSIONS Data on RSV-associated hospitalization rates are limited, but available estimates are lower than those reported in older adults and young children. As countries debate whether to include RSV vaccines in maternal vaccination programs, which are primarily intended to protect infants, this information could be useful in shaping vaccine policy decisions.
Collapse
Affiliation(s)
- Sebastien Kenmoe
- Centre for Global Health, Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Helen Y Chu
- Department of Medicine, Division of Allergy and Infectious Diseases, University of Washington, Seattle, Washington, USA
| | - Fatimah S Dawood
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Jennifer Milucky
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Wanitchaya Kittikraisak
- Influenza Program, Thailand Ministry of Public Health-US Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand
| | - Hamish Matthewson
- Centre for Global Health, Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Durga Kulkarni
- Centre for Global Health, Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Piyarat Suntarattiwong
- Pediatric Infectious Diseases Unit, Queen Sirikit National Institute of Child Health, Bangkok, Thailand
| | - Collrane Frivold
- Department of Medicine, Division of Allergy and Infectious Diseases, University of Washington, Seattle, Washington, USA
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
| | - Sarita Mohanty
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Fiona Havers
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - You Li
- Centre for Global Health, Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
- School of Public Health, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Harish Nair
- Centre for Global Health, Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
- School of Public Health, Nanjing Medical University, Nanjing, Jiangsu, China
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| |
Collapse
|
6
|
Frutos AM, Price AM, Harker E, Reeves EL, Ahmad HM, Murugan V, Martin ET, House S, Saade EA, Zimmerman RK, Gaglani M, Wernli KJ, Walter EB, Michaels MG, Staat MA, Weinberg GA, Selvarangan R, Boom JA, Klein EJ, Halasa NB, Ginde AA, Gibbs KW, Zhu Y, Self WH, Tartof SY, Klein NP, Dascomb K, DeSilva MB, Weber ZA, Yang DH, Ball SW, Surie D, DeCuir J, Dawood FS, Moline HL, Toepfer AP, Clopper BR, Link-Gelles R, Payne AB, Chung JR, Flannery B, Lewis NM, Olson SM, Adams K, Tenforde MW, Garg S, Grohskopf LA, Reed C, Ellington S. Interim Estimates of 2023-24 Seasonal Influenza Vaccine Effectiveness - United States. MMWR Morb Mortal Wkly Rep 2024; 73:168-174. [PMID: 38421935 PMCID: PMC10907036 DOI: 10.15585/mmwr.mm7308a3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
In the United States, annual influenza vaccination is recommended for all persons aged ≥6 months. Using data from four vaccine effectiveness (VE) networks during the 2023-24 influenza season, interim influenza VE was estimated among patients aged ≥6 months with acute respiratory illness-associated medical encounters using a test-negative case-control study design. Among children and adolescents aged 6 months-17 years, VE against influenza-associated outpatient visits ranged from 59% to 67% and against influenza-associated hospitalization ranged from 52% to 61%. Among adults aged ≥18 years, VE against influenza-associated outpatient visits ranged from 33% to 49% and against hospitalization from 41% to 44%. VE against influenza A ranged from 46% to 59% for children and adolescents and from 27% to 46% for adults across settings. VE against influenza B ranged from 64% to 89% for pediatric patients in outpatient settings and from 60% to 78% for all adults across settings. These findings demonstrate that the 2023-24 seasonal influenza vaccine is effective at reducing the risk for medically attended influenza virus infection. CDC recommends that all persons aged ≥6 months who have not yet been vaccinated this season get vaccinated while influenza circulates locally.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - CDC Influenza Vaccine Effectiveness Collaborators
- Influenza Division, National Center for Immunization and Respiratory Diseases, CDC; Epidemic Intelligence Service, CDC; Biodesign Center for Personalized Diagnostics, Arizona State University, Tempe, Arizona; University of Michigan School of Public Health, Ann Arbor, Michigan; Washington University School of Medicine in St. Louis, St. Louis, Missouri; University Hospitals of Cleveland, Cleveland, Ohio; University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; Baylor Scott & White Health, Temple, Texas; Baylor College of Medicine, Temple, Texas; Texas A&M University College of Medicine, Temple, Texas; Kaiser Permanente Washington Health Research Institute, Seattle, Washington; Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California; Duke Human Vaccine Institute, Duke University School of Medicine, Durham, North Carolina; UPMC Children’s Hospital of Pittsburgh, Pittsburgh, Pennsylvania; University of Cincinnati College of Medicine, Cincinnati, Ohio; Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio; University of Rochester School of Medicine and Dentistry, Rochester, New York; University of Missouri-Kansas City School of Medicine, Kansas City, Missouri; Children’s Mercy Hospital, Kansas City, Missouri; Baylor College of Medicine, Houston, Texas; Texas Children’s Hospital, Houston, Texas; Seattle Children’s Research Institute, Seattle, Washington; Vanderbilt University Medical Center, Nashville, Tennessee; University of Colorado School of Medicine, Aurora, Colorado; Wake Forest University School of Medicine, Winston-Salem, North Carolina; Kaiser Permanente Department of Research & Evaluation, Pasadena, California; Kaiser Permanente Vaccine Study Center, Kaiser Permanente Northern California Division of Research, Oakland, California; Division of Infectious Diseases and Clinical Epidemiology, Intermountain Health, Salt Lake City, Utah; HealthPartners Institute, Minneapolis, Minnesota; Westat, Rockville, Maryland; Coronavirus and Other Respiratory Viruses Division, National Center for Immunization and Respiratory Diseases, CDC
| |
Collapse
|
7
|
DeCuir J, Payne AB, Self WH, Rowley EA, Dascomb K, DeSilva MB, Irving SA, Grannis SJ, Ong TC, Klein NP, Weber ZA, Reese SE, Ball SW, Barron MA, Naleway AL, Dixon BE, Essien I, Bride D, Natarajan K, Fireman B, Shah AB, Okwuazi E, Wiegand R, Zhu Y, Lauring AS, Martin ET, Gaglani M, Peltan ID, Brown SM, Ginde AA, Mohr NM, Gibbs KW, Hager DN, Prekker M, Mohamed A, Srinivasan V, Steingrub JS, Khan A, Busse LW, Duggal A, Wilson JG, Chang SY, Mallow C, Kwon JH, Exline MC, Columbus C, Vaughn IA, Safdar B, Mosier JM, Harris ES, Casey JD, Chappell JD, Grijalva CG, Swan SA, Johnson C, Lewis NM, Ellington S, Adams K, Tenforde MW, Paden CR, Dawood FS, Fleming-Dutra KE, Surie D, Link-Gelles R. Interim Effectiveness of Updated 2023-2024 (Monovalent XBB.1.5) COVID-19 Vaccines Against COVID-19-Associated Emergency Department and Urgent Care Encounters and Hospitalization Among Immunocompetent Adults Aged ≥18 Years - VISION and IVY Networks, September 2023-January 2024. MMWR Morb Mortal Wkly Rep 2024; 73:180-188. [PMID: 38421945 PMCID: PMC10907041 DOI: 10.15585/mmwr.mm7308a5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
In September 2023, CDC's Advisory Committee on Immunization Practices recommended updated 2023-2024 (monovalent XBB.1.5) COVID-19 vaccination for all persons aged ≥6 months to prevent COVID-19, including severe disease. However, few estimates of updated vaccine effectiveness (VE) against medically attended illness are available. This analysis evaluated VE of an updated COVID-19 vaccine dose against COVID-19-associated emergency department (ED) or urgent care (UC) encounters and hospitalization among immunocompetent adults aged ≥18 years during September 2023-January 2024 using a test-negative, case-control design with data from two CDC VE networks. VE against COVID-19-associated ED/UC encounters was 51% (95% CI = 47%-54%) during the first 7-59 days after an updated dose and 39% (95% CI = 33%-45%) during the 60-119 days after an updated dose. VE estimates against COVID-19-associated hospitalization from two CDC VE networks were 52% (95% CI = 47%-57%) and 43% (95% CI = 27%-56%), with a median interval from updated dose of 42 and 47 days, respectively. Updated COVID-19 vaccine provided increased protection against COVID-19-associated ED/UC encounters and hospitalization among immunocompetent adults. These results support CDC recommendations for updated 2023-2024 COVID-19 vaccination. All persons aged ≥6 months should receive updated 2023-2024 COVID-19 vaccine.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - CDC COVID-19 Vaccine Effectiveness Collaborators
- Coronavirus and Other
Respiratory Viruses Division, National Center for Immunization and Respiratory
Diseases, CDC; Vanderbilt University Medical Center, Nashville,
Tennessee; Westat,
Rockville, Maryland; Division of Infectious Diseases and Clinical Epidemiology,
Intermountain Healthcare, Salt Lake City, Utah; HealthPartners Institute,
Minneapolis, Minnesota; Kaiser Permanente Center for Health Research,
Portland, Oregon; Indiana University School of Medicine, Indianapolis,
Indiana; Regenstrief
Institute Center for Biomedical Informatics, Indianapolis, Indiana; University of Colorado
School of Medicine, Aurora, Colorado; Kaiser Permanente Vaccine Study Center, Kaiser
Permanente Northern California Division of Research, Oakland, California;
Department of
Biomedical Informatics, Columbia University Irving Medical Center, New York, New
York; New
York-Presbyterian Hospital, New York, New York; General Dynamics Information
Technology, Falls Church, Virginia; University of Michigan, Ann Arbor, Michigan;
Baylor Scott
& White Health, Texas; Baylor College of Medicine, Temple, Texas; Intermountain Medical
Center, Murray, Utah; University of Utah, Salt Lake City, Utah; University of Iowa, Iowa
City, Iowa; Wake
Forest School of Medicine, Winston-Salem, North Carolina; Johns Hopkins University School of
Medicine, Baltimore, Maryland; Hennepin County Medical Center, Minneapolis,
Minnesota; Montefiore
Medical Center, Albert Einstein College of Medicine, New York, New York; University of Washington,
Seattle, Washington; Baystate Medical Center, Springfield, Massachusetts;
Oregon Health
& Science University, Portland, Oregon; Emory University, Atlanta, Georgia; Cleveland Clinic,
Cleveland, Ohio; Stanford University School of Medicine, Stanford,
California; Ronald
Reagan UCLA Medical Center, Los Angeles, California; University of Miami, Miami, Florida;
Washington
University in St. Louis, St. Louis, Missouri; The Ohio State University, Columbus,
Ohio; Texas A&M
University College of Medicine, Dallas, Texas; Henry Ford Health, Detroit,
Michigan; Yale
University School of Medicine, New Haven, Connecticut; University of Arizona, Tucson,
Arizona; Influenza
Division, National Center for Immunization and Respiratory Diseases, CDC
| |
Collapse
|
8
|
Edens C, Clopper BR, DeVies J, Benitez A, McKeever ER, Johns D, Wolff B, Selvarangan R, Schuster JE, Weinberg GA, Szilagyi PG, Dawood FS, Radhakrishnan L, Quigley C, Sahni LC, Halasa N, Stewart LS, McMorrow ML, Whitaker B, Zerr DM, Avadhanula V, Williams JV, Michaels MG, Kite-Powell A, Englund JA, Staat MA, Hartnett K, Moline HL, Cohen AL, Diaz M. Notes from the Field: Reemergence of Mycoplasma pneumoniae Infections in Children and Adolescents After the COVID-19 Pandemic, United States, 2018-2024. MMWR Morb Mortal Wkly Rep 2024; 73:149-151. [PMID: 38386615 PMCID: PMC10899077 DOI: 10.15585/mmwr.mm7307a3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/24/2024]
|
9
|
Patamasingh Na Ayudhaya O, Kittikraisak W, Phadungkiatwatana P, Hunt DR, Tomyabatra K, Chotpitayasunondh T, Galang RR, Chang K, Brummer T, Puttanavijarn L, Malek P, Dawood FS, Mott JA. Evaluation of cesarean delivery rates and factors associated with cesarean delivery among women enrolled in a pregnancy cohort study at two tertiary hospitals in Thailand. BMC Pregnancy Childbirth 2024; 24:149. [PMID: 38383397 PMCID: PMC10880209 DOI: 10.1186/s12884-024-06314-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 02/02/2024] [Indexed: 02/23/2024] Open
Abstract
BACKGROUND Cesarean delivery rates have increased globally resulting in a public health concern. We estimate rates of cesarean deliveries among Thai women using the World Health Organization (WHO) Robson Classification system and compare rates by Robson group to the Robson guideline for acceptable rates to identify groups that might benefit most from interventions for rate reduction. METHODS In 2017 and 2018, we established cohorts of pregnant women aged ≥ 18 years seeking prenatal care at two tertiary Thai hospitals and followed them until 6-8 weeks postpartum. Three in-person interviews (enrollment, end of pregnancy, and postpartum) were conducted using structured questionnaires to obtain demographic characteristics, health history, and delivery information. Cesarean delivery indication was classified based on core obstetric variables (parity, previous cesarean delivery, number of fetuses, fetal presentation, gestational week, and onset of labor) assigned to 10 groups according to the Robson Classification. Logistic regression was used to identify factors associated with cesarean delivery among nulliparous women with singleton, cephalic, term pregnancies. RESULTS Of 2,137 participants, 970 (45%) had cesarean deliveries. The median maternal age at delivery was 29 years (interquartile range, 25-35); 271 (13%) participants had existing medical conditions; and 446 (21%) had pregnancy complications. The cesarean delivery rate varied by Robson group. Multiparous women with > 1 previous uterine scar, with a single cephalic pregnancy, ≥ 37 weeks gestation (group 5) contributed the most (14%) to the overall cesarean rate, whereas those with a single pregnancy with a transverse or oblique lie, including women with previous uterine scars (group 9) contributed the least (< 1%). Factors independently associated with cesarean delivery included age ≥ 25 years, pre-pregnancy obesity, new/worsen medical condition during pregnancy, fetal distress, abnormal labor, infant size for gestational age ≥ 50th percentiles, and self-pay for delivery fees. Women with existing blood conditions were less likely to have cesarean delivery. CONCLUSIONS Almost one in two pregnancies among women in our cohorts resulted in cesarean deliveries. Compared to WHO guidelines, cesarean delivery rates were elevated in selected Robson groups indicating that tailored interventions to minimize non-clinically indicated cesarean delivery for specific groups of pregnancies may be warranted.
Collapse
Affiliation(s)
| | - Wanitchaya Kittikraisak
- Influenza Program, Thailand Ministry of Public Health - U.S. Centers for Disease Control and Prevention Collaboration, Ministry of Public Health (DDC building 7), Tiwanon Road, Nonthaburi, 11000, Thailand.
| | | | | | | | - Tawee Chotpitayasunondh
- Queen Sirikit National Institute of Child Health, Ministry of Public Health, Bangkok, Thailand
| | - Romeo R Galang
- Division of Reproductive Health, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Karen Chang
- Division of Reproductive Health, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | | | | | - Fatimah S Dawood
- Influenza Division, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Joshua A Mott
- Influenza Program, Thailand Ministry of Public Health - U.S. Centers for Disease Control and Prevention Collaboration, Ministry of Public Health (DDC building 7), Tiwanon Road, Nonthaburi, 11000, Thailand
- Influenza Division, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
| |
Collapse
|
10
|
Centor RM, Tenforde MW, Dawood FS. Web Exclusive. Annals On Call - Encouraging Influenza Vaccination. Ann Intern Med 2024; 177:eA230004. [PMID: 38373313 DOI: 10.7326/a23-0004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/21/2024] Open
Affiliation(s)
- Robert M Centor
- Huntsville Regional Medical Campus, University of Alabama Birmingham School of Medicine, Birmingham, Alabama (R.M.C.)
| | - Mark W Tenforde
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia (M.W.T., F.S.D.)
| | - Fatimah S Dawood
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia (M.W.T., F.S.D.)
| |
Collapse
|
11
|
Liu F, Gross FL, Joshi S, Gaglani M, Naleway AL, Murthy K, Groom HC, Wesley MG, Edwards LJ, Grant L, Kim SS, Sambhara S, Gangappa S, Tumpey T, Thompson MG, Fry AM, Flannery B, Dawood FS, Levine MZ. Redirecting antibody responses from egg-adapted epitopes following repeat vaccination with recombinant or cell culture-based versus egg-based influenza vaccines. Nat Commun 2024; 15:254. [PMID: 38177116 PMCID: PMC10767121 DOI: 10.1038/s41467-023-44551-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 12/19/2023] [Indexed: 01/06/2024] Open
Abstract
Repeat vaccination with egg-based influenza vaccines could preferentially boost antibodies targeting the egg-adapted epitopes and reduce immunogenicity to circulating viruses. In this randomized trial (Clinicaltrials.gov: NCT03722589), sera pre- and post-vaccination with quadrivalent inactivated egg-based (IIV4), cell culture-based (ccIIV4), and recombinant (RIV4) influenza vaccines were collected from healthcare personnel (18-64 years) in 2018-19 (N = 723) and 2019-20 (N = 684) influenza seasons. We performed an exploratory analysis. Vaccine egg-adapted changes had the most impact on A(H3N2) immunogenicity. In year 1, RIV4 induced higher neutralizing and total HA head binding antibodies to cell- A(H3N2) virus than ccIIV4 and IIV4. In year 2, among the 7 repeat vaccination arms (IIV4-IIV4, IIV4-ccIIV4, IIV4-RIV4, RIV4-ccIIV4, RIV4-RIV4, ccIIV4-ccIIV4 and ccIIV4-RIV4), repeat vaccination with either RIV4 or ccIIV4 further improved antibody responses to circulating viruses with decreased neutralizing antibody egg/cell ratio. RIV4 also had higher post-vaccination A(H1N1)pdm09 and A(H3N2) HA stalk antibodies in year 1, but there was no significant difference in HA stalk antibody fold rise among vaccine groups in either year 1 or year 2. Multiple seasons of non-egg-based vaccination may be needed to redirect antibody responses from immune memory to egg-adapted epitopes and re-focus the immune responses towards epitopes on the circulating viruses to improve vaccine effectiveness.
Collapse
Affiliation(s)
- Feng Liu
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - F Liaini Gross
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Sneha Joshi
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Manjusha Gaglani
- Baylor Scott & White Health, Temple, TX, USA
- Baylor College of Medicine, Temple, TX, USA
- Texas A & M University, College of Medicine, Temple, TX, USA
| | - Allison L Naleway
- Kaiser Permanente Northwest Center for Health Research, Portland, OR, USA
| | | | - Holly C Groom
- Kaiser Permanente Northwest Center for Health Research, Portland, OR, USA
| | - Meredith G Wesley
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, USA
- Abt Associates, Atlanta, GA, USA
| | | | - Lauren Grant
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Sara S Kim
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | | | - Terrence Tumpey
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Mark G Thompson
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Alicia M Fry
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Brendan Flannery
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Fatimah S Dawood
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Min Z Levine
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, USA.
| |
Collapse
|
12
|
Tenforde MW, Dawood FS, Ellington SR, Grohskopf LA, Flannery B, Garg S, Reed C. Communicating the Value of Influenza Vaccines to Patients: Translating Vaccine Effectiveness to Acceptance. Ann Intern Med 2023; 176:1670-1671. [PMID: 38011706 DOI: 10.7326/m23-2802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2023] Open
Affiliation(s)
- Mark W Tenforde
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia (M.W.T., F.S.D., S.R.E., L.A.G., B.F., S.G., C.R.)
| | - Fatimah S Dawood
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia (M.W.T., F.S.D., S.R.E., L.A.G., B.F., S.G., C.R.)
| | - Sascha R Ellington
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia (M.W.T., F.S.D., S.R.E., L.A.G., B.F., S.G., C.R.)
| | - Lisa A Grohskopf
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia (M.W.T., F.S.D., S.R.E., L.A.G., B.F., S.G., C.R.)
| | - Brendan Flannery
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia (M.W.T., F.S.D., S.R.E., L.A.G., B.F., S.G., C.R.)
| | - Shikha Garg
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia (M.W.T., F.S.D., S.R.E., L.A.G., B.F., S.G., C.R.)
| | - Carrie Reed
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia (M.W.T., F.S.D., S.R.E., L.A.G., B.F., S.G., C.R.)
| |
Collapse
|
13
|
Wilks SH, Mühlemann B, Shen X, Türeli S, LeGresley EB, Netzl A, Caniza MA, Chacaltana-Huarcaya JN, Corman VM, Daniell X, Datto MB, Dawood FS, Denny TN, Drosten C, Fouchier RAM, Garcia PJ, Halfmann PJ, Jassem A, Jeworowski LM, Jones TC, Kawaoka Y, Krammer F, McDanal C, Pajon R, Simon V, Stockwell MS, Tang H, van Bakel H, Veguilla V, Webby R, Montefiori DC, Smith DJ. Mapping SARS-CoV-2 antigenic relationships and serological responses. Science 2023; 382:eadj0070. [PMID: 37797027 DOI: 10.1126/science.adj0070] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 08/23/2023] [Indexed: 10/07/2023]
Abstract
During the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic, multiple variants escaping preexisting immunity emerged, causing reinfections of previously exposed individuals. Here, we used antigenic cartography to analyze patterns of cross-reactivity among 21 variants and 15 groups of human sera obtained after primary infection with 10 different variants or after messenger RNA (mRNA)-1273 or mRNA-1273.351 vaccination. We found antigenic differences among pre-Omicron variants caused by substitutions at spike-protein positions 417, 452, 484, and 501. Quantifying changes in response breadth over time and with additional vaccine doses, our results show the largest increase between 4 weeks and >3 months after a second dose. We found changes in immunodominance of different spike regions, depending on the variant an individual was first exposed to, with implications for variant risk assessment and vaccine-strain selection.
Collapse
Affiliation(s)
- Samuel H Wilks
- Center for Pathogen Evolution, Department of Zoology, University of Cambridge, Cambridge CB2 3EJ, UK
| | - Barbara Mühlemann
- Institute of Virology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 10117 Berlin, Germany
- German Centre for Infection Research (DZIF), partner site Charité, 10117 Berlin, Germany
| | - Xiaoying Shen
- Department of Surgery, Duke University School of Medicine, Durham, NC, USA
- Duke Human Vaccine Institute, Duke University School of Medicine, Durham, NC, USA
| | - Sina Türeli
- Center for Pathogen Evolution, Department of Zoology, University of Cambridge, Cambridge CB2 3EJ, UK
| | - Eric B LeGresley
- Center for Pathogen Evolution, Department of Zoology, University of Cambridge, Cambridge CB2 3EJ, UK
| | - Antonia Netzl
- Center for Pathogen Evolution, Department of Zoology, University of Cambridge, Cambridge CB2 3EJ, UK
| | - Miguela A Caniza
- Department of Global Pediatric Medicine, Department of Infectious Diseases, St. Jude Children's Research Hospital, Memphis, TN, USA
| | | | - Victor M Corman
- Institute of Virology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 10117 Berlin, Germany
- German Centre for Infection Research (DZIF), partner site Charité, 10117 Berlin, Germany
| | - Xiaoju Daniell
- Department of Surgery, Duke University School of Medicine, Durham, NC, USA
| | - Michael B Datto
- Department of Pathology, Duke University School of Medicine, Durham, NC, USA
| | | | - Thomas N Denny
- Duke Human Vaccine Institute, Duke University School of Medicine, Durham, NC, USA
| | - Christian Drosten
- Institute of Virology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 10117 Berlin, Germany
- German Centre for Infection Research (DZIF), partner site Charité, 10117 Berlin, Germany
| | | | - Patricia J Garcia
- School of Public Health, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Peter J Halfmann
- Influenza Research Institute, Department of Pathobiological Science, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, WI, USA
| | - Agatha Jassem
- BC Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Lara M Jeworowski
- Institute of Virology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 10117 Berlin, Germany
| | - Terry C Jones
- Center for Pathogen Evolution, Department of Zoology, University of Cambridge, Cambridge CB2 3EJ, UK
- Institute of Virology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 10117 Berlin, Germany
- German Centre for Infection Research (DZIF), partner site Charité, 10117 Berlin, Germany
| | - Yoshihiro Kawaoka
- Influenza Research Institute, Department of Pathobiological Science, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, WI, USA
- Division of Virology, Institute of Medical Science, University of Tokyo, Tokyo, Japan
- The Research Center for Global Viral Diseases, National Center for Global Health and Medicine Research Institute, Tokyo, Japan
- Pandemic Preparedness, Infection and Advanced Research Center (UTOPIA), University of Tokyo, Tokyo, Japan
| | - Florian Krammer
- Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Pathology, Cellular and Molecular Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Charlene McDanal
- Department of Surgery, Duke University School of Medicine, Durham, NC, USA
| | | | - Viviana Simon
- Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Pathology, Cellular and Molecular Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Division of Infectious Diseases, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- The Global Health and Emerging Pathogen Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Melissa S Stockwell
- Division of Child and Adolescent Health, Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons, and Department of Population and Family Health, Mailman School of Public Health, New York, NY, USA
| | - Haili Tang
- Department of Surgery, Duke University School of Medicine, Durham, NC, USA
| | - Harm van Bakel
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Vic Veguilla
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Richard Webby
- Department of Infectious Diseases, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - David C Montefiori
- Department of Surgery, Duke University School of Medicine, Durham, NC, USA
- Duke Human Vaccine Institute, Duke University School of Medicine, Durham, NC, USA
| | - Derek J Smith
- Center for Pathogen Evolution, Department of Zoology, University of Cambridge, Cambridge CB2 3EJ, UK
| |
Collapse
|
14
|
Mohanty S, Tita AT, Varner M, Stockwell MS, Newes‐Adeyi G, Battarbee AN, Reichle L, Morrill T, Daugherty M, Mourad M, Silverio Francisco RA, Woodworth K, Wielgosz K, Galang R, Maniatis P, Semenova V, Dawood FS. Association between SARS-CoV-2 infections during pregnancy and preterm live birth. Influenza Other Respir Viruses 2023; 17:e13192. [PMID: 37744991 PMCID: PMC10511836 DOI: 10.1111/irv.13192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 07/28/2023] [Accepted: 08/09/2023] [Indexed: 09/26/2023] Open
Abstract
We examined associations between mild or asymptomatic prenatal SARS-CoV-2 infection and preterm live birth in a prospective cohort study. During August 2020-October 2021, pregnant persons were followed with systematic surveillance for RT-PCR or serologically confirmed SARS-CoV-2 infection until pregnancy end. The association between prenatal SARS-CoV-2 infection and preterm birth was assessed using Cox proportional-hazards regression. Among 954 pregnant persons with a live birth, 185 (19%) had prenatal SARS-CoV-2 infection and 123 (13%) had preterm birth. The adjusted hazard ratio for the association between SARS-CoV-2 infection and preterm birth was 1.28 (95% confidence interval 0.82-1.99, p = 0.28), although results did not reach statistical significance.
Collapse
Affiliation(s)
- Sarita Mohanty
- Centers for Disease Control and PreventionAtlantaGeorgiaUSA
| | - Alan T. Tita
- Center for Women's Reproductive Health and Department of Obstetrics and Gynecology, Division of Maternal‐Fetal MedicineUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - Michael Varner
- Department of Obstetrics and GynecologyUniversity of Utah Health Sciences CenterSalt Lake CityUtahUSA
| | - Melissa S. Stockwell
- Division of Child and Adolescent Health, Department of PediatricsColumbia University Irving Medical CenterNew YorkNew YorkUSA
- Department of Population and Family Health, Mailman School of Public HealthColumbia University Irving Medical CenterNew YorkNew YorkUSA
- New York‐Presbyterian HospitalNew YorkNew YorkUSA
| | | | - Ashley N. Battarbee
- Center for Women's Reproductive Health and Department of Obstetrics and Gynecology, Division of Maternal‐Fetal MedicineUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | | | | | | | - Mirella Mourad
- Division of Child and Adolescent Health, Department of PediatricsColumbia University Irving Medical CenterNew YorkNew YorkUSA
| | - Raul A. Silverio Francisco
- Division of Child and Adolescent Health, Department of PediatricsColumbia University Irving Medical CenterNew YorkNew YorkUSA
| | - Kate Woodworth
- Centers for Disease Control and PreventionAtlantaGeorgiaUSA
| | | | - Romeo Galang
- Centers for Disease Control and PreventionAtlantaGeorgiaUSA
| | - Pete Maniatis
- Centers for Disease Control and PreventionAtlantaGeorgiaUSA
| | - Vera Semenova
- Centers for Disease Control and PreventionAtlantaGeorgiaUSA
| | | |
Collapse
|
15
|
Wilks SH, Mühlemann B, Shen X, Türeli S, LeGresley EB, Netzl A, Caniza MA, Chacaltana-Huarcaya JN, Corman VM, Daniell X, Datto MB, Dawood FS, Denny TN, Drosten C, Fouchier RAM, Garcia PJ, Halfmann PJ, Jassem A, Jeworowski LM, Jones TC, Kawaoka Y, Krammer F, McDanal C, Pajon R, Simon V, Stockwell MS, Tang H, van Bakel H, Veguilla V, Webby R, Montefiori DC, Smith DJ. Mapping SARS-CoV-2 antigenic relationships and serological responses. bioRxiv 2023:2022.01.28.477987. [PMID: 35860221 PMCID: PMC9298128 DOI: 10.1101/2022.01.28.477987] [Citation(s) in RCA: 21] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
During the SARS-CoV-2 pandemic, multiple variants escaping pre-existing immunity emerged, causing concerns about continued protection. Here, we use antigenic cartography to analyze patterns of cross-reactivity among a panel of 21 variants and 15 groups of human sera obtained following primary infection with 10 different variants or after mRNA-1273 or mRNA-1273.351 vaccination. We find antigenic differences among pre-Omicron variants caused by substitutions at spike protein positions 417, 452, 484, and 501. Quantifying changes in response breadth over time and with additional vaccine doses, our results show the largest increase between 4 weeks and >3 months post-2nd dose. We find changes in immunodominance of different spike regions depending on the variant an individual was first exposed to, with implications for variant risk assessment and vaccine strain selection.
Collapse
Affiliation(s)
- Samuel H Wilks
- Center for Pathogen Evolution, Department of Zoology, University of Cambridge, Cambridge, CB2 3EJ, UK
| | - Barbara Mühlemann
- Institute of Virology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 10117 Berlin, Germany
- German Centre for Infection Research (DZIF), partner site Charité, 10117 Berlin, Germany
| | - Xiaoying Shen
- Department of Surgery, Duke University School of Medicine, Durham, NC, USA
- Duke Human Vaccine Institute, Duke University School of Medicine, Durham, NC, USA
| | - Sina Türeli
- Center for Pathogen Evolution, Department of Zoology, University of Cambridge, Cambridge, CB2 3EJ, UK
| | - Eric B LeGresley
- Center for Pathogen Evolution, Department of Zoology, University of Cambridge, Cambridge, CB2 3EJ, UK
| | - Antonia Netzl
- Center for Pathogen Evolution, Department of Zoology, University of Cambridge, Cambridge, CB2 3EJ, UK
| | - Miguela A Caniza
- Department of Global Pediatric Medicine, Department of Infectious Diseases, St. Jude Children's Research Hospital, Memphis, TN, USA
| | | | - Victor M Corman
- Institute of Virology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 10117 Berlin, Germany
- German Centre for Infection Research (DZIF), partner site Charité, 10117 Berlin, Germany
| | - Xiaoju Daniell
- Department of Surgery, Duke University School of Medicine, Durham, NC, USA
| | - Michael B Datto
- Department of Pathology, Duke University School of Medicine, Durham, NC, USA
| | | | - Thomas N Denny
- Duke Human Vaccine Institute, Duke University School of Medicine, Durham, NC, USA
| | - Christian Drosten
- Institute of Virology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 10117 Berlin, Germany
- German Centre for Infection Research (DZIF), partner site Charité, 10117 Berlin, Germany
| | | | - Patricia J Garcia
- School of Public Health, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Peter J Halfmann
- Influenza Research Institute, Department of Pathobiological Science, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, WI, USA
| | - Agatha Jassem
- BC Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Lara M Jeworowski
- Institute of Virology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 10117 Berlin, Germany
| | - Terry C Jones
- Center for Pathogen Evolution, Department of Zoology, University of Cambridge, Cambridge, CB2 3EJ, UK
- Institute of Virology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 10117 Berlin, Germany
- German Centre for Infection Research (DZIF), partner site Charité, 10117 Berlin, Germany
| | - Yoshihiro Kawaoka
- Influenza Research Institute, Department of Pathobiological Science, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, WI, USA
- Division of Virology, Institute of Medical Science, University of Tokyo, Tokyo, Japan
- The Research Center for Global Viral Diseases, National Center for Global Health and Medicine Research Institute, Tokyo, Japan
- Pandemic Preparedness, Infection and Advanced Research Center (UTOPIA), University of Tokyo, Tokyo, Japan
| | - Florian Krammer
- Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Pathology, Cellular and Molecular Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Charlene McDanal
- Department of Surgery, Duke University School of Medicine, Durham, NC, USA
| | | | - Viviana Simon
- Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Pathology, Cellular and Molecular Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Division of Infectious Diseases, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- The Global Health and Emerging Pathogen Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Melissa S Stockwell
- Division of Child and Adolescent Health, Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons, and Department of Population and Family Health, Mailman School of Public Health, New York, NY, USA
| | - Haili Tang
- Department of Surgery, Duke University School of Medicine, Durham, NC, USA
| | - Harm van Bakel
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Vic Veguilla
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Richard Webby
- Department of Infectious Diseases, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - David C Montefiori
- Department of Surgery, Duke University School of Medicine, Durham, NC, USA
- Duke Human Vaccine Institute, Duke University School of Medicine, Durham, NC, USA
| | - Derek J Smith
- Center for Pathogen Evolution, Department of Zoology, University of Cambridge, Cambridge, CB2 3EJ, UK
| |
Collapse
|
16
|
Naleway AL, Kim SS, Flannery B, Levine MZ, Murthy K, Sambhara S, Gangappa S, Edwards LJ, Ball S, Grant L, Zunie T, Cao W, Gross FL, Groom H, Fry AM, Hunt D, Jeddy Z, Mishina M, Wesley MG, Spencer S, Thompson MG, Gaglani M, Dawood FS. Immunogenicity of High-Dose Egg-Based, Recombinant, and Cell Culture-Based Influenza Vaccines Compared With Standard-Dose Egg-Based Influenza Vaccine Among Health Care Personnel Aged 18-65 Years in 2019-2020. Open Forum Infect Dis 2023; 10:ofad223. [PMID: 37305842 PMCID: PMC10249269 DOI: 10.1093/ofid/ofad223] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 04/20/2023] [Indexed: 06/13/2023] Open
Abstract
Background Emerging data suggest that second-generation influenza vaccines with higher hemagglutinin (HA) antigen content and/or different production methods may induce stronger antibody responses to HA than standard-dose egg-based influenza vaccines in adults. We compared antibody responses to high-dose egg-based inactivated (HD-IIV3), recombinant (RIV4), and cell culture-based (ccIIV4) vs standard-dose egg-based inactivated influenza vaccine (SD-IIV4) among health care personnel (HCP) aged 18-65 years in 2 influenza seasons (2018-2019, 2019-2020). Methods In the second trial season, newly and re-enrolled HCPs who received SD-IIV4 in season 1 were randomized to receive RIV4, ccIIV4, or SD-IIV4 or were enrolled in an off-label, nonrandomized arm to receive HD-IIV3. Prevaccination and 1-month-postvaccination sera were tested by hemagglutination inhibition (HI) assay against 4 cell culture propagated vaccine reference viruses. Primary outcomes, adjusted for study site and baseline HI titer, were seroconversion rate (SCR), geometric mean titers (GMTs), mean fold rise (MFR), and GMT ratios that compared vaccine groups to SD-IIV4. Results Among 390 HCP in the per-protocol population, 79 received HD-IIV3, 103 RIV4, 106 ccIIV4, and 102 SD-IIV4. HD-IIV3 recipients had similar postvaccination antibody titers compared with SD-IIV4 recipients, whereas RIV4 recipients had significantly higher 1-month-postvaccination antibody titers against vaccine reference viruses for all outcomes. Conclusions HD-IIV3 did not induce higher antibody responses than SD-IIV4, but, consistent with previous studies, RIV4 was associated with higher postvaccination antibody titers. These findings suggest that recombinant vaccines rather than vaccines with higher egg-based antigen doses may provide improved antibody responses in highly vaccinated populations.
Collapse
Affiliation(s)
- Allison L Naleway
- Correspondence: Allison Naleway, PhD, Kaiser Permanente Center for Health Research, 3800 N. Interstate Ave, Portland, OR 97227 (); or Fatimah Dawood, MD, Centers for Disease Control and Prevention, 1600 Clifton Rd, Atlanta, GA 30333 ()
| | - Sara S Kim
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Brendan Flannery
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Min Z Levine
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | | | | | | | | | - Lauren Grant
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | - Weiping Cao
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - F Liaini Gross
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Holly Groom
- Kaiser Permanente Center for Health Research, Portland, Oregon, USA
| | - Alicia M Fry
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | | | | | - Meredith G Wesley
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- Abt Associates, Atlanta, Georgia, USA
| | - Sarah Spencer
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Mark G Thompson
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Manjusha Gaglani
- Baylor Scott & White Health, Temple, Texas, USA
- Texas A&M University, College of Medicine, Temple, Texas, USA
| | - Fatimah S Dawood
- Correspondence: Allison Naleway, PhD, Kaiser Permanente Center for Health Research, 3800 N. Interstate Ave, Portland, OR 97227 (); or Fatimah Dawood, MD, Centers for Disease Control and Prevention, 1600 Clifton Rd, Atlanta, GA 30333 ()
| |
Collapse
|
17
|
Dawood FS, Tita A, Stockwell MS, Newes-Adeyi G, Wielgosz K, Gyamfi-Bannerman C, Battarbee A, Reichle L, Thornburg N, Ellington S, Galang RR, Vorwaller K, Vargas CY, Morrill T, Parks M, Powers E, Gibson M, Varner M. Neutralizing Antibody Responses to Messenger RNA Coronavirus Disease 2019 Vaccines Versus Severe Acute Respiratory Syndrome Coronavirus 2 Infection Among Pregnant Women and Vaccine-Induced Antibody Transfer to Infants. Open Forum Infect Dis 2023; 10:ofad204. [PMID: 37187508 PMCID: PMC10167992 DOI: 10.1093/ofid/ofad204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 04/14/2023] [Indexed: 05/17/2023] Open
Abstract
Background Early coronavirus disease 2019 (COVID-19) vaccine trials excluded pregnant women, resulting in limited data about immunogenicity and maternal-fetal antibody transfer, particularly by gestational timing of vaccination. Methods In this multicenter observational immunogenicity study, pregnant and nonpregnant women receiving COVID-19 vaccines were prospectively enrolled. Participants had sera collected before vaccination, at 14-28 days after each vaccine dose, at delivery (umbilical cord and peripheral), and from their infants at 3 and 6 months. Geometric mean titers (GMTs) of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ID50 neutralizing antibody (nAb) against D614G-like viruses were compared by participant characteristics. Results Overall, 23 nonpregnant and 85 pregnant participants (trimester of first vaccine dose: 10 first, 47 second, 28 third) were enrolled. Ninety-three percent (76/82 with blood samples) of pregnant participants had detectable SARS-CoV-2 nAb after 2 vaccine doses, but GMTs (95% confidence intervals) were lower in pregnant participants than nonpregnant participants (1722 [1136-2612] vs 4419 [2012-9703]; P = .04). By 3 and 6 months, 28% and 74% of infants, respectively, of vaccinated participants had no detectable nAb to D614G-like viruses. Among the 71 pregnant participants without detectable nAb before vaccination, cord blood GMTs at delivery were 5-fold higher among participants vaccinated during the third versus first trimester, and cord blood nAb titers appeared inversely correlated with weeks since first vaccine dose (R2 = 0.06, P = .06). Conclusions Though most pregnant women develop nAb after 2 doses of mRNA COVID-19 vaccines, this analysis suggests that infant protection from maternal vaccination varies by gestational timing of vaccination and wanes. Additional prevention strategies such as caregiver vaccination may warrant consideration to optimize infant protection.
Collapse
Affiliation(s)
- Fatimah S Dawood
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Alan Tita
- Center for Women's Reproductive Health and Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Melissa S Stockwell
- New York–Presbyterian Hospital, New York, New York, USA
- Division of Child and Adolescent Health, Department of Pediatrics, Columbia University Irving Medical Center, New York, New York, USA
- Department of Population and Family Health, Mailman School of Public Health, Columbia University Irving Medical Center, New York, New York, USA
| | | | - Kristina Wielgosz
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Cynthia Gyamfi-Bannerman
- New York–Presbyterian Hospital, New York, New York, USA
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, New York, USA
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Diego, California, USA
| | - Ashley Battarbee
- Center for Women's Reproductive Health and Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | | | - Natalie Thornburg
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Sascha Ellington
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Romeo R Galang
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Kelly Vorwaller
- Department of Obstetrics and Gynecology, University of Utah Health Sciences Center, Salt Lake City, Utah, USA
| | | | | | - Mickey Parks
- Center for Women's Reproductive Health and Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Emily Powers
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, New York, USA
| | - Marie Gibson
- Department of Obstetrics and Gynecology, University of Utah Health Sciences Center, Salt Lake City, Utah, USA
| | - Michael Varner
- Department of Obstetrics and Gynecology, University of Utah Health Sciences Center, Salt Lake City, Utah, USA
| |
Collapse
|
18
|
Dawood FS, Couture A, Zhang X, Stockwell MS, Porucznik CA, Stanford JB, Hetrich M, Veguilla V, Thornburg N, Heaney CD, Wang J, Duque J, Jeddy Z, Deloria Knoll M, Karron R. Severe Acute Respiratory Syndrome Coronavirus 2 Neutralizing Antibody Responses After Community Infections in Children and Adults. Open Forum Infect Dis 2023; 10:ofad168. [PMID: 37213425 PMCID: PMC10199115 DOI: 10.1093/ofid/ofad168] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 03/24/2023] [Indexed: 04/01/2024] Open
Abstract
Background We compared postinfection severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) neutralizing antibody (nAb) responses among children and adults while the D614G-like strain and Alpha, Iota, and Delta variants circulated. Methods During August 2020-October 2021, households with adults and children were enrolled and followed in Utah, New York City, and Maryland. Participants collected weekly respiratory swabs that were tested for SARS-CoV-2 and had sera collected during enrollment and follow-up. Sera were tested for SARS-CoV-2 nAb by pseudovirus assay. Postinfection titers were characterized with biexponential decay models. Results Eighty participants had SARS-CoV-2 infection during the study (47 with D614G-like virus, 17 with B.1.1.7, and 8 each with B.1.617.2 and B.1.526 virus). Homologous nAb geometric mean titers (GMTs) trended higher in adults (GMT = 2320) versus children 0-4 (GMT = 425, P = .33) and 5-17 years (GMT = 396, P = .31) at 1-5 weeks postinfection but were similar from 6 weeks. Timing of peak titers was similar by age. Results were consistent when participants with self-reported infection before enrollment were included (n = 178). Conclusions The SARS-CoV-2 nAb titers differed in children compared to adults early after infection but were similar by 6 weeks postinfection. If postvaccination nAb kinetics have similar trends, vaccine immunobridging studies may need to compare nAb responses in adults and children 6 weeks or more after vaccination.
Collapse
Affiliation(s)
- Fatimah S Dawood
- COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Alexia Couture
- COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Xueyan Zhang
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Melissa S Stockwell
- Division of Child and Adolescent Health, Department of Pediatrics, Columbia University Irving Medical Center, New York, New York, USA
- Department of Population and Family Health, Mailman School of Public Health, Columbia University Irving Medical Center, New York, New York, USA
| | - Christina A Porucznik
- Division of Public Health, Department of Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Joseph B Stanford
- Division of Public Health, Department of Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Marissa Hetrich
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Vic Veguilla
- COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Natalie Thornburg
- COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Christopher D Heaney
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Jing Wang
- COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | - Zuha Jeddy
- Abt Associates, Cambridge, Massachusetts, USA
| | - Maria Deloria Knoll
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Ruth Karron
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| |
Collapse
|
19
|
Griffin I, Irving SA, Arriola CS, Campbell AP, Li DK, Dawood FS, Doughty-Skierski C, Ferber JR, Ferguson N, Hadden L, Henderson JT, Juergens M, Kancharla V, Naleway AL, Newes-Adeyi G, Nicholson E, Odouli R, Reichle L, Sanyang M, Woodworth K, Munoz FM. Incidence Rates of Medically Attended COVID-19 in Infants Less Than 6 Months of Age. Pediatr Infect Dis J 2023; 42:315-320. [PMID: 36602338 PMCID: PMC9990480 DOI: 10.1097/inf.0000000000003823] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/10/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND Studies suggest infants may be at increased risk of severe coronavirus disease 2019 (COVID-19) relative to older children, but few data exist regarding the incidence of COVID-19 episodes and associated risk factors. We estimate incidence rates and describe characteristics associated with medically attended COVID-19 episodes among infants younger than 6 months of age. METHODS We analyzed electronic medical record data from a cohort of infants born March 1, 2020-February 28, 2021. Data from 3 health care delivery systems included demographic characteristics, maternal and infant outpatient visit and hospitalization diagnoses and severe acute respiratory syndrome coronavirus syndrome 2 (SARS-CoV-2) test results. Medically attended COVID-19 episodes were defined by positive SARS-CoV-2 clinical tests and/or COVID-19 diagnosis codes during medical care visits. Unadjusted and site-adjusted incidence rates by infant month of age, low and high SARS-CoV-2 circulation periods and maternal COVID-19 diagnosis were calculated. RESULTS Among 18,192 infants <6 months of age whose mothers received prenatal care within the 3 systems, 173 (1.0%) had medically attended COVID-19 episodes. Incidence rates were highest among infants under 1 month of age (2.0 per 1000 person-weeks) and 1 month (2.0 per 1000 person-weeks) compared with older infants. Incidence rates were also higher for infants born to women with postpartum COVID-19 compared with women without known COVID-19 and women diagnosed with COVID-19 during pregnancy. CONCLUSIONS Infants of women with postpartum COVID-19 had a higher risk of medically attended COVID-19 than infants born to mothers who were diagnosed during pregnancy or never diagnosed underscoring the importance of COVID-19 prevention measures for their household members and caregivers to prevent infections in infants.
Collapse
Affiliation(s)
- Isabel Griffin
- From the COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Carmen Sofia Arriola
- From the COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Angela P. Campbell
- From the COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - De-Kun Li
- Department of Obstetrics and Gynecology, Kaiser Permanente Northern California, Oakland, California
| | - Fatimah S. Dawood
- From the COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Jeannette R. Ferber
- Department of Obstetrics and Gynecology, Kaiser Permanente Northern California, Oakland, California
| | | | | | | | | | | | - Allison L. Naleway
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon
| | | | | | - Roxana Odouli
- Department of Obstetrics and Gynecology, Kaiser Permanente Northern California, Oakland, California
| | | | - Mo Sanyang
- Baylor College of Medicine, Houston, Texas
| | - Kate Woodworth
- From the COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | |
Collapse
|
20
|
Praphasiri P, Prasert K, Shrestha M, Ditsungnoen D, Chittaganpich M, Chawalchitiporn S, Dawood FS, Sirilak S, Mott JA. Does prior vaccination affect the immune response to seasonal influenza vaccination among older adults? Findings from a prospective cohort study in a Northeastern Province of Thailand. PLoS One 2023; 18:e0279962. [PMID: 36735691 PMCID: PMC9897550 DOI: 10.1371/journal.pone.0279962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Accepted: 12/15/2022] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND We measured the immunogenicity of seasonal trivalent inactivated influenza vaccines (IIV3) among older Thai adults and the effect of one-year prior vaccination status on immune responses. METHOD Adults aged ≥65 years (n = 370) were vaccinated with Southern Hemisphere IIV3 in 2015. Hemagglutination inhibition assays were performed using goose red blood cells on sera collected from the participants at baseline and after 1, 6, and 12 months of vaccination. Prior year vaccination (in 2014) was verified with the national health security office database. We analyzed the associations between prior vaccination and geometric mean titers (GMT) at each time point using generalized linear regression on logged transformed titers, and seroprotection and seroconversion using Log-binomial regression. RESULTS At baseline, previously vaccinated participants (n = 203) had a significantly higher GMT and seroprotection against all three influenza strains than those previously unvaccinated (n = 167) (all p-values <0.001). Seroprotection rates were similar after one month in both groups for A(H1N1)pdm09 (adjusted risk ratio [aRR] 1.10, 95% CI 0.97-1.25), and A(H3N2) (aRR 1.08, 95% CI 0.87-1.33), but higher in previously vaccinated persons for B (aRR 1.20, 95% CI 1.08-1.32). At 12 months, 50% or more had seroprotection in previously vaccinated group with no difference between previously vaccinated or unvaccinated persons. Seroconversion was lower in the previously vaccinated group for A(H1N1)pdm09 (aRR 0.62, 95% CI 0.43-0.89), but did not differ between the two groups for A(H3N2) (aRR 0.94, 95% CI 0.69-1.28) and B (aRR 0.85, 95% CI 0.60-1.20). CONCLUSION Influenza vaccination elicited good humoral response in older Thai adults. While seroconversion seemed attenuated in persons previously vaccinated for influenza A(H1N1)pdm09 (the only vaccine strain not to change), this was not apparent for influenza A(H3N2) and B, and prior vaccination was not associated with any inhibition in seroprotection.
Collapse
Affiliation(s)
- Prabda Praphasiri
- Influenza Program, Thailand MOPH-US CDC Collaboration, Nonthaburi, Thailand
- * E-mail:
| | | | - Manash Shrestha
- Faculty of Social Sciences and Humanities, Mahidol University, Nakhon Pathom, Thailand
| | | | | | | | - Fatimah S. Dawood
- Influenza Division, US Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | - Supakit Sirilak
- Office of The Permanent Secretary, Ministry of Public Health, Nonthaburi, Thailand
| | - Joshua A. Mott
- Influenza Program, Thailand MOPH-US CDC Collaboration, Nonthaburi, Thailand
- Influenza Division, US Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| |
Collapse
|
21
|
Owusu D, Dawood FS, Azziz-Baumgartner E, Tinoco Y, Soto G, Gonzalez O, Cabrera S, Florian R, Llajaruna E, Hunt DR, Wesley MG, Yau T, Arriola CS. Effectiveness of Maternal Influenza Vaccination in Peru PRIME Cohort. Open Forum Infect Dis 2023; 10:ofad033. [PMID: 36817741 PMCID: PMC9927556 DOI: 10.1093/ofid/ofad033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 01/17/2023] [Indexed: 02/04/2023] Open
Abstract
Background Few studies have examined influenza vaccine effectiveness (VE) among women during pregnancy in middle-income countries. We used data from a prospective cohort of women who were pregnant in Peru to estimate effectiveness of the 2018 Southern Hemisphere influenza vaccine. Methods Women at <28 weeks gestation were enrolled from 4 tertiary level hospitals in Lima, Peru at the start of the 2018 influenza season and followed until the end of their pregnancies. Participants had mid-turbinate nasal swabs collected and tested for influenza by reverse-transcription polymerase chain reaction (RT-PCR) with onset of ≥1 of myalgia, cough, runny nose or nasal congestion, sore throat, or difficulty breathing. Time-varying Cox proportional hazard regression models were used to estimate the risk of RT-PCR-confirmed influenza infection after adjusting for inverse probability treatment weight. Results We followed 1896 women for a median of 127 days (interquartile range [IQR], 86-174). Participants had a median age of 29 years (IQR, 24-34). Among the 1896 women, 49% were vaccinated with the 2018 influenza vaccine and 1039 (55%) developed influenza-like illness, 76 (7%) of whom had RT-PCR-confirmed influenza. Incidence rates of RT-PCR-confirmed influenza were 36.6 and 15.3 per 100 000 person-days among women who were unvaccinated and vaccinated, respectively. Adjusted influenza VE was 22% (95% confidence interval, -64.1% to 62.9%). Conclusions Participants vaccinated against influenza had more than 50% lower incidence of RT-PCR-confirmed influenza illness. Although the VE estimated through propensity weight-adjusted time-varying Cox regression did not reach statistical significance, our findings provide additional evidence about the value of maternal influenza vaccination in middle-income countries.
Collapse
Affiliation(s)
- Daniel Owusu
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Fatimah S Dawood
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | - Yeny Tinoco
- U.S. Naval Medical Research Unit No. 6, Bellavista, Peru
| | - Giselle Soto
- U.S. Naval Medical Research Unit No. 6, Bellavista, Peru
| | | | | | | | | | | | - Meredith G Wesley
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- Abt Associates, Inc., Atlanta, Georgia, USA
| | - Tat Yau
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Carmen S Arriola
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| |
Collapse
|
22
|
Bendall EE, Paz-Bailey G, Santiago GA, Porucznik CA, Stanford JB, Stockwell MS, Duque J, Jeddy Z, Veguilla V, Major C, Rivera-Amill V, Rolfes MA, Dawood FS, Lauring AS. SARS-CoV-2 Genomic Diversity in Households Highlights the Challenges of Sequence-Based Transmission Inference. mSphere 2022; 7:e0040022. [PMID: 36377913 PMCID: PMC9769559 DOI: 10.1128/msphere.00400-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The reliability of sequence-based inference of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission is not clear. Sequence data from infections among household members can define the expected genomic diversity of a virus along a defined transmission chain. SARS-CoV-2 cases were identified prospectively among 2,369 participants in 706 households. Specimens with a reverse transcription-PCR cycle threshold of ≤30 underwent whole-genome sequencing. Intrahost single-nucleotide variants (iSNV) were identified at a ≥5% frequency. Phylogenetic trees were used to evaluate the relationship of household and community sequences. There were 178 SARS-CoV-2 cases in 706 households. Among 147 specimens sequenced, 106 yielded a whole-genome consensus with coverage suitable for identifying iSNV. Twenty-six households had sequences from multiple cases within 14 days. Consensus sequences were indistinguishable among cases in 15 households, while 11 had ≥1 consensus sequence that differed by 1 to 2 mutations. Sequences from households and the community were often interspersed on phylogenetic trees. Identification of iSNV improved inference in 2 of 15 households with indistinguishable consensus sequences and in 6 of 11 with distinct ones. In multiple-infection households, whole-genome consensus sequences differed by 0 to 1 mutations. Identification of shared iSNV occasionally resolved linkage, but the low genomic diversity of SARS-CoV-2 limits the utility of "sequence-only" transmission inference. IMPORTANCE We performed whole-genome sequencing of SARS-CoV-2 from prospectively identified cases in three longitudinal household cohorts. In a majority of multi-infection households, SARS-CoV-2 consensus sequences were indistinguishable, and they differed by 1 to 2 mutations in the rest. Importantly, even with modest genomic surveillance of the community (3 to 5% of cases sequenced), it was not uncommon to find community sequences interspersed with household sequences on phylogenetic trees. Identification of shared minority variants only occasionally resolved these ambiguities in transmission linkage. Overall, the low genomic diversity of SARS-CoV-2 limits the utility of "sequence-only" transmission inference. Our work highlights the need to carefully consider both epidemiologic linkage and sequence data to define transmission chains in households, hospitals, and other transmission settings.
Collapse
Affiliation(s)
- Emily E. Bendall
- Department of Microbiology and Immunology, University of Michigan, Ann Arbor, Michigan, USA
| | - Gabriela Paz-Bailey
- Centers for Disease Control and Preventiongrid.416738.f, Atlanta, Georgia, USA
| | | | - Christina A. Porucznik
- Division of Public Health, Department of Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Joseph B. Stanford
- Division of Public Health, Department of Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Melissa S. Stockwell
- Division of Child and Adolescent Health, Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, USA
- Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York, New York, USA
| | | | - Zuha Jeddy
- Abt Associates, Rockville, Maryland, USA
| | - Vic Veguilla
- Centers for Disease Control and Preventiongrid.416738.f, Atlanta, Georgia, USA
| | - Chelsea Major
- Centers for Disease Control and Preventiongrid.416738.f, Atlanta, Georgia, USA
| | - Vanessa Rivera-Amill
- Ponce Research Institute, Ponce Health Sciences University, Ponce, Puerto Rico, USA
| | - Melissa A. Rolfes
- Centers for Disease Control and Preventiongrid.416738.f, Atlanta, Georgia, USA
| | - Fatimah S. Dawood
- Centers for Disease Control and Preventiongrid.416738.f, Atlanta, Georgia, USA
| | - Adam S. Lauring
- Department of Microbiology and Immunology, University of Michigan, Ann Arbor, Michigan, USA
- Division of Infectious Diseases, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| |
Collapse
|
23
|
Hetrich MK, Oliva J, Wanionek K, Knoll MD, Lamore M, Esteban I, Veguilla V, Dawood FS, Karron RA. Epidemiology of human parainfluenza virus type 3 (HPIV-3) and respiratory syncytial virus (RSV) infections in the time of COVID-19: findings from a household cohort in Maryland. Clin Infect Dis 2022; 76:1349-1357. [PMID: 36503986 DOI: 10.1093/cid/ciac942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 11/28/2022] [Accepted: 12/08/2022] [Indexed: 12/14/2022] Open
Abstract
Abstract
Background
During the COVID-19 pandemic, human parainfluenza type 3 (HPIV-3) and respiratory syncytial virus (RSV) circulation increased as non-pharmaceutical interventions were relaxed. Using data from 175 households (n = 690 members) followed between November 2020–October 2021, we characterized
HPIV-3 and RSV burden in children aged 0-4 years and infection patterns in their households.
Methods
Households with ≥1 child aged 0-4 years were enrolled and members collected weekly nasal swabs (NS) and additional swabs with COVID-like illness onset. We tested all NS from symptomatic episodes in children aged 0-4 years for HPIV-3, RSV, and SARS-CoV-2 by reverse-transcriptase polymerase chain reaction (RT-PCR). Among children with HPIV-3 or RSV infection, we tested all contemporaneous NS collected from household members. We compared incidence rates (IRs) of symptomatic infection with each virus among children aged 0-4 years during epidemic periods, identified household primary infections as the earliest detected infection, and examined community exposures associated with primary infection.
Results
Overall, 41/175 (23.4%) households had individuals with HPIV-3 (n = 45) or RSV (n = 46) infections. Among children aged 0-4 years, IRs of symptomatic infection/1,000 person-weeks were 8.7[6.0, 12.2] for HPIV-3, 7.6[4.8, 11.4] for RSV, and 1.9[1.0, 3.5] for SARS-CoV-2. 35/36 primary HPIV-3 or RSV infections occurred in children aged 0-4 years. Children with childcare/preschool attendance had higher odds of primary infection (OR = 10.81, 95% CI: 3.14-37.23).
Conclusion
Among children aged 0-4 years in this cohort, IRs of symptomatic HPIV-3 and RSV infection were four-fold higher than for SARS-CoV-2 during epidemic periods. HPIV-3 and RSV were almost exclusively introduced into households by infants and preschool children.
Collapse
Affiliation(s)
- Marissa K Hetrich
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University , Baltimore, MD , USA
| | - Jennifer Oliva
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University , Baltimore, MD , USA
| | - Kimberli Wanionek
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University , Baltimore, MD , USA
| | - Maria Deloria Knoll
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University , Baltimore, MD , USA
| | - Matthew Lamore
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University , Baltimore, MD , USA
| | - Ignacio Esteban
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University , Baltimore, MD , USA
- INFANT Foundation , Buenos Aires , Argentina
| | - Vic Veguilla
- Centers for Disease Control and Prevention , Atlanta, GA , USA
| | | | - Ruth A Karron
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University , Baltimore, MD , USA
| | | |
Collapse
|
24
|
Wielgosz K, Dawood FS, Stockwell MS, Varner M, Newes-Adeyi G, Ellington S, Vargas C, Bruno AM, Powers E, Morrill T, Reichle L, Battarbee AN, Tita AT. Agreement Between Pregnant Individuals' Self-Report of Coronavirus Disease 2019 (COVID-19) Vaccination and Medical Record Documentation. Obstet Gynecol 2022; 140:989-992. [PMID: 36357976 PMCID: PMC10563869 DOI: 10.1097/aog.0000000000004994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 09/15/2022] [Indexed: 11/13/2022]
Abstract
For public health research such as vaccine uptake or effectiveness assessments, self-reported coronavirus disease 2019 (COVID-19) vaccination status may be a more efficient measure than verifying vaccination status from medical records if agreement between sources is high. We assessed agreement between self-reported and medical record-documented COVID-19 vaccination status among pregnant individuals followed in a cohort during August 2020-October 2021. At end of pregnancy, participants completed questionnaires about COVID-19 vaccine receipt during pregnancy; staff verified vaccination status using medical records. Agreement was assessed between self-reported and medical record vaccination status using Cohen's kappa. There was high agreement between self-reported and medical record vaccination status (Kappa coefficient=0.94, 95% CI 0.91-0.98), suggesting that self-report may be acceptable for ascertaining COVID-19 vaccination status during pregnancy.
Collapse
Affiliation(s)
| | | | - Melissa S. Stockwell
- Division of Child and Adolescent Health, Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons, New York, NY
- Department of Population and Family Health, Mailman School of Public Health, Columbia University Irving Medical Center, New York, NY
| | - Michael Varner
- Department of Obstetrics and Gynecology, Department of Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City, UT
| | | | | | - Celibell Vargas
- Division of Child and Adolescent Health, Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons, New York, NY
| | - Ann M. Bruno
- Department of Obstetrics and Gynecology, Department of Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City, UT
| | - Emily Powers
- Department of Obstetrics and Gynecology, Department of Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City, UT
| | | | | | - Ashley N. Battarbee
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL
- Center for Women’s Reproductive Health, University of Alabama at Birmingham, Birmingham, AL
| | - Alan T. Tita
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL
- Center for Women’s Reproductive Health, University of Alabama at Birmingham, Birmingham, AL
| |
Collapse
|
25
|
Ricks PM, Njie GJ, Dawood FS, Blain AE, Winstead A, Popoola A, Jones C, Li C, Fuller J, Anantharam P, Olson N, Walker AT, Biggerstaff M, Marston BJ, Arthur RR, Bennett SD, Moolenaar RL. Lessons Learned from CDC's Global COVID-19 Early Warning and Response Surveillance System. Emerg Infect Dis 2022; 28:S8-S16. [PMID: 36502410 DOI: 10.3201/eid2813.212544] [Citation(s) in RCA: 1] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Early warning and response surveillance (EWARS) systems were widely used during the early COVID-19 response. Evaluating the effectiveness of EWARS systems is critical to ensuring global health security. We describe the Centers for Disease Control and Prevention (CDC) global COVID-19 EWARS (CDC EWARS) system and the resources CDC used to gather, manage, and analyze publicly available data during the prepandemic period. We evaluated data quality and validity by measuring reporting completeness and compared these with data from Johns Hopkins University, the European Centre for Disease Prevention and Control, and indicator-based data from the World Health Organization. CDC EWARS was integral in guiding CDC's early COVID-19 response but was labor-intensive and became less informative as case-level data decreased and the pandemic evolved. However, CDC EWARS data were similar to those reported by other organizations, confirming the validity of each system and suggesting collaboration could improve EWARS systems during future pandemics.
Collapse
|
26
|
Quesada MG, Hetrich MK, Zeger S, Sharma J, Na YB, Veguilla V, Karron RA, Dawood FS, Knoll MD, Council-DiBitetto C, Ghasri T, Gormley A, Gatto M, Herbert K, Jordan M, Loehr K, Morsell J, Oliva J, Mateo JS, Schappell E, Smith K, Wanionek K, Weadon C, Williams-Soro P, Woods S. Predictors of SARS-CoV-2 seropositivity prior to COVID-19 vaccination among children 0-4 years and their household members in the SEARCh Study. Open Forum Infect Dis 2022; 9:ofac507. [PMID: 36324323 PMCID: PMC9619557 DOI: 10.1093/ofid/ofac507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 09/28/2022] [Indexed: 11/24/2022] Open
Abstract
Background Estimates of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) seroprevalence in young children and risk factors for seropositivity are scarce. Using data from a prospective cohort study of households during the pre-coronavirus disease 2019 (COVID-19) vaccine period, we estimated SARS-CoV-2 seroprevalence by age and evaluated risk factors for SARS-CoV-2 seropositivity. Methods The SARS-CoV-2 Epidemiology and Response in Children (SEARCh) study enrolled 175 Maryland households (690 participants) with ≥1 child aged 0–4 years during November 2020–March 2021; individuals vaccinated against COVID-19 were ineligible. At enrollment, participants completed questionnaires about sociodemographic and health status and work, school, and daycare attendance. Participants were tested for SARS-CoV-2 antibodies in sera. Logistic regression models with generalized estimating equations (GEE) to account for correlation within households assessed predictors of individual- and household-level SARS-CoV-2 seropositivity. Results Of 681 (98.7%) participants with enrollment serology results, 55 (8.1%; 95% confidence interval [CI], 6.3%–10.4%) participants from 21 (12.0%) households were seropositive for SARS-CoV-2. Among seropositive participants, fewer children than adults reported being tested for SARS-CoV-2 infection before enrollment (odds ratio [OR] = 0.23; 95% CI, .06–.73). Seropositivity was similar by age (GEE OR vs 0–4 years: 1.19 for 5–17 years, 1.36 for adults; P = .16) and was significantly higher among adults working outside the home (GEE adjusted OR = 2.2; 95% CI, 1.1–4.4) but not among children attending daycare or school. Conclusions Before study enrollment, children and adults in this cohort had similar rates of SARS-CoV-2 infection as measured by serology. An adult household member working outside the home increased a household's odds of SARS-CoV-2 infection, whereas a child attending daycare or school in person did not.
Collapse
Affiliation(s)
- Maria Garcia Quesada
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University , Baltimore, MD , USA
| | - Marissa K Hetrich
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University , Baltimore, MD , USA
| | - Scott Zeger
- Department of Biostatistics, Bloomberg School of Public Health, Johns Hopkins University , Baltimore, MD , USA
| | - Jayati Sharma
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University , Baltimore, MD , USA
| | - Yu Bin Na
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University , Baltimore, MD , USA
| | - Vic Veguilla
- Centers for Disease Control and Prevention , Atlanta, GA , USA
| | - Ruth A Karron
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University , Baltimore, MD , USA
| | | | - Maria D Knoll
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University , Baltimore, MD , USA
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
27
|
Gaglani M, Kim SS, Naleway AL, Levine MZ, Edwards L, Murthy K, Dunnigan K, Zunie T, Groom H, Ball S, Jeddy Z, Hunt D, Wesley MG, Sambhara S, Gangappa S, Grant L, Cao W, Gross FL, Mishina M, Fry AM, Thompson MG, Dawood FS, Flannery B. Effect of Repeat Vaccination on Immunogenicity of Quadrivalent Cell-Culture and Recombinant Influenza Vaccines Among Healthcare Personnel Aged 18-64 Years: A Randomized, Open-Label Trial. Clin Infect Dis 2022; 76:e1168-e1176. [PMID: 36031405 PMCID: PMC9907492 DOI: 10.1093/cid/ciac683] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 08/10/2022] [Accepted: 08/19/2022] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Antibody responses to non-egg-based standard-dose cell-culture influenza vaccine (containing 15 µg hemagglutinin [HA]/component) and recombinant vaccine (containing 45 µg HA/component) during consecutive seasons have not been studied in the United States. METHODS In a randomized trial of immunogenicity of quadrivalent influenza vaccines among healthcare personnel (HCP) aged 18-64 years over 2 consecutive seasons, HCP who received recombinant-HA influenza vaccine (RIV) or cell culture-based inactivated influenza vaccine (ccIIV) during the first season (year 1) were re-randomized the second season of 2019-2020 (year 2 [Y2]) to receive ccIIV or RIV, resulting in 4 ccIIV/RIV combinations. In Y2, hemagglutination inhibition antibody titers against reference cell-grown vaccine viruses were compared in each ccIIV/RIV group with titers among HCP randomized both seasons to receive egg-based, standard-dose inactivated influenza vaccine (IIV) using geometric mean titer (GMT) ratios of Y2 post-vaccination titers. RESULTS Y2 data from 414 HCP were analyzed per protocol. Compared with 60 IIV/IIV recipients, 74 RIV/RIV and 106 ccIIV/RIV recipients showed significantly elevated GMT ratios (Bonferroni corrected P < .007) against all components except A(H3N2). Post-vaccination GMT ratios for ccIIV/ccIIV and RIV/ccIIV were not significantly elevated compared with IIV/IIV except for RIV/ccIIV against A(H1N1)pdm09. CONCLUSIONS In adult HCP, receipt of RIV in 2 consecutive seasons or the second season was more immunogenic than consecutive egg-based IIV for 3 of the 4 components of quadrivalent vaccine. Immunogenicity of ccIIV/ccIIV was similar to that of IIV/IIV. Differences in HA antigen content may play a role in immunogenicity of influenza vaccination in consecutive seasons. CLINICAL TRIALS REGISTRATION NCT03722589.
Collapse
Affiliation(s)
- Manjusha Gaglani
- Correspondence: M. Gaglani, 2401 S. 31st St, MS-CK-300, Temple, TX 76508 ()
| | - Sara S Kim
- Influenza Division of the National Center for Immunization and Respiratory Diseases (NCIRD), Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Allison L Naleway
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon, USA
| | - Min Z Levine
- Influenza Division of the National Center for Immunization and Respiratory Diseases (NCIRD), Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | - Kempapura Murthy
- Department of Pediatrics, Baylor Scott & White Health, Temple, Texas, USA
| | - Kayan Dunnigan
- Department of Pediatrics, Baylor Scott & White Health, Temple, Texas, USA
| | - Tnelda Zunie
- Department of Pediatrics, Baylor Scott & White Health, Temple, Texas, USA
| | - Holly Groom
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon, USA
| | | | | | | | | | - Suryaprakash Sambhara
- Influenza Division of the National Center for Immunization and Respiratory Diseases (NCIRD), Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Shivaprakash Gangappa
- Influenza Division of the National Center for Immunization and Respiratory Diseases (NCIRD), Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Lauren Grant
- Influenza Division of the National Center for Immunization and Respiratory Diseases (NCIRD), Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Weiping Cao
- Influenza Division of the National Center for Immunization and Respiratory Diseases (NCIRD), Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - F Liaini Gross
- Influenza Division of the National Center for Immunization and Respiratory Diseases (NCIRD), Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Margarita Mishina
- Influenza Division of the National Center for Immunization and Respiratory Diseases (NCIRD), Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Alicia M Fry
- Influenza Division of the National Center for Immunization and Respiratory Diseases (NCIRD), Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Mark G Thompson
- Influenza Division of the National Center for Immunization and Respiratory Diseases (NCIRD), Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Fatimah S Dawood
- Influenza Division of the National Center for Immunization and Respiratory Diseases (NCIRD), Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | |
Collapse
|
28
|
Delahoy MJ, Munoz F, Li DK, Arriola CS, Bond NL, Daugherty M, Ferber J, Ferguson N, Hadden L, Henderson JT, Irving SA, Juergens M, Kancharla V, Greenberg M, Odouli R, Newes-Adeyi G, Nicholson EG, Reichle L, Sanyang M, Snead M, Dawood FS, Naleway AL. Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Testing and Detection During Peripartum Hospitalizations Among a Multicenter Cohort of Pregnant Persons: March 2020-February 2021. Clin Infect Dis 2022; 76:e51-e59. [PMID: 35959949 PMCID: PMC9384720 DOI: 10.1093/cid/ciac657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 08/02/2022] [Accepted: 08/10/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Identifying severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections during peripartum hospitalizations is important to guide care, implement prevention measures, and understand infection burden. METHODS This cross-sectional analysis used electronic health record data from hospitalizations during which pregnancies ended (peripartum hospitalizations) among a cohort of pregnant persons at 3 US integrated healthcare networks (sites 1-3). Maternal demographic, medical encounter, SARS-CoV-2 testing, and pregnancy and neonatal outcome information was extracted for persons with estimated delivery and pregnancy end dates during March 2020-February 2021 and ≥1 antenatal care record. Site-stratified multivariable logistic regression was used to identify factors associated with testing and compare pregnancy and neonatal outcomes among persons tested. RESULTS Among 17 858 pregnant persons, 10 863 (60.8%) had peripartum SARS-CoV-2 testing; 222/10 683 (2.0%) had positive results. Testing prevalence varied by site and was lower during March-May 2020. Factors associated with higher peripartum SARS-CoV-2 testing odds were Asian race (adjusted odds ratio [aOR]: 1.36; 95% confidence interval [CI]: 1.03-1.79; referent: White) (site 1), Hispanic or Latino ethnicity (aOR: 1.33; 95% CI: 1.08-1.64) (site 2), peripartum Medicaid coverage (aOR: 1.33; 95% CI: 1.06-1.66) (site 1), and preterm hospitalization (aOR: 1.69; 95% CI: 1.19-2.39 [site 1]; aOR: 1.39; 95% CI: 1.03-1.88 [site 2]). CONCLUSIONS Findings highlight potential disparities in SARS-CoV-2 peripartum testing by demographic and pregnancy characteristics. Testing practice variations should be considered when interpreting studies relying on convenience samples of pregnant persons testing positive for SARS-CoV-2. Efforts to address testing differences between groups could improve equitable testing practices and care for pregnant persons with SARS-CoV-2 infections.
Collapse
Affiliation(s)
- Miranda J Delahoy
- Corresponding Author: Miranda J. Delahoy, Centers for Disease Control and Prevention, 1600 Clifton Rd MS H24-7, Atlanta, GA 30329, USA;
| | - Flor Munoz
- Baylor College of Medicine, Houston, TX, USA
| | - De Kun Li
- Kaiser Permanente Northern California, Oakland, CA, USA
| | - Carmen Sofia Arriola
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Michael Daugherty
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | | | | | | | - Stephanie A Irving
- Center for Health Research, Kaiser Permanente Northwest, Portland, OR, USA
| | | | | | - Mara Greenberg
- Department of Obstetrics and Gynecology, Kaiser Permanente Oakland Medical Center, Oakland, CA, USA
| | - Roxana Odouli
- Kaiser Permanente Northern California, Oakland, CA, USA
| | | | | | | | | | - Margaret Snead
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Fatimah S Dawood
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Allison L Naleway
- Center for Health Research, Kaiser Permanente Northwest, Portland, OR, USA
| |
Collapse
|
29
|
Sumner KM, Karron RA, Stockwell MS, Dawood FS, Stanford JB, Mellis A, Hacker E, Thind P, Castro MJE, Harris JP, Knoll MD, Schappell E, Hetrich MK, Duque J, Jeddy Z, Altunkaynak K, Poe B, Meece J, Stefanski E, Tong S, Lee JS, Dixon A, Veguilla V, Rolfes MA, Porucznik CA. Impact of age and symptom development on SARS-CoV-2 transmission in households with children—Maryland, New York, and Utah, August 2020–October 2021. Open Forum Infect Dis 2022; 9:ofac390. [PMID: 35991589 PMCID: PMC9384637 DOI: 10.1093/ofid/ofac390] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 08/05/2022] [Indexed: 11/13/2022] Open
Abstract
ABSTRACT
Background
Households are common places for spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We investigated factors associated with household transmission and acquisition of SARS-CoV-2.
Methods
Households with children ages <18 years were enrolled into prospective, longitudinal cohorts and followed August 2020─August 2021 in Utah, September 2020─August 2021 in New York City, and November 2020─October 2021 in Maryland. Participants self-collected nasal swabs weekly and with onset of acute illness. Swabs were tested for SARS-CoV-2 using reverse-transcription polymerase chain reaction. We assessed factors associated with SARS-CoV-2 acquisition using a multi-level logistic regression adjusted for household size and clustering and SARS-CoV-2 transmission using a logistic regression adjusted for household size.
Results
Among 2,053 people (513 households) enrolled, 180 people (8.8%; in 76 households) tested positive for SARS-CoV-2. Compared to children <12y, odds of acquiring infection were lower for adults ≥18y (adjusted odds ratio[aOR]:0.34, 95% confidence interval[CI]:0.14–0.87); however, this may reflect vaccination status, which protected against SARS-CoV-2 acquisition (aOR:0.17, 95%CI:0.03–0.91). Odds of onward transmission was similar between symptomatic and asymptomatic primary cases (aOR:1.00, 95%CI:0.35–2.93) and did not differ by age (12–17vs. < 12y aOR:1.08, 95%CI:0.20–5.62; ≥18vs. < 12y aOR:1.70, 95%CI:0.52–5.83).
Conclusions
Adults had lower odds of acquiring SARS-CoV-2 compared to children, but this association might be influenced by COVID-19 vaccination, which was primarily available for adults and protective against infection. In contrast, all ages, regardless of symptoms and COVID-19 vaccination, had similar odds of transmitting SARS-CoV-2. Findings underscore the importance of SARS-CoV-2 mitigation measures for persons of all ages.
Collapse
Affiliation(s)
- Kelsey M Sumner
- Centers for Disease Control and Prevention COVID-19 Response , Atlanta, GA , USA
- Epidemic Intelligence Service, Centers for Disease Control and Prevention , Atlanta, GA , USA
| | - Ruth A Karron
- Center for Immunization Research, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University , Baltimore, MD , USA
| | - Melissa S Stockwell
- Division of Child and Adolescent Health, Department of Pediatrics, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center , New York, NY , USA
- Department of Population and Family Health, Mailman School of Public Health, Columbia University Irving Medical Center , New York, NY , USA
| | - Fatimah S Dawood
- Centers for Disease Control and Prevention COVID-19 Response , Atlanta, GA , USA
| | - Joseph B Stanford
- Division of Public Health, Department of Family and Preventive Medicine, University of Utah School of Medicine , Salt Lake City, UT , USA
| | - Alexandra Mellis
- Centers for Disease Control and Prevention COVID-19 Response , Atlanta, GA , USA
| | - Emily Hacker
- Division of Public Health, Department of Family and Preventive Medicine, University of Utah School of Medicine , Salt Lake City, UT , USA
| | - Priyam Thind
- Division of Child and Adolescent Health, Department of Pediatrics, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center , New York, NY , USA
| | - Maria Julia E Castro
- Division of Child and Adolescent Health, Department of Pediatrics, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center , New York, NY , USA
| | - John Paul Harris
- Division of Child and Adolescent Health, Department of Pediatrics, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center , New York, NY , USA
| | - Maria Deloria Knoll
- International Vaccine Access Center, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University , Baltimore, MD , USA
| | - Elizabeth Schappell
- Center for Immunization Research, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University , Baltimore, MD , USA
| | - Marissa K Hetrich
- International Vaccine Access Center, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University , Baltimore, MD , USA
| | | | | | | | | | - Jennifer Meece
- Marshfield Clinic Research Institute , Marshfield, WI , USA
| | | | - Suxiang Tong
- Centers for Disease Control and Prevention COVID-19 Response , Atlanta, GA , USA
| | - Justin S Lee
- Centers for Disease Control and Prevention COVID-19 Response , Atlanta, GA , USA
| | - Ashton Dixon
- Centers for Disease Control and Prevention COVID-19 Response , Atlanta, GA , USA
| | - Vic Veguilla
- Centers for Disease Control and Prevention COVID-19 Response , Atlanta, GA , USA
| | - Melissa A Rolfes
- Centers for Disease Control and Prevention COVID-19 Response , Atlanta, GA , USA
| | - Christina A Porucznik
- Division of Public Health, Department of Family and Preventive Medicine, University of Utah School of Medicine , Salt Lake City, UT , USA
| | | | | |
Collapse
|
30
|
Karron RA, Hetrich MK, Na YB, Knoll MD, Schappell E, Meece J, Hanson E, Tong S, Lee JS, Veguilla V, Dawood FS. Assessment of Clinical and Virological Characteristics of SARS-CoV-2 Infection Among Children Aged 0 to 4 Years and Their Household Members. JAMA Netw Open 2022; 5:e2227348. [PMID: 36044218 PMCID: PMC9434363 DOI: 10.1001/jamanetworkopen.2022.27348] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
IMPORTANCE Few studies have prospectively assessed SARS-CoV-2 community infection in children aged 0 to 4 years. Information about SARS-CoV-2 incidence and clinical and virological features in young children could help guide prevention and mitigation strategies. OBJECTIVE To assess SARS-CoV-2 incidence, clinical and virological features, and symptoms in a prospective household cohort and to compare viral load by age group, symptoms, and SARS-CoV-2 lineage in young children, older children, and adults. DESIGN, SETTING, AND PARTICIPANTS This prospective cohort study enrolled 690 participants from 175 Maryland households with 1 or more children aged 0 to 4 years between November 24, 2020, and October 15, 2021. For 8 months after enrollment, participants completed weekly symptom questionnaires and submitted self-collected nasal swabs for SARS-CoV-2 qualitative real-time reverse transcriptase polymerase chain reaction (RT-PCR) testing, quantitative RT-PCR testing, and viral lineage determination. For the analyses, SARS-CoV-2 Alpha and Delta lineages were considered variants of interest or concern. Sera collected at enrollment and at approximately 4 months and 8 months after enrollment were assayed for SARS-CoV-2 spike and nucleocapsid protein antibodies. MAIN OUTCOMES AND MEASURES Incidence, clinical and virological characteristics, and symptoms of SARS-CoV-2 infection by age group and correlations between (1) highest detected viral load and symptom frequency and (2) highest detected viral load and SARS-CoV-2 lineage. RESULTS Among 690 participants (355 [51.4%] female and 335 [48.6%] male), 256 individuals (37.1%) were children aged 0 to 4 years, 100 (14.5%) were children aged 5 to 17 years, and 334 (48.4%) were adults aged 18 to 74 years. A total of 15 participants (2.2%) were Asian, 24 (3.5%) were Black, 603 (87.4%) were White, 43 (6.2%) were multiracial, and 5 (0.7%) were of other races; 33 participants (4.8%) were Hispanic, and 657 (95.2%) were non-Hispanic. Overall, 54 participants (7.8%) had SARS-CoV-2 infection during the surveillance period, including 22 of 256 children (8.6%) aged 0 to 4 years, 11 of 100 children (11.0%) aged 5 to 17 years, and 21 of 334 adults (6.3%). Incidence rates per 1000 person-weeks were 2.25 (95% CI, 1.28-3.65) infections among children aged 0 to 4 years, 3.48 (95% CI, 1.59-6.61) infections among children aged 5 to 17 years, and 1.08 (95% CI, 0.52-1.98) infections among adults. Children aged 0 to 17 years with SARS-CoV-2 infection were more frequently asymptomatic (11 of 30 individuals [36.7%]) compared with adults (3 of 21 individuals [14.3%]), with children aged 0 to 4 years most frequently asymptomatic (7 of 19 individuals [36.8%]). The highest detected viral load did not differ between asymptomatic vs symptomatic individuals overall (median [IQR], 2.8 [1.5-3.3] log10 copies/mL vs 2.8 [1.8-4.4] log10 copies/mL) or by age group (median [IQR] for ages 0-4 years, 2.7 [2.4-4.4] log10 copies/mL; ages 5-17 years: 2.4 [1.1-4.0] log10 copies/mL; ages 18-74 years: 2.9 [1.9-4.6] log10 copies/mL). The number of symptoms was significantly correlated with viral load among adults (R = 0.69; P < .001) but not children (ages 0-4 years: R = 0.02; P = .91; ages 5-17 years: R = 0.18; P = .58). The highest detected viral load was greater among those with Delta variant infections (median [IQR], 4.4 [3.9-5.1] log10 copies/mL) than those with infections from variants not of interest or concern (median [IQR], 1.9 [1.1-3.6] log10 copies/mL; P = .009) or those with Alpha variant infections (median [IQR], 2.6 [2.3-3.4] log10 copies/mL; P = .006). CONCLUSIONS AND RELEVANCE In this study, SARS-CoV-2 infections were frequently asymptomatic among children aged 0 to 4 years; the presence and number of symptoms did not correlate with viral load. These findings suggest that symptom screening may be insufficient to prevent outbreaks involving young children.
Collapse
Affiliation(s)
- Ruth A. Karron
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Marissa K. Hetrich
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Yu Bin Na
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Maria Deloria Knoll
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Elizabeth Schappell
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Jennifer Meece
- Marshfield Clinic Research Institute, Marshfield, Wisconsin
| | | | - Suxiang Tong
- COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Justin S. Lee
- COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Vic Veguilla
- COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Fatimah S. Dawood
- COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, Georgia
| |
Collapse
|
31
|
Veguilla V, Fowlkes AL, Bissonnette A, Beitel S, Gaglani M, Porucznik CA, Stockwell MS, Tyner HL, Naleway AL, Yoon SK, Caban-Martinez AJ, Wesley MG, Duque J, Jeddy Z, Stanford JB, Daugherty M, Dixon A, Burgess JL, Odean M, Groom HC, Phillips AL, Schaefer-Solle N, Mistry P, Rolfes MA, Thompson M, Dawood FS, Meece J. Detection and Stability of SARS-CoV-2 in Three Self-Collected Specimen Types: Flocked Midturbinate Swab (MTS) in Viral Transport Media, Foam MTS, and Saliva. Microbiol Spectr 2022; 10:e0103322. [PMID: 35665629 PMCID: PMC9241800 DOI: 10.1128/spectrum.01033-22] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 05/19/2022] [Indexed: 11/20/2022] Open
Abstract
Respiratory specimen collection materials shortages hampers severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) testing. We compared specimen alternatives and evaluated SARS-CoV-2 RNA stability under simulated shipping conditions. We compared concordance of RT-PCR detection of SARS-CoV-2 from flocked midturbinate swabs (MTS) in viral transport media (VTM), foam MTS without VTM, and saliva. Specimens were collected between August 2020 and April 2021 from three prospective cohorts. We compared RT-PCR cycle quantification (Cq) for Spike (S), Nucleocapsid (N), and the Open Reading Frame 1ab (ORF) genes for flocked MTS and saliva specimens tested before and after exposure to a range of storage temperatures (4-30°C) and times (2, 3, and 7 days). Of 1,900 illnesses with ≥2 specimen types tested, 335 (18%) had SARS-CoV-2 detected in ≥1 specimen; 304 (91%) were concordant across specimen types. Among illnesses with SARS-CoV-2 detection, 97% (95% confidence interval [CI]: 94-98%) were positive on flocked MTS, 99% (95% CI: 97-100%) on saliva, and 89% (95% CI: 84-93%) on foam MTS. SARS-CoV-2 RNA was detected in flocked MTS and saliva stored up to 30°C for 7 days. All specimen types provided highly concordant SARS-CoV-2 results. These findings support a range of viable options for specimen types, collection, and transport methods that may facilitate SARS-CoV-2 testing during supply and personnel shortages. IMPORTANCE Findings from this analysis indicate that (1) self-collection of flocked and foam MTS and saliva samples is feasible in both adults and children, (2) foam MTS with VTM and saliva are both viable and reasonable alternatives to traditional flocked MTS in VTM for SARS-CoV-2 detection, and (3) these sample types may be stored and transported at ambient temperatures for up to 7 days without compromising sample quality. These findings support methods of sample collection for SARS-CoV-2 detection that may facilitate widespread community testing in the setting of supply and personnel shortages during the current pandemic.
Collapse
Affiliation(s)
- Vic Veguilla
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | - Adam Bissonnette
- Integrated Research & Development Laboratory, Marshfield Clinic Research Institute, Marshfield, Wisconsin, USA
| | - Shawn Beitel
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona, USA
| | - Manjusha Gaglani
- Baylor Scott and White Health, Temple, Texas, USA
- Texas A&M University College of Medicine, Temple, Texas, USA
| | - Christina A. Porucznik
- Division of Public Health, Department of Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Melissa S. Stockwell
- Division of Child and Adolescent Health, Department of Pediatrics, Columbia University Irving Medical Center, New York, New York, USA
- Department of Population and Family Health, Mailman School of Public Health, Columbia University Irving Medical Center, New York, New York, USA
| | | | - Allison L. Naleway
- Kaiser Permanente Northwest Center for Health Research, Portland, Oregon, USA
| | - Sarang K. Yoon
- Division of Public Health, Department of Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | | | | | - Jazmin Duque
- Abt Associates, Inc., Cambridge, Massachusetts, USA
| | - Zuha Jeddy
- Abt Associates, Inc., Cambridge, Massachusetts, USA
| | - Joseph B. Stanford
- Division of Public Health, Department of Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | | | - Ashton Dixon
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Jefferey L. Burgess
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona, USA
| | - Marilyn Odean
- St. Luke’s Regional Health Care System, Duluth, Minnesota, USA
- The Whiteside Institute for Clinical Research, Duluth, Minnesota, USA
| | - Holly C. Groom
- Kaiser Permanente Northwest Center for Health Research, Portland, Oregon, USA
| | - Andrew L. Phillips
- Division of Public Health, Department of Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | | | | | | | - Mark Thompson
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | - Jennifer Meece
- Integrated Research & Development Laboratory, Marshfield Clinic Research Institute, Marshfield, Wisconsin, USA
| |
Collapse
|
32
|
Arriola CS, Li DK, Muñoz F, Daugherty M, Doughty-Skierski C, Ellington S, Ferber J, Ferguson N, Greenberg M, Hadden L, Henderson JT, Irving SA, Juergens M, Kancharla V, Naleway AL, Newes-Adeyi G, Nicholson E, Odouli R, Reichle L, Sanyang M, Dawood FS. Factors Associated with Hospitalization with Symptomatic COVID-19 Illness Among Pregnant Individuals: A Multi-Center Retrospective Cohort Study. Open Forum Infect Dis 2022. [PMCID: PMC9278221 DOI: 10.1093/ofid/ofac308] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background Pregnant individuals are at increased risk of COVID-19 hospitalization and death, and primary and booster COVID-19 vaccination is recommended for this population. Methods Among a cohort of pregnant individuals who received prenatal care at three healthcare systems in the United States, we estimated the cumulative incidence of hospitalization with symptomatic COVID-19 illness. We also identified factors associated with COVID-19 hospitalization using a multivariable Cox proportional-hazards model with pregnancy weeks as the timescale and a time-varying adjustor that accounted for SARS-CoV-2 circulation; model covariates included site, age, race, ethnicity, insurance status, pre-pregnancy weight status, and selected underlying medical conditions. Data were collected primarily through medical record extraction. Results Among 19,456 pregnant individuals with an estimated due date March 1, 2020-February 28, 2021, 75 (0.4%) were hospitalized with symptomatic COVID-19. Factors associated with hospitalization for symptomatic COVID-19 were Hispanic ethnicity (aHR: 2.7; 95% CI: 1.3,5.5), native Hawaiian or Pacific Islander race (aHR: 12; 95% CI: 3.2,45.5), age <25 years (aHR: 3.1; 95% CI: 1.3,7.6), pre-pregnancy obesity (aHR: 2.1; 95% CI: 1.1,3.9), diagnosis of a metabolic disorder (aHR: 2.2; 95% CI: 1.2,3.8), lung disease excluding asthma (aHR: 49; 95% CI: 28,84) and cardiovascular disease (aHR: 2.6; 95% CI: 1.5,4.7). Conclusion Although hospitalization with symptomatic COVID-19 was uncommon, pregnant individuals should be aware of risk factors associated with severe illness when considering COVID-19 vaccination.
Collapse
Affiliation(s)
| | - De Kun Li
- Kaiser Permanente Northern California , Oakland, California , USA
| | - Flor Muñoz
- Baylor College of Medicine , Houston, Texas , USA
| | | | | | - Sascha Ellington
- Centers for Disease Control and Prevention , Atlanta, Georgia , USA
| | - Jeannette Ferber
- Kaiser Permanente Northern California , Oakland, California , USA
| | | | - Mara Greenberg
- Kaiser Permanente Northern California , Oakland, California , USA
| | | | - Jillian T Henderson
- Center for Health Research , Kaiser Permanente Northwest, Portland, Oregon , USA
| | - Stephanie A Irving
- Center for Health Research , Kaiser Permanente Northwest, Portland, Oregon , USA
| | | | | | - Allison L Naleway
- Center for Health Research , Kaiser Permanente Northwest, Portland, Oregon , USA
| | | | | | - Roxana Odouli
- Centers for Disease Control and Prevention , Atlanta, Georgia , USA
| | | | - Mo Sanyang
- Baylor College of Medicine , Houston, Texas , USA
| | - Fatimah S Dawood
- Centers for Disease Control and Prevention , Atlanta, Georgia , USA
| |
Collapse
|
33
|
Regan AK, Wesley MG, Gaglani M, Kim SS, Edwards LJ, Murthy K, Jeddy Z, Naleway AL, Flannery B, Dawood FS, Groom H. Consistency of self-reported and documented historical influenza vaccination status of US healthcare workers. Influenza Other Respir Viruses 2022; 16:881-890. [PMID: 35415884 PMCID: PMC9343323 DOI: 10.1111/irv.12988] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 03/11/2022] [Accepted: 03/13/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Healthcare personnel (HCP) are a priority group for annual influenza vaccination. Few studies have assessed the validity of recall of prior influenza vaccination status among HCP, especially for more than one preceding season. METHODS Using data from a randomized controlled trial of influenza vaccination among 947 HCP from two US healthcare systems, we assessed agreement between participant self-report and administrative record documentation of influenza vaccination status during the preceding five influenza seasons; kappa coefficients and sensitivity values were calculated. Administrative record documentation was considered the gold standard. Documented vaccination sources included electronic medical records, employee health records, outside immunization providers, and the state immunization information system. RESULTS Among 683 HCP with prior influenza immunization information, 89.7% (95% CI: 87.2%, 91.9%) of HCP were able to self-report their vaccination status for the season preceding the survey. By the fifth preceding season, 82.6% (95% CI: 79.5%, 85.3%) of HCP were able to self-report. Among HCP who self-reported their vaccination status, agreement between self-report and documented vaccination status ranged from 81.9% (95% CI: 77.2%, 86.7%) for the fifth season to 90.5% (95% CI: 87.2%, 93.9%) for the season preceding interview. HCP who received vaccine for only some of the preceding five seasons (18.3%) more commonly had ≥2 errors in their recall compared with those vaccinated all five preceding seasons (55.7% vs. 4.3%). CONCLUSIONS Self-reported vaccination status is a reliable source for historical influenza vaccination information among HCP who are consistently vaccinated but less reliable for those with a history of inconsistent vaccination.
Collapse
Affiliation(s)
- Annette K Regan
- School of Nursing and Health Professions, University of San Francisco, Orange, California, USA.,Department of Epidemiology, Fielding School of Public Health, University of California Los Angeles, Los Angeles, California, USA.,Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Nedlands, Western Australia, Australia.,School of Public Health, Texas A&M University, College Station, Texas, USA
| | - Meredith G Wesley
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.,Abt Associates, Atlanta, Georgia, USA
| | - Manjusha Gaglani
- Baylor Scott & White Health, Temple, Texas, USA.,Texas A&M University College of Medicine, College Station, Texas, USA
| | - Sara S Kim
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | | | | | - Allison L Naleway
- The Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon, USA
| | - Brendan Flannery
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Fatimah S Dawood
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Holly Groom
- The Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon, USA
| |
Collapse
|
34
|
Karron RA, Garcia Quesada M, Schappell EA, Schmidt SD, Deloria Knoll M, Hetrich MK, Veguilla V, Doria-Rose NA, Dawood FS. Binding and neutralizing antibody responses to SARS-CoV-2 in young children exceed those in adults. JCI Insight 2022; 7:157963. [PMID: 35316213 PMCID: PMC9089786 DOI: 10.1172/jci.insight.157963] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 03/04/2022] [Indexed: 11/23/2022] Open
Abstract
Background SARS-CoV-2 infections are frequently milder in children than adults, suggesting that immune responses may vary with age. However, information is limited regarding SARS-CoV-2 immune responses in young children. Methods We compared receptor binding domain–binding antibody (RBDAb) titers and SARS-CoV-2–neutralizing antibody titers, measured by pseudovirus-neutralizing antibody assay in serum specimens obtained from children aged 0–4 years and 5–17 years and in adults aged 18–62 years at the time of enrollment in a prospective longitudinal household study of SARS-CoV-2 infection. Results Among 56 seropositive participants at enrollment, children aged 0–4 years had more than 10-fold higher RBDAb titers than adults (416 vs. 31, P < 0.0001) and the highest RBDAb titers in 11 of 12 households with seropositive children and adults. Children aged 0–4 years had only 2-fold higher neutralizing antibody than adults, resulting in higher binding-to-neutralizing antibody ratios compared with adults (2.36 vs. 0.35 for ID50, P = 0.0004). Conclusion These findings suggest that young children mount robust antibody responses to SARS-CoV-2 following community infections. Additionally, these results support using neutralizing antibody to measure the immunogenicity of COVID-19 vaccines in children aged 0–4 years. Funding CDC (award 75D30120C08737).
Collapse
Affiliation(s)
- Ruth A Karron
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, United States of America
| | - Maria Garcia Quesada
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, United States of America
| | - Elizabeth A Schappell
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, United States of America
| | - Stephen D Schmidt
- Vaccine Research Center, NIAID, NIH, Bethesda, United States of America
| | - Maria Deloria Knoll
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, United States of America
| | - Marissa K Hetrich
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, United States of America
| | | | | | | |
Collapse
|
35
|
Holstein R, Dawood FS, O'Halloran A, Cummings C, Ujamaa D, Daily Kirley P, Yousey-Hindes K, Fawcett E, Monroe ML, Kim S, Lynfield R, McMullen C, Muse A, Bennett NM, Billing LM, Sutton M, Thomas A, Talbot HK, Schaffner W, Risk I, Reed C, Garg S. Characteristics and Outcomes of Hospitalized Pregnant Women With Influenza, 2010 to 2019 : A Repeated Cross-Sectional Study. Ann Intern Med 2022; 175:149-158. [PMID: 34958603 DOI: 10.7326/m21-3668] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [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] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Pregnant women may be at increased risk for severe influenza-associated outcomes. OBJECTIVE To describe characteristics and outcomes of hospitalized pregnant women with influenza. DESIGN Repeated cross-sectional study. SETTING The population-based U.S. Influenza Hospitalization Surveillance Network during the 2010-2011 through 2018-2019 influenza seasons. PATIENTS Pregnant women (aged 15 to 44 years) hospitalized with laboratory-confirmed influenza identified through provider-initiated or facility-based testing practices. MEASUREMENTS Clinical characteristics, interventions, and in-hospital maternal and fetal outcomes were obtained through medical chart abstraction. Multivariable logistic regression was used to evaluate the association between influenza A subtype and severe maternal influenza-associated outcomes, including intensive care unit (ICU) admission, mechanical ventilation, extracorporeal membrane oxygenation, or in-hospital death. RESULTS Of 9652 women aged 15 to 44 years and hospitalized with influenza, 2690 (27.9%) were pregnant. Among the 2690 pregnant women, the median age was 28 years, 62% were in their third trimester, and 42% had at least 1 underlying condition. Overall, 32% were vaccinated against influenza and 88% received antiviral treatment. Five percent required ICU admission, 2% required mechanical ventilation, and 0.3% (n = 8) died. Pregnant women with influenza A H1N1 were more likely to have severe outcomes than those with influenza A H3N2 (adjusted risk ratio, 1.9 [95% CI, 1.3 to 2.8]). Most women (71%) were still pregnant at hospital discharge. Among 754 women who were no longer pregnant at discharge, 96% had a pregnancy resulting in live birth, and 3% experienced fetal loss. LIMITATION Maternal and fetal outcomes that occurred after hospital discharge were not captured. CONCLUSION Over 9 influenza seasons, one third of reproductive-aged women hospitalized with influenza were pregnant. Influenza A H1N1 was associated with more severe maternal outcomes. Pregnant women remain a high-priority target group for vaccination. PRIMARY FUNDING SOURCE Centers for Disease Control and Prevention.
Collapse
Affiliation(s)
- Rachel Holstein
- Centers for Disease Control and Prevention, Atlanta, Georgia (R.H., F.S.D., A.O., C.C., C.R., S.G.)
| | - Fatimah S Dawood
- Centers for Disease Control and Prevention, Atlanta, Georgia (R.H., F.S.D., A.O., C.C., C.R., S.G.)
| | - Alissa O'Halloran
- Centers for Disease Control and Prevention, Atlanta, Georgia (R.H., F.S.D., A.O., C.C., C.R., S.G.)
| | - Charisse Cummings
- Centers for Disease Control and Prevention, Atlanta, Georgia (R.H., F.S.D., A.O., C.C., C.R., S.G.)
| | - Dawud Ujamaa
- Centers for Disease Control and Prevention, Atlanta, Georgia, and General Dynamics Information Technology, Falls Church, Virginia (D.U.)
| | - Pam Daily Kirley
- California Emerging Infections Program, Oakland, California (P.D.K.)
| | - Kimberly Yousey-Hindes
- Connecticut Emerging Infections Program, Yale School of Public Health, New Haven, Connecticut (K.Y.)
| | - Emily Fawcett
- Emerging Infections Program, Georgia Department of Health, and Veterans Affairs Medical Center, Atlanta, Georgia, and Foundation for Atlanta Veterans Education and Research, Decatur, Georgia (E.F.)
| | - Maya L Monroe
- Maryland Department of Health, Baltimore, Maryland (M.L.M.)
| | - Sue Kim
- Michigan Department of Health and Human Services, Lansing, Michigan (S.K.)
| | - Ruth Lynfield
- Minnesota Department of Health, St. Paul, Minnesota (R.L.)
| | | | - Alison Muse
- New York State Department of Health, Albany, New York (A.M.)
| | - Nancy M Bennett
- University of Rochester School of Medicine and Dentistry, Rochester, New York (N.M.B.)
| | | | | | - Ann Thomas
- Oregon Health Authority, Portland, Oregon (M.S., A.T.)
| | - H Keipp Talbot
- Vanderbilt University School of Medicine, Nashville, Tennessee (H.K.T., W.S.)
| | - William Schaffner
- Vanderbilt University School of Medicine, Nashville, Tennessee (H.K.T., W.S.)
| | - Ilene Risk
- Salt Lake County Health Department, Salt Lake City, Utah (I.R.)
| | - Carrie Reed
- Centers for Disease Control and Prevention, Atlanta, Georgia (R.H., F.S.D., A.O., C.C., C.R., S.G.)
| | - Shikha Garg
- Centers for Disease Control and Prevention, Atlanta, Georgia (R.H., F.S.D., A.O., C.C., C.R., S.G.)
| |
Collapse
|
36
|
Dawood FS, Porucznik CA, Veguilla V, Stanford JB, Duque J, Rolfes MA, Dixon A, Thind P, Hacker E, Castro MJE, Jeddy Z, Daugherty M, Altunkaynak K, Hunt DR, Kattel U, Meece J, Stockwell MS. Incidence Rates, Household Infection Risk, and Clinical Characteristics of SARS-CoV-2 Infection Among Children and Adults in Utah and New York City, New York. JAMA Pediatr 2022; 176:59-67. [PMID: 34623377 PMCID: PMC8501415 DOI: 10.1001/jamapediatrics.2021.4217] [Citation(s) in RCA: 73] [Impact Index Per Article: 36.5] [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] [Indexed: 12/30/2022]
Abstract
IMPORTANCE Data about the risk of SARS-CoV-2 infection among children compared with adults are needed to inform COVID-19 risk communication and prevention strategies, including COVID-19 vaccination policies for children. OBJECTIVE To compare incidence rates and clinical characteristics of SARS-CoV-2 infection among adults and children and estimated household infection risks within a prospective household cohort. DESIGN, SETTING, AND PARTICIPANTS Households with at least 1 child aged 0 to 17 years in selected counties in Utah and New York City, New York, were eligible for enrollment. From September 2020 through April 2021, participants self-collected midturbinate nasal swabs for reverse transcription-polymerase chain reaction testing for SARS-CoV-2 and responded to symptom questionnaires each week. Participants also self-collected additional respiratory specimens with onset of COVID-19-like illness. For children unable to self-collect respiratory specimens, an adult caregiver collected the specimens. MAIN OUTCOMES AND MEASURES The primary outcome was incident cases of any SARS-CoV-2 infection, including asymptomatic and symptomatic infections. Additional measures were the asymptomatic fraction of infection calculated by dividing incidence rates of asymptomatic infection by rates of any infection, clinical characteristics of infection, and household infection risks. Primary outcomes were compared by participant age group. RESULTS A total of 1236 participants in 310 households participated in surveillance, including 176 participants (14%) who were aged 0 to 4 years, 313 (25%) aged 5 to 11 years, 163 (13%) aged 12 to 17 years, and 584 (47%) 18 years or older. Overall incidence rates of SARS-CoV-2 infection were 3.8 (95% CI, 2.4-5.9) and 7.7 (95% CI, 4.1-14.5) per 1000 person-weeks among the Utah and New York City cohorts, respectively. Site-adjusted incidence rates per 1000 person-weeks were similar by age group: 6.3 (95% CI, 3.6-11.0) for children 0 to 4 years, 4.4 (95% CI, 2.5-7.5) for children 5 to 11 years, 6.0 (95% CI, 3.0-11.7) for children 12 to 17 years, and 5.1 (95% CI, 3.3-7.8) for adults (≥18 years). The asymptomatic fractions of infection by age group were 52%, 50%, 45%, and 12% among individuals aged 0 to 4 years, 5 to 11 years, 12 to 17 years, and 18 years or older, respectively. Among 40 households with 1 or more SARS-CoV-2 infections, the mean risk of SARS-CoV-2 infection among all enrolled household members was 52% (range, 11%-100%), with higher risks in New York City compared with Utah (80% [95% CI, 64%-91%] vs 44% [95% CI, 36%-53%]; P < .001). CONCLUSIONS AND RELEVANCE In this study, children had similar incidence rates of SARS-CoV-2 infection compared with adults, but a larger proportion of infections among children were asymptomatic.
Collapse
Affiliation(s)
| | - Christina A. Porucznik
- Division of Public Health, Department of Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City
| | - Vic Veguilla
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Joseph B. Stanford
- Division of Public Health, Department of Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City
| | | | | | - Ashton Dixon
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Priyam Thind
- Division of Child and Adolescent Health, Department of Pediatrics, Columbia University Irving Medical Center, New York, New York
| | - Emily Hacker
- Division of Public Health, Department of Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City
| | - Maria Julia E. Castro
- Division of Child and Adolescent Health, Department of Pediatrics, Columbia University Irving Medical Center, New York, New York
| | | | | | | | | | | | | | - Melissa S. Stockwell
- Division of Child and Adolescent Health, Department of Pediatrics, Columbia University Irving Medical Center, New York, New York,Department of Population and Family Health, Mailman School of Public Health, Columbia University Irving Medical Center, New York, New York
| |
Collapse
|
37
|
Battarbee AN, Stockwell MS, Varner M, Newes-Adeyi G, Daugherty M, Gyamfi-Bannerman C, Tita AT, Vorwaller K, Vargas C, Subramaniam A, Reichle L, Galang RR, Powers E, Lucca-Susana M, Parks M, Chen TJ, Razzaghi H, Dawood FS. Attitudes Toward COVID-19 Illness and COVID-19 Vaccination among Pregnant Women: A Cross-Sectional Multicenter Study during August-December 2020. Am J Perinatol 2022; 39:75-83. [PMID: 34598291 DOI: 10.1055/s-0041-1735878] [Citation(s) in RCA: 57] [Impact Index Per Article: 28.5] [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] [Indexed: 02/08/2023]
Abstract
OBJECTIVE The aim of the study was to evaluate pregnant women's attitudes toward COVID-19 illness and vaccination and identify factors associated with vaccine acceptability. STUDY DESIGN This was a cross-sectional survey among pregnant women enrolled in a prospective COVID-19 cohort study in Salt Lake City, UT, Birmingham, AL, and New York, NY, from August 9 to December 10, 2020. Women were eligible if they were 18 to 50 years old and <28 weeks of gestation. Upon enrollment, women completed surveys regarding concerns about COVID-19 illness and likelihood of getting COVID-19 vaccine if one were available during pregnancy. Vaccine acceptability was defined as a response of "very likely" or "somewhat likely" on a 4-point Likert scale. Factors associated with vaccine acceptability were assessed with multivariable logistic regression. RESULTS Of 939 pregnant women eligible for the main cohort study, 915 (97%) consented to participate. Among these 915 women, 39% self-identified as White, 23% Black, 33% Hispanic, and 4% Other. Sixty-two percent received an influenza vaccine last season. Seventy-two percent worried about getting sick with COVID-19. If they were to get sick, 92% worried about harm to their pregnancy and 80% about harm to themselves. Only 41% reported they would get a vaccine. Of women who were unlikely to get vaccinated, the most frequently cited concern was vaccine safety for their pregnancy (82%). Non-Hispanic Black and Hispanic women had lower odds of accepting a vaccine compared with non-Hispanic White women (adjusted odds ratios [aOR] 0.4, 95% CI 0.2-0.6 for both). Receipt of influenza vaccine during the previous season was associated with higher odds of vaccine acceptability (aOR 2.1, 95% CI 1.5-3.0). CONCLUSION Although most pregnant women worried about COVID-19 illness, <50% were willing to get vaccinated during pregnancy. Racial and ethnic disparities in plans to accept COVID-19 vaccine highlight the need to prioritize strategies to address perceived barriers among groups at high risk for COVID-19. KEY POINTS · Less than half of pregnant patients stated they would get a COVID-19 vaccine.. · Protecting their baby was the most common reason for acceptance and refusal of the COVID-19 vaccine.. · Patients of minority race/ethnicity and those without prior influenza vaccination were less likely to accept the COVID-19 vaccine..
Collapse
Affiliation(s)
- Ashley N Battarbee
- Center for Women's Reproductive Health and Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Melissa S Stockwell
- Department of Pediatrics, Division of Child and Adolescent Health, Columbia University Irving Medical Center, New York, New York.,Department of Population and Family Health, Mailman School of Public Health, Columbia University Irving Medical Center, New York, New York.,Department of Obstetrics and Gynecology, New York-Presbyterian Hospital, New York, New York
| | - Michael Varner
- Department of Obstetrics and Gynecology, University of Utah Health Sciences Center, Salt Lake City, Utah
| | | | | | - Cynthia Gyamfi-Bannerman
- Department of Obstetrics and Gynecology, New York-Presbyterian Hospital, New York, New York.,Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Columbia University Irving Medical Center, New York, New York
| | - Alan T Tita
- Center for Women's Reproductive Health and Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Kelly Vorwaller
- Department of Obstetrics and Gynecology, University of Utah Health Sciences Center, Salt Lake City, Utah
| | - Celibell Vargas
- Department of Pediatrics, Division of Child and Adolescent Health, Columbia University Irving Medical Center, New York, New York
| | - Akila Subramaniam
- Center for Women's Reproductive Health and Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | | | - Romeo R Galang
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Emily Powers
- Department of Obstetrics and Gynecology, University of Utah Health Sciences Center, Salt Lake City, Utah
| | - Miriam Lucca-Susana
- Department of Obstetrics and Gynecology, New York-Presbyterian Hospital, New York, New York.,Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Columbia University Irving Medical Center, New York, New York
| | - Mickey Parks
- Center for Women's Reproductive Health and Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Tiffany J Chen
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Hilda Razzaghi
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | | |
Collapse
|
38
|
Karron RA, Quesada MG, Schappell EA, Schmidt SD, Knoll MD, Hetrich MK, Veguilla V, Doria-Rose N, Dawood FS. Binding and Neutralizing Antibody Responses to SARS-CoV-2 in Infants and Young Children Exceed Those in Adults. medRxiv 2021:2021.12.20.21268034. [PMID: 34981066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
SARS-CoV-2 infections are frequently milder in children than adults, suggesting that immune responses may vary with age. However, information is limited regarding SARS-CoV-2 immune responses in young children. We compared Receptor Binding Domain binding antibody (RBDAb) and SARS-CoV-2 neutralizing antibody (neutAb) in children aged 0-4 years, 5-17 years, and in adults aged 18-62 years in a SARS-CoV-2 household study. Among 55 participants seropositive at enrollment, children aged 0-4 years had >10-fold higher RBDAb titers than adults (373 vs.35, P <0.0001), and the highest RBDAb titers in 11/12 households with seropositive children and adults. Children aged 0-4 years had 2-fold higher neutAb than adults, resulting in higher binding to neutralizing (B/N)Ab ratios compared to adults (1.9 vs. 0.4 for ID 50 , P=0.0002). Findings suggest that young children mount robust antibody responses to SARS-CoV-2 following community infections. Additionally, these results support using neutAb to measure the immunogenicity of COVID-19 vaccines in children aged 0-4 years.
Collapse
|
39
|
Karron RA, Quesada MG, Schappell EA, Schmidt SD, Knoll MD, Hetrich MK, Veguilla V, Doria-Rose N, Dawood FS. Binding and Neutralizing Antibody Responses to SARS-CoV-2 in Infants and Young Children Exceed Those in Adults. medRxiv 2021:2021.12.20.21268034. [PMID: 34981066 PMCID: PMC8722609 DOI: 10.1101/2021.12.20.21268034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/25/2023]
Abstract
SARS-CoV-2 infections are frequently milder in children than adults, suggesting that immune responses may vary with age. However, information is limited regarding SARS-CoV-2 immune responses in young children. We compared Receptor Binding Domain binding antibody (RBDAb) and SARS-CoV-2 neutralizing antibody (neutAb) in children aged 0-4 years, 5-17 years, and in adults aged 18-62 years in a SARS-CoV-2 household study. Among 55 participants seropositive at enrollment, children aged 0-4 years had >10-fold higher RBDAb titers than adults (373 vs.35, P <0.0001), and the highest RBDAb titers in 11/12 households with seropositive children and adults. Children aged 0-4 years had 2-fold higher neutAb than adults, resulting in higher binding to neutralizing (B/N)Ab ratios compared to adults (1.9 vs. 0.4 for ID 50 , P=0.0002). Findings suggest that young children mount robust antibody responses to SARS-CoV-2 following community infections. Additionally, these results support using neutAb to measure the immunogenicity of COVID-19 vaccines in children aged 0-4 years.
Collapse
|
40
|
Wesley MG, Tinoco Y, Patel A, Suntarratiwong P, Hunt D, Sinthuwattanawibool C, Soto G, Kittikraisak W, Das PK, Arriola CS, Hombroek D, Mott J, Kurhe K, Bhargav S, Prakash A, Florian R, Gonzales O, Cabrera S, Llajaruna E, Brummer T, Malek P, Saha S, Garg S, Azziz-Baumgartner E, Thompson MG, Dawood FS. Performance of Symptom-Based Case Definitions to Identify Influenza Virus Infection Among Pregnant Women in Middle-Income Countries: Findings From the Pregnancy and Influenza Multinational Epidemiologic (PRIME) Study. Clin Infect Dis 2021; 73:e4321-e4328. [PMID: 33173947 PMCID: PMC10563868 DOI: 10.1093/cid/ciaa1697] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The World Health Organization (WHO) recommends case definitions for influenza surveillance that are also used in public health research, although their performance has not been assessed in many risk groups, including pregnant women in whom influenza may manifest differently. We evaluated the performance of symptom-based definitions to detect influenza in a cohort of pregnant women in India, Peru, and Thailand. METHODS In 2017 and 2018, we contacted 11 277 pregnant women twice weekly during the influenza season to identify illnesses with new or worsened cough, runny nose, sore throat, difficulty breathing, or myalgia and collected data on other symptoms and nasal swabs for influenza real-time reverse transcription-polymerase chain reaction (rRT-PCR) testing. We calculated sensitivity, specificity, positive-predictive value, and negative-predictive value of each symptom predictor, WHO respiratory illness case definitions, and a de novo definition derived from results of multivariable modeling. RESULTS Of 5444 eligible illness episodes among 3965 participants, 310 (6%) were positive for influenza. In a multivariable model, measured fever ≥38°C (adjusted odds ratio [95% confidence interval], 4.6 [3.1-6.8]), myalgia (3.0 [2.2-4.0]), cough (2.7 [1.9-3.9]), and chills (1.6 [1.1-2.4]) were independently associated with influenza illness. A definition based on these 4 (measured fever, cough, chills, or myalgia) was 95% sensitive and 27% specific. The WHO influenza-like illness (ILI) definition was 16% sensitive and 98% specific. CONCLUSIONS The current WHO ILI case definition was highly specific but had low sensitivity. The intended use of case definitions should be considered when evaluating the tradeoff between sensitivity and specificity.
Collapse
Affiliation(s)
- Meredith G Wesley
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Yeny Tinoco
- US Naval Medical Research Unit No. 6, Bellavista, Peru
| | - Archana Patel
- Lata Medical Research Foundation, Nagpur, India
- Datta Meghe Institute of Medical Sciences, Sawangi, India
| | - Piyarat Suntarratiwong
- Queen Sirikit National Institute of Child Health, Thailand Ministry of Public Health, Bangkok, Thailand
| | | | | | - Giselle Soto
- US Naval Medical Research Unit No. 6, Bellavista, Peru
| | - Wanitchaya Kittikraisak
- Thailand Ministry of Public Health-US Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand
| | | | - Carmen Sofia Arriola
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | - Joshua Mott
- Thailand Ministry of Public Health-US Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand
| | - Kunal Kurhe
- Lata Medical Research Foundation, Nagpur, India
| | | | | | | | | | | | | | | | | | - Siddhartha Saha
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Shikha Garg
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | - Mark G Thompson
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Fatimah S Dawood
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| |
Collapse
|
41
|
Cohen C, Kleynhans J, von Gottberg A, McMorrow ML, Wolter N, Bhiman JN, Moyes J, du Plessis M, Carrim M, Buys A, Martinson NA, Kahn K, Tollman S, Lebina L, Wafawanaka F, du Toit J, Xavier Gómez-Olivé F, Dawood FS, Mkhencele T, Sun K, Viboud C, Tempia S. SARS-CoV-2 incidence, transmission and reinfection in a rural and an urban setting: results of the PHIRST-C cohort study, South Africa, 2020-2021. medRxiv 2021:2021.07.20.21260855. [PMID: 34909794 PMCID: PMC8669861 DOI: 10.1101/2021.07.20.21260855] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND By August 2021, South Africa experienced three SARS-CoV-2 waves; the second and third associated with emergence of Beta and Delta variants respectively. METHODS We conducted a prospective cohort study during July 2020-August 2021 in one rural and one urban community. Mid-turbinate nasal swabs were collected twice-weekly from household members irrespective of symptoms and tested for SARS-CoV-2 using real-time reverse transcription polymerase chain reaction (rRT-PCR). Serum was collected every two months and tested for anti-SARS-CoV-2 antibodies. RESULTS Among 115,759 nasal specimens from 1,200 members (follow-up rate 93%), 1976 (2%) were SARS-CoV-2-positive. By rRT-PCR and serology combined, 62% (749/1200) of individuals experienced ≥1 SARS-CoV-2 infection episode, and 12% (87/749) experienced reinfection. Of 662 PCR-confirmed episodes with available data, 15% (n=97) were associated with ≥1 symptom. Among 222 households, 200 (90%) had ≥1 SARS-CoV-2-positive individual. Household cumulative infection risk (HCIR) was 25% (213/856). On multivariable analysis, accounting for age and sex, index case lower cycle threshold value (OR 3.9, 95%CI 1.7-8.8), urban community (OR 2.0,95%CI 1.1-3.9), Beta (OR 4.2, 95%CI 1.7-10.1) and Delta (OR 14.6, 95%CI 5.7-37.5) variant infection were associated with increased HCIR. HCIR was similar for symptomatic (21/110, 19%) and asymptomatic (195/775, 25%) index cases (p=0.165). Attack rates were highest in individuals aged 13-18 years and individuals in this age group were more likely to experience repeat infections and to acquire SARS-CoV-2 infection. People living with HIV who were not virally supressed were more likely to develop symptomatic illness, and shed SARS-CoV-2 for longer compared to HIV-uninfected individuals. CONCLUSIONS In this study, 85% of SARS-CoV-2 infections were asymptomatic and index case symptom status did not affect HCIR, suggesting a limited role for control measures targeting symptomatic individuals. Increased household transmission of Beta and Delta variants, likely contributed to successive waves, with >60% of individuals infected by the end of follow-up. RESEARCH IN CONTEXT Evidence before this study: Previous studies have generated wide-ranging estimates of the proportion of SARS-CoV-2 infections which are asymptomatic. A recent systematic review found that 20% (95% CI 3%-67%) of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections remained asymptomatic throughout infection and that transmission from asymptomatic individuals was reduced. A systematic review and meta-analysis of 87 household transmission studies of SARS-CoV-2 found an estimated secondary attack rate of 19% (95% CI 16-22). The review also found that household secondary attack rates were increased from symptomatic index cases and that adults were more likely to acquire infection. As of December 2021, South Africa experienced three waves of SARS-CoV-2 infections; the second and third waves were associated with circulation of Beta and Delta variants respectively. SARS-CoV-2 vaccines became available in February 2021, but uptake was low in study sites reaching 5% fully vaccinated at the end of follow up. Studies to quantify the burden of asymptomatic infections, symptomatic fraction, reinfection frequency, duration of shedding and household transmission of SARS-CoV-2 from asymptomatically infected individuals have mostly been conducted as part of outbreak investigations or in specific settings. Comprehensive systematic community studies of SARS-CoV-2 burden and transmission including for the Beta and Delta variants are lacking, especially in low vaccination settings.Added value of this study: We conducted a unique detailed COVID-19 household cohort study over a 13 month period in South Africa, with real time reverse transcriptase polymerase chain reaction (rRT-PCR) testing twice a week irrespective of symptoms and bimonthly serology. By the end of the study in August 2021, 749 (62%) of 1200 individuals from 222 randomly sampled households in a rural and an urban community in South Africa had at least one confirmed SARS-CoV-2 infection, detected on rRT-PCR and/or serology, and 12% (87/749) experienced reinfection. Symptom data were analysed for 662 rRT-PCR-confirmed infection episodes that occurred >14 days after the start of follow-up (of a total of 718 rRT-PCR-confirmed episodes), of these, 15% (n=97) were associated with one or more symptoms. Among symptomatic indvidiausl, 9% (n=9) were hospitalised and 2% (n=2) died. Ninety percent (200/222) of included households, had one or more individual infected with SARS-CoV-2 on rRT-PCR and/or serology within the household. SARS-CoV-2 infected index cases transmitted the infection to 25% (213/856) of susceptible household contacts. Index case ribonucleic acid (RNA) viral load proxied by rRT-PCR cycle threshold value was strongly predictive of household transmission. Presence of symptoms in the index case was not associated with household transmission. Household transmission was four times greater from index cases infected with Beta variant and fifteen times greater from index cases infected with Delta variant compared to wild-type infection. Attack rates were highest in individuals aged 13-18 years and individuals in this age group were more likely to experience repeat infections and to acquire SARS-CoV-2 infection within households. People living with HIV (PLHIV) who were not virally supressed were more likely to develop symptomatic illness when infected with SARS-CoV-2, and shed SARS-CoV-2 for longer when compared to HIV-uninfected individuals.Implications of all the available evidence: We found a high rate of SARS-CoV-2 infection in households in a rural community and an urban community in South Africa, with the majority of infections being asymptomatic in individuals of all ages. Asymptomatic individuals transmitted SARS-CoV-2 at similar levels to symptomatic individuals suggesting that interventions targeting symptomatic individuals such as symptom-based testing and contact tracing of individuals tested because they report symptoms may have a limited impact as control measures. Increased household transmission of Beta and Delta variants, likely contributed to recurrent waves of COVID-19, with >60% of individuals infected by the end of follow-up. Higher attack rates, reinfection and acquisition in adolescents and prolonged SARS-CoV-2 shedding in PLHIV who were not virally suppressed suggests that prioritised vaccination of individuals in these groups could impact community transmission.
Collapse
Affiliation(s)
- Cheryl Cohen
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Jackie Kleynhans
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Anne von Gottberg
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa
- School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Meredith L McMorrow
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Nicole Wolter
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa
- School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Jinal N. Bhiman
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa
- School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Jocelyn Moyes
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Mignon du Plessis
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa
- School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Maimuna Carrim
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa
- School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Amelia Buys
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa
| | - Neil A Martinson
- Perinatal HIV Research Unit, MRC Soweto Matlosana Collaborating Centre for HIV/AIDS and TB, University of the Witwatersrand, South Africa
- DST/NRF Centre of Excellence for Biomedical Tuberculosis Research, University of the Witwatersrand, Johannesburg, South Africa
- Johns Hopkins University Center for TB Research, Baltimore, Maryland, United States of America
| | - Kathleen Kahn
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Stephen Tollman
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Limakatso Lebina
- Perinatal HIV Research Unit, MRC Soweto Matlosana Collaborating Centre for HIV/AIDS and TB, University of the Witwatersrand, South Africa
- Africa Health Research Institute, KwaZulu-Natal, South Africa
| | - Floidy Wafawanaka
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Jacques du Toit
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Francesc Xavier Gómez-Olivé
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Fatimah S. Dawood
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Thulisa Mkhencele
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa
| | - Kaiyun Sun
- Division of International Epidemiology and Population Studies, Fogarty International Center, National Institutes of Health, Bethesda, MD, USA
| | - Cécile Viboud
- Division of International Epidemiology and Population Studies, Fogarty International Center, National Institutes of Health, Bethesda, MD, USA
| | | | - Stefano Tempia
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| |
Collapse
|
42
|
Suntarattiwong P, Mott JA, Mohanty S, Sinthuwattanawibool C, Srisantiroj N, Patamasingh Na Ayudhaya O, Klungthong C, Fernandez S, Kim L, Hunt D, Hombroek D, Brummer T, Chotpitayasunondh T, Dawood FS, Kittikraisak W. Feasibility and Performance of Self-Collected Nasal Swabs for Detection of Influenza Virus, Respiratory Syncytial Virus, and Human Metapneumovirus. J Infect Dis 2021; 224:831-838. [PMID: 34467984 DOI: 10.1093/infdis/jiab023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Accepted: 01/14/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND We assessed performance of participant-collected midturbinate nasal swabs compared to study staff-collected midturbinate nasal swabs for the detection of respiratory viruses among pregnant women in Bangkok, Thailand. METHODS We enrolled pregnant women aged ≥18 years and followed them throughout the 2018 influenza season. Women with acute respiratory illness self-collected midturbinate nasal swabs at home for influenza viruses, respiratory syncytial viruses (RSV), and human metapneumoviruses (hMPV) real-time RT-PCR testing and the study nurse collected a second midturbinate nasal swab during home visits. Paired specimens were processed and tested on the same day. RESULTS The majority (109, 60%) of 182 participants were 20-30 years old. All 200 paired swabs had optimal specimen quality. The median time from symptom onsets to participant-collected swabs was 2 days and to staff-collected swabs was also 2 days. The median time interval between the 2 swabs was 2 hours. Compared to staff-collected swabs, the participant-collected swabs were 93% sensitive and 99% specific for influenza virus detection, 94% sensitive and 99% specific for RSV detection, and 100% sensitive and 100% specific for hMPV detection. CONCLUSIONS Participant-collected midturbinate nasal swabs were a valid alternative approach for laboratory confirmation of influenza-, RSV-, and hMPV-associated illnesses among pregnant women in a community setting.
Collapse
Affiliation(s)
| | - Joshua A Mott
- Influenza Program, Thailand Ministry of Public Health-US Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand
- Influenza Division, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Sarita Mohanty
- Influenza Division, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Chalinthorn Sinthuwattanawibool
- Influenza Program, Thailand Ministry of Public Health-US Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand
| | | | | | - Chonticha Klungthong
- Department of Virology, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
| | - Stefan Fernandez
- Department of Virology, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
| | - Lindsay Kim
- Division of Viral Diseases, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | | | | | | | - Fatimah S Dawood
- Influenza Division, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Wanitchaya Kittikraisak
- Influenza Program, Thailand Ministry of Public Health-US Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand
| |
Collapse
|
43
|
Dawood FS, Varner M, Tita A, Newes-Adeyi G, Gyamfi-Bannerman C, Battarbee A, Bruno A, Daugherty M, Reichle L, Vorwaller K, Vargas C, Parks M, Powers E, Lucca-Susana M, Gibson M, Subramaniam A, Cheng YJ, Feng PJ, Ellington S, Galang RR, Meece J, Flygare C, Stockwell MS. Incidence, Clinical Characteristics, and Risk Factors of SARS-CoV-2 Infection among Pregnant Individuals in the United States. Clin Infect Dis 2021; 74:2218-2226. [PMID: 34410340 PMCID: PMC8513407 DOI: 10.1093/cid/ciab713] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Data about the risk of SARS-CoV-2 infection among pregnant individuals are needed to inform infection prevention guidance and counseling for this population. METHODS We prospectively followed a cohort of pregnant individuals during August 2020-March 2021 at three U.S. sites. The three primary outcomes were incidence rates of any SARS-CoV-2 infection, symptomatic infection, and asymptomatic infection, during pregnancy during periods of SARS-CoV-2 circulation. Participants self-collected weekly mid-turbinate nasal swabs for SARS-CoV-2 RT-PCR testing, completed weekly illness symptom questionnaires, and submitted additional swabs with COVID-19-like symptoms. An overall SARS-CoV-2 infection incidence rate weighted by population counts of women of reproductive age in each state was calculated. RESULTS Among 1098 pregnant individuals followed for a mean of 10 weeks, nine percent (99/1098) had SARS-CoV-2 infections during the study. Population weighted incidence rates of SARS-CoV-2 infection were 10.0 per 1,000 (95% confidence interval [CI] 5.7-14.3) person-weeks for any infection, 5.7 per 1,000 (95% CI 1.7-9.7) for symptomatic infections, and 3.5 per 1,000 (95% CI 0-7.1) for asymptomatic infections. Among 96 participants with SARS-CoV-2 infection and symptom data, the most common symptoms were nasal congestion (72%), cough (64%), headache (59%), and change in taste or smell (54%); 28% had measured or subjective fever. The median symptom duration was 10 days (IQR6-16 days). CONCLUSION Pregnant individuals had a 1% risk of SARS-CoV-2 infection per week. Study findings provide information about SARS-CoV-2 infection risk during pregnancy to inform counseling for pregnant individuals about infection prevention practices, including COVID-19 vaccination.
Collapse
Affiliation(s)
| | - Michael Varner
- Department of Obstetrics and Gynecology, University of Utah Health Sciences Center, Salt Lake City, Utah, USA
| | - Alan Tita
- Center for Women's Reproductive Health and Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, University of Alabama at Birmingham, USA
| | | | - Cynthia Gyamfi-Bannerman
- Department of Obstetrics and Gynecology Division of Maternal-Fetal Medicine, Columbia University Irving Medical Center, USA.,New York-Presbyterian Hospital, New York, NY, USA
| | - Ashley Battarbee
- Center for Women's Reproductive Health and Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, University of Alabama at Birmingham, USA
| | - Ann Bruno
- Department of Obstetrics and Gynecology, University of Utah Health Sciences Center, Salt Lake City, Utah, USA
| | | | | | - Kelly Vorwaller
- Department of Obstetrics and Gynecology, University of Utah Health Sciences Center, Salt Lake City, Utah, USA
| | - Celibell Vargas
- Division of Child and Adolescent Health, Department of Pediatrics, Columbia University Irving Medical Center, New York, NY, USA
| | - Mickey Parks
- Center for Women's Reproductive Health and Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, University of Alabama at Birmingham, USA
| | - Emily Powers
- Department of Obstetrics and Gynecology, University of Utah Health Sciences Center, Salt Lake City, Utah, USA
| | - Miriam Lucca-Susana
- Department of Obstetrics and Gynecology Division of Maternal-Fetal Medicine, Columbia University Irving Medical Center, USA.,New York-Presbyterian Hospital, New York, NY, USA
| | - Marie Gibson
- Department of Obstetrics and Gynecology, University of Utah Health Sciences Center, Salt Lake City, Utah, USA
| | - Akila Subramaniam
- Center for Women's Reproductive Health and Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, University of Alabama at Birmingham, USA
| | - Yiling J Cheng
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Pei-Jean Feng
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Romeo R Galang
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | | | - Melissa S Stockwell
- New York-Presbyterian Hospital, New York, NY, USA.,Division of Child and Adolescent Health, Department of Pediatrics, Columbia University Irving Medical Center, New York, NY, USA.,Department of Population and Family Health, Mailman School of Public Health, Columbia University Irving Medical Center, New York, NY, USA
| |
Collapse
|
44
|
Dawood FS, Naleway AL, Flannery B, Levine MZ, Murthy K, Sambhara S, Gangappa S, Edwards L, Ball S, Beacham L, Belongia E, Bounds K, Cao W, Gross FL, Groom H, Fry AM, Hunt D, Jeddy Z, Mishina M, Kim SS, Wesley MG, Spencer S, Thompson MG, Gaglani M. Comparison of the Immunogenicity of Cell Culture-Based and Recombinant Quadrivalent Influenza Vaccines to Conventional Egg-Based Quadrivalent Influenza Vaccines among Healthcare Personnel Aged 18-64 Years: A Randomized Open-Label Trial. Clin Infect Dis 2021; 73:1973-1981. [PMID: 34245243 PMCID: PMC8499731 DOI: 10.1093/cid/ciab566] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Indexed: 01/19/2023] Open
Abstract
Background RIV4 and cell-culture based inactivated influenza vaccine (ccIIV4) have not been compared to egg-based IIV4 in healthcare personnel, a population with frequent influenza vaccination that may blunt vaccine immune responses over time. We conducted a randomized trial among healthcare personnel (HCP) aged 18–64 years to compare humoral immune responses to ccIIV4 and RIV4 to IIV4. Methods During the 2018–2019 season, participants were randomized to receive ccIIV4, RIV4, or IIV4 and had serum samples collected prevaccination, 1 and 6 months postvaccination. Serum samples were tested by hemagglutination inhibition (HI) for influenza A/H1N1, B/Yamagata, and B/Victoria and microneutralization (MN) for A/H3N2 against cell-grown vaccine reference viruses. Primary outcomes at 1 month were seroconversion rate (SCR), geometric mean titers (GMT), GMT ratio, and mean fold rise (MFR) in the intention-to-treat population. Results In total, 727 participants were included (283 ccIIV4, 202 RIV4, and 242 IIV4). At 1 month, responses to ccIIV4 were similar to IIV4 by SCR, GMT, GMT ratio, and MFR. RIV4 induced higher SCRs, GMTs, and MFRs than IIV4 against A/H1N1, A/H3N2, and B/Yamagata. The GMT ratio of RIV4 to egg-based vaccines was 1.5 (95% confidence interval [CI] 1.2–1.9) for A/H1N1, 3.0 (95% CI: 2.4–3.7) for A/H3N2, 1.1 (95% CI: .9–1.4) for B/Yamagata, and 1.1 (95% CI: .9–1.3) for B/Victoria. At 6 months, ccIIV4 recipients had similar GMTs to IIV4, whereas RIV4 recipients had higher GMTs against A/H3N2 and B/Yamagata. Conclusions RIV4 resulted in improved antibody responses by HI and MN compared to egg-based vaccines against 3 of 4 cell-grown vaccine strains 1 month postvaccination, suggesting a possible additional benefit from RIV4.
Collapse
Affiliation(s)
- Fatimah S Dawood
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Allison L Naleway
- The Center for Health Research, Kaiser Permanente Northwest, Portland, OR, USA
| | - Brendan Flannery
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Min Z Levine
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Kempapura Murthy
- Baylor Scott & White Health, Texas A&M University, College of Medicine, Temple, Texas, USA
| | | | | | | | - Sarah Ball
- Abt Associates, Atlanta, GA, USA.,Westat, Rockville, MD, USA
| | - Lauren Beacham
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Edward Belongia
- Marshfield Clinic Research Institute, Marshfield, Wisconsin, USA
| | - Kelsey Bounds
- Baylor Scott & White Health, Texas A&M University, College of Medicine, Temple, Texas, USA
| | - Weiping Cao
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - F Liaini Gross
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Holly Groom
- The Center for Health Research, Kaiser Permanente Northwest, Portland, OR, USA
| | - Alicia M Fry
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | | | | | - Sara S Kim
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Meredith G Wesley
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA.,Abt Associates, Atlanta, GA, USA
| | - Sarah Spencer
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Mark G Thompson
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Manjusha Gaglani
- Baylor Scott & White Health, Texas A&M University, College of Medicine, Temple, Texas, USA
| |
Collapse
|
45
|
Arriola CS, Suntarattiwong P, Dawood FS, Soto G, Das P, Hunt DR, Sinthuwattanawibool C, Kurhe K, Thompson MG, Wesley MG, Saha S, Hombroek D, Brummer T, Kittikraisak W, Kaoiean S, Neyra J, Romero C, Patel A, Bhargav S, Khedikar V, Garg S, Mott JA, Gonzales O, Cabrera S, Florian R, Parvekar S, Tomyabatra K, Prakash A, Tinoco YO. What do pregnant women think about influenza disease and vaccination practices in selected countries. Hum Vaccin Immunother 2021; 17:2176-2184. [PMID: 33499708 PMCID: PMC8189050 DOI: 10.1080/21645515.2020.1851536] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 11/11/2020] [Indexed: 11/05/2022] Open
Abstract
Introduction: We evaluated knowledge, attitudes, and practices (KAP) related to influenza and influenza vaccination among pregnant women in three selected countries.Methods: During 2017, pregnant women seeking antenatal care at hospitals at participating sites were enrolled. We described characteristics and responses to KAP questions. We also evaluated predictors associated with influenza vaccination during pregnancy at sites with substantial influenza vaccine uptake by multivariable logistic regression.Results: Overall, 4,648 pregnant women completed the survey. There were substantial differences among the three survey populations; only 8% of the women in Nagpur had heard of influenza, compared to 90% in Lima and 96% in Bangkok (p-value<0.01). Despite significant differences in sociodemographic characteristics in the three populations, most participants across sites who were aware of influenza prior to study enrollment believe they and their infants are at risk of influenza and related complications and believe influenza vaccination is safe and effective. Half of women in Lima had verified receipt of influenza vaccine compared to <5% in Bangkok and Nagpur (p < .05). For further analysis conducted among women in Lima only, household income above the poverty line (aOR: 1.38; 95%CI: 1.01, 1.88), having 8+ antenatal visits, compared to 0-4 (aOR: 2.41; 95%CI: 1.39, 2.87, respectively), having 0 children, compared to 2+ (aOR: 1.96; 95%CIs: 1.23, 3.12), and vaccination recommended by a health-care provider (aOR: 8.25; 95%CI: 6.11, 11.14) were strongly associated with receipt of influenza vaccine during pregnancy.Conclusions: Our findings identify opportunities for targeted interventions to improve influenza vaccine uptake among pregnant women in these settings.
Collapse
Affiliation(s)
- Carmen S. Arriola
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Piyarat Suntarattiwong
- Queen Sirikit National Institute of Child Health, Thailand Ministry of Public Health, Bangkok, Thailand
| | - Fatimah S. Dawood
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Giselle Soto
- U.S. Naval Medical Research Unit No. 6, Bellavista, Peru
| | - Prabir Das
- Lata Medical Research Foundation, Nagpur, India
| | | | | | - Kunal Kurhe
- Lata Medical Research Foundation, Nagpur, India
| | - Mark G. Thompson
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Meredith G. Wesley
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Siddhartha Saha
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | | | - Wanitchaya Kittikraisak
- Thailand Ministry of Public Health - US Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand
| | - Surasak Kaoiean
- Rajavithi Hospital, Thailand Ministry of Public Health, Bangkok, Thailand
| | - Joan Neyra
- U.S. Naval Medical Research Unit No. 6, Bellavista, Peru
| | - Candice Romero
- U.S. Naval Medical Research Unit No. 6, Bellavista, Peru
| | - Archana Patel
- Lata Medical Research Foundation, Nagpur, India
- Datta Meghe Institute of Medical Sciences, Sawangi, India
| | | | | | - Shikha Garg
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Joshua A Mott
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, USA
- Thailand Ministry of Public Health - US Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand
| | | | | | | | | | - Krissada Tomyabatra
- Nopparat Rajathanee Hospital, Thailand Ministry of Public Health, Bangkok, Thailand
| | | | - Yeny O. Tinoco
- U.S. Naval Medical Research Unit No. 6, Bellavista, Peru
| |
Collapse
|
46
|
Thanee C, Kittikraisak W, Sinthuwattanawibool C, Roekworachai K, Klinklom A, Kornsitthikul K, Jirasakpisarn S, Srirompotong U, Chittaganpitch M, Dawood FS, Suntarattiwong P, Mott JA, Chotpitayasunondh T. Knowledge, attitude/perception, and practice related to seasonal influenza vaccination among caregivers of young Thai children: A cross-sectional study. PLoS One 2021; 16:e0253561. [PMID: 34170935 PMCID: PMC8232445 DOI: 10.1371/journal.pone.0253561] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 06/07/2021] [Indexed: 12/01/2022] Open
Abstract
Background Seasonal influenza vaccination uptake among young children in Thailand is low despite national recommendation for vaccination. We implemented a knowledge, attitude/perception, and practice survey to understand determinants of influenza vaccination in children aged six months to two years. Methods Using a cross-sectional design, we interviewed caregivers of 700 children in seven hospitals using a structured questionnaire to collect information on caregivers’ and children’s demographic characteristics, and caregivers’ knowledge of influenza illness and national vaccine recommendation, attitude/perception toward influenza vaccine, and information sources. We verified children’s influenza vaccination status against medical records (vaccinated vs. unvaccinated). Logistic regression was used to examine factors independently associated with children receiving influenza vaccination in the 2018 season using the dataset restricted to only children’s parents. Variables associated with vaccination at p-value ≤0.20 were included in subsequent multivariable logistic models. Significant independent determinants of children’s influenza vaccination and collinearity of covariates were assessed. The final model was constructed using a stepwise backward elimination approach with variables significant at p-value <0.05 retained in the model. Results During August 2018-February 2019, 700 children’s caregivers completed the questionnaire; 61 (9%) were caregivers of vaccinated children. Caregivers of the vaccinated children were statistically more likely to have higher education (61% vs. 38%; p-value<0.01) and to know of influenza illness (93% vs. 76%; p-value = 0.03) than those of the unvaccinated group. Factors associated with children receiving influenza vaccination were identifying healthcare providers as a primary source of information about influenza illness for parents (adjusted odds ratio [aOR], 2.8; 95% confidence interval [CI], 1.3–6.0), parents’ strongly agreeing with the national recommendation for influenza vaccination in young children (aOR, 2.9; 95% CI, 1.5–5.9), using health insurance provided by the government or parent’s employer for children’s doctor visits (aOR, 2.6; 95% CI, 1.1–6.6), and the children’s history of receiving influenza vaccination in the 2017 season or earlier (aOR, 3.2; 95% CI, 1.4–7.8). Conclusion The majority of caregivers of children in this study had knowledge of influenza illness and influenza vaccine. Caregivers reported various sources of information regarding influenza illness and the vaccine, but healthcare providers remained the most trusted source. Children’s history of influenza vaccination in prior season(s) was the strongest determinant of children being vaccinated for influenza in the current season.
Collapse
Affiliation(s)
- Chareeya Thanee
- Sunpasitthiprasong Hospital, Ministry of Public Health, Ubon Ratchathani, Thailand
| | - Wanitchaya Kittikraisak
- Influenza Program, Thailand Ministry of Public Health–U.S. Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand
- * E-mail:
| | - Chalinthorn Sinthuwattanawibool
- Influenza Program, Thailand Ministry of Public Health–U.S. Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand
| | | | - Arunee Klinklom
- Surat Thani Hospital, Ministry of Public Health, Surat Thani, Thailand
| | | | | | | | | | - Fatimah S. Dawood
- Influenza Division, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Piyarat Suntarattiwong
- Queen Sirikit National Institute of Child Health, Ministry of Public Health, Bangkok, Thailand
| | - Joshua A. Mott
- Influenza Program, Thailand Ministry of Public Health–U.S. Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand
- Influenza Division, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Tawee Chotpitayasunondh
- Queen Sirikit National Institute of Child Health, Ministry of Public Health, Bangkok, Thailand
| |
Collapse
|
47
|
Wall DJ, Patel MM, Chung JR, Lee B, Dawood FS. Antibody Response and Protection After Receipt of Inactivated Influenza Vaccine: A Systematic Review. Pediatrics 2021; 147:peds.2020-019901. [PMID: 34039716 DOI: 10.1542/peds.2020-019901] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/22/2021] [Indexed: 11/24/2022] Open
Abstract
CONTEXT Children are at increased risk of influenza-related complications. Public health agencies recommend 2 doses of influenza vaccine for children 6 months through 8 years of age receiving the vaccine for the first time. OBJECTIVE To systematically review studies comparing vaccine effectiveness (VE) and immunogenicity after 1 or 2 doses of inactivated influenza vaccine (IIV) in children. DATA SOURCES Data sources included Medline, Embase, and Cochrane Library databases. STUDY SELECTION We included studies published in a peer reviewed journal up to April 2, 2019, with available abstracts, written in English, and with children aged 6 months through 8 years. DATA EXTRACTION VE among fully and partially vaccinated children was compared with that of unvaccinated children. We extracted geometric mean titers of serum hemagglutination inhibition (HAI) antibodies against influenza A(H1N1), A(H3N2), and B-lineage vaccine antigens after 1 and 2 IIV doses. Outcomes were evaluated by age, timing of doses, vaccine composition, and prevaccination titers. RESULTS A total of 10 VE and 16 immunogenicity studies were included. VE was higher for fully vaccinated groups than partially vaccinated groups, especially for children aged 6-23 months. Our findings show increased HAI titers after 2 doses, compared with 1. Older children and groups with prevaccination antibodies have robust HAI titers after 1 dose. Similar vaccine strains across doses, not the timing of doses, positively affects immune response. LIMITATIONS Few studies focused on older children. Researchers typically administered one-half the standard dose of IIV. HAI antibodies are an imperfect correlate of protection. CONCLUSIONS Findings support policies recommending 2 IIV doses in children to provide optimal protection against influenza.
Collapse
Affiliation(s)
- Danielle J Wall
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia.,The Robert Larner, MD, College of Medicine.,The University of Vermont Medical Center, Burlington, Vermont
| | - Manish M Patel
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jessie R Chung
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Benjamin Lee
- Department of Pediatrics and.,Vaccine Testing Center, The University of Vermont, Burlington, Vermont; and
| | - Fatimah S Dawood
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia;
| |
Collapse
|
48
|
Dawood FS, Varner M, Munoz F, Stockwell MS, Suyama J, Li DK, Tita A, Mathias L, Shakib JH, Piedra PA, Gyamfi-Bannerman C, Weissman A, Ferber J, Battarbee AN, Wesley MG, Vorwaller K, Powers E, Gibson M, Bond N, Santarcangelo P, Avadhanula V, Newes-Adeyi G, Hunt DR, Subramaniam A, Sanusi A, Boone A, Ogokeh C, Macio I, Odouli R, Thind P, Vargas CY, Almonte C, Galang R, Shapiro-Mendoza C, Campbell AP. Respiratory Viral Infections and Infection Prevention Practices among Women with Acute Respiratory Illness during Delivery Hospitalizations during the 2019-2020 Influenza Season. J Infect Dis 2021; 225:50-54. [PMID: 34037764 DOI: 10.1093/infdis/jiab292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Accepted: 05/21/2021] [Indexed: 11/12/2022] Open
Abstract
We conducted a cross-sectional study of pregnant women with acute respiratory illness during delivery hospitalizations in influenza season to describe clinical testing for respiratory viruses and infection prevention practices. Women had nasal swabs tested for influenza and other respiratory viruses. Among 91 enrolled women, 22 (24%) had clinical testing for influenza. Based on clinical and study testing combined, 41/91 (45%) women had samples positive for respiratory viruses. The most common virus was influenza (17/91, 19%); 53% (9/17) of influenza virus infections were identified through study testing alone. Only 16% of women were on droplet precautions. Peripartum respiratory infections may be underrecognized.
Collapse
Affiliation(s)
- Fatimah S Dawood
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Michael Varner
- Department of Obstetrics and Gynecology, University of Utah Health Sciences Center, Salt Lake City, Utah, USA
| | - Flor Munoz
- Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA
| | - Melissa S Stockwell
- Division of Child and Adolescent Health, Department of Pediatrics, Columbia University Irving Medical Center, New York, NY, USA.,Department of Population and Family Health, Mailman School of Public Health, Columbia University Irving Medical Center, New York, NY, USA.,New York-Presbyterian Hospital, New York, NY, USA
| | - Joe Suyama
- Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - De-Kun Li
- Division of Research, Kaiser Foundation Research Institute, Kaiser Permanente, Oakland, CA, USA
| | - Alan Tita
- Center for Women's Reproductive Health and Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL, USA
| | | | - Julie H Shakib
- Department of Obstetrics and Gynecology, University of Utah Health Sciences Center, Salt Lake City, Utah, USA
| | - Pedro A Piedra
- Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA.,Department of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, TX, USA
| | - Cynthia Gyamfi-Bannerman
- New York-Presbyterian Hospital, New York, NY, USA.,Department of OBGYN, Division of Maternal-Fetal Medicine, Columbia University Irving Medical Center, USA
| | - Alexandra Weissman
- Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jeannette Ferber
- Division of Research, Kaiser Foundation Research Institute, Kaiser Permanente, Oakland, CA, USA
| | - Ashley N Battarbee
- Center for Women's Reproductive Health and Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL, USA
| | | | - Kelly Vorwaller
- Department of Obstetrics and Gynecology, University of Utah Health Sciences Center, Salt Lake City, Utah, USA
| | - Emily Powers
- Department of Obstetrics and Gynecology, University of Utah Health Sciences Center, Salt Lake City, Utah, USA
| | - Marie Gibson
- Department of Obstetrics and Gynecology, University of Utah Health Sciences Center, Salt Lake City, Utah, USA
| | - Nanette Bond
- Department of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, TX, USA
| | - Patricia Santarcangelo
- Department of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, TX, USA
| | - Vasanthi Avadhanula
- Department of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, TX, USA
| | | | | | - Akila Subramaniam
- Center for Women's Reproductive Health and Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Ayodeji Sanusi
- Center for Women's Reproductive Health and Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Amy Boone
- Center for Women's Reproductive Health and Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Constance Ogokeh
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Ingrid Macio
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh Medical Center Magee-Womens Hospital, Pittsburgh, PA, USA
| | - Roxana Odouli
- Division of Research, Kaiser Foundation Research Institute, Kaiser Permanente, Oakland, CA, USA
| | - Priyam Thind
- Division of Child and Adolescent Health, Department of Pediatrics, Columbia University Irving Medical Center, New York, NY, USA
| | - Celibell Y Vargas
- Division of Child and Adolescent Health, Department of Pediatrics, Columbia University Irving Medical Center, New York, NY, USA
| | - Casandra Almonte
- Department of OBGYN, Division of Maternal-Fetal Medicine, Columbia University Irving Medical Center, USA
| | - Romeo Galang
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Carrie Shapiro-Mendoza
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Angela P Campbell
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, USA
| |
Collapse
|
49
|
Praphasiri P, Shrestha M, Patumanond J, Nakphook S, Chawalchitiporn S, Ditsungnoen D, Dawood FS, Mott JA, Prasert K. Underlying cardiopulmonary conditions as a risk factor for influenza and respiratory syncytial virus infection among community-dwelling adults aged ≥ 65 years in Thailand: Findings from a two-year prospective cohort study. Influenza Other Respir Viruses 2021; 15:634-640. [PMID: 33764688 PMCID: PMC8404046 DOI: 10.1111/irv.12855] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 03/04/2021] [Accepted: 03/07/2021] [Indexed: 12/02/2022] Open
Abstract
Background Adults with cardiopulmonary conditions may be at increased risk of influenza and respiratory syncytial virus (RSV) infection, but it is not well‐established and few data are available from middle‐income countries. Methods Using data from a prospective cohort study of influenza vaccine effectiveness, we estimated and compared the incidences of influenza and RSV between community‐dwelling Thai adults aged ≥ 65 years with and without cardiopulmonary conditions. During May 2015‐May 2017, older adults in a rural province in Thailand were followed‐up with weekly surveillance for acute respiratory illness (ARI), defined broadly as new onset or worsening of cough with or without fever, and hospitalized ARI. When ill, nasal self‐swabs and/or nasopharyngeal swabs were collected for reverse‐transcription polymerase chain reaction testing. We used Poisson regression to calculate incidence rate ratios (IRR), adjusting for age, sex, current smoking, number of hospital visits, weekly influenza activity, and influenza vaccination. Results Overall, 3220 adults with a median age of 71 years (IQR 68‐76) were enrolled; 1324 (41.1%) were male; and 313 (9.7%) had ≥1 underlying cardiopulmonary condition, most commonly chronic obstructive pulmonary disease (131; 41.2%) or asthma (73; 23.3%). Participants with cardiopulmonary conditions had higher incidences of ARI, influenza, and RSV than those without (Adjusted IRR: 1.84, 95% CI 1.64‐2.07; 1.86, 95% CI 1.07‐3.26; 2.04, 95% CI 1.11‐3.76, respectively). Conclusion Older adults in rural Thailand with cardiopulmonary conditions have increased rates of ARI, influenza, and RSV infections. Our findings support efforts to ensure this population has access to influenza vaccines and other respiratory illness prevention measures.
Collapse
Affiliation(s)
- Prabda Praphasiri
- Influenza Program, Thailand MOPH-US CDC Collaboration, Nonthaburi, Thailand
| | | | | | - Sutthichai Nakphook
- Institute of Preventive Medicine, Department of Disease Control, Ministry of Public Health, Nonthaburi, Thailand
| | | | | | - Fatimah S Dawood
- Influenza Division, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Joshua A Mott
- Influenza Program, Thailand MOPH-US CDC Collaboration, Nonthaburi, Thailand.,Influenza Division, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | |
Collapse
|
50
|
Dawood FS, Kittikraisak W, Patel A, Rentz Hunt D, Suntarattiwong P, Wesley MG, Thompson MG, Soto G, Mundhada S, Arriola CS, Azziz-Baumgartner E, Brummer T, Cabrera S, Chang HH, Deshmukh M, Ellison D, Florian R, Gonzales O, Kurhe K, Kaoiean S, Rawangban B, Lindstrom S, Llajaruna E, Mott JA, Saha S, Prakash A, Mohanty S, Sinthuwattanawibool C, Tinoco Y. Incidence of influenza during pregnancy and association with pregnancy and perinatal outcomes in three middle-income countries: a multisite prospective longitudinal cohort study. Lancet Infect Dis 2021; 21:97-106. [PMID: 33129424 PMCID: PMC10563867 DOI: 10.1016/s1473-3099(20)30592-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 05/22/2020] [Accepted: 07/02/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Influenza vaccination during pregnancy prevents influenza among women and their infants but remains underused among pregnant women. We aimed to quantify the risk of antenatal influenza and examine its association with perinatal outcomes. METHODS We did a prospective cohort study in pregnant women in India, Peru, and Thailand. Before the 2017 and 2018 influenza seasons, we enrolled pregnant women aged 18 years or older with expected delivery dates 8 weeks or more after the season started. We contacted women twice weekly until the end of pregnancy to identify illnesses with symptoms of myalgia, cough, runny nose or nasal congestion, sore throat, or difficulty breathing and collected mid-turbinate nasal swabs from symptomatic women for influenza real-time RT-PCR testing. We assessed the association of antenatal influenza with preterm birth, late pregnancy loss (≥13 weeks gestation), small for gestational age (SGA), and birthweight of term singleton infants using Cox proportional hazards models or generalised linear models to adjust for potential confounders. FINDINGS Between March 13, 2017, and Aug 3, 2018, we enrolled 11 277 women with a median age of 26 years (IQR 23-31) and gestational age of 19 weeks (14-24). 1474 (13%) received influenza vaccines. 310 participants (3%) had influenza (270 [87%] influenza A and 40 [13%] influenza B). Influenza incidences weighted by the population of women of childbearing age in each study country were 88·7 per 10 000 pregnant woman-months (95% CI 68·6 to 114·8) during the 2017 season and 69·6 per 10 000 pregnant woman-months (53·8 to 90·2) during the 2018 season. Antenatal influenza was not associated with preterm birth (adjusted hazard ratio [aHR] 1·4, 95% CI 0·9 to 2·0; p=0·096) or having an SGA infant (adjusted relative risk 1·0, 95% CI 0·8 to 1·3, p=0·97), but was associated with late pregnancy loss (aHR 10·7, 95% CI 4·3 to 27·0; p<0·0001) and reduction in mean birthweight of term, singleton infants (-55·3 g, 95% CI -109·3 to -1·4; p=0·0445). INTERPRETATION Women had a 0·7-0·9% risk of influenza per month of pregnancy during the influenza season, and antenatal influenza was associated with increased risk for some adverse pregnancy outcomes. These findings support the added value of antenatal influenza vaccination to improve perinatal outcomes. FUNDING US Centers for Disease Control and Prevention. TRANSLATIONS For the Thai, Hindi, Marathi and Spanish translations of the abstract see Supplementary Materials section.
Collapse
Affiliation(s)
- Fatimah S Dawood
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Wanitchaya Kittikraisak
- Thailand Ministry of Public Health-US Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand
| | - Archana Patel
- Lata Medical Research Foundation, Nagpur, India; Datta Meghe Institute of Medical Sciences, Wardha, India
| | | | - Piyarat Suntarattiwong
- Queen Sirikit National Institute of Child Health, Thailand Ministry of Public Health, Bangkok, Thailand
| | - Meredith G Wesley
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, USA; Abt Associates, Atlanta, GA, USA
| | - Mark G Thompson
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Giselle Soto
- US Naval Medical Research Unit No 6, Bellavista, Peru
| | | | - Carmen S Arriola
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | | | | | - Howard H Chang
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | | | - Damon Ellison
- Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
| | | | | | - Kunal Kurhe
- Lata Medical Research Foundation, Nagpur, India
| | | | | | - Stephen Lindstrom
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Joshua A Mott
- Thailand Ministry of Public Health-US Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand
| | - Siddhartha Saha
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Sarita Mohanty
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Yeny Tinoco
- US Naval Medical Research Unit No 6, Bellavista, Peru
| |
Collapse
|