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Link-Gelles R, Rowley EA, DeSilva MB, Dascomb K, Irving SA, Klein NP, Grannis SJ, Ong TC, Weber ZA, Fleming-Dutra KE, McEvoy CE, Akinsete O, Bride D, Sheffield T, Naleway AL, Zerbo O, Fireman B, Hansen J, Goddard K, Dixon BE, Rogerson C, Fadel WF, Duszynski T, Rao S, Barron MA, Reese SE, Ball SW, Dunne MM, Natarajan K, Okwuazi E, Shah AB, Wiegand R, Tenforde MW, Payne AB. Interim Effectiveness of Updated 2023-2024 (Monovalent XBB.1.5) COVID-19 Vaccines Against COVID-19-Associated Hospitalization Among Adults Aged ≥18 Years with Immunocompromising Conditions - VISION Network, September 2023-February 2024. MMWR Morb Mortal Wkly Rep 2024; 73:271-276. [PMID: 38547037 PMCID: PMC10986819 DOI: 10.15585/mmwr.mm7312a5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/02/2024]
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. As with past COVID-19 vaccines, additional doses may be considered for persons with immunocompromising conditions, who are at higher risk for severe COVID-19 and might have decreased response to vaccination. In this analysis, vaccine effectiveness (VE) of an updated COVID-19 vaccine dose against COVID-19-associated hospitalization was evaluated during September 2023-February 2024 using data from the VISION VE network. Among adults aged ≥18 years with immunocompromising conditions, VE against COVID-19-associated hospitalization was 38% in the 7-59 days after receipt of an updated vaccine dose and 34% in the 60-119 days after receipt of an updated dose. Few persons (18%) in this high-risk study population had received updated COVID-19 vaccine. All persons aged ≥6 months should receive updated 2023-2024 COVID-19 vaccination; persons with immunocompromising conditions may get additional updated COVID-19 vaccine doses ≥2 months after the last recommended COVID-19 vaccine.
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Levy ME, Yang D, Dunne MM, Miley K, Irving SA, Grannis SJ, Weber ZA, Griggs EP, Spark TL, Bassett E, Embi PJ, Gaglani M, Natarajan K, Valvi NR, Ong TC, Naleway AL, Stenehjem E, Klein NP, Link‐Gelles R, DeSilva MB, Kharbanda AB, Raiyani C, Beaton MA, Dixon BE, Rao S, Dascomb K, Patel P, Mamawala M, Han J, Fadel WF, Barron MA, Grisel N, Dickerson M, Liao I, Arndorfer J, Najdowski M, Murthy K, Ray C, Tenforde MW, Ball SW. Risk of COVID-19 Hospitalization and Protection Associated With mRNA Vaccination Among US Adults With Psychiatric Disorders. Influenza Other Respir Viruses 2024; 18:e13269. [PMID: 38494192 PMCID: PMC10944689 DOI: 10.1111/irv.13269] [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: 08/15/2023] [Revised: 02/06/2024] [Accepted: 02/07/2024] [Indexed: 03/19/2024] Open
Abstract
BACKGROUND Although psychiatric disorders have been associated with reduced immune responses to other vaccines, it remains unknown whether they influence COVID-19 vaccine effectiveness (VE). This study evaluated risk of COVID-19 hospitalization and estimated mRNA VE stratified by psychiatric disorder status. METHODS In a retrospective cohort analysis of the VISION Network in four US states, the rate of laboratory-confirmed COVID-19-associated hospitalization between December 2021 and August 2022 was compared across psychiatric diagnoses and by monovalent mRNA COVID-19 vaccination status using Cox proportional hazards regression. RESULTS Among 2,436,999 adults, 22.1% had ≥1 psychiatric disorder. The incidence of COVID-19-associated hospitalization was higher among patients with any versus no psychiatric disorder (394 vs. 156 per 100,000 person-years, p < 0.001). Any psychiatric disorder (adjusted hazard ratio [aHR], 1.27; 95% CI, 1.18-1.37) and mood (aHR, 1.25; 95% CI, 1.15-1.36), anxiety (aHR, 1.33, 95% CI, 1.22-1.45), and psychotic (aHR, 1.41; 95% CI, 1.14-1.74) disorders were each significant independent predictors of hospitalization. Among patients with any psychiatric disorder, aHRs for the association between vaccination and hospitalization were 0.35 (95% CI, 0.25-0.49) after a recent second dose, 0.08 (95% CI, 0.06-0.11) after a recent third dose, and 0.33 (95% CI, 0.17-0.66) after a recent fourth dose, compared to unvaccinated patients. Corresponding VE estimates were 65%, 92%, and 67%, respectively, and were similar among patients with no psychiatric disorder (68%, 92%, and 79%). CONCLUSION Psychiatric disorders were associated with increased risk of COVID-19-associated hospitalization. However, mRNA vaccination provided similar protection regardless of psychiatric disorder status, highlighting its benefit for individuals with psychiatric disorders.
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Affiliation(s)
| | | | | | | | | | - Shaun J. Grannis
- Center for Biomedical InformaticsRegenstrief InstituteIndianapolisIndianaUSA
- School of MedicineIndiana UniversityIndianapolisIndianaUSA
| | | | - Eric P. Griggs
- Coronavirus and Other Respiratory Viruses Division, National Center for Immunization and Respiratory DiseasesCenters for Disease Control and PreventionAtlantaGeorgiaUSA
| | | | | | - Peter J. Embi
- Center for Biomedical InformaticsRegenstrief InstituteIndianapolisIndianaUSA
- Vanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Manjusha Gaglani
- Baylor Scott & White HealthTempleTexasUSA
- Texas A&M University College of MedicineTempleTexasUSA
| | - Karthik Natarajan
- Department of Biomedical InformaticsColumbia University Irving Medical CenterNew YorkNew YorkUSA
- New York Presbyterian HospitalNew YorkNew YorkUSA
| | - Nimish R. Valvi
- Center for Biomedical InformaticsRegenstrief InstituteIndianapolisIndianaUSA
| | - Toan C. Ong
- School of MedicineUniversity of Colorado Anschutz Medical CampusAuroraColoradoUSA
| | | | - Edward Stenehjem
- Division of Infectious Diseases and Clinical EpidemiologyIntermountain HealthcareSalt Lake CityUtahUSA
| | - Nicola P. Klein
- Kaiser Permanente Vaccine Study CenterKaiser Permanente Northern California Division of ResearchOaklandCaliforniaUSA
| | - Ruth Link‐Gelles
- Coronavirus and Other Respiratory Viruses Division, National Center for Immunization and Respiratory DiseasesCenters for Disease Control and PreventionAtlantaGeorgiaUSA
| | | | | | | | - Maura A. Beaton
- Department of Biomedical InformaticsColumbia University Irving Medical CenterNew YorkNew YorkUSA
| | - Brian E. Dixon
- Center for Biomedical InformaticsRegenstrief InstituteIndianapolisIndianaUSA
- Fairbanks School of Public HealthIndiana UniversityIndianapolisIndianaUSA
| | - Suchitra Rao
- School of MedicineUniversity of Colorado Anschutz Medical CampusAuroraColoradoUSA
| | - Kristin Dascomb
- Division of Infectious Diseases and Clinical EpidemiologyIntermountain HealthcareSalt Lake CityUtahUSA
| | - Palak Patel
- Influenza Division, National Center for Immunization and Respiratory DiseasesCenters for Disease Control and PreventionAtlantaGeorgiaUSA
| | | | - Jungmi Han
- Department of Biomedical InformaticsColumbia University Irving Medical CenterNew YorkNew YorkUSA
| | - William F. Fadel
- Center for Biomedical InformaticsRegenstrief InstituteIndianapolisIndianaUSA
- Fairbanks School of Public HealthIndiana UniversityIndianapolisIndianaUSA
| | - Michelle A. Barron
- School of MedicineUniversity of Colorado Anschutz Medical CampusAuroraColoradoUSA
| | - Nancy Grisel
- Division of Infectious Diseases and Clinical EpidemiologyIntermountain HealthcareSalt Lake CityUtahUSA
| | - Monica Dickerson
- Influenza Division, National Center for Immunization and Respiratory DiseasesCenters for Disease Control and PreventionAtlantaGeorgiaUSA
| | | | - Julie Arndorfer
- Division of Infectious Diseases and Clinical EpidemiologyIntermountain HealthcareSalt Lake CityUtahUSA
| | - Morgan Najdowski
- Coronavirus and Other Respiratory Viruses Division, National Center for Immunization and Respiratory DiseasesCenters for Disease Control and PreventionAtlantaGeorgiaUSA
| | | | - Caitlin Ray
- Influenza Division, National Center for Immunization and Respiratory DiseasesCenters for Disease Control and PreventionAtlantaGeorgiaUSA
| | - Mark W. Tenforde
- Influenza Division, National Center for Immunization and Respiratory DiseasesCenters for Disease Control and PreventionAtlantaGeorgiaUSA
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3
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Griggs EP, Mitchell PK, Lazariu V, Gaglani M, McEvoy C, Klein NP, Valvi NR, Irving SA, Kojima N, Stenehjem E, Crane B, Rao S, Grannis SJ, Embi PJ, Kharbanda AB, Ong TC, Natarajan K, Dascomb K, Naleway AL, Bassett E, DeSilva MB, Dickerson M, Konatham D, Fireman B, Allen KS, Barron MA, Beaton M, Arndorfer J, Vazquez-Benitez G, Garg S, Murthy K, Goddard K, Dixon BE, Han J, Grisel N, Raiyani C, Lewis N, Fadel WF, Stockwell MS, Mamawala M, Hansen J, Zerbo O, Patel P, Link-Gelles R, Adams K, Tenforde MW. Clinical Epidemiology and Risk Factors for Critical Outcomes Among Vaccinated and Unvaccinated Adults Hospitalized With COVID-19-VISION Network, 10 States, June 2021-March 2023. Clin Infect Dis 2024; 78:338-348. [PMID: 37633258 DOI: 10.1093/cid/ciad505] [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: 07/31/2023] [Accepted: 08/22/2023] [Indexed: 08/28/2023] Open
Abstract
BACKGROUND The epidemiology of coronavirus disease 2019 (COVID-19) continues to develop with emerging variants, expanding population-level immunity, and advances in clinical care. We describe changes in the clinical epidemiology of COVID-19 hospitalizations and risk factors for critical outcomes over time. METHODS We included adults aged ≥18 years from 10 states hospitalized with COVID-19 June 2021-March 2023. We evaluated changes in demographics, clinical characteristics, and critical outcomes (intensive care unit admission and/or death) and evaluated critical outcomes risk factors (risk ratios [RRs]), stratified by COVID-19 vaccination status. RESULTS A total of 60 488 COVID-19-associated hospitalizations were included in the analysis. Among those hospitalized, median age increased from 60 to 75 years, proportion vaccinated increased from 18.2% to 70.1%, and critical outcomes declined from 24.8% to 19.4% (all P < .001) between the Delta (June-December, 2021) and post-BA.4/BA.5 (September 2022-March 2023) periods. Hospitalization events with critical outcomes had a higher proportion of ≥4 categories of medical condition categories assessed (32.8%) compared to all hospitalizations (23.0%). Critical outcome risk factors were similar for unvaccinated and vaccinated populations; presence of ≥4 medical condition categories was most strongly associated with risk of critical outcomes regardless of vaccine status (unvaccinated: adjusted RR, 2.27 [95% confidence interval {CI}, 2.14-2.41]; vaccinated: adjusted RR, 1.73 [95% CI, 1.56-1.92]) across periods. CONCLUSIONS The proportion of adults hospitalized with COVID-19 who experienced critical outcomes decreased with time, and median patient age increased with time. Multimorbidity was most strongly associated with critical outcomes.
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Affiliation(s)
- Eric P Griggs
- Coronavirus and Other Respiratory Viruses Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | - Victoria Lazariu
- Department of Clinical Research, Westat, Inc, Rockville, Maryland, USA
| | - Manjusha Gaglani
- Section of Pediatric Infectious Diseases, Department of Pediatrics, Baylor Scott & White Health, Temple, Texas, USA
- Department of Medical Education, Texas A&M University College of Medicine, Temple, Texas, USA
| | - Charlene McEvoy
- Department of Research, HealthPartners Institute, Minneapolis, Minnesota, USA
| | - Nicola P Klein
- Kaiser Permanente Vaccine Study Center, Division of Research, Kaiser Permanente Northern California, Oakland, USA
| | - Nimish R Valvi
- Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, Indiana, USA
| | - Stephanie A Irving
- Department of Science Programs, Kaiser Permanente Center for Health Research, Portland, Oregon, USA
| | - Noah Kojima
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Edward Stenehjem
- Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City, Utah, USA
| | - Bradley Crane
- Department of Science Programs, Kaiser Permanente Center for Health Research, Portland, Oregon, USA
| | - Suchitra Rao
- Department of Biomedical Informatics, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Shaun J Grannis
- Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, Indiana, USA
- Department of Family Medicine, School of Medicine, Indiana University, Indianapolis, Indiana, USA
| | - Peter J Embi
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Anupam B Kharbanda
- Department of Emergency Medicine, Children's Minnesota, Minneapolis, Minnesota, USA
| | - Toan C Ong
- Department of Biomedical Informatics, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Karthik Natarajan
- Department of Biomedical Informatics, Columbia University Irving Medical Center, New York, New York, USA
- Medical Informatics Services, New York-Presbyterian Hospital, New York, New York, USA
| | - Kristin Dascomb
- Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City, Utah, USA
| | - Allison L Naleway
- Department of Science Programs, Kaiser Permanente Center for Health Research, Portland, Oregon, USA
| | - Elizabeth Bassett
- Department of Clinical Research, Westat, Inc, Rockville, Maryland, USA
| | - Malini B DeSilva
- Department of Research, HealthPartners Institute, Minneapolis, Minnesota, USA
| | - Monica Dickerson
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Deepika Konatham
- Department of Research Analytics and Development, Baylor Scott & White Research Institute, Baylor Scott & White Health, Temple, Texas, USA
| | - Bruce Fireman
- Kaiser Permanente Vaccine Study Center, Division of Research, Kaiser Permanente Northern California, Oakland, USA
| | - Katie S Allen
- Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, Indiana, USA
- Fairbanks School of Public Health, Indiana University, Indianapolis, Indiana, USA
| | - Michelle A Barron
- Department of Biomedical Informatics, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Maura Beaton
- Department of Biomedical Informatics, Columbia University Irving Medical Center, New York, New York, USA
| | - Julie Arndorfer
- Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City, Utah, USA
| | | | - Shikha Garg
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Kempapura Murthy
- Department of Research Analytics and Development, Baylor Scott & White Research Institute, Baylor Scott & White Health, Temple, Texas, USA
| | - Kristin Goddard
- Kaiser Permanente Vaccine Study Center, Division of Research, Kaiser Permanente Northern California, Oakland, USA
| | - Brian E Dixon
- Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, Indiana, USA
- Fairbanks School of Public Health, Indiana University, Indianapolis, Indiana, USA
| | - Jungmi Han
- Department of Biomedical Informatics, Columbia University Irving Medical Center, New York, New York, USA
| | - Nancy Grisel
- Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City, Utah, USA
| | - Chandni Raiyani
- Department of Research Analytics and Development, Baylor Scott & White Research Institute, Baylor Scott & White Health, Temple, Texas, USA
| | - Ned Lewis
- Kaiser Permanente Vaccine Study Center, Division of Research, Kaiser Permanente Northern California, Oakland, USA
| | - William F Fadel
- Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, Indiana, USA
- Fairbanks School of Public Health, Indiana University, Indianapolis, Indiana, USA
| | - Melissa S Stockwell
- Division of Child & Adolescent Health, Department of Pediatrics, New York-Presbyterian Hospital, New York, New York, USA
- Division of Child and Adolescent Health, Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
- Department of Population and Family Health, Columbia University Mailman School of Public Health, New York, New York, USA
| | - Mufaddal Mamawala
- Department of Research Analytics and Development, Baylor Scott & White Research Institute, Baylor Scott & White Health, Temple, Texas, USA
| | - John Hansen
- Kaiser Permanente Vaccine Study Center, Division of Research, Kaiser Permanente Northern California, Oakland, USA
| | - Ousseny Zerbo
- Kaiser Permanente Vaccine Study Center, Division of Research, Kaiser Permanente Northern California, Oakland, USA
| | - Palak Patel
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Ruth Link-Gelles
- Coronavirus and Other Respiratory Viruses Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Katherine Adams
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Mark W Tenforde
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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4
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Embi PJ, Levy ME, Patel P, DeSilva MB, Gaglani M, Dascomb K, Dunne MM, Klein NP, Ong TC, Grannis SJ, Natarajan K, Yang DH, Stenehjem E, Zerbo O, McEvoy C, Rao S, Thompson MG, Konatham D, Irving SA, Dixon BE, Han J, Schrader KE, Grisel N, Lewis N, Kharbanda AB, Barron MA, Reynolds S, Liao IC, Fadel WF, Rowley EA, Arndorfer J, Goddard K, Murthy K, Valvi NR, Weber ZA, Fireman B, Reese SE, Ball SW, Naleway AL. Effectiveness of COVID-19 vaccines at preventing emergency department or urgent care encounters and hospitalizations among immunocompromised adults: An observational study of real-world data across 10 US states from August-December 2021. Vaccine 2023; 41:5424-5434. [PMID: 37479609 PMCID: PMC10201325 DOI: 10.1016/j.vaccine.2023.05.038] [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: 01/13/2023] [Revised: 05/06/2023] [Accepted: 05/16/2023] [Indexed: 07/23/2023]
Abstract
BACKGROUND Immunocompromised (IC) persons are at increased risk for severe COVID-19 outcomes and are less protected by 1-2 COVID-19 vaccine doses than are immunocompetent (non-IC) persons. We compared vaccine effectiveness (VE) against medically attended COVID-19 of 2-3 mRNA and 1-2 viral-vector vaccine doses between IC and non-IC adults. METHODS Using a test-negative design among eight VISION Network sites, VE against laboratory-confirmed COVID-19-associated emergency department (ED) or urgent care (UC) events and hospitalizations from 26 August-25 December 2021 was estimated separately among IC and non-IC adults and among specific IC condition subgroups. Vaccination status was defined using number and timing of doses. VE for each status (versus unvaccinated) was adjusted for age, geography, time, prior positive test result, and local SARS-CoV-2 circulation. RESULTS We analyzed 8,848 ED/UC events and 18,843 hospitalizations among IC patients and 200,071 ED/UC events and 70,882 hospitalizations among non-IC patients. Among IC patients, 3-dose mRNA VE against ED/UC (73% [95% CI: 64-80]) and hospitalization (81% [95% CI: 76-86]) was lower than that among non-IC patients (ED/UC: 94% [95% CI: 93-94]; hospitalization: 96% [95% CI: 95-97]). Similar patterns were observed for viral-vector vaccines. Transplant recipients had lower VE than other IC subgroups. CONCLUSIONS During B.1.617.2 (Delta) variant predominance, IC adults received moderate protection against COVID-19-associated medical events from three mRNA doses, or one viral-vector dose plus a second dose of any product. However, protection was lower in IC versus non-IC patients, especially among transplant recipients, underscoring the need for additional protection among IC adults.
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Affiliation(s)
- Peter J Embi
- Vanderbilt University Medical Center, Nashville, TN, USA; Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, IN, USA.
| | | | - Palak Patel
- Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta, GA, USA
| | | | - Manjusha Gaglani
- Baylor Scott & White Health, Texas A&M College of Medicine, Temple, TX, USA; Texas A&M University College of Medicine, Temple, Texas, USA
| | - Kristin Dascomb
- Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City, UT, USA
| | | | - Nicola P Klein
- Kaiser Permanente Vaccine Study Center, Kaiser Permanente Northern California Division of Research, Oakland, CA, USA
| | - Toan C Ong
- School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Shaun J Grannis
- Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, IN, USA; Indiana University School of Medicine, Indianapolis, IN, USA
| | - Karthik Natarajan
- Department of Biomedical Informatics, Columbia University Irving Medical Center, New York, NY, USA; New York Presbyterian Hospital, New York, NY, USA
| | | | - Edward Stenehjem
- Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City, UT, USA
| | - Ousseny Zerbo
- Kaiser Permanente Vaccine Study Center, Kaiser Permanente Northern California Division of Research, Oakland, CA, USA
| | | | - Suchitra Rao
- School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Mark G Thompson
- Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta, GA, USA
| | - Deepika Konatham
- Baylor Scott & White Health, Texas A&M College of Medicine, Temple, TX, USA
| | - Stephanie A Irving
- Center for Health Research, Kaiser Permanente Northwest, Portland, OR, USA
| | - Brian E Dixon
- Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, IN, USA; Fairbanks School of Public Health, Indiana University, Indianapolis, IN, USA
| | - Jungmi Han
- Department of Biomedical Informatics, Columbia University Irving Medical Center, New York, NY, USA
| | | | - Nancy Grisel
- Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City, UT, USA
| | - Ned Lewis
- Kaiser Permanente Vaccine Study Center, Kaiser Permanente Northern California Division of Research, Oakland, CA, USA
| | | | - Michelle A Barron
- School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Sue Reynolds
- Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta, GA, USA
| | - I-Chia Liao
- Baylor Scott & White Health, Texas A&M College of Medicine, Temple, TX, USA
| | - William F Fadel
- Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, IN, USA; Fairbanks School of Public Health, Indiana University, Indianapolis, IN, USA
| | | | - Julie Arndorfer
- Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City, UT, USA
| | - Kristin Goddard
- Kaiser Permanente Vaccine Study Center, Kaiser Permanente Northern California Division of Research, Oakland, CA, USA
| | - Kempapura Murthy
- Baylor Scott & White Health, Texas A&M College of Medicine, Temple, TX, USA
| | - Nimish R Valvi
- Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, IN, USA
| | | | - Bruce Fireman
- Kaiser Permanente Vaccine Study Center, Kaiser Permanente Northern California Division of Research, Oakland, CA, USA
| | | | | | - Allison L Naleway
- Center for Health Research, Kaiser Permanente Northwest, Portland, OR, USA
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5
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Adams K, Riddles JJ, Rowley EAK, Grannis SJ, Gaglani M, Fireman B, Hartmann E, Naleway AL, Stenehjem E, Hughes A, Dalton AF, Natarajan K, Dascomb K, Raiyani C, Irving SA, Sloan-Aagard C, Kharbanda AB, DeSilva MB, Dixon BE, Ong TC, Keller J, Dickerson M, Grisel N, Murthy K, Nanez J, Fadel WF, Ball SW, Patel P, Arndorfer J, Mamawala M, Valvi NR, Dunne MM, Griggs EP, Embi PJ, Thompson MG, Link-Gelles R, Tenforde MW. Number needed to vaccinate with a COVID-19 booster to prevent a COVID-19-associated hospitalization during SARS-CoV-2 Omicron BA.1 variant predominance, December 2021-February 2022, VISION Network: a retrospective cohort study. Lancet Reg Health Am 2023; 23:100530. [PMID: 37333688 PMCID: PMC10266334 DOI: 10.1016/j.lana.2023.100530] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 05/17/2023] [Accepted: 05/24/2023] [Indexed: 06/20/2023]
Abstract
Background Understanding the usefulness of additional COVID-19 vaccine doses-particularly given varying disease incidence-is needed to support public health policy. We characterize the benefits of COVID-19 booster doses using number needed to vaccinate (NNV) to prevent one COVID-19-associated hospitalization or emergency department encounter. Methods We conducted a retrospective cohort study of immunocompetent adults at five health systems in four U.S. states during SARS-CoV-2 Omicron BA.1 predominance (December 2021-February 2022). Included patients completed a primary mRNA COVID-19 vaccine series and were either eligible to or received a booster dose. NNV were estimated using hazard ratios for each outcome (hospitalization and emergency department encounters), with results stratified by three 25-day periods and site. Findings 1,285,032 patients contributed 938 hospitalizations and 2076 emergency department encounters. 555,729 (43.2%) patients were aged 18-49 years, 363,299 (28.3%) 50-64 years, and 366,004 (28.5%) ≥65 years. Most patients were female (n = 765,728, 59.6%), White (n = 990,224, 77.1%), and non-Hispanic (n = 1,063,964, 82.8%). 37.2% of patients received a booster and 62.8% received only two doses. Median estimated NNV to prevent one hospitalization was 205 (range 44-615) and NNV was lower across study periods for adults aged ≥65 years (110, 46, and 88, respectively) and those with underlying medical conditions (163, 69, and 131, respectively). Median estimated NNV to prevent one emergency department encounter was 156 (range 75-592). Interpretation The number of patients needed to receive a booster dose was highly dependent on local disease incidence, outcome severity, and patient risk factors for moderate-to-severe disease. Funding Funding was provided by the Centers for Disease Control and Prevention though contract 75D30120C07986 to Westat, Inc. and contract 75D30120C07765 to Kaiser Foundation Hospitals.
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Affiliation(s)
- Katherine Adams
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | | | - Shaun J Grannis
- Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, IN, USA
- School of Medicine, Indiana University, Indianapolis, IN, USA
| | - Manjusha Gaglani
- Baylor Scott & White Health, Temple, TX, USA
- Texas A&M University College of Medicine, Temple, TX, USA
| | - Bruce Fireman
- Kaiser Permanente Vaccine Study Center, Kaiser Permanente Northern California Division of Research, Oakland, CA, USA
| | - Emily Hartmann
- Paso del Norte Health Information Exchange (PHIX), El Paso, TX, USA
| | | | - Edward Stenehjem
- Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City, UT, USA
| | | | - Alexandra F Dalton
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Karthik Natarajan
- Department of Biomedical Informatics, Columbia University Irving Medical Center, New York, NY, USA
- NewYork-Presbyterian Hospital, New York, NY, USA
| | - Kristin Dascomb
- Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City, UT, USA
| | | | | | - Chantel Sloan-Aagard
- Paso del Norte Health Information Exchange (PHIX), El Paso, TX, USA
- Brigham Young University Department of Public Health, Provo, UT, USA
| | | | | | - Brian E Dixon
- Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, IN, USA
- Fairbanks School of Public Health, Indiana University, Indianapolis, IN, USA
| | - Toan C Ong
- School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | | | - Monica Dickerson
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Nancy Grisel
- Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City, UT, USA
| | | | - Juan Nanez
- Paso del Norte Health Information Exchange (PHIX), El Paso, TX, USA
| | - William F Fadel
- Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, IN, USA
- Fairbanks School of Public Health, Indiana University, Indianapolis, IN, USA
| | | | - Palak Patel
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Julie Arndorfer
- Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City, UT, USA
| | | | - Nimish R Valvi
- Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, IN, USA
| | | | - Eric P Griggs
- Coronavirus and Other Respiratory Viruses Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Peter J Embi
- Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, IN, USA
- Vanderbilt University Medical Center, Nashville, TN, USA
| | - Mark G Thompson
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Ruth Link-Gelles
- Coronavirus and Other Respiratory Viruses Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Mark W Tenforde
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Link-Gelles R, Weber ZA, Reese SE, Payne AB, Gaglani M, Adams K, Kharbanda AB, Natarajan K, DeSilva MB, Dascomb K, Irving SA, Klein NP, Grannis SJ, Ong TC, Embi PJ, Dunne MM, Dickerson M, McEvoy C, Arndorfer J, Naleway AL, Goddard K, Dixon BE, Griggs EP, Hansen J, Valvi N, Najdowski M, Timbol J, Rogerson C, Fireman B, Fadel WF, Patel P, Ray CS, Wiegand R, Ball S, Tenforde MW. Estimates of Bivalent mRNA Vaccine Durability in Preventing COVID-19-Associated Hospitalization and Critical Illness Among Adults with and Without Immunocompromising Conditions - VISION Network, September 2022-April 2023. Am J Transplant 2023; 23:1062-1076. [PMID: 37394267 DOI: 10.1016/j.ajt.2023.06.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/04/2023]
Affiliation(s)
- Ruth Link-Gelles
- Coronavirus and Other Respiratory Viruses Division, National Center for Immunization and Respiratory Diseases, CDC.
| | | | | | - Amanda B Payne
- Coronavirus and Other Respiratory Viruses Division, National Center for Immunization and Respiratory Diseases, CDC
| | - Manjusha Gaglani
- Section of Pediatric Infectious Diseases, Department of Pediatrics, Baylor Scott & White Health, Temple, Texas; Department of Medical Education, Texas A&M University College of Medicine, Temple, Texas
| | - Katherine Adams
- Influenza Division, National Center for Immunization and Respiratory Diseases, CDC
| | | | - Karthik Natarajan
- Department of Biomedical Informatics, Columbia University Irving Medical Center, New York, New York; NewYork-Presbyterian Hospital, New York, New York
| | | | - Kristin Dascomb
- Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City, Utah
| | | | - Nicola P Klein
- Kaiser Permanente Vaccine Study Center, Kaiser Permanente Northern California Division of Research, Oakland, California
| | - Shaun J Grannis
- Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, Indiana; School of Medicine, Indiana University, Indianapolis, Indiana
| | - Toan C Ong
- School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Peter J Embi
- Vanderbilt University Medical Center, Nashville, Tennessee
| | | | - Monica Dickerson
- Influenza Division, National Center for Immunization and Respiratory Diseases, CDC
| | | | - Julie Arndorfer
- Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City, Utah
| | | | - Kristin Goddard
- Kaiser Permanente Vaccine Study Center, Kaiser Permanente Northern California Division of Research, Oakland, California
| | - Brian E Dixon
- Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, Indiana; Fairbanks School of Public Health, Indiana University, Indianapolis, Indiana
| | - Eric P Griggs
- Coronavirus and Other Respiratory Viruses Division, National Center for Immunization and Respiratory Diseases, CDC
| | - John Hansen
- Kaiser Permanente Vaccine Study Center, Kaiser Permanente Northern California Division of Research, Oakland, California
| | - Nimish Valvi
- Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, Indiana
| | - Morgan Najdowski
- Coronavirus and Other Respiratory Viruses Division, National Center for Immunization and Respiratory Diseases, CDC
| | - Julius Timbol
- Kaiser Permanente Vaccine Study Center, Kaiser Permanente Northern California Division of Research, Oakland, California
| | - Colin Rogerson
- Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, Indiana
| | - Bruce Fireman
- Kaiser Permanente Vaccine Study Center, Kaiser Permanente Northern California Division of Research, Oakland, California
| | - William F Fadel
- Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, Indiana; Fairbanks School of Public Health, Indiana University, Indianapolis, Indiana
| | - Palak Patel
- Influenza Division, National Center for Immunization and Respiratory Diseases, CDC
| | - Caitlin S Ray
- Influenza Division, National Center for Immunization and Respiratory Diseases, CDC
| | - Ryan Wiegand
- Coronavirus and Other Respiratory Viruses Division, National Center for Immunization and Respiratory Diseases, CDC
| | | | - Mark W Tenforde
- Influenza Division, National Center for Immunization and Respiratory Diseases, CDC
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7
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Link-Gelles R, Weber ZA, Reese SE, Payne AB, Gaglani M, Adams K, Kharbanda AB, Natarajan K, DeSilva MB, Dascomb K, Irving SA, Klein NP, Grannis SJ, Ong TC, Embi PJ, Dunne MM, Dickerson M, McEvoy C, Arndorfer J, Naleway AL, Goddard K, Dixon BE, Griggs EP, Hansen J, Valvi N, Najdowski M, Timbol J, Rogerson C, Fireman B, Fadel WF, Patel P, Ray CS, Wiegand R, Ball S, Tenforde MW. Estimates of Bivalent mRNA Vaccine Durability in Preventing COVID-19-Associated Hospitalization and Critical Illness Among Adults with and Without Immunocompromising Conditions - VISION Network, September 2022-April 2023. MMWR Morb Mortal Wkly Rep 2023; 72:579-588. [PMID: 37227984 DOI: 10.15585/mmwr.mm7221a3] [Citation(s) in RCA: 32] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
On September 1, 2022, CDC's Advisory Committee on Immunization Practices (ACIP) recommended a single bivalent mRNA COVID-19 booster dose for persons aged ≥12 years who had completed at least a monovalent primary series. Early vaccine effectiveness (VE) estimates among adults aged ≥18 years showed receipt of a bivalent booster dose provided additional protection against COVID-19-associated emergency department and urgent care visits and hospitalizations compared with that in persons who had received only monovalent vaccine doses (1); however, insufficient time had elapsed since bivalent vaccine authorization to assess the durability of this protection. The VISION Network* assessed VE against COVID-19-associated hospitalizations by time since bivalent vaccine receipt during September 13, 2022-April 21, 2023, among adults aged ≥18 years with and without immunocompromising conditions. During the first 7-59 days after vaccination, compared with no vaccination, VE for receipt of a bivalent vaccine dose among adults aged ≥18 years was 62% (95% CI = 57%-67%) among adults without immunocompromising conditions and 28% (95% CI = 10%-42%) among adults with immunocompromising conditions. Among adults without immunocompromising conditions, VE declined to 24% (95% CI = 12%-33%) among those aged ≥18 years by 120-179 days after vaccination. VE was generally lower for adults with immunocompromising conditions. A bivalent booster dose provided the highest protection, and protection was sustained through at least 179 days against critical outcomes, including intensive care unit (ICU) admission or in-hospital death. These data support updated recommendations allowing additional optional bivalent COVID-19 vaccine doses for certain high-risk populations. All eligible persons should stay up to date with recommended COVID-19 vaccines.
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8
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Dalton AF, Weber ZA, Allen KS, Stenehjem E, Irving SA, Spark TL, Adams K, Zerbo O, Lazariu V, Dixon BE, Dascomb K, Hartmann E, Kharbanda AB, Ong TC, DeSilva MB, Beaton M, Gaglani M, Patel P, Naleway AL, Kish MNS, Grannis SJ, Grisel N, Sloan-Aagard C, Rao S, Raiyani C, Dickerson M, Bassett E, Fadel WF, Arndorfer J, Nanez J, Barron MA, Vazquez-Benitez G, Liao IC, Griggs EP, Reese SE, Valvi NR, Murthy K, Rowley EAK, Embi PJ, Ball S, Link-Gelles R, Tenforde MW. Relationships Between Social Vulnerability and Coronavirus Disease 2019 Vaccination Coverage and Vaccine Effectiveness. Clin Infect Dis 2023; 76:1615-1625. [PMID: 36611252 PMCID: PMC10949185 DOI: 10.1093/cid/ciad003] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 12/09/2022] [Accepted: 01/03/2023] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) vaccination coverage remains lower in communities with higher social vulnerability. Factors such as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) exposure risk and access to healthcare are often correlated with social vulnerability and may therefore contribute to a relationship between vulnerability and observed vaccine effectiveness (VE). Understanding whether these factors impact VE could contribute to our understanding of real-world VE. METHODS We used electronic health record data from 7 health systems to assess vaccination coverage among patients with medically attended COVID-19-like illness. We then used a test-negative design to assess VE for 2- and 3-dose messenger RNA (mRNA) adult (≥18 years) vaccine recipients across Social Vulnerability Index (SVI) quartiles. SVI rankings were determined by geocoding patient addresses to census tracts; rankings were grouped into quartiles for analysis. RESULTS In July 2021, primary series vaccination coverage was higher in the least vulnerable quartile than in the most vulnerable quartile (56% vs 36%, respectively). In February 2022, booster dose coverage among persons who had completed a primary series was higher in the least vulnerable quartile than in the most vulnerable quartile (43% vs 30%). VE among 2-dose and 3-dose recipients during the Delta and Omicron BA.1 periods of predominance was similar across SVI quartiles. CONCLUSIONS COVID-19 vaccination coverage varied substantially by SVI. Differences in VE estimates by SVI were minimal across groups after adjusting for baseline patient factors. However, lower vaccination coverage among more socially vulnerable groups means that the burden of illness is still disproportionately borne by the most socially vulnerable populations.
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Affiliation(s)
- Alexandra F Dalton
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta, Georgia, USA
| | | | - Katie S Allen
- Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, Indiana, USA
- Fairbanks School of Public Health, Indiana University, Indianapolis, Indiana, USA
| | - Edward Stenehjem
- Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City, Utah, USA
| | - Stephanie A Irving
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon, USA
| | | | - Katherine Adams
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta, Georgia, USA
| | - Ousseny Zerbo
- Kaiser Permanente Vaccine Study Center, Kaiser Permanente Northern California Division of Research, Oakland, California, USA
| | | | - Brian E Dixon
- Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, Indiana, USA
- Fairbanks School of Public Health, Indiana University, Indianapolis, Indiana, USA
| | - Kristin Dascomb
- Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City, Utah, USA
| | - Emily Hartmann
- Paso del Norte Health Information Exchange (PHIX), El Paso, Texas, USA
| | - Anupam B Kharbanda
- Department of Pediatric Emergency Medicine, Children's Minnesota, Minneapolis, Minnesota, USA
| | - Toan C Ong
- School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Malini B DeSilva
- Division of Research, HealthPartners Institute, Minneapolis, Minnesota, USA
| | - Maura Beaton
- Department of Biomedical Informatics, Columbia University Irving Medical Center, New York, New York, USA
| | - Manjusha Gaglani
- Baylor Scott & White Health, Temple, Texas, USA
- Texas A&M University College of Medicine, Temple, Texas, USA
| | - Palak Patel
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta, Georgia, USA
| | - Allison L Naleway
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon, USA
| | | | - Shaun J Grannis
- Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, Indiana, USA
- Fairbanks School of Public Health, Indiana University, Indianapolis, Indiana, USA
| | - Nancy Grisel
- Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City, Utah, USA
| | - Chantel Sloan-Aagard
- Paso del Norte Health Information Exchange (PHIX), El Paso, Texas, USA
- Brigham Young University Department of Public Health, Provo, Utah, USA
| | - Suchitra Rao
- School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | | | - Monica Dickerson
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta, Georgia, USA
| | | | - William F Fadel
- Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, Indiana, USA
- Fairbanks School of Public Health, Indiana University, Indianapolis, Indiana, USA
| | - Julie Arndorfer
- Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City, Utah, USA
| | - Juan Nanez
- Paso del Norte Health Information Exchange (PHIX), El Paso, Texas, USA
| | - Michelle A Barron
- School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | | | - I Chia Liao
- Baylor Scott & White Health, Temple, Texas, USA
| | - Eric P Griggs
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta, Georgia, USA
| | | | - Nimish R Valvi
- Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, Indiana, USA
| | | | | | - Peter J Embi
- Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, Indiana, USA
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | | | - Ruth Link-Gelles
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta, Georgia, USA
| | - Mark W Tenforde
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta, Georgia, USA
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9
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Klein NP, Demarco M, Fleming-Dutra KE, Stockwell MS, Kharbanda AB, Gaglani M, Rao S, Lewis N, Irving SA, Hartmann E, Natarajan K, Dalton AF, Zerbo O, DeSilva MB, Konatham D, Stenehjem E, Rowley EAK, Ong TC, Grannis SJ, Sloan-Aagard C, Han J, Verani JR, Raiyani C, Dascomb K, Reese SE, Barron MA, Fadel WF, Naleway AL, Nanez J, Dickerson M, Goddard K, Murthy K, Grisel N, Weber ZA, Dixon BE, Patel P, Fireman B, Arndorfer J, Valvi NR, Griggs EP, Hallowell C, Embi PJ, Ball SW, Thompson MG, Tenforde MW, Link-Gelles R. Effectiveness of BNT162b2 COVID-19 Vaccination in Children and Adolescents. Pediatrics 2023; 151:191035. [PMID: 37026401 DOI: 10.1542/peds.2022-060894] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/08/2023] [Indexed: 04/08/2023] Open
Abstract
OBJECTIVES We assessed BNT162b2 vaccine effectiveness (VE) against mild to moderate and severe coronavirus disease 2019 (COVID-19) in children and adolescents through the Omicron BA.4/BA.5 period. METHODS Using VISION Network records from April 2021 to September 2022, we conducted a test-negative, case-control study assessing VE against COVID-19-associated emergency department/urgent care (ED/UC) encounters and hospitalizations using logistic regression, conditioned on month and site, adjusted for covariates. RESULTS We compared 9800 ED/UC cases with 70 232 controls, and 305 hospitalized cases with 2612 controls. During Delta, 2-dose VE against ED/UC encounters at 12 to 15 years was initially 93% (95% confidence interval 89 to 95), waning to 77% (69% to 84%) after ≥150 days. At ages 16 to 17, VE was initially 93% (86% to 97%), waning to 72% (63% to 79%) after ≥150 days. During Omicron, VE at ages 12 to 15 was initially 64% (44% to 77%), waning to 13% (3% to 23%) after 60 days; at ages 16 to 17 VE was 31% (10% to 47%) during days 60 to 149, waning to 7% (-8 to 20%) after 150 days. A monovalent booster increased VE to 54% (40% to 65%) at ages 12 to 15 and 46% (30% to 58%) at ages 16 to 17. At ages 5 to 11, 2-dose VE was 49% (33% to 61%) initially and 41% (29% to 51%) after 150 days. During Delta, VE against hospitalizations at ages 12 to 17 was high (>97%), and at ages 16 to 17 remained 98% (73% to 100%) beyond 150 days; during Omicron, hospitalizations were too infrequent to precisely estimate VE. CONCLUSIONS BNT162b2 protected children and adolescents against mild to moderate and severe COVID-19. VE was lower during Omicron predominance including BA.4/BA.5, waned after dose 2 but increased after a monovalent booster. Children and adolescents should receive all recommended COVID-19 vaccinations.
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Affiliation(s)
- Nicola P Klein
- Kaiser Permanente Vaccine Study Center, Kaiser Permanente Northern California Division of Research, Oakland, California
| | | | | | - Melissa S Stockwell
- Division of Child and Adolescent Health, Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons, New York, New York
- Department of Population and Family Health, Columbia University Mailman School of Public Health, New York, New York
- NewYork-Presbyterian Hospital, New York, New York
| | | | - Manjusha Gaglani
- Department of Pediatrics, Section of Pediatric Infectious Diseases, Baylor Scott & White Health, Temple, Texas
- Department of Medical Education, Texas A&M University College of Medicine, Temple, Texas
| | - Suchitra Rao
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Ned Lewis
- Kaiser Permanente Vaccine Study Center, Kaiser Permanente Northern California Division of Research, Oakland, California
| | | | - Emily Hartmann
- Paso del Norte Health Information Exchange (PHIX), El Paso, Texas
| | - Karthik Natarajan
- NewYork-Presbyterian Hospital, New York, New York
- Department of Biomedical Informatics, Columbia University Irving Medical Center, New York, New York
| | - Alexandra F Dalton
- Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta, Georgia
| | - Ousseny Zerbo
- Kaiser Permanente Vaccine Study Center, Kaiser Permanente Northern California Division of Research, Oakland, California
| | | | - Deepika Konatham
- Department of Pediatrics, Section of Pediatric Infectious Diseases, Baylor Scott & White Health, Temple, Texas
| | - Edward Stenehjem
- Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City, Utah
| | | | - Toan C Ong
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Shaun J Grannis
- Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, Indiana
- School of Medicine, Indiana University, Indianapolis, Indiana
| | - Chantel Sloan-Aagard
- Paso del Norte Health Information Exchange (PHIX), El Paso, Texas
- Brigham Young University Department of Public Health, Provo, Utah
| | - Jungmi Han
- Paso del Norte Health Information Exchange (PHIX), El Paso, Texas
| | - Jennifer R Verani
- Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta, Georgia
| | - Chandni Raiyani
- Department of Pediatrics, Section of Pediatric Infectious Diseases, Baylor Scott & White Health, Temple, Texas
| | - Kristin Dascomb
- Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City, Utah
| | | | - Michelle A Barron
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - William F Fadel
- Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, Indiana
- Fairbanks School of Public Health, Indiana University, Indianapolis; and
| | | | - Juan Nanez
- Paso del Norte Health Information Exchange (PHIX), El Paso, Texas
| | - Monica Dickerson
- Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta, Georgia
| | - Kristin Goddard
- Kaiser Permanente Vaccine Study Center, Kaiser Permanente Northern California Division of Research, Oakland, California
| | - Kempapura Murthy
- Department of Pediatrics, Section of Pediatric Infectious Diseases, Baylor Scott & White Health, Temple, Texas
| | - Nancy Grisel
- Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City, Utah
| | | | - Brian E Dixon
- Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, Indiana
- Fairbanks School of Public Health, Indiana University, Indianapolis; and
| | - Palak Patel
- Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta, Georgia
| | - Bruce Fireman
- Kaiser Permanente Vaccine Study Center, Kaiser Permanente Northern California Division of Research, Oakland, California
| | - Julie Arndorfer
- Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City, Utah
| | - Nimish R Valvi
- Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, Indiana
| | - Eric P Griggs
- Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta, Georgia
| | | | - Peter J Embi
- Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, Indiana
- Vanderbilt University Medical Center, Nashville, Tennessee
| | | | - Mark G Thompson
- Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta, Georgia
| | - Mark W Tenforde
- Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta, Georgia
| | - Ruth Link-Gelles
- Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta, Georgia
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10
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Link-Gelles R, Levy ME, Natarajan K, Reese SE, Naleway AL, Grannis SJ, Klein NP, DeSilva MB, Ong TC, Gaglani M, Hartmann E, Dickerson M, Stenehjem E, Kharbanda AB, Han J, Spark TL, Irving SA, Dixon BE, Zerbo O, McEvoy CE, Rao S, Raiyani C, Sloan-Aagard C, Patel P, Dascomb K, Uhlemann AC, Dunne MM, Fadel WF, Lewis N, Barron MA, Murthy K, Nanez J, Griggs EP, Grisel N, Annavajhala MK, Akinseye A, Valvi NR, Goddard K, Mamawala M, Arndorfer J, Yang DH, Embí PJ, Fireman B, Ball SW, Tenforde MW. Estimation of COVID-19 mRNA Vaccine Effectiveness and COVID-19 Illness and Severity by Vaccination Status During Omicron BA.4 and BA.5 Sublineage Periods. JAMA Netw Open 2023; 6:e232598. [PMID: 36920396 PMCID: PMC10018321 DOI: 10.1001/jamanetworkopen.2023.2598] [Citation(s) in RCA: 29] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/16/2023] Open
Abstract
IMPORTANCE Recent SARS-CoV-2 Omicron variant sublineages, including BA.4 and BA.5, may be associated with greater immune evasion and less protection against COVID-19 after vaccination. OBJECTIVES To evaluate the estimated vaccine effectiveness (VE) of 2, 3, or 4 doses of COVID-19 mRNA vaccination among immunocompetent adults during a period of BA.4 or BA.5 predominant circulation; and to evaluate the relative severity of COVID-19 in hospitalized patients across Omicron BA.1, BA.2 or BA.2.12.1, and BA.4 or BA.5 sublineage periods. DESIGN, SETTING, AND PARTICIPANTS This test-negative case-control study was conducted in 10 states with data from emergency department (ED) and urgent care (UC) encounters and hospitalizations from December 16, 2021, to August 20, 2022. Participants included adults with COVID-19-like illness and molecular testing for SARS-CoV-2. Data were analyzed from August 2 to September 21, 2022. EXPOSURES mRNA COVID-19 vaccination. MAIN OUTCOMES AND MEASURES The outcomes of interest were COVID-19 ED or UC encounters, hospitalizations, and admission to the intensive care unit (ICU) or in-hospital death. VE associated with protection against medically attended COVID-19 was estimated, stratified by care setting and vaccine doses (2, 3, or 4 doses vs 0 doses as the reference group). Among hospitalized patients with COVID-19, demographic and clinical characteristics and in-hospital outcomes were compared across sublineage periods. RESULTS During the BA.4 and BA.5 predominant period, there were 82 229 eligible ED and UC encounters among patients with COVID-19-like illness (median [IQR] age, 51 [33-70] years; 49 682 [60.4%] female patients), and 19 114 patients (23.2%) had test results positive for SARS-CoV-2; among 21 007 hospitalized patients (median [IQR] age, 71 [58-81] years; 11 209 [53.4%] female patients), 3583 (17.1 %) had test results positive for SARS-CoV-2. Estimated VE against hospitalization was 25% (95% CI, 17%-32%) for receipt of 2 vaccine doses at 150 days or more after receipt, 68% (95% CI, 50%-80%) for a third dose 7 to 119 days after receipt, and 36% (95% CI, 29%-42%) for a third dose 120 days or more (median [IQR], 235 [204-262] days) after receipt. Among patients aged 65 years or older who had received a fourth vaccine dose, VE was 66% (95% CI, 53%-75%) at 7 to 59 days after vaccination and 57% (95% CI, 44%-66%) at 60 days or more (median [IQR], 88 [75-105] days) after vaccination. Among hospitalized patients with COVID-19, ICU admission or in-hospital death occurred in 21.4% of patients during the BA.1 period vs 14.7% during the BA.4 and BA.5 period (standardized mean difference: 0.17). CONCLUSIONS AND RELEVANCE In this case-control study of COVID-19 vaccines and illness, VE associated with protection against medically attended COVID-19 illness was lower with increasing time since last dose; estimated VE was higher after receipt of 1 or 2 booster doses compared with a primary series alone.
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Affiliation(s)
- Ruth Link-Gelles
- Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta, Georgia
| | | | - Karthik Natarajan
- Department of Biomedical Informatics, Columbia University Irving Medical Center, New York, New York
- New York–Presbyterian Hospital, New York, New York
| | | | | | - Shaun J. Grannis
- Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, Indiana
- School of Medicine, Indiana University, Indianapolis
| | - Nicola P. Klein
- Kaiser Permanente Vaccine Study Center, Kaiser Permanente Northern California Division of Research, Oakland
| | | | - Toan C. Ong
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora
| | - Manjusha Gaglani
- Baylor Scott and White Health, Temple, Texas
- Texas A&M University College of Medicine, Temple
| | - Emily Hartmann
- Paso del Norte Health Information Exchange, El Paso, Texas
| | - Monica Dickerson
- Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta, Georgia
| | - Edward Stenehjem
- Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City, Utah
| | | | - Jungmi Han
- Department of Biomedical Informatics, Columbia University Irving Medical Center, New York, New York
| | | | | | - Brian E. Dixon
- Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, Indiana
- Fairbanks School of Public Health, Indiana University, Indianapolis
| | - Ousseny Zerbo
- Kaiser Permanente Vaccine Study Center, Kaiser Permanente Northern California Division of Research, Oakland
| | | | - Suchitra Rao
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora
| | | | - Chantel Sloan-Aagard
- Paso del Norte Health Information Exchange, El Paso, Texas
- Department of Public Health, Brigham Young University, Provo, Utah
| | - Palak Patel
- Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta, Georgia
| | - Kristin Dascomb
- Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City, Utah
| | - Anne-Catrin Uhlemann
- Department of Internal Medicine, Division of Infectious Disease, Columbia University Irving Medical Center, New York, New York
| | | | - William F. Fadel
- Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, Indiana
- Fairbanks School of Public Health, Indiana University, Indianapolis
| | - Ned Lewis
- Kaiser Permanente Vaccine Study Center, Kaiser Permanente Northern California Division of Research, Oakland
| | - Michelle A. Barron
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora
| | | | - Juan Nanez
- Paso del Norte Health Information Exchange, El Paso, Texas
| | - Eric P. Griggs
- Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta, Georgia
| | - Nancy Grisel
- Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City, Utah
| | - Medini K. Annavajhala
- Department of Internal Medicine, Division of Infectious Disease, Columbia University Irving Medical Center, New York, New York
| | | | - Nimish R. Valvi
- Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, Indiana
| | - Kristin Goddard
- Kaiser Permanente Vaccine Study Center, Kaiser Permanente Northern California Division of Research, Oakland
| | | | - Julie Arndorfer
- Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City, Utah
| | | | - Peter J. Embí
- Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, Indiana
- Vanderbilt University Medical Center, Nashville, Tennessee
| | - Bruce Fireman
- Kaiser Permanente Vaccine Study Center, Kaiser Permanente Northern California Division of Research, Oakland
| | | | - Mark W. Tenforde
- Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta, Georgia
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11
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Dbeibo L, Lucky CW, Fadel WF, Sadowski J, Beeler C, Kelley K, Williams J, Webb D, Kara A. Two-step algorithm-based Clostridioides difficile testing as a tool for antibiotic stewardship. Clin Microbiol Infect 2023:S1198-743X(23)00061-7. [PMID: 36804907 DOI: 10.1016/j.cmi.2023.02.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [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: 10/10/2022] [Revised: 01/25/2023] [Accepted: 02/07/2023] [Indexed: 02/21/2023]
Abstract
OBJECTIVES Diagnosis of Clostridium difficile infection (CDI) can be challenging due to high colonization rates. Unlike PCR-only testing, two-step algorithm testing (that includes toxin and PCR) may help differentiate colonization from active infection, but it is unknown if this type of testing impacts treatment decisions. We examined the association between changing CDI diagnostic methods, the way the testing results were displayed, and the rates of CDI-specific treatment. METHODS We performed a retrospective analysis of positive C. difficile cases over 2 years, a year preceding and following our institution's transition from PCR to two-step testing. During the PCR period, results were displayed in the electronic medical record as 'positive'. In the two-step period, positive results were either displayed as 'likely colonized' or 'toxin positive'. Rates of CDI-specific therapy and adverse patient outcomes (30-day mortality and intensive care unit admission) were compared among the three groups. RESULTS A total of 610 patients had positive results over the study period. Of the 354 patients in the PCR group, 329 (93%) were treated with CDI-specific therapy. Of the 142 patients in the likely colonized group, 59 (42%) were treated. All 114 patients in the toxin-positive group were treated. Multivariate analysis of patients who were PCR positive or likely colonized showed that tests sent in the two-step era were less likely to be associated with treatment for CDI (odds ratio 0.05, 95% CI 0.03-0.09). DISCUSSION We found a correlation between changing the type of test and the way the results were displayed and reduction in CDI-specific antibiotic use without restricting clinician diagnostic ordering.
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Affiliation(s)
- Lana Dbeibo
- Division of Infectious Diseases, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA; Infection Prevention, Indiana University Health, Indianapolis, IN, USA.
| | - Christine W Lucky
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - William F Fadel
- Department of Biostatistics and Health Data Science, Indiana University Fairbanks School of Public Health, Indianapolis, IN, USA
| | - Joshua Sadowski
- Infection Prevention, Indiana University Health, Indianapolis, IN, USA
| | - Cole Beeler
- Division of Infectious Diseases, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA; Infection Prevention, Indiana University Health, Indianapolis, IN, USA
| | - Kristen Kelley
- Infection Prevention, Indiana University Health, Indianapolis, IN, USA
| | - Joy Williams
- University of Wisconsin Hospitals and Clinics, Wisconsin, Madison, WI, USA
| | - Douglas Webb
- Infection Prevention, Indiana University Health, Indianapolis, IN, USA
| | - Areeba Kara
- Division of General Internal Medicine and Geriatrics, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
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12
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Bozio CH, Butterfield KA, Briggs Hagen M, Grannis S, Drawz P, Hartmann E, Ong TC, Fireman B, Natarajan K, Dascomb K, Gaglani M, DeSilva MB, Yang DH, Midgley CM, Dixon BE, Naleway AL, Grisel N, Liao IC, Reese SE, Fadel WF, Irving SA, Lewis N, Arndorfer J, Murthy K, Riddles J, Valvi NR, Mamawala M, Embi PJ, Thompson MG, Stenehjem E. Protection from COVID-19 mRNA vaccination and prior SARS-CoV-2 infection against COVID-19-associated encounters in adults during Delta and Omicron predominance. J Infect Dis 2023:7045997. [PMID: 36806690 DOI: 10.1093/infdis/jiad040] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 01/27/2023] [Accepted: 02/10/2023] [Indexed: 02/20/2023] Open
Abstract
BACKGROUND Data assessing protection conferred from COVID-19 mRNA vaccination and/or prior SARS-CoV-2 infection during Delta and Omicron predominance periods in the U.S. are limited. METHODS This cohort study included persons ≥18 years who had ≥1 healthcare encounter across four health systems and had been tested for SARS-CoV-2 before August 26, 2021. COVID-19 mRNA vaccination and prior SARS-CoV-2 infection defined the exposure. Cox regression estimated hazard ratios (HRs) for the Delta and Omicron periods; protection was calculated as (1-HR)x100%. RESULTS Compared to unvaccinated and previously uninfected persons, during Delta predominance, protection against COVID-19-associated hospitalizations was high for those 2- or 3-dose vaccinated and previously infected, 3-dose vaccinated alone, and prior infection alone (range:91%-97%, with overlapping 95% confidence intervals (95%CIs)); during Omicron predominance, estimates were lower (range:77%-90%). Protection against COVID-19-associated emergency department/urgent care (ED/UC) encounters during Delta predominance was high for those exposure groups (range:86%-93%); during Omicron predominance, protection remained high for those 3-dose vaccinated with or without a prior infection (76% (95%CI=67%-83%) and 71% (95%CI=67%-73%), respectively). CONCLUSIONS COVID-19 mRNA vaccination and/or prior SARS-CoV-2 infection provided protection against COVID-19-associated hospitalizations and ED/UC encounters regardless of variant. Staying up-to-date with COVID-19 vaccination still provides protection against severe COVID-19 disease, regardless of prior infection.
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Affiliation(s)
- Catherine H Bozio
- Centers for Disease Control and Prevention COVID-19 Emergency Response Team, Atlanta, Georgia, USA
| | | | - Melissa Briggs Hagen
- Centers for Disease Control and Prevention COVID-19 Emergency Response Team, Atlanta, Georgia, USA
| | - Shaun Grannis
- Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, Indiana, USA.,Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Paul Drawz
- Division of Nephrology & Hypertension, University of Minnesota, Minneapolis, Minnesota, USA
| | - Emily Hartmann
- Paso Del Norte Health Information Exchange, El Paso, Texas, USA
| | - Toan C Ong
- School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Bruce Fireman
- Kaiser Permanente Vaccine Study Center, Kaiser Permanente Northern California Division of Research, Oakland, California, USA
| | - Karthik Natarajan
- Department of Biomedical Informatics, Columbia University Irving Medical Center, New York, New York, USA.,New York Presbyterian Hospital, New York, New York, USA
| | - Kristin Dascomb
- Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City, Utah, USA
| | - Manjusha Gaglani
- Baylor Scott & White Health, Texas A&M University College of Medicine, Temple, Texas, USA.,Texas A&M University College of Medicine, Temple, Texas
| | | | | | - Claire M Midgley
- Centers for Disease Control and Prevention COVID-19 Emergency Response Team, Atlanta, Georgia, USA
| | - Brian E Dixon
- Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, Indiana, USA.,Fairbanks School of Public Health, Indiana University, Indianapolis, Indiana, USA
| | - Allison L Naleway
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon, USA
| | - Nancy Grisel
- Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City, Utah, USA
| | - I-Chia Liao
- Baylor Scott & White Health, Texas A&M University College of Medicine, Temple, Texas, USA
| | | | - William F Fadel
- Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, Indiana, USA.,Fairbanks School of Public Health, Indiana University, Indianapolis, Indiana, USA
| | - Stephanie A Irving
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon, USA
| | - Ned Lewis
- Kaiser Permanente Vaccine Study Center, Kaiser Permanente Northern California Division of Research, Oakland, California, USA
| | - Julie Arndorfer
- Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City, Utah, USA
| | - Kempapura Murthy
- Baylor Scott & White Health, Texas A&M University College of Medicine, Temple, Texas, USA
| | | | - Nimish R Valvi
- Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, Indiana, USA
| | - Mufaddal Mamawala
- Baylor Scott & White Health, Texas A&M University College of Medicine, Temple, Texas, USA
| | - Peter J Embi
- Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, Indiana, USA.,Regenstrief Institute, Indianapolis, Indiana, USA
| | - Mark G Thompson
- Centers for Disease Control and Prevention COVID-19 Emergency Response Team, Atlanta, Georgia, USA
| | - Edward Stenehjem
- Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City, Utah, USA
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13
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DeSilva MB, Mitchell PK, Klein NP, Dixon BE, Tenforde MW, Thompson MG, Naleway AL, Grannis SJ, Ong TC, Natarajan K, Reese SE, Zerbo O, Kharbanda AB, Patel P, Stenehjem E, Raiyani C, Irving SA, Fadel WF, Rao S, Han J, Reynolds S, Davis JM, Lewis N, McEvoy C, Dickerson M, Dascomb K, Valvi NR, Barron MA, Goddard K, Vazquez-Benitez G, Grisel N, Mamawala M, Embi PJ, Fireman B, Essien IJ, Griggs EP, Arndorfer J, Gaglani M. Protection of 2 and 3 mRNA Vaccine Doses Against Severe Outcomes Among Adults Hospitalized with COVID-19 – VISION Network, August 2021 – March 2022. J Infect Dis 2022; 227:961-969. [PMID: 36415904 DOI: 10.1093/infdis/jiac458] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 11/14/2022] [Accepted: 11/21/2022] [Indexed: 11/24/2022] Open
Abstract
Abstract
Background
We assessed COVID-19 vaccination impact on illness severity among adults hospitalized with COVID-19 August 2021–March 2022.
Methods
We evaluated differences in intensive care unit (ICU) admission, in-hospital death, and length of stay among vaccinated (2 or 3 mRNA vaccine doses) versus unvaccinated patients aged ≥18 years hospitalized for ≥24 hours with COVID-19-like illness (CLI) and positive SARS-CoV-2 molecular testing. We calculated odds ratios for ICU admission and death and subdistribution hazard ratios (SHR) for time to hospital discharge adjusted for age, geographic region, calendar time, and local virus circulation.
Results
We included 27,149 SARS-CoV-2 positive hospitalizations. During both Delta and Omicron-predominant periods, protection against ICU admission was strongest among 3-dose vaccinees compared with unvaccinated patients (Delta OR [CI]: 0.52 [0.28–0.96]); Omicron OR [CI]: 0.69 [0.54–0.87]). During both periods, risk of in-hospital of death was lower among vaccinated compared with unvaccinated but ORs were overlapping; during Omicron, lowest among 3-dose vaccinees (OR [CI] 0.39 [0.28–0.54]). We observed SHR >1 across all vaccination strata in both periods indicating faster discharge for vaccinated patients.
Conclusions
COVID-19 vaccination was associated with lower rates of ICU admission and in-hospital death in both Delta and Omicron periods compared with being unvaccinated.
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Affiliation(s)
- Malini B DeSilva
- HealthPartners Institute , Minneapolis, Minnesota , United States
| | | | - Nicola P Klein
- Kaiser Permanente Vaccine Study Center, Kaiser Permanente Northern California Division of Research , Oakland, California , United States
| | - Brian E Dixon
- Center for Biomedical Informatics, Regenstrief Institute , Indianapolis, Indiana , United States
- Fairbanks School of Public Health, Indiana University , Indianapolis, Indiana , United States
| | - Mark W Tenforde
- Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta, Georgia , United States
| | - Mark G Thompson
- Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta, Georgia , United States
| | - Allison L Naleway
- Center for Health Research, Kaiser Permanente Northwest , Portland, Oregon , United States
| | - Shaun J Grannis
- Center for Biomedical Informatics, Regenstrief Institute , Indianapolis, Indiana , United States
- School of Medicine, Indiana University , Indianapolis, Indiana , United States
| | - Toan C Ong
- School of Medicine, University of Colorado Anschutz Medical Campus , Aurora, Colorado , United States
| | - Karthik Natarajan
- Department of Biomedical Informatics, Columbia University Irving Medical Center, New York , New York
- New York Presbyterian Hospital, New York , New York , United States
| | | | - Ousseny Zerbo
- Kaiser Permanente Vaccine Study Center, Kaiser Permanente Northern California Division of Research , Oakland, California , United States
| | | | - Palak Patel
- Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta, Georgia , United States
| | - Edward Stenehjem
- Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare , Salt Lake City, Utah , United States
| | | | - Stephanie A Irving
- Center for Health Research, Kaiser Permanente Northwest , Portland, Oregon , United States
| | - William F Fadel
- Center for Biomedical Informatics, Regenstrief Institute , Indianapolis, Indiana , United States
- Fairbanks School of Public Health, Indiana University , Indianapolis, Indiana , United States
| | - Suchitra Rao
- School of Medicine, Indiana University , Indianapolis, Indiana , United States
| | - Jungmi Han
- Department of Biomedical Informatics, Columbia University Irving Medical Center, New York , New York
| | - Sue Reynolds
- Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta, Georgia , United States
| | | | - Ned Lewis
- Kaiser Permanente Vaccine Study Center, Kaiser Permanente Northern California Division of Research , Oakland, California , United States
| | - Charlene McEvoy
- HealthPartners Institute , Minneapolis, Minnesota , United States
| | - Monica Dickerson
- Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta, Georgia , United States
| | - Kristin Dascomb
- Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare , Salt Lake City, Utah , United States
| | - Nimish R Valvi
- Center for Biomedical Informatics, Regenstrief Institute , Indianapolis, Indiana , United States
| | - Michelle A Barron
- School of Medicine, University of Colorado Anschutz Medical Campus , Aurora, Colorado , United States
| | - Kristin Goddard
- Kaiser Permanente Vaccine Study Center, Kaiser Permanente Northern California Division of Research , Oakland, California , United States
| | | | - Nancy Grisel
- Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare , Salt Lake City, Utah , United States
| | | | - Peter J Embi
- Center for Biomedical Informatics, Regenstrief Institute , Indianapolis, Indiana , United States
- Vanderbilt University Medical Center , Nashville, Tennessee , United States
| | - Bruce Fireman
- Kaiser Permanente Vaccine Study Center, Kaiser Permanente Northern California Division of Research , Oakland, California , United States
| | - Inih J Essien
- HealthPartners Institute , Minneapolis, Minnesota , United States
| | - Eric P Griggs
- Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta, Georgia , United States
| | - Julie Arndorfer
- Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare , Salt Lake City, Utah , United States
| | - Manjusha Gaglani
- Texas A&M University College of Medicine , Temple, Texas , United States
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14
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Dixon BE, Fadel WF, Duszynski TJ, Caine VA, Meyer JF, Saysana M. Mitigation of COVID-19 at the 2021 National Collegiate Athletic Association Men’s Basketball Tournament. BMC Public Health 2022; 22:2061. [DOI: 10.1186/s12889-022-14547-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 11/04/2022] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Data are lacking regarding the risk of viral SARS-CoV-2 transmission during a large indoor sporting event involving fans utilizing a controlled environment. We sought to describe case characteristics, mitigation protocols used, variants detected, and secondary infections detected during the 2021 National Collegiate Athletic Association (NCAA) Men’s Basketball Tournament involving collegiate athletes from across the U.S.
Methods
This retrospective cohort study used data collected from March 16 to April 3, 2021, as part of a closed environment which required daily reverse transcription-polymerase chain reaction (RT-PCR) testing, social distancing, universal masking, and limited contact between tiers of participants. Nearly 3000 players, staff, and vendors participated in indoor, unmasked activities that involved direct exposure between cases and noninfected individuals. The main outcome of interest was transmission of SARS-CoV-2 virus, as measured by the number of new infections and variant(s) detected among positive cases. Secondary infections were identified through contact tracing by public health officials.
Results
Out of 2660 participants, 15 individuals (0.56%) screened positive for SARS-CoV-2. Four cases involved players or officials, and all cases were detected before any individual played in or officiated a game. Secondary transmissions all occurred outside the controlled environment. Among those disqualified from the tournament (4 cases; 26.7%), all individuals tested positive for the Iota variant (B.1.526). All other cases involved the Alpha variant (B.1.1.7). Nearly all teams (N = 58; 85.3%) reported that some individuals had received at least one dose of a vaccine. Overall, 17.9% of participants either had at least one dose of the vaccine or possessed documented infection within 90 days of the tournament.
Conclusion
In this retrospective cohort study of the 2021 NCAA Men’s Basketball Tournament closed environment, only a few cases were detected, and they were discovered in advance of potential exposure. These findings support the U.S. Centers for Disease Control and Prevention (CDC) guidelines for large indoor sporting events during the COVID-19 pandemic.
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15
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Britton A, Embi PJ, Levy ME, Gaglani M, DeSilva MB, Dixon BE, Dascomb K, Patel P, Schrader KE, Klein NP, Ong TC, Natarajan K, Hartmann E, Kharbanda AB, Irving SA, Dickerson M, Dunne MM, Raiyani C, Grannis SJ, Stenehjem E, Zerbo O, Rao S, Han J, Sloan-Aagard C, Griggs EP, Weber ZA, Murthy K, Fadel WF, Grisel N, McEvoy C, Lewis N, Barron MA, Nanez J, Reese SE, Mamawala M, Valvi NR, Arndorfer J, Goddard K, Yang DH, Fireman B, Ball SW, Link-Gelles R, Naleway AL, Tenforde MW. Effectiveness of COVID-19 mRNA Vaccines Against COVID-19-Associated Hospitalizations Among Immunocompromised Adults During SARS-CoV-2 Omicron Predominance - VISION Network, 10 States, December 2021-August 2022. MMWR Morb Mortal Wkly Rep 2022; 71:1335-1342. [PMID: 36264840 PMCID: PMC9590295 DOI: 10.15585/mmwr.mm7142a4] [Citation(s) in RCA: 45] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Persons with moderate-to-severe immunocompromising conditions might have reduced protection after COVID-19 vaccination, compared with persons without immunocompromising conditions (1-3). On August 13, 2021, the Advisory Committee on Immunization Practices (ACIP) recommended that adults with immunocompromising conditions receive an expanded primary series of 3 doses of an mRNA COVID-19 vaccine. ACIP followed with recommendations on September 23, 2021, for a fourth (booster) dose and on September 1, 2022, for a new bivalent mRNA COVID-19 vaccine booster dose, containing components of the BA.4 and BA.5 sublineages of the Omicron (B.1.1.529) variant (4). Data on vaccine effectiveness (VE) of monovalent COVID-19 vaccines among persons with immunocompromising conditions since the emergence of the Omicron variant in December 2021 are limited. In the multistate VISION Network,§ monovalent 2-, 3-, and 4-dose mRNA VE against COVID-19-related hospitalization were estimated among adults with immunocompromising conditions¶ hospitalized with COVID-19-like illness,** using a test-negative design comparing odds of previous vaccination among persons with a positive or negative molecular test result (case-patients and control-patients) for SARS-CoV-2 (the virus that causes COVID-19). During December 16, 2021-August 20, 2022, among SARS-CoV-2 test-positive case-patients, 1,815 (36.3%), 1,387 (27.7%), 1,552 (31.0%), and 251 (5.0%) received 0, 2, 3, and 4 mRNA COVID-19 vaccine doses, respectively. Among test-negative control-patients during this period, 6,928 (23.7%), 7,411 (25.4%), 12,734 (43.6%), and 2,142 (7.3%) received these respective doses. Overall, VE against COVID-19-related hospitalization among adults with immunocompromising conditions hospitalized for COVID-like illness during Omicron predominance was 36% ≥14 days after dose 2, 69% 7-89 days after dose 3, and 44% ≥90 days after dose 3. Restricting the analysis to later periods when Omicron sublineages BA.2/BA.2.12.1 and BA.4/BA.5 were predominant and 3-dose recipients were eligible to receive a fourth dose, VE was 32% ≥90 days after dose 3 and 43% ≥7 days after dose 4. Protection offered by vaccination among persons with immunocompromising conditions during Omicron predominance was moderate even after a 3-dose monovalent primary series or booster dose. Given the incomplete protection against hospitalization afforded by monovalent COVID-19 vaccines, persons with immunocompromising conditions might benefit from updated bivalent vaccine booster doses that target recently circulating Omicron sublineages, in line with ACIP recommendations. Further, additional protective recommendations for persons with immunocompromising conditions, including the use of prophylactic antibody therapy, early access to and use of antivirals, and enhanced nonpharmaceutical interventions such as well-fitting masks or respirators, should also be considered.
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16
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Ferdinands JM, Rao S, Dixon BE, Mitchell PK, DeSilva MB, Irving SA, Lewis N, Natarajan K, Stenehjem E, Grannis SJ, Han J, McEvoy C, Ong TC, Naleway AL, Reese SE, Embi PJ, Dascomb K, Klein NP, Griggs EP, Liao IC, Yang DH, Fadel WF, Grisel N, Goddard K, Patel P, Murthy K, Birch R, Valvi NR, Arndorfer J, Zerbo O, Dickerson M, Raiyani C, Williams J, Bozio CH, Blanton L, Link-Gelles R, Barron MA, Gaglani M, Thompson MG, Fireman B. Waning of vaccine effectiveness against moderate and severe covid-19 among adults in the US from the VISION network: test negative, case-control study. BMJ 2022; 379:e072141. [PMID: 36191948 PMCID: PMC9527398 DOI: 10.1136/bmj-2022-072141] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
OBJECTIVE To estimate the effectiveness of mRNA vaccines against moderate and severe covid-19 in adults by time since second, third, or fourth doses, and by age and immunocompromised status. DESIGN Test negative case-control study. SETTING Hospitals, emergency departments, and urgent care clinics in 10 US states, 17 January 2021 to 12 July 2022. PARTICIPANTS 893 461 adults (≥18 years) admitted to one of 261 hospitals or to one of 272 emergency department or 119 urgent care centers for covid-like illness tested for SARS-CoV-2. MAIN OUTCOME MEASURES The main outcome was waning of vaccine effectiveness with BNT162b2 (Pfizer-BioNTech) or mRNA-1273 (Moderna) vaccine during the omicron and delta periods, and the period before delta was dominant using logistic regression conditioned on calendar week and geographic area while adjusting for age, race, ethnicity, local virus circulation, immunocompromised status, and likelihood of being vaccinated. RESULTS 45 903 people admitted to hospital with covid-19 (cases) were compared with 213 103 people with covid-like illness who tested negative for SARS-CoV-2 (controls), and 103 287 people admitted to emergency department or urgent care with covid-19 (cases) were compared with 531 168 people with covid-like illness who tested negative for SARS-CoV-2. In the omicron period, vaccine effectiveness against covid-19 requiring admission to hospital was 89% (95% confidence interval 88% to 90%) within two months after dose 3 but waned to 66% (63% to 68%) by four to five months. Vaccine effectiveness of three doses against emergency department or urgent care visits was 83% (82% to 84%) initially but waned to 46% (44% to 49%) by four to five months. Waning was evident in all subgroups, including young adults and individuals who were not immunocompromised; although waning was morein people who were immunocompromised. Vaccine effectiveness increased among most groups after a fourth dose in whom this booster was recommended. CONCLUSIONS Effectiveness of mRNA vaccines against moderate and severe covid-19 waned with time after vaccination. The findings support recommendations for a booster dose after a primary series and consideration of additional booster doses.
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Affiliation(s)
- Jill M Ferdinands
- Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta, GA, USA
| | - Suchitra Rao
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Brian E Dixon
- Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, IN, USA
- Fairbanks School of Public Health, Indiana University, Indianapolis, IN, USA
| | | | | | - Stephanie A Irving
- Center for Health Research, Kaiser Permanente Northwest, Portland, OR, USA
| | - Ned Lewis
- Kaiser Permanente Vaccine Study Center, Kaiser Permanente Northern California Division of Research, Oakland, CA, USA
| | - Karthik Natarajan
- Department of Biomedical Informatics, Columbia University Irving Medical Center, New York, NY, USA
- New York Presbyterian Hospital, New York, NY, USA
| | - Edward Stenehjem
- Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City, UT, USA
| | - Shaun J Grannis
- Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, IN, USA
- Indiana University School of Medicine, Indianapolis, IN, USA
| | - Jungmi Han
- Department of Biomedical Informatics, Columbia University Irving Medical Center, New York, NY, USA
| | | | - Toan C Ong
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Allison L Naleway
- Center for Health Research, Kaiser Permanente Northwest, Portland, OR, USA
| | | | | | - Kristin Dascomb
- Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City, UT, USA
| | - Nicola P Klein
- Kaiser Permanente Vaccine Study Center, Kaiser Permanente Northern California Division of Research, Oakland, CA, USA
| | - Eric P Griggs
- Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta, GA, USA
| | | | | | - William F Fadel
- Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, IN, USA
- Fairbanks School of Public Health, Indiana University, Indianapolis, IN, USA
| | - Nancy Grisel
- Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City, UT, USA
| | - Kristin Goddard
- Kaiser Permanente Vaccine Study Center, Kaiser Permanente Northern California Division of Research, Oakland, CA, USA
| | - Palak Patel
- Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta, GA, USA
| | | | | | - Nimish R Valvi
- Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, IN, USA
| | - Julie Arndorfer
- Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City, UT, USA
| | - Ousseny Zerbo
- Kaiser Permanente Vaccine Study Center, Kaiser Permanente Northern California Division of Research, Oakland, CA, USA
| | - Monica Dickerson
- Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta, GA, USA
| | | | - Jeremiah Williams
- Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta, GA, USA
| | - Catherine H Bozio
- Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta, GA, USA
| | - Lenee Blanton
- Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta, GA, USA
| | - Ruth Link-Gelles
- Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta, GA, USA
| | - Michelle A Barron
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | | | - Mark G Thompson
- Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta, GA, USA
| | - Bruce Fireman
- Kaiser Permanente Vaccine Study Center, Kaiser Permanente Northern California Division of Research, Oakland, CA, USA
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Schrag SJ, Verani JR, Dixon BE, Page JM, Butterfield KA, Gaglani M, Vazquez-Benitez G, Zerbo O, Natarajan K, Ong TC, Lazariu V, Rao S, Beaver R, Ellington SR, Klein NP, Irving SA, Grannis SJ, Kiduko S, Barron MA, Midturi J, Dickerson M, Lewis N, Stockwell MS, Stenehjem E, Fadel WF, Link-Gelles R, Murthy K, Goddard K, Grisel N, Valvi NR, Fireman B, Arndorfer J, Konatham D, Ball S, Thompson MG, Naleway AL. Estimation of COVID-19 mRNA Vaccine Effectiveness Against Medically Attended COVID-19 in Pregnancy During Periods of Delta and Omicron Variant Predominance in the United States. JAMA Netw Open 2022; 5:e2233273. [PMID: 36156146 PMCID: PMC9513651 DOI: 10.1001/jamanetworkopen.2022.33273] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [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: 12/15/2022] Open
Abstract
IMPORTANCE Pregnant people are at high risk for severe COVID-19 but were excluded from mRNA vaccine trials; data on COVID-19 vaccine effectiveness (VE) are needed. OBJECTIVE To evaluate the estimated effectiveness of mRNA vaccination against medically attended COVID-19 among pregnant people during Delta and Omicron predominance. DESIGN, SETTING, AND PARTICIPANTS This test-negative, case-control study was conducted from June 2021 to June 2022 in a network of 306 hospitals and 164 emergency department and urgent care (ED/UC) facilities across 10 US states, including 4517 ED/UC encounters and 975 hospitalizations among pregnant people with COVID-19-like illness (CLI) who underwent SARS-CoV-2 molecular testing. EXPOSURES Two doses (14-149 and ≥150 days prior) and 3 doses (7-119 and ≥120 days prior) of COVID-19 mRNA vaccine (≥1 dose received during pregnancy) vs unvaccinated. MAIN OUTCOMES AND MEASURES Estimated VE against laboratory-confirmed COVID-19-associated ED/UC encounter or hospitalization, based on the adjusted odds ratio (aOR) for prior vaccination; VE was calculated as (1 - aOR) × 100%. RESULTS Among 4517 eligible CLI-associated ED/UC encounters and 975 hospitalizations, 885 (19.6%) and 334 (34.3%) were SARS-CoV-2 positive, respectively; the median (IQR) patient age was 28 (24-32) years and 31 (26-35) years, 537 (12.0%) and 118 (12.0%) were non-Hispanic Black and 1189 (26.0%) and 240 (25.0%) were Hispanic. During Delta predominance, the estimated VE against COVID-19-associated ED/UC encounters was 84% (95% CI, 69% to 92%) for 2 doses within 14 to 149 days, 75% (95% CI, 5% to 93%) for 2 doses 150 or more days prior, and 81% (95% CI, 30% to 95%) for 3 doses 7 to 119 days prior; estimated VE against COVID-19-associated hospitalization was 99% (95% CI, 96% to 100%), 96% (95% CI, 86% to 99%), and 97% (95% CI, 79% to 100%), respectively. During Omicron predominance, for ED/UC encounters, the estimated VE of 2 doses within 14 to 149 days, 2 doses 150 or more days, 3 doses within 7 to 119 days, and 3 doses 120 or more days prior was 3% (95% CI, -49% to 37%), 42% (95% CI, -16% to 72%), 79% (95% CI, 59% to 89%), and -124% (95% CI, -414% to 2%), respectively; for hospitalization, estimated VE was 86% (95% CI, 41% to 97%), 64% (95% CI, -102% to 93%), 86% (95% CI, 28% to 97%), and -53% (95% CI, -1254% to 83%), respectively. CONCLUSIONS AND RELEVANCE In this study, maternal mRNA COVID-19 vaccination, including booster dose, was associated with protection against medically attended COVID-19. VE estimates were higher against COVID-19-associated hospitalization than ED/UC visits and lower against the Omicron variant than the Delta variant. Protection waned over time, particularly during Omicron predominance.
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Affiliation(s)
| | | | - Brian E. Dixon
- Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, Indiana
- Fairbanks School of Public Health, Indiana University, Indianapolis
| | - Jessica M. Page
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Intermountain Healthcare, University of Utah, Salt Lake City
| | | | - Manjusha Gaglani
- Baylor Scott & White Health Temple, Texas
- Texas A&M University College of Medicine, Temple
| | | | - Ousseny Zerbo
- Kaiser Permanente Vaccine Study Center, Kaiser Permanente Northern California Division of Research, Oakland
| | - Karthik Natarajan
- Department of Biomedical Informatics, Columbia University Irving Medical Center, New York, New York
- NewYork-Presbyterian Hospital, New York
| | - Toan C. Ong
- School of Medicine, University of Colorado Anschutz Medical Campus, Aurora
| | | | - Suchitra Rao
- School of Medicine, University of Colorado Anschutz Medical Campus, Aurora
| | | | | | - Nicola P. Klein
- Kaiser Permanente Vaccine Study Center, Kaiser Permanente Northern California Division of Research, Oakland
| | | | - Shaun J. Grannis
- Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, Indiana
- Indiana University School of Medicine, Indianapolis
| | | | - Michelle A. Barron
- School of Medicine, University of Colorado Anschutz Medical Campus, Aurora
| | | | | | - Ned Lewis
- Kaiser Permanente Vaccine Study Center, Kaiser Permanente Northern California Division of Research, Oakland
| | - Melissa S. Stockwell
- NewYork-Presbyterian Hospital, New York
- Division of Child and Adolescent Health, Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons, New York, New York
- Department of Population and Family Health, Columbia University Mailman School of Public Health, New York, New York
| | - Edward Stenehjem
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Intermountain Healthcare, University of Utah, Salt Lake City
| | - William F. Fadel
- Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, Indiana
- Fairbanks School of Public Health, Indiana University, Indianapolis
| | | | | | - Kristin Goddard
- Kaiser Permanente Vaccine Study Center, Kaiser Permanente Northern California Division of Research, Oakland
| | - Nancy Grisel
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Intermountain Healthcare, University of Utah, Salt Lake City
| | - Nimish R. Valvi
- Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, Indiana
| | - Bruce Fireman
- Kaiser Permanente Vaccine Study Center, Kaiser Permanente Northern California Division of Research, Oakland
| | - Julie Arndorfer
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Intermountain Healthcare, University of Utah, Salt Lake City
| | | | | | | | - Allison L. Naleway
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon
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Link-Gelles R, Levy ME, Gaglani M, Irving SA, Stockwell M, Dascomb K, DeSilva MB, Reese SE, Liao IC, Ong TC, Grannis SJ, McEvoy C, Patel P, Klein NP, Hartmann E, Stenehjem E, Natarajan K, Naleway AL, Murthy K, Rao S, Dixon BE, Kharbanda AB, Akinseye A, Dickerson M, Lewis N, Grisel N, Han J, Barron MA, Fadel WF, Dunne MM, Goddard K, Arndorfer J, Konatham D, Valvi NR, Currey JC, Fireman B, Raiyani C, Zerbo O, Sloan-Aagard C, Ball SW, Thompson MG, Tenforde MW. Effectiveness of 2, 3, and 4 COVID-19 mRNA Vaccine Doses Among Immunocompetent Adults During Periods when SARS-CoV-2 Omicron BA.1 and BA.2/BA.2.12.1 Sublineages Predominated - VISION Network, 10 States, December 2021-June 2022. MMWR Morb Mortal Wkly Rep 2022; 71:931-939. [PMID: 35862287 PMCID: PMC9310634 DOI: 10.15585/mmwr.mm7129e1] [Citation(s) in RCA: 73] [Impact Index Per Article: 36.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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Bernard C, Jakait B, Fadel WF, Mocello AR, Onono MA, Bukusi EA, Wools-Kaloustian KK, Cohen CR, Patel RC. Preferences for Multipurpose Technology and Non-oral Methods of Antiretroviral Therapy Among Women Living With HIV in Western Kenya: A Survey Study. Front Glob Womens Health 2022; 3:869623. [PMID: 35663925 PMCID: PMC9160913 DOI: 10.3389/fgwh.2022.869623] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 04/27/2022] [Indexed: 11/17/2022] Open
Abstract
Introduction Understanding interests in and preferences for multipurpose technology (MPT) for the co-administration of contraception and antiretroviral therapy (ART) and alternative, non-oral ART methods among women living with HIV (WLHIV) is vital to successful implementation of future treatment options, such as long-acting injectable ART. Methods Between May 2016 and March 2017 we conducted a cross-sectional telephone survey of 1,132 WLHIV of reproductive potential with prior experience using intermediate- or long-acting contraceptive methods in western Kenya. We present descriptive statistics and multinomial logistic regression to evaluate predictors of interest in specific MPT and non-oral ART methods. Results Two-thirds (67%) reported interest in MPT, with the most common reason for interest being ease of using a single medication for both purposes of HIV treatment and pregnancy prevention (26%). Main reasons for lack of interest in MPT were need to stop/not use contraception while continuing ART (21%) and risk of side effects (16%). Important characteristics of MPT were effectiveness for pregnancy prevention (26%) and HIV treatment (24%) and less than daily dosing (19%). Important characteristics of non-oral ART methods were less than daily dosing (47%), saving time accessing ART (16%), and effectiveness of HIV treatment (15%). The leading preferred methods for both MPT and non-oral ART were injectables (50 and 54%) and implants (32 and 31%). Prior use of a contraceptive implant or injectable predicted interest in similar methods for both MPT and non-oral ART methods, while this relationship did not appear to vary between younger vs. older WLHIV. Discussion Most WLHIV in western Kenya are interested in MPT for HIV treatment and contraception. Prior exposure to contraceptive implants or injectables appears to predict interest in similar methods of MPT and non-oral ART. Developers of MPT and non-oral ART methods should strongly consider WLHIV's preferences, including their changing reproductive desires.
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Affiliation(s)
- Caitlin Bernard
- Department of Obstetrics & Gynecology, Division of Family Planning, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Beatrice Jakait
- Moi Teaching & Referral Hospital/Moi University & Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - William F. Fadel
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis, IN, United States
| | - A. Rain Mocello
- Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology & Reproductive Health, University of California San Francisco, CA, United States
| | - Maricianah A. Onono
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Elizabeth A. Bukusi
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | | | - Craig R. Cohen
- Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology & Reproductive Health, University of California San Francisco, CA, United States
| | - Rena C. Patel
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, WA, United States
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20
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Natarajan K, Prasad N, Dascomb K, Irving SA, Yang DH, Gaglani M, Klein NP, DeSilva MB, Ong TC, Grannis SJ, Stenehjem E, Link-Gelles R, Rowley EA, Naleway AL, Han J, Raiyani C, Benitez GV, Rao S, Lewis N, Fadel WF, Grisel N, Griggs EP, Dunne MM, Stockwell MS, Mamawala M, McEvoy C, Barron MA, Goddard K, Valvi NR, Arndorfer J, Patel P, Mitchell PK, Smith M, Kharbanda AB, Fireman B, Embi PJ, Dickerson M, Davis JM, Zerbo O, Dalton AF, Wondimu MH, Azziz-Baumgartner E, Bozio CH, Reynolds S, Ferdinands J, Williams J, Schrag SJ, Verani JR, Ball S, Thompson MG, Dixon BE. Effectiveness of Homologous and Heterologous COVID-19 Booster Doses Following 1 Ad.26.COV2.S (Janssen [Johnson & Johnson]) Vaccine Dose Against COVID-19-Associated Emergency Department and Urgent Care Encounters and Hospitalizations Among Adults - VISION Network, 10 States, December 2021-March 2022. MMWR Morb Mortal Wkly Rep 2022; 71:495-502. [PMID: 35358170 PMCID: PMC8979598 DOI: 10.15585/mmwr.mm7113e2] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
CDC recommends that all persons aged ≥18 years receive a single COVID-19 vaccine booster dose ≥2 months after receipt of an Ad.26.COV2.S (Janssen [Johnson & Johnson]) adenovirus vector-based primary series vaccine; a heterologous COVID-19 mRNA vaccine is preferred over a homologous (matching) Janssen vaccine for booster vaccination. This recommendation was made in light of the risks for rare but serious adverse events following receipt of a Janssen vaccine, including thrombosis with thrombocytopenia syndrome and Guillain-Barré syndrome† (1), and clinical trial data indicating similar or higher neutralizing antibody response following heterologous boosting compared with homologous boosting (2). Data on real-world vaccine effectiveness (VE) of different booster strategies following a primary Janssen vaccine dose are limited, particularly during the period of Omicron variant predominance. The VISION Network§ determined real-world VE of 1 Janssen vaccine dose and 2 alternative booster dose strategies: 1) a homologous booster (i.e., 2 Janssen doses) and 2) a heterologous mRNA booster (i.e., 1 Janssen dose/1 mRNA dose). In addition, VE of these booster strategies was compared with VE of a homologous booster following mRNA primary series vaccination (i.e., 3 mRNA doses). The study examined 80,287 emergency department/urgent care (ED/UC) visits¶ and 25,244 hospitalizations across 10 states during December 16, 2021-March 7, 2022, when Omicron was the predominant circulating variant.** VE against laboratory-confirmed COVID-19-associated ED/UC encounters was 24% after 1 Janssen dose, 54% after 2 Janssen doses, 79% after 1 Janssen/1 mRNA dose, and 83% after 3 mRNA doses. VE for the same vaccination strategies against laboratory-confirmed COVID-19-associated hospitalizations were 31%, 67%, 78%, and 90%, respectively. All booster strategies provided higher protection than a single Janssen dose against ED/UC visits and hospitalizations during Omicron variant predominance. Vaccination with 1 Janssen/1 mRNA dose provided higher protection than did 2 Janssen doses against COVID-19-associated ED/UC visits and was comparable to protection provided by 3 mRNA doses during the first 120 days after a booster dose. However, 3 mRNA doses provided higher protection against COVID-19-associated hospitalizations than did other booster strategies during the same time interval since booster dose. All adults who have received mRNA vaccines for their COVID-19 primary series vaccination should receive an mRNA booster dose when eligible. Adults who received a primary Janssen vaccine dose should preferentially receive a heterologous mRNA vaccine booster dose ≥2 months later, or a homologous Janssen vaccine booster dose if mRNA vaccine is contraindicated or unavailable. Further investigation of the durability of protection afforded by different booster strategies is warranted.
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Klein NP, Stockwell MS, Demarco M, Gaglani M, Kharbanda AB, Irving SA, Rao S, Grannis SJ, Dascomb K, Murthy K, Rowley EA, Dalton AF, DeSilva MB, Dixon BE, Natarajan K, Stenehjem E, Naleway AL, Lewis N, Ong TC, Patel P, Konatham D, Embi PJ, Reese SE, Han J, Grisel N, Goddard K, Barron MA, Dickerson M, Liao IC, Fadel WF, Yang DH, Arndorfer J, Fireman B, Griggs EP, Valvi NR, Hallowell C, Zerbo O, Reynolds S, Ferdinands J, Wondimu MH, Williams J, Bozio CH, Link-Gelles R, Azziz-Baumgartner E, Schrag SJ, Thompson MG, Verani JR. Effectiveness of COVID-19 Pfizer-BioNTech BNT162b2 mRNA Vaccination in Preventing COVID-19-Associated Emergency Department and Urgent Care Encounters and Hospitalizations Among Nonimmunocompromised Children and Adolescents Aged 5-17 Years - VISION Network, 10 States, April 2021-January 2022. MMWR Morb Mortal Wkly Rep 2022; 71:352-358. [PMID: 35239634 PMCID: PMC8893336 DOI: 10.15585/mmwr.mm7109e3] [Citation(s) in RCA: 109] [Impact Index Per Article: 54.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
The efficacy of the BNT162b2 (Pfizer-BioNTech) vaccine against laboratory-confirmed COVID-19 exceeded 90% in clinical trials that included children and adolescents aged 5-11, 12-15, and 16-17 years (1-3). Limited real-world data on 2-dose mRNA vaccine effectiveness (VE) in persons aged 12-17 years (referred to as adolescents in this report) have also indicated high levels of protection against SARS-CoV-2 (the virus that causes COVID-19) infection and COVID-19-associated hospitalization (4-6); however, data on VE against the SARS-CoV-2 B.1.1.529 (Omicron) variant and duration of protection are limited. Pfizer-BioNTech VE data are not available for children aged 5-11 years. In partnership with CDC, the VISION Network* examined 39,217 emergency department (ED) and urgent care (UC) encounters and 1,699 hospitalizations† among persons aged 5-17 years with COVID-19-like illness across 10 states during April 9, 2021-January 29, 2022,§ to estimate VE using a case-control test-negative design. Among children aged 5-11 years, VE against laboratory-confirmed COVID-19-associated ED and UC encounters 14-67 days after dose 2 (the longest interval after dose 2 in this age group) was 46%. Among adolescents aged 12-15 and 16-17 years, VE 14-149 days after dose 2 was 83% and 76%, respectively; VE ≥150 days after dose 2 was 38% and 46%, respectively. Among adolescents aged 16-17 years, VE increased to 86% ≥7 days after dose 3 (booster dose). VE against COVID-19-associated ED and UC encounters was substantially lower during the Omicron predominant period than the B.1.617.2 (Delta) predominant period among adolescents aged 12-17 years, with no significant protection ≥150 days after dose 2 during Omicron predominance. However, in adolescents aged 16-17 years, VE during the Omicron predominant period increased to 81% ≥7 days after a third booster dose. During the full study period, including pre-Delta, Delta, and Omicron predominant periods, VE against laboratory-confirmed COVID-19-associated hospitalization among children aged 5-11 years was 74% 14-67 days after dose 2, with wide CIs that included zero. Among adolescents aged 12-15 and 16-17 years, VE 14-149 days after dose 2 was 92% and 94%, respectively; VE ≥150 days after dose 2 was 73% and 88%, respectively. All eligible children and adolescents should remain up to date with recommended COVID-19 vaccinations, including a booster dose for those aged 12-17 years.
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Ferdinands JM, Rao S, Dixon BE, Mitchell PK, DeSilva MB, Irving SA, Lewis N, Natarajan K, Stenehjem E, Grannis SJ, Han J, McEvoy C, Ong TC, Naleway AL, Reese SE, Embi PJ, Dascomb K, Klein NP, Griggs EP, Konatham D, Kharbanda AB, Yang DH, Fadel WF, Grisel N, Goddard K, Patel P, Liao IC, Birch R, Valvi NR, Reynolds S, Arndorfer J, Zerbo O, Dickerson M, Murthy K, Williams J, Bozio CH, Blanton L, Verani JR, Schrag SJ, Dalton AF, Wondimu MH, Link-Gelles R, Azziz-Baumgartner E, Barron MA, Gaglani M, Thompson MG, Fireman B. Waning 2-Dose and 3-Dose Effectiveness of mRNA Vaccines Against COVID-19-Associated Emergency Department and Urgent Care Encounters and Hospitalizations Among Adults During Periods of Delta and Omicron Variant Predominance - VISION Network, 10 States, August 2021-January 2022. MMWR Morb Mortal Wkly Rep 2022. [PMID: 35176007 DOI: 10.1558/mmwr.mm7107e2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/14/2023]
Abstract
CDC recommends that all persons aged ≥12 years receive a booster dose of COVID-19 mRNA vaccine ≥5 months after completion of a primary mRNA vaccination series and that immunocompromised persons receive a third primary dose.* Waning of vaccine protection after 2 doses of mRNA vaccine has been observed during the period of the SARS-CoV-2 B.1.617.2 (Delta) variant predominance† (1-5), but little is known about durability of protection after 3 doses during periods of Delta or SARS-CoV-2 B.1.1.529 (Omicron) variant predominance. A test-negative case-control study design using data from eight VISION Network sites§ examined vaccine effectiveness (VE) against COVID-19 emergency department/urgent care (ED/UC) visits and hospitalizations among U.S. adults aged ≥18 years at various time points after receipt of a second or third vaccine dose during two periods: Delta variant predominance and Omicron variant predominance (i.e., periods when each variant accounted for ≥50% of sequenced isolates).¶ Persons categorized as having received 3 doses included those who received a third dose in a primary series or a booster dose after a 2 dose primary series (including the reduced-dosage Moderna booster). The VISION Network analyzed 241,204 ED/UC encounters** and 93,408 hospitalizations across 10 states during August 26, 2021-January 22, 2022. VE after receipt of both 2 and 3 doses was lower during the Omicron-predominant than during the Delta-predominant period at all time points evaluated. During both periods, VE after receipt of a third dose was higher than that after a second dose; however, VE waned with increasing time since vaccination. During the Omicron period, VE against ED/UC visits was 87% during the first 2 months after a third dose and decreased to 66% among those vaccinated 4-5 months earlier; VE against hospitalizations was 91% during the first 2 months following a third dose and decreased to 78% ≥4 months after a third dose. For both Delta- and Omicron-predominant periods, VE was generally higher for protection against hospitalizations than against ED/UC visits. All eligible persons should remain up to date with recommended COVID-19 vaccinations to best protect against COVID-19-associated hospitalizations and ED/UC visits.
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Ferdinands JM, Rao S, Dixon BE, Mitchell PK, DeSilva MB, Irving SA, Lewis N, Natarajan K, Stenehjem E, Grannis SJ, Han J, McEvoy C, Ong TC, Naleway AL, Reese SE, Embi PJ, Dascomb K, Klein NP, Griggs EP, Konatham D, Kharbanda AB, Yang DH, Fadel WF, Grisel N, Goddard K, Patel P, Liao IC, Birch R, Valvi NR, Reynolds S, Arndorfer J, Zerbo O, Dickerson M, Murthy K, Williams J, Bozio CH, Blanton L, Verani JR, Schrag SJ, Dalton AF, Wondimu MH, Link-Gelles R, Azziz-Baumgartner E, Barron MA, Gaglani M, Thompson MG, Fireman B. Waning 2-Dose and 3-Dose Effectiveness of mRNA Vaccines Against COVID-19-Associated Emergency Department and Urgent Care Encounters and Hospitalizations Among Adults During Periods of Delta and Omicron Variant Predominance - VISION Network, 10 States, August 2021-January 2022. MMWR Morb Mortal Wkly Rep 2022; 71:255-263. [PMID: 35176007 PMCID: PMC8853475 DOI: 10.15585/mmwr.mm7107e2] [Citation(s) in RCA: 258] [Impact Index Per Article: 129.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Thompson MG, Natarajan K, Irving SA, Rowley EA, Griggs EP, Gaglani M, Klein NP, Grannis SJ, DeSilva MB, Stenehjem E, Reese SE, Dickerson M, Naleway AL, Han J, Konatham D, McEvoy C, Rao S, Dixon BE, Dascomb K, Lewis N, Levy ME, Patel P, Liao IC, Kharbanda AB, Barron MA, Fadel WF, Grisel N, Goddard K, Yang DH, Wondimu MH, Murthy K, Valvi NR, Arndorfer J, Fireman B, Dunne MM, Embi P, Azziz-Baumgartner E, Zerbo O, Bozio CH, Reynolds S, Ferdinands J, Williams J, Link-Gelles R, Schrag SJ, Verani JR, Ball S, Ong TC. Effectiveness of a Third Dose of mRNA Vaccines Against COVID-19-Associated Emergency Department and Urgent Care Encounters and Hospitalizations Among Adults During Periods of Delta and Omicron Variant Predominance - VISION Network, 10 States, August 2021-January 2022. MMWR Morb Mortal Wkly Rep 2022; 71:139-145. [PMID: 35085224 PMCID: PMC9351525 DOI: 10.15585/mmwr.mm7104e3] [Citation(s) in RCA: 268] [Impact Index Per Article: 134.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Estimates of COVID-19 mRNA vaccine effectiveness (VE) have declined in recent months (1,2) because of waning vaccine induced immunity over time,* possible increased immune evasion by SARS-CoV-2 variants (3), or a combination of these and other factors. CDC recommends that all persons aged ≥12 years receive a third dose (booster) of an mRNA vaccine ≥5 months after receipt of the second mRNA vaccine dose and that immunocompromised individuals receive a third primary dose.† A third dose of BNT162b2 (Pfizer-BioNTech) COVID-19 vaccine increases neutralizing antibody levels (4), and three recent studies from Israel have shown improved effectiveness of a third dose in preventing COVID-19 associated with infections with the SARS-CoV-2 B.1.617.2 (Delta) variant (5-7). Yet, data are limited on the real-world effectiveness of third doses of COVID-19 mRNA vaccine in the United States, especially since the SARS-CoV-2 B.1.1.529 (Omicron) variant became predominant in mid-December 2021. The VISION Network§ examined VE by analyzing 222,772 encounters from 383 emergency departments (EDs) and urgent care (UC) clinics and 87,904 hospitalizations from 259 hospitals among adults aged ≥18 years across 10 states from August 26, 2021¶ to January 5, 2022. Analyses were stratified by the period before and after the Omicron variant became the predominant strain (>50% of sequenced viruses) at each study site. During the period of Delta predominance across study sites in the United States (August-mid-December 2021), VE against laboratory-confirmed COVID-19-associated ED and UC encounters was 86% 14-179 days after dose 2, 76% ≥180 days after dose 2, and 94% ≥14 days after dose 3. Estimates of VE for the same intervals after vaccination during Omicron variant predominance were 52%, 38%, and 82%, respectively. During the period of Delta variant predominance, VE against laboratory-confirmed COVID-19-associated hospitalizations was 90% 14-179 days after dose 2, 81% ≥180 days after dose 2, and 94% ≥14 days after dose 3. During Omicron variant predominance, VE estimates for the same intervals after vaccination were 81%, 57%, and 90%, respectively. The highest estimates of VE against COVID-19-associated ED and UC encounters or hospitalizations during both Delta- and Omicron-predominant periods were among adults who received a third dose of mRNA vaccine. All unvaccinated persons should get vaccinated as soon as possible. All adults who have received mRNA vaccines during their primary COVID-19 vaccination series should receive a third dose when eligible, and eligible persons should stay up to date with COVID-19 vaccinations.
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Embi PJ, Levy ME, Naleway AL, Patel P, Gaglani M, Natarajan K, Dascomb K, Ong TC, Klein NP, Liao IC, Grannis SJ, Han J, Stenehjem E, Dunne MM, Lewis N, Irving SA, Rao S, McEvoy C, Bozio CH, Murthy K, Dixon BE, Grisel N, Yang DH, Goddard K, Kharbanda AB, Reynolds S, Raiyani C, Fadel WF, Arndorfer J, Rowley EA, Fireman B, Ferdinands J, Valvi NR, Ball SW, Zerbo O, Griggs EP, Mitchell PK, Porter RM, Kiduko SA, Blanton L, Zhuang Y, Steffens A, Reese SE, Olson N, Williams J, Dickerson M, McMorrow M, Schrag SJ, Verani JR, Fry AM, Azziz-Baumgartner E, Barron MA, Thompson MG, DeSilva MB. Effectiveness of two-dose vaccination with mRNA COVID-19 vaccines against COVID-19-associated hospitalizations among immunocompromised adults-Nine States, January-September 2021. Am J Transplant 2022; 22:306-314. [PMID: 34967121 PMCID: PMC9805402 DOI: 10.1111/ajt.16641] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- Peter J. Embi
- Regenstrief Institute, Indianapolis, Indiana, USA,Indiana University School of Medicine, Indianapolis, Indiana, USA,Correspondence Peter J. Embi, Regenstrief Institute, Indianapolis, IN, USA.
| | | | - Allison L. Naleway
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon
| | | | - Manjusha Gaglani
- Baylor Scott & White Health, Texas A&M University College of Medicine, Temple, Texas
| | - Karthik Natarajan
- Department of Biomedical Informatics, Columbia University, New York, New York,New York Presbyterian Hospital, New York New, York
| | - Kristin Dascomb
- Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City, Utah
| | - Toan C. Ong
- School of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, Colorado
| | - Nicola P. Klein
- Kaiser Permanente Vaccine Study Center, Kaiser Permanente Northern California, Oakland, California
| | - I-Chia Liao
- Baylor Scott & White Health, Texas A&M University College of Medicine, Temple, Texas
| | - Shaun J. Grannis
- Indiana University School of Medicine, Indianapolis, Indiana, USA,Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, Indiana
| | - Jungmi Han
- Department of Biomedical Informatics, Columbia University, New York, New York
| | - Edward Stenehjem
- Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City, Utah
| | | | - Ned Lewis
- Kaiser Permanente Vaccine Study Center, Kaiser Permanente Northern California, Oakland, California
| | | | - Suchitra Rao
- School of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, Colorado
| | | | | | - Kempapura Murthy
- Baylor Scott & White Health, Texas A&M University College of Medicine, Temple, Texas
| | - Brian E. Dixon
- Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, Indiana,Fairbanks School of Public Health, Indiana University, Indianapolis, Indiana
| | - Nancy Grisel
- Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City, Utah
| | | | - Kristin Goddard
- Kaiser Permanente Vaccine Study Center, Kaiser Permanente Northern California, Oakland, California
| | | | | | - Chandni Raiyani
- Baylor Scott & White Health, Texas A&M University College of Medicine, Temple, Texas
| | - William F. Fadel
- Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, Indiana,Fairbanks School of Public Health, Indiana University, Indianapolis, Indiana
| | - Julie Arndorfer
- Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City, Utah
| | | | - Bruce Fireman
- Kaiser Permanente Vaccine Study Center, Kaiser Permanente Northern California, Oakland, California
| | | | - Nimish R. Valvi
- Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, Indiana
| | | | - Ousseny Zerbo
- Kaiser Permanente Vaccine Study Center, Kaiser Permanente Northern California, Oakland, California
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Michelle A. Barron
- School of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, Colorado
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Bozio CH, Grannis SJ, Naleway AL, Ong TC, Butterfield KA, DeSilva MB, Natarajan K, Yang DH, Rao S, Klein NP, Irving SA, Dixon BE, Dascomb K, Liao IC, Reynolds S, McEvoy C, Han J, Reese SE, Lewis N, Fadel WF, Grisel N, Murthy K, Ferdinands J, Kharbanda AB, Mitchell PK, Goddard K, Embi PJ, Arndorfer J, Raiyani C, Patel P, Rowley EA, Fireman B, Valvi NR, Griggs EP, Levy ME, Zerbo O, Porter RM, Birch RJ, Blanton L, Ball SW, Steffens A, Olson N, Williams J, Dickerson M, McMorrow M, Schrag SJ, Verani JR, Fry AM, Azziz-Baumgartner E, Barron M, Gaglani M, Thompson MG, Stenehjem E. Laboratory-Confirmed COVID-19 Among Adults Hospitalized with COVID-19-Like Illness with Infection-Induced or mRNA Vaccine-Induced SARS-CoV-2 Immunity - Nine States, January-September 2021. MMWR Morb Mortal Wkly Rep 2021; 70:1539-1544. [PMID: 34735425 PMCID: PMC8568091 DOI: 10.15585/mmwr.mm7044e1] [Citation(s) in RCA: 68] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Previous infection with SARS-CoV-2 (the virus that causes COVID-19) or COVID-19 vaccination can provide immunity and protection from subsequent SARS-CoV-2 infection and illness. CDC used data from the VISION Network* to examine hospitalizations in adults with COVID-19-like illness and compared the odds of receiving a positive SARS-CoV-2 test result, and thus having laboratory-confirmed COVID-19, between unvaccinated patients with a previous SARS-CoV-2 infection occurring 90-179 days before COVID-19-like illness hospitalization, and patients who were fully vaccinated with an mRNA COVID-19 vaccine 90-179 days before hospitalization with no previous documented SARS-CoV-2 infection. Hospitalized adults aged ≥18 years with COVID-19-like illness were included if they had received testing at least twice: once associated with a COVID-19-like illness hospitalization during January-September 2021 and at least once earlier (since February 1, 2020, and ≥14 days before that hospitalization). Among COVID-19-like illness hospitalizations in persons whose previous infection or vaccination occurred 90-179 days earlier, the odds of laboratory-confirmed COVID-19 (adjusted for sociodemographic and health characteristics) among unvaccinated, previously infected adults were higher than the odds among fully vaccinated recipients of an mRNA COVID-19 vaccine with no previous documented infection (adjusted odds ratio [aOR] = 5.49; 95% confidence interval [CI] = 2.75-10.99). These findings suggest that among hospitalized adults with COVID-19-like illness whose previous infection or vaccination occurred 90-179 days earlier, vaccine-induced immunity was more protective than infection-induced immunity against laboratory-confirmed COVID-19. All eligible persons should be vaccinated against COVID-19 as soon as possible, including unvaccinated persons previously infected with SARS-CoV-2.
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Embi PJ, Levy ME, Naleway AL, Patel P, Gaglani M, Natarajan K, Dascomb K, Ong TC, Klein NP, Liao IC, Grannis SJ, Han J, Stenehjem E, Dunne MM, Lewis N, Irving SA, Rao S, McEvoy C, Bozio CH, Murthy K, Dixon BE, Grisel N, Yang DH, Goddard K, Kharbanda AB, Reynolds S, Raiyani C, Fadel WF, Arndorfer J, Rowley EA, Fireman B, Ferdinands J, Valvi NR, Ball SW, Zerbo O, Griggs EP, Mitchell PK, Porter RM, Kiduko SA, Blanton L, Zhuang Y, Steffens A, Reese SE, Olson N, Williams J, Dickerson M, McMorrow M, Schrag SJ, Verani JR, Fry AM, Azziz-Baumgartner E, Barron MA, Thompson MG, DeSilva MB. Effectiveness of 2-Dose Vaccination with mRNA COVID-19 Vaccines Against COVID-19-Associated Hospitalizations Among Immunocompromised Adults - Nine States, January-September 2021. MMWR Morb Mortal Wkly Rep 2021; 70:1553-1559. [PMID: 34735426 PMCID: PMC8568092 DOI: 10.15585/mmwr.mm7044e3] [Citation(s) in RCA: 114] [Impact Index Per Article: 38.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Immunocompromised persons, defined as those with suppressed humoral or cellular immunity resulting from health conditions or medications, account for approximately 3% of the U.S. adult population (1). Immunocompromised adults are at increased risk for severe COVID-19 outcomes (2) and might not acquire the same level of protection from COVID-19 mRNA vaccines as do immunocompetent adults (3,4). To evaluate vaccine effectiveness (VE) among immunocompromised adults, data from the VISION Network* on hospitalizations among persons aged ≥18 years with COVID-19-like illness from 187 hospitals in nine states during January 17-September 5, 2021 were analyzed. Using selected discharge diagnoses,† VE against COVID-19-associated hospitalization conferred by completing a 2-dose series of an mRNA COVID-19 vaccine ≥14 days before the index hospitalization date§ (i.e., being fully vaccinated) was evaluated using a test-negative design comparing 20,101 immunocompromised adults (10,564 [53%] of whom were fully vaccinated) and 69,116 immunocompetent adults (29,456 [43%] of whom were fully vaccinated). VE of 2 doses of mRNA COVID-19 vaccine against COVID-19-associated hospitalization was lower among immunocompromised patients (77%; 95% confidence interval [CI] = 74%-80%) than among immunocompetent patients (90%; 95% CI = 89%-91%). This difference persisted irrespective of mRNA vaccine product, age group, and timing of hospitalization relative to SARS-CoV-2 (the virus that causes COVID-19) B.1.617.2 (Delta) variant predominance in the state of hospitalization. VE varied across immunocompromising condition subgroups, ranging from 59% (organ or stem cell transplant recipients) to 81% (persons with a rheumatologic or inflammatory disorder). Immunocompromised persons benefit from mRNA COVID-19 vaccination but are less protected from severe COVID-19 outcomes than are immunocompetent persons, and VE varies among immunocompromised subgroups. Immunocompromised persons receiving mRNA COVID-19 vaccines should receive 3 doses and a booster, consistent with CDC recommendations (5), practice nonpharmaceutical interventions, and, if infected, be monitored closely and considered early for proven therapies that can prevent severe outcomes.
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Thompson MG, Stenehjem E, Grannis S, Ball SW, Naleway AL, Ong TC, DeSilva MB, Natarajan K, Bozio CH, Lewis N, Dascomb K, Dixon BE, Birch RJ, Irving SA, Rao S, Kharbanda E, Han J, Reynolds S, Goddard K, Grisel N, Fadel WF, Levy ME, Ferdinands J, Fireman B, Arndorfer J, Valvi NR, Rowley EA, Patel P, Zerbo O, Griggs EP, Porter RM, Demarco M, Blanton L, Steffens A, Zhuang Y, Olson N, Barron M, Shifflett P, Schrag SJ, Verani JR, Fry A, Gaglani M, Azziz-Baumgartner E, Klein NP. Effectiveness of Covid-19 Vaccines in Ambulatory and Inpatient Care Settings. N Engl J Med 2021; 385:1355-1371. [PMID: 34496194 PMCID: PMC8451184 DOI: 10.1056/nejmoa2110362] [Citation(s) in RCA: 269] [Impact Index Per Article: 89.7] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND There are limited data on the effectiveness of the vaccines against symptomatic coronavirus disease 2019 (Covid-19) currently authorized in the United States with respect to hospitalization, admission to an intensive care unit (ICU), or ambulatory care in an emergency department or urgent care clinic. METHODS We conducted a study involving adults (≥50 years of age) with Covid-19-like illness who underwent molecular testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We assessed 41,552 admissions to 187 hospitals and 21,522 visits to 221 emergency departments or urgent care clinics during the period from January 1 through June 22, 2021, in multiple states. The patients' vaccination status was documented in electronic health records and immunization registries. We used a test-negative design to estimate vaccine effectiveness by comparing the odds of a positive test for SARS-CoV-2 infection among vaccinated patients with those among unvaccinated patients. Vaccine effectiveness was adjusted with weights based on propensity-for-vaccination scores and according to age, geographic region, calendar time (days from January 1, 2021, to the index date for each medical visit), and local virus circulation. RESULTS The effectiveness of full messenger RNA (mRNA) vaccination (≥14 days after the second dose) was 89% (95% confidence interval [CI], 87 to 91) against laboratory-confirmed SARS-CoV-2 infection leading to hospitalization, 90% (95% CI, 86 to 93) against infection leading to an ICU admission, and 91% (95% CI, 89 to 93) against infection leading to an emergency department or urgent care clinic visit. The effectiveness of full vaccination with respect to a Covid-19-associated hospitalization or emergency department or urgent care clinic visit was similar with the BNT162b2 and mRNA-1273 vaccines and ranged from 81% to 95% among adults 85 years of age or older, persons with chronic medical conditions, and Black or Hispanic adults. The effectiveness of the Ad26.COV2.S vaccine was 68% (95% CI, 50 to 79) against laboratory-confirmed SARS-CoV-2 infection leading to hospitalization and 73% (95% CI, 59 to 82) against infection leading to an emergency department or urgent care clinic visit. CONCLUSIONS Covid-19 vaccines in the United States were highly effective against SARS-CoV-2 infection requiring hospitalization, ICU admission, or an emergency department or urgent care clinic visit. This vaccine effectiveness extended to populations that are disproportionately affected by SARS-CoV-2 infection. (Funded by the Centers for Disease Control and Prevention.).
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Affiliation(s)
- Mark G Thompson
- From the Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta (M.G.T., C.H.B., S. Reynolds, J.F., P.P., E.P.G., R.M.P., L.B., A.S., N.O., S.J.S., J.R.V., A.F., E.A.-B.); the Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City (E.S., K.D., N.G., J.A.); the Center for Biomedical Informatics, Regenstrief Institute (S.G., B.E.D., W.F.F., N.R.V.), Indiana University School of Medicine (S.G.), and Indiana University Richard M. Fairbanks School of Public Health (B.E.D., W.F.F., N.R.V.) - all in Indianapolis; Westat, Rockville, MD (S.W.B., R.J.B., M.E.L., E.A.R., M.D., Y.Z., P.S.); the Kaiser Permanente Northwest Center for Health Research, Portland, OR (A.L.N., S.A.I.); the Department of Medicine, Anschutz Medical Campus, University of Colorado, Aurora (T.C.O., S. Rao, M.B.); HealthPartners Institute, Minneapolis (M.B.D., E.K.); the Department of Biomedical Informatics, Columbia University Irving Medical Center (K.N., J.H.), and New York-Presbyterian Hospital (K.N.) - both in New York; the Vaccine Study Center, Division of Research, Kaiser Permanente Northern California, Oakland (N.L., K.G., B.F., O.Z., N.P.K.); and Baylor Scott and White Health, Texas A&M University College of Medicine, Temple, TX (M.G.)
| | - Edward Stenehjem
- From the Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta (M.G.T., C.H.B., S. Reynolds, J.F., P.P., E.P.G., R.M.P., L.B., A.S., N.O., S.J.S., J.R.V., A.F., E.A.-B.); the Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City (E.S., K.D., N.G., J.A.); the Center for Biomedical Informatics, Regenstrief Institute (S.G., B.E.D., W.F.F., N.R.V.), Indiana University School of Medicine (S.G.), and Indiana University Richard M. Fairbanks School of Public Health (B.E.D., W.F.F., N.R.V.) - all in Indianapolis; Westat, Rockville, MD (S.W.B., R.J.B., M.E.L., E.A.R., M.D., Y.Z., P.S.); the Kaiser Permanente Northwest Center for Health Research, Portland, OR (A.L.N., S.A.I.); the Department of Medicine, Anschutz Medical Campus, University of Colorado, Aurora (T.C.O., S. Rao, M.B.); HealthPartners Institute, Minneapolis (M.B.D., E.K.); the Department of Biomedical Informatics, Columbia University Irving Medical Center (K.N., J.H.), and New York-Presbyterian Hospital (K.N.) - both in New York; the Vaccine Study Center, Division of Research, Kaiser Permanente Northern California, Oakland (N.L., K.G., B.F., O.Z., N.P.K.); and Baylor Scott and White Health, Texas A&M University College of Medicine, Temple, TX (M.G.)
| | - Shaun Grannis
- From the Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta (M.G.T., C.H.B., S. Reynolds, J.F., P.P., E.P.G., R.M.P., L.B., A.S., N.O., S.J.S., J.R.V., A.F., E.A.-B.); the Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City (E.S., K.D., N.G., J.A.); the Center for Biomedical Informatics, Regenstrief Institute (S.G., B.E.D., W.F.F., N.R.V.), Indiana University School of Medicine (S.G.), and Indiana University Richard M. Fairbanks School of Public Health (B.E.D., W.F.F., N.R.V.) - all in Indianapolis; Westat, Rockville, MD (S.W.B., R.J.B., M.E.L., E.A.R., M.D., Y.Z., P.S.); the Kaiser Permanente Northwest Center for Health Research, Portland, OR (A.L.N., S.A.I.); the Department of Medicine, Anschutz Medical Campus, University of Colorado, Aurora (T.C.O., S. Rao, M.B.); HealthPartners Institute, Minneapolis (M.B.D., E.K.); the Department of Biomedical Informatics, Columbia University Irving Medical Center (K.N., J.H.), and New York-Presbyterian Hospital (K.N.) - both in New York; the Vaccine Study Center, Division of Research, Kaiser Permanente Northern California, Oakland (N.L., K.G., B.F., O.Z., N.P.K.); and Baylor Scott and White Health, Texas A&M University College of Medicine, Temple, TX (M.G.)
| | - Sarah W Ball
- From the Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta (M.G.T., C.H.B., S. Reynolds, J.F., P.P., E.P.G., R.M.P., L.B., A.S., N.O., S.J.S., J.R.V., A.F., E.A.-B.); the Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City (E.S., K.D., N.G., J.A.); the Center for Biomedical Informatics, Regenstrief Institute (S.G., B.E.D., W.F.F., N.R.V.), Indiana University School of Medicine (S.G.), and Indiana University Richard M. Fairbanks School of Public Health (B.E.D., W.F.F., N.R.V.) - all in Indianapolis; Westat, Rockville, MD (S.W.B., R.J.B., M.E.L., E.A.R., M.D., Y.Z., P.S.); the Kaiser Permanente Northwest Center for Health Research, Portland, OR (A.L.N., S.A.I.); the Department of Medicine, Anschutz Medical Campus, University of Colorado, Aurora (T.C.O., S. Rao, M.B.); HealthPartners Institute, Minneapolis (M.B.D., E.K.); the Department of Biomedical Informatics, Columbia University Irving Medical Center (K.N., J.H.), and New York-Presbyterian Hospital (K.N.) - both in New York; the Vaccine Study Center, Division of Research, Kaiser Permanente Northern California, Oakland (N.L., K.G., B.F., O.Z., N.P.K.); and Baylor Scott and White Health, Texas A&M University College of Medicine, Temple, TX (M.G.)
| | - Allison L Naleway
- From the Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta (M.G.T., C.H.B., S. Reynolds, J.F., P.P., E.P.G., R.M.P., L.B., A.S., N.O., S.J.S., J.R.V., A.F., E.A.-B.); the Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City (E.S., K.D., N.G., J.A.); the Center for Biomedical Informatics, Regenstrief Institute (S.G., B.E.D., W.F.F., N.R.V.), Indiana University School of Medicine (S.G.), and Indiana University Richard M. Fairbanks School of Public Health (B.E.D., W.F.F., N.R.V.) - all in Indianapolis; Westat, Rockville, MD (S.W.B., R.J.B., M.E.L., E.A.R., M.D., Y.Z., P.S.); the Kaiser Permanente Northwest Center for Health Research, Portland, OR (A.L.N., S.A.I.); the Department of Medicine, Anschutz Medical Campus, University of Colorado, Aurora (T.C.O., S. Rao, M.B.); HealthPartners Institute, Minneapolis (M.B.D., E.K.); the Department of Biomedical Informatics, Columbia University Irving Medical Center (K.N., J.H.), and New York-Presbyterian Hospital (K.N.) - both in New York; the Vaccine Study Center, Division of Research, Kaiser Permanente Northern California, Oakland (N.L., K.G., B.F., O.Z., N.P.K.); and Baylor Scott and White Health, Texas A&M University College of Medicine, Temple, TX (M.G.)
| | - Toan C Ong
- From the Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta (M.G.T., C.H.B., S. Reynolds, J.F., P.P., E.P.G., R.M.P., L.B., A.S., N.O., S.J.S., J.R.V., A.F., E.A.-B.); the Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City (E.S., K.D., N.G., J.A.); the Center for Biomedical Informatics, Regenstrief Institute (S.G., B.E.D., W.F.F., N.R.V.), Indiana University School of Medicine (S.G.), and Indiana University Richard M. Fairbanks School of Public Health (B.E.D., W.F.F., N.R.V.) - all in Indianapolis; Westat, Rockville, MD (S.W.B., R.J.B., M.E.L., E.A.R., M.D., Y.Z., P.S.); the Kaiser Permanente Northwest Center for Health Research, Portland, OR (A.L.N., S.A.I.); the Department of Medicine, Anschutz Medical Campus, University of Colorado, Aurora (T.C.O., S. Rao, M.B.); HealthPartners Institute, Minneapolis (M.B.D., E.K.); the Department of Biomedical Informatics, Columbia University Irving Medical Center (K.N., J.H.), and New York-Presbyterian Hospital (K.N.) - both in New York; the Vaccine Study Center, Division of Research, Kaiser Permanente Northern California, Oakland (N.L., K.G., B.F., O.Z., N.P.K.); and Baylor Scott and White Health, Texas A&M University College of Medicine, Temple, TX (M.G.)
| | - Malini B DeSilva
- From the Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta (M.G.T., C.H.B., S. Reynolds, J.F., P.P., E.P.G., R.M.P., L.B., A.S., N.O., S.J.S., J.R.V., A.F., E.A.-B.); the Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City (E.S., K.D., N.G., J.A.); the Center for Biomedical Informatics, Regenstrief Institute (S.G., B.E.D., W.F.F., N.R.V.), Indiana University School of Medicine (S.G.), and Indiana University Richard M. Fairbanks School of Public Health (B.E.D., W.F.F., N.R.V.) - all in Indianapolis; Westat, Rockville, MD (S.W.B., R.J.B., M.E.L., E.A.R., M.D., Y.Z., P.S.); the Kaiser Permanente Northwest Center for Health Research, Portland, OR (A.L.N., S.A.I.); the Department of Medicine, Anschutz Medical Campus, University of Colorado, Aurora (T.C.O., S. Rao, M.B.); HealthPartners Institute, Minneapolis (M.B.D., E.K.); the Department of Biomedical Informatics, Columbia University Irving Medical Center (K.N., J.H.), and New York-Presbyterian Hospital (K.N.) - both in New York; the Vaccine Study Center, Division of Research, Kaiser Permanente Northern California, Oakland (N.L., K.G., B.F., O.Z., N.P.K.); and Baylor Scott and White Health, Texas A&M University College of Medicine, Temple, TX (M.G.)
| | - Karthik Natarajan
- From the Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta (M.G.T., C.H.B., S. Reynolds, J.F., P.P., E.P.G., R.M.P., L.B., A.S., N.O., S.J.S., J.R.V., A.F., E.A.-B.); the Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City (E.S., K.D., N.G., J.A.); the Center for Biomedical Informatics, Regenstrief Institute (S.G., B.E.D., W.F.F., N.R.V.), Indiana University School of Medicine (S.G.), and Indiana University Richard M. Fairbanks School of Public Health (B.E.D., W.F.F., N.R.V.) - all in Indianapolis; Westat, Rockville, MD (S.W.B., R.J.B., M.E.L., E.A.R., M.D., Y.Z., P.S.); the Kaiser Permanente Northwest Center for Health Research, Portland, OR (A.L.N., S.A.I.); the Department of Medicine, Anschutz Medical Campus, University of Colorado, Aurora (T.C.O., S. Rao, M.B.); HealthPartners Institute, Minneapolis (M.B.D., E.K.); the Department of Biomedical Informatics, Columbia University Irving Medical Center (K.N., J.H.), and New York-Presbyterian Hospital (K.N.) - both in New York; the Vaccine Study Center, Division of Research, Kaiser Permanente Northern California, Oakland (N.L., K.G., B.F., O.Z., N.P.K.); and Baylor Scott and White Health, Texas A&M University College of Medicine, Temple, TX (M.G.)
| | - Catherine H Bozio
- From the Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta (M.G.T., C.H.B., S. Reynolds, J.F., P.P., E.P.G., R.M.P., L.B., A.S., N.O., S.J.S., J.R.V., A.F., E.A.-B.); the Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City (E.S., K.D., N.G., J.A.); the Center for Biomedical Informatics, Regenstrief Institute (S.G., B.E.D., W.F.F., N.R.V.), Indiana University School of Medicine (S.G.), and Indiana University Richard M. Fairbanks School of Public Health (B.E.D., W.F.F., N.R.V.) - all in Indianapolis; Westat, Rockville, MD (S.W.B., R.J.B., M.E.L., E.A.R., M.D., Y.Z., P.S.); the Kaiser Permanente Northwest Center for Health Research, Portland, OR (A.L.N., S.A.I.); the Department of Medicine, Anschutz Medical Campus, University of Colorado, Aurora (T.C.O., S. Rao, M.B.); HealthPartners Institute, Minneapolis (M.B.D., E.K.); the Department of Biomedical Informatics, Columbia University Irving Medical Center (K.N., J.H.), and New York-Presbyterian Hospital (K.N.) - both in New York; the Vaccine Study Center, Division of Research, Kaiser Permanente Northern California, Oakland (N.L., K.G., B.F., O.Z., N.P.K.); and Baylor Scott and White Health, Texas A&M University College of Medicine, Temple, TX (M.G.)
| | - Ned Lewis
- From the Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta (M.G.T., C.H.B., S. Reynolds, J.F., P.P., E.P.G., R.M.P., L.B., A.S., N.O., S.J.S., J.R.V., A.F., E.A.-B.); the Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City (E.S., K.D., N.G., J.A.); the Center for Biomedical Informatics, Regenstrief Institute (S.G., B.E.D., W.F.F., N.R.V.), Indiana University School of Medicine (S.G.), and Indiana University Richard M. Fairbanks School of Public Health (B.E.D., W.F.F., N.R.V.) - all in Indianapolis; Westat, Rockville, MD (S.W.B., R.J.B., M.E.L., E.A.R., M.D., Y.Z., P.S.); the Kaiser Permanente Northwest Center for Health Research, Portland, OR (A.L.N., S.A.I.); the Department of Medicine, Anschutz Medical Campus, University of Colorado, Aurora (T.C.O., S. Rao, M.B.); HealthPartners Institute, Minneapolis (M.B.D., E.K.); the Department of Biomedical Informatics, Columbia University Irving Medical Center (K.N., J.H.), and New York-Presbyterian Hospital (K.N.) - both in New York; the Vaccine Study Center, Division of Research, Kaiser Permanente Northern California, Oakland (N.L., K.G., B.F., O.Z., N.P.K.); and Baylor Scott and White Health, Texas A&M University College of Medicine, Temple, TX (M.G.)
| | - Kristin Dascomb
- From the Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta (M.G.T., C.H.B., S. Reynolds, J.F., P.P., E.P.G., R.M.P., L.B., A.S., N.O., S.J.S., J.R.V., A.F., E.A.-B.); the Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City (E.S., K.D., N.G., J.A.); the Center for Biomedical Informatics, Regenstrief Institute (S.G., B.E.D., W.F.F., N.R.V.), Indiana University School of Medicine (S.G.), and Indiana University Richard M. Fairbanks School of Public Health (B.E.D., W.F.F., N.R.V.) - all in Indianapolis; Westat, Rockville, MD (S.W.B., R.J.B., M.E.L., E.A.R., M.D., Y.Z., P.S.); the Kaiser Permanente Northwest Center for Health Research, Portland, OR (A.L.N., S.A.I.); the Department of Medicine, Anschutz Medical Campus, University of Colorado, Aurora (T.C.O., S. Rao, M.B.); HealthPartners Institute, Minneapolis (M.B.D., E.K.); the Department of Biomedical Informatics, Columbia University Irving Medical Center (K.N., J.H.), and New York-Presbyterian Hospital (K.N.) - both in New York; the Vaccine Study Center, Division of Research, Kaiser Permanente Northern California, Oakland (N.L., K.G., B.F., O.Z., N.P.K.); and Baylor Scott and White Health, Texas A&M University College of Medicine, Temple, TX (M.G.)
| | - Brian E Dixon
- From the Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta (M.G.T., C.H.B., S. Reynolds, J.F., P.P., E.P.G., R.M.P., L.B., A.S., N.O., S.J.S., J.R.V., A.F., E.A.-B.); the Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City (E.S., K.D., N.G., J.A.); the Center for Biomedical Informatics, Regenstrief Institute (S.G., B.E.D., W.F.F., N.R.V.), Indiana University School of Medicine (S.G.), and Indiana University Richard M. Fairbanks School of Public Health (B.E.D., W.F.F., N.R.V.) - all in Indianapolis; Westat, Rockville, MD (S.W.B., R.J.B., M.E.L., E.A.R., M.D., Y.Z., P.S.); the Kaiser Permanente Northwest Center for Health Research, Portland, OR (A.L.N., S.A.I.); the Department of Medicine, Anschutz Medical Campus, University of Colorado, Aurora (T.C.O., S. Rao, M.B.); HealthPartners Institute, Minneapolis (M.B.D., E.K.); the Department of Biomedical Informatics, Columbia University Irving Medical Center (K.N., J.H.), and New York-Presbyterian Hospital (K.N.) - both in New York; the Vaccine Study Center, Division of Research, Kaiser Permanente Northern California, Oakland (N.L., K.G., B.F., O.Z., N.P.K.); and Baylor Scott and White Health, Texas A&M University College of Medicine, Temple, TX (M.G.)
| | - Rebecca J Birch
- From the Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta (M.G.T., C.H.B., S. Reynolds, J.F., P.P., E.P.G., R.M.P., L.B., A.S., N.O., S.J.S., J.R.V., A.F., E.A.-B.); the Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City (E.S., K.D., N.G., J.A.); the Center for Biomedical Informatics, Regenstrief Institute (S.G., B.E.D., W.F.F., N.R.V.), Indiana University School of Medicine (S.G.), and Indiana University Richard M. Fairbanks School of Public Health (B.E.D., W.F.F., N.R.V.) - all in Indianapolis; Westat, Rockville, MD (S.W.B., R.J.B., M.E.L., E.A.R., M.D., Y.Z., P.S.); the Kaiser Permanente Northwest Center for Health Research, Portland, OR (A.L.N., S.A.I.); the Department of Medicine, Anschutz Medical Campus, University of Colorado, Aurora (T.C.O., S. Rao, M.B.); HealthPartners Institute, Minneapolis (M.B.D., E.K.); the Department of Biomedical Informatics, Columbia University Irving Medical Center (K.N., J.H.), and New York-Presbyterian Hospital (K.N.) - both in New York; the Vaccine Study Center, Division of Research, Kaiser Permanente Northern California, Oakland (N.L., K.G., B.F., O.Z., N.P.K.); and Baylor Scott and White Health, Texas A&M University College of Medicine, Temple, TX (M.G.)
| | - Stephanie A Irving
- From the Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta (M.G.T., C.H.B., S. Reynolds, J.F., P.P., E.P.G., R.M.P., L.B., A.S., N.O., S.J.S., J.R.V., A.F., E.A.-B.); the Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City (E.S., K.D., N.G., J.A.); the Center for Biomedical Informatics, Regenstrief Institute (S.G., B.E.D., W.F.F., N.R.V.), Indiana University School of Medicine (S.G.), and Indiana University Richard M. Fairbanks School of Public Health (B.E.D., W.F.F., N.R.V.) - all in Indianapolis; Westat, Rockville, MD (S.W.B., R.J.B., M.E.L., E.A.R., M.D., Y.Z., P.S.); the Kaiser Permanente Northwest Center for Health Research, Portland, OR (A.L.N., S.A.I.); the Department of Medicine, Anschutz Medical Campus, University of Colorado, Aurora (T.C.O., S. Rao, M.B.); HealthPartners Institute, Minneapolis (M.B.D., E.K.); the Department of Biomedical Informatics, Columbia University Irving Medical Center (K.N., J.H.), and New York-Presbyterian Hospital (K.N.) - both in New York; the Vaccine Study Center, Division of Research, Kaiser Permanente Northern California, Oakland (N.L., K.G., B.F., O.Z., N.P.K.); and Baylor Scott and White Health, Texas A&M University College of Medicine, Temple, TX (M.G.)
| | - Suchitra Rao
- From the Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta (M.G.T., C.H.B., S. Reynolds, J.F., P.P., E.P.G., R.M.P., L.B., A.S., N.O., S.J.S., J.R.V., A.F., E.A.-B.); the Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City (E.S., K.D., N.G., J.A.); the Center for Biomedical Informatics, Regenstrief Institute (S.G., B.E.D., W.F.F., N.R.V.), Indiana University School of Medicine (S.G.), and Indiana University Richard M. Fairbanks School of Public Health (B.E.D., W.F.F., N.R.V.) - all in Indianapolis; Westat, Rockville, MD (S.W.B., R.J.B., M.E.L., E.A.R., M.D., Y.Z., P.S.); the Kaiser Permanente Northwest Center for Health Research, Portland, OR (A.L.N., S.A.I.); the Department of Medicine, Anschutz Medical Campus, University of Colorado, Aurora (T.C.O., S. Rao, M.B.); HealthPartners Institute, Minneapolis (M.B.D., E.K.); the Department of Biomedical Informatics, Columbia University Irving Medical Center (K.N., J.H.), and New York-Presbyterian Hospital (K.N.) - both in New York; the Vaccine Study Center, Division of Research, Kaiser Permanente Northern California, Oakland (N.L., K.G., B.F., O.Z., N.P.K.); and Baylor Scott and White Health, Texas A&M University College of Medicine, Temple, TX (M.G.)
| | - Elyse Kharbanda
- From the Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta (M.G.T., C.H.B., S. Reynolds, J.F., P.P., E.P.G., R.M.P., L.B., A.S., N.O., S.J.S., J.R.V., A.F., E.A.-B.); the Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City (E.S., K.D., N.G., J.A.); the Center for Biomedical Informatics, Regenstrief Institute (S.G., B.E.D., W.F.F., N.R.V.), Indiana University School of Medicine (S.G.), and Indiana University Richard M. Fairbanks School of Public Health (B.E.D., W.F.F., N.R.V.) - all in Indianapolis; Westat, Rockville, MD (S.W.B., R.J.B., M.E.L., E.A.R., M.D., Y.Z., P.S.); the Kaiser Permanente Northwest Center for Health Research, Portland, OR (A.L.N., S.A.I.); the Department of Medicine, Anschutz Medical Campus, University of Colorado, Aurora (T.C.O., S. Rao, M.B.); HealthPartners Institute, Minneapolis (M.B.D., E.K.); the Department of Biomedical Informatics, Columbia University Irving Medical Center (K.N., J.H.), and New York-Presbyterian Hospital (K.N.) - both in New York; the Vaccine Study Center, Division of Research, Kaiser Permanente Northern California, Oakland (N.L., K.G., B.F., O.Z., N.P.K.); and Baylor Scott and White Health, Texas A&M University College of Medicine, Temple, TX (M.G.)
| | - Jungmi Han
- From the Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta (M.G.T., C.H.B., S. Reynolds, J.F., P.P., E.P.G., R.M.P., L.B., A.S., N.O., S.J.S., J.R.V., A.F., E.A.-B.); the Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City (E.S., K.D., N.G., J.A.); the Center for Biomedical Informatics, Regenstrief Institute (S.G., B.E.D., W.F.F., N.R.V.), Indiana University School of Medicine (S.G.), and Indiana University Richard M. Fairbanks School of Public Health (B.E.D., W.F.F., N.R.V.) - all in Indianapolis; Westat, Rockville, MD (S.W.B., R.J.B., M.E.L., E.A.R., M.D., Y.Z., P.S.); the Kaiser Permanente Northwest Center for Health Research, Portland, OR (A.L.N., S.A.I.); the Department of Medicine, Anschutz Medical Campus, University of Colorado, Aurora (T.C.O., S. Rao, M.B.); HealthPartners Institute, Minneapolis (M.B.D., E.K.); the Department of Biomedical Informatics, Columbia University Irving Medical Center (K.N., J.H.), and New York-Presbyterian Hospital (K.N.) - both in New York; the Vaccine Study Center, Division of Research, Kaiser Permanente Northern California, Oakland (N.L., K.G., B.F., O.Z., N.P.K.); and Baylor Scott and White Health, Texas A&M University College of Medicine, Temple, TX (M.G.)
| | - Sue Reynolds
- From the Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta (M.G.T., C.H.B., S. Reynolds, J.F., P.P., E.P.G., R.M.P., L.B., A.S., N.O., S.J.S., J.R.V., A.F., E.A.-B.); the Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City (E.S., K.D., N.G., J.A.); the Center for Biomedical Informatics, Regenstrief Institute (S.G., B.E.D., W.F.F., N.R.V.), Indiana University School of Medicine (S.G.), and Indiana University Richard M. Fairbanks School of Public Health (B.E.D., W.F.F., N.R.V.) - all in Indianapolis; Westat, Rockville, MD (S.W.B., R.J.B., M.E.L., E.A.R., M.D., Y.Z., P.S.); the Kaiser Permanente Northwest Center for Health Research, Portland, OR (A.L.N., S.A.I.); the Department of Medicine, Anschutz Medical Campus, University of Colorado, Aurora (T.C.O., S. Rao, M.B.); HealthPartners Institute, Minneapolis (M.B.D., E.K.); the Department of Biomedical Informatics, Columbia University Irving Medical Center (K.N., J.H.), and New York-Presbyterian Hospital (K.N.) - both in New York; the Vaccine Study Center, Division of Research, Kaiser Permanente Northern California, Oakland (N.L., K.G., B.F., O.Z., N.P.K.); and Baylor Scott and White Health, Texas A&M University College of Medicine, Temple, TX (M.G.)
| | - Kristin Goddard
- From the Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta (M.G.T., C.H.B., S. Reynolds, J.F., P.P., E.P.G., R.M.P., L.B., A.S., N.O., S.J.S., J.R.V., A.F., E.A.-B.); the Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City (E.S., K.D., N.G., J.A.); the Center for Biomedical Informatics, Regenstrief Institute (S.G., B.E.D., W.F.F., N.R.V.), Indiana University School of Medicine (S.G.), and Indiana University Richard M. Fairbanks School of Public Health (B.E.D., W.F.F., N.R.V.) - all in Indianapolis; Westat, Rockville, MD (S.W.B., R.J.B., M.E.L., E.A.R., M.D., Y.Z., P.S.); the Kaiser Permanente Northwest Center for Health Research, Portland, OR (A.L.N., S.A.I.); the Department of Medicine, Anschutz Medical Campus, University of Colorado, Aurora (T.C.O., S. Rao, M.B.); HealthPartners Institute, Minneapolis (M.B.D., E.K.); the Department of Biomedical Informatics, Columbia University Irving Medical Center (K.N., J.H.), and New York-Presbyterian Hospital (K.N.) - both in New York; the Vaccine Study Center, Division of Research, Kaiser Permanente Northern California, Oakland (N.L., K.G., B.F., O.Z., N.P.K.); and Baylor Scott and White Health, Texas A&M University College of Medicine, Temple, TX (M.G.)
| | - Nancy Grisel
- From the Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta (M.G.T., C.H.B., S. Reynolds, J.F., P.P., E.P.G., R.M.P., L.B., A.S., N.O., S.J.S., J.R.V., A.F., E.A.-B.); the Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City (E.S., K.D., N.G., J.A.); the Center for Biomedical Informatics, Regenstrief Institute (S.G., B.E.D., W.F.F., N.R.V.), Indiana University School of Medicine (S.G.), and Indiana University Richard M. Fairbanks School of Public Health (B.E.D., W.F.F., N.R.V.) - all in Indianapolis; Westat, Rockville, MD (S.W.B., R.J.B., M.E.L., E.A.R., M.D., Y.Z., P.S.); the Kaiser Permanente Northwest Center for Health Research, Portland, OR (A.L.N., S.A.I.); the Department of Medicine, Anschutz Medical Campus, University of Colorado, Aurora (T.C.O., S. Rao, M.B.); HealthPartners Institute, Minneapolis (M.B.D., E.K.); the Department of Biomedical Informatics, Columbia University Irving Medical Center (K.N., J.H.), and New York-Presbyterian Hospital (K.N.) - both in New York; the Vaccine Study Center, Division of Research, Kaiser Permanente Northern California, Oakland (N.L., K.G., B.F., O.Z., N.P.K.); and Baylor Scott and White Health, Texas A&M University College of Medicine, Temple, TX (M.G.)
| | - William F Fadel
- From the Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta (M.G.T., C.H.B., S. Reynolds, J.F., P.P., E.P.G., R.M.P., L.B., A.S., N.O., S.J.S., J.R.V., A.F., E.A.-B.); the Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City (E.S., K.D., N.G., J.A.); the Center for Biomedical Informatics, Regenstrief Institute (S.G., B.E.D., W.F.F., N.R.V.), Indiana University School of Medicine (S.G.), and Indiana University Richard M. Fairbanks School of Public Health (B.E.D., W.F.F., N.R.V.) - all in Indianapolis; Westat, Rockville, MD (S.W.B., R.J.B., M.E.L., E.A.R., M.D., Y.Z., P.S.); the Kaiser Permanente Northwest Center for Health Research, Portland, OR (A.L.N., S.A.I.); the Department of Medicine, Anschutz Medical Campus, University of Colorado, Aurora (T.C.O., S. Rao, M.B.); HealthPartners Institute, Minneapolis (M.B.D., E.K.); the Department of Biomedical Informatics, Columbia University Irving Medical Center (K.N., J.H.), and New York-Presbyterian Hospital (K.N.) - both in New York; the Vaccine Study Center, Division of Research, Kaiser Permanente Northern California, Oakland (N.L., K.G., B.F., O.Z., N.P.K.); and Baylor Scott and White Health, Texas A&M University College of Medicine, Temple, TX (M.G.)
| | - Matthew E Levy
- From the Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta (M.G.T., C.H.B., S. Reynolds, J.F., P.P., E.P.G., R.M.P., L.B., A.S., N.O., S.J.S., J.R.V., A.F., E.A.-B.); the Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City (E.S., K.D., N.G., J.A.); the Center for Biomedical Informatics, Regenstrief Institute (S.G., B.E.D., W.F.F., N.R.V.), Indiana University School of Medicine (S.G.), and Indiana University Richard M. Fairbanks School of Public Health (B.E.D., W.F.F., N.R.V.) - all in Indianapolis; Westat, Rockville, MD (S.W.B., R.J.B., M.E.L., E.A.R., M.D., Y.Z., P.S.); the Kaiser Permanente Northwest Center for Health Research, Portland, OR (A.L.N., S.A.I.); the Department of Medicine, Anschutz Medical Campus, University of Colorado, Aurora (T.C.O., S. Rao, M.B.); HealthPartners Institute, Minneapolis (M.B.D., E.K.); the Department of Biomedical Informatics, Columbia University Irving Medical Center (K.N., J.H.), and New York-Presbyterian Hospital (K.N.) - both in New York; the Vaccine Study Center, Division of Research, Kaiser Permanente Northern California, Oakland (N.L., K.G., B.F., O.Z., N.P.K.); and Baylor Scott and White Health, Texas A&M University College of Medicine, Temple, TX (M.G.)
| | - Jill Ferdinands
- From the Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta (M.G.T., C.H.B., S. Reynolds, J.F., P.P., E.P.G., R.M.P., L.B., A.S., N.O., S.J.S., J.R.V., A.F., E.A.-B.); the Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City (E.S., K.D., N.G., J.A.); the Center for Biomedical Informatics, Regenstrief Institute (S.G., B.E.D., W.F.F., N.R.V.), Indiana University School of Medicine (S.G.), and Indiana University Richard M. Fairbanks School of Public Health (B.E.D., W.F.F., N.R.V.) - all in Indianapolis; Westat, Rockville, MD (S.W.B., R.J.B., M.E.L., E.A.R., M.D., Y.Z., P.S.); the Kaiser Permanente Northwest Center for Health Research, Portland, OR (A.L.N., S.A.I.); the Department of Medicine, Anschutz Medical Campus, University of Colorado, Aurora (T.C.O., S. Rao, M.B.); HealthPartners Institute, Minneapolis (M.B.D., E.K.); the Department of Biomedical Informatics, Columbia University Irving Medical Center (K.N., J.H.), and New York-Presbyterian Hospital (K.N.) - both in New York; the Vaccine Study Center, Division of Research, Kaiser Permanente Northern California, Oakland (N.L., K.G., B.F., O.Z., N.P.K.); and Baylor Scott and White Health, Texas A&M University College of Medicine, Temple, TX (M.G.)
| | - Bruce Fireman
- From the Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta (M.G.T., C.H.B., S. Reynolds, J.F., P.P., E.P.G., R.M.P., L.B., A.S., N.O., S.J.S., J.R.V., A.F., E.A.-B.); the Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City (E.S., K.D., N.G., J.A.); the Center for Biomedical Informatics, Regenstrief Institute (S.G., B.E.D., W.F.F., N.R.V.), Indiana University School of Medicine (S.G.), and Indiana University Richard M. Fairbanks School of Public Health (B.E.D., W.F.F., N.R.V.) - all in Indianapolis; Westat, Rockville, MD (S.W.B., R.J.B., M.E.L., E.A.R., M.D., Y.Z., P.S.); the Kaiser Permanente Northwest Center for Health Research, Portland, OR (A.L.N., S.A.I.); the Department of Medicine, Anschutz Medical Campus, University of Colorado, Aurora (T.C.O., S. Rao, M.B.); HealthPartners Institute, Minneapolis (M.B.D., E.K.); the Department of Biomedical Informatics, Columbia University Irving Medical Center (K.N., J.H.), and New York-Presbyterian Hospital (K.N.) - both in New York; the Vaccine Study Center, Division of Research, Kaiser Permanente Northern California, Oakland (N.L., K.G., B.F., O.Z., N.P.K.); and Baylor Scott and White Health, Texas A&M University College of Medicine, Temple, TX (M.G.)
| | - Julie Arndorfer
- From the Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta (M.G.T., C.H.B., S. Reynolds, J.F., P.P., E.P.G., R.M.P., L.B., A.S., N.O., S.J.S., J.R.V., A.F., E.A.-B.); the Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City (E.S., K.D., N.G., J.A.); the Center for Biomedical Informatics, Regenstrief Institute (S.G., B.E.D., W.F.F., N.R.V.), Indiana University School of Medicine (S.G.), and Indiana University Richard M. Fairbanks School of Public Health (B.E.D., W.F.F., N.R.V.) - all in Indianapolis; Westat, Rockville, MD (S.W.B., R.J.B., M.E.L., E.A.R., M.D., Y.Z., P.S.); the Kaiser Permanente Northwest Center for Health Research, Portland, OR (A.L.N., S.A.I.); the Department of Medicine, Anschutz Medical Campus, University of Colorado, Aurora (T.C.O., S. Rao, M.B.); HealthPartners Institute, Minneapolis (M.B.D., E.K.); the Department of Biomedical Informatics, Columbia University Irving Medical Center (K.N., J.H.), and New York-Presbyterian Hospital (K.N.) - both in New York; the Vaccine Study Center, Division of Research, Kaiser Permanente Northern California, Oakland (N.L., K.G., B.F., O.Z., N.P.K.); and Baylor Scott and White Health, Texas A&M University College of Medicine, Temple, TX (M.G.)
| | - Nimish R Valvi
- From the Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta (M.G.T., C.H.B., S. Reynolds, J.F., P.P., E.P.G., R.M.P., L.B., A.S., N.O., S.J.S., J.R.V., A.F., E.A.-B.); the Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City (E.S., K.D., N.G., J.A.); the Center for Biomedical Informatics, Regenstrief Institute (S.G., B.E.D., W.F.F., N.R.V.), Indiana University School of Medicine (S.G.), and Indiana University Richard M. Fairbanks School of Public Health (B.E.D., W.F.F., N.R.V.) - all in Indianapolis; Westat, Rockville, MD (S.W.B., R.J.B., M.E.L., E.A.R., M.D., Y.Z., P.S.); the Kaiser Permanente Northwest Center for Health Research, Portland, OR (A.L.N., S.A.I.); the Department of Medicine, Anschutz Medical Campus, University of Colorado, Aurora (T.C.O., S. Rao, M.B.); HealthPartners Institute, Minneapolis (M.B.D., E.K.); the Department of Biomedical Informatics, Columbia University Irving Medical Center (K.N., J.H.), and New York-Presbyterian Hospital (K.N.) - both in New York; the Vaccine Study Center, Division of Research, Kaiser Permanente Northern California, Oakland (N.L., K.G., B.F., O.Z., N.P.K.); and Baylor Scott and White Health, Texas A&M University College of Medicine, Temple, TX (M.G.)
| | - Elizabeth A Rowley
- From the Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta (M.G.T., C.H.B., S. Reynolds, J.F., P.P., E.P.G., R.M.P., L.B., A.S., N.O., S.J.S., J.R.V., A.F., E.A.-B.); the Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City (E.S., K.D., N.G., J.A.); the Center for Biomedical Informatics, Regenstrief Institute (S.G., B.E.D., W.F.F., N.R.V.), Indiana University School of Medicine (S.G.), and Indiana University Richard M. Fairbanks School of Public Health (B.E.D., W.F.F., N.R.V.) - all in Indianapolis; Westat, Rockville, MD (S.W.B., R.J.B., M.E.L., E.A.R., M.D., Y.Z., P.S.); the Kaiser Permanente Northwest Center for Health Research, Portland, OR (A.L.N., S.A.I.); the Department of Medicine, Anschutz Medical Campus, University of Colorado, Aurora (T.C.O., S. Rao, M.B.); HealthPartners Institute, Minneapolis (M.B.D., E.K.); the Department of Biomedical Informatics, Columbia University Irving Medical Center (K.N., J.H.), and New York-Presbyterian Hospital (K.N.) - both in New York; the Vaccine Study Center, Division of Research, Kaiser Permanente Northern California, Oakland (N.L., K.G., B.F., O.Z., N.P.K.); and Baylor Scott and White Health, Texas A&M University College of Medicine, Temple, TX (M.G.)
| | - Palak Patel
- From the Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta (M.G.T., C.H.B., S. Reynolds, J.F., P.P., E.P.G., R.M.P., L.B., A.S., N.O., S.J.S., J.R.V., A.F., E.A.-B.); the Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City (E.S., K.D., N.G., J.A.); the Center for Biomedical Informatics, Regenstrief Institute (S.G., B.E.D., W.F.F., N.R.V.), Indiana University School of Medicine (S.G.), and Indiana University Richard M. Fairbanks School of Public Health (B.E.D., W.F.F., N.R.V.) - all in Indianapolis; Westat, Rockville, MD (S.W.B., R.J.B., M.E.L., E.A.R., M.D., Y.Z., P.S.); the Kaiser Permanente Northwest Center for Health Research, Portland, OR (A.L.N., S.A.I.); the Department of Medicine, Anschutz Medical Campus, University of Colorado, Aurora (T.C.O., S. Rao, M.B.); HealthPartners Institute, Minneapolis (M.B.D., E.K.); the Department of Biomedical Informatics, Columbia University Irving Medical Center (K.N., J.H.), and New York-Presbyterian Hospital (K.N.) - both in New York; the Vaccine Study Center, Division of Research, Kaiser Permanente Northern California, Oakland (N.L., K.G., B.F., O.Z., N.P.K.); and Baylor Scott and White Health, Texas A&M University College of Medicine, Temple, TX (M.G.)
| | - Ousseny Zerbo
- From the Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta (M.G.T., C.H.B., S. Reynolds, J.F., P.P., E.P.G., R.M.P., L.B., A.S., N.O., S.J.S., J.R.V., A.F., E.A.-B.); the Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City (E.S., K.D., N.G., J.A.); the Center for Biomedical Informatics, Regenstrief Institute (S.G., B.E.D., W.F.F., N.R.V.), Indiana University School of Medicine (S.G.), and Indiana University Richard M. Fairbanks School of Public Health (B.E.D., W.F.F., N.R.V.) - all in Indianapolis; Westat, Rockville, MD (S.W.B., R.J.B., M.E.L., E.A.R., M.D., Y.Z., P.S.); the Kaiser Permanente Northwest Center for Health Research, Portland, OR (A.L.N., S.A.I.); the Department of Medicine, Anschutz Medical Campus, University of Colorado, Aurora (T.C.O., S. Rao, M.B.); HealthPartners Institute, Minneapolis (M.B.D., E.K.); the Department of Biomedical Informatics, Columbia University Irving Medical Center (K.N., J.H.), and New York-Presbyterian Hospital (K.N.) - both in New York; the Vaccine Study Center, Division of Research, Kaiser Permanente Northern California, Oakland (N.L., K.G., B.F., O.Z., N.P.K.); and Baylor Scott and White Health, Texas A&M University College of Medicine, Temple, TX (M.G.)
| | - Eric P Griggs
- From the Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta (M.G.T., C.H.B., S. Reynolds, J.F., P.P., E.P.G., R.M.P., L.B., A.S., N.O., S.J.S., J.R.V., A.F., E.A.-B.); the Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City (E.S., K.D., N.G., J.A.); the Center for Biomedical Informatics, Regenstrief Institute (S.G., B.E.D., W.F.F., N.R.V.), Indiana University School of Medicine (S.G.), and Indiana University Richard M. Fairbanks School of Public Health (B.E.D., W.F.F., N.R.V.) - all in Indianapolis; Westat, Rockville, MD (S.W.B., R.J.B., M.E.L., E.A.R., M.D., Y.Z., P.S.); the Kaiser Permanente Northwest Center for Health Research, Portland, OR (A.L.N., S.A.I.); the Department of Medicine, Anschutz Medical Campus, University of Colorado, Aurora (T.C.O., S. Rao, M.B.); HealthPartners Institute, Minneapolis (M.B.D., E.K.); the Department of Biomedical Informatics, Columbia University Irving Medical Center (K.N., J.H.), and New York-Presbyterian Hospital (K.N.) - both in New York; the Vaccine Study Center, Division of Research, Kaiser Permanente Northern California, Oakland (N.L., K.G., B.F., O.Z., N.P.K.); and Baylor Scott and White Health, Texas A&M University College of Medicine, Temple, TX (M.G.)
| | - Rachael M Porter
- From the Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta (M.G.T., C.H.B., S. Reynolds, J.F., P.P., E.P.G., R.M.P., L.B., A.S., N.O., S.J.S., J.R.V., A.F., E.A.-B.); the Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City (E.S., K.D., N.G., J.A.); the Center for Biomedical Informatics, Regenstrief Institute (S.G., B.E.D., W.F.F., N.R.V.), Indiana University School of Medicine (S.G.), and Indiana University Richard M. Fairbanks School of Public Health (B.E.D., W.F.F., N.R.V.) - all in Indianapolis; Westat, Rockville, MD (S.W.B., R.J.B., M.E.L., E.A.R., M.D., Y.Z., P.S.); the Kaiser Permanente Northwest Center for Health Research, Portland, OR (A.L.N., S.A.I.); the Department of Medicine, Anschutz Medical Campus, University of Colorado, Aurora (T.C.O., S. Rao, M.B.); HealthPartners Institute, Minneapolis (M.B.D., E.K.); the Department of Biomedical Informatics, Columbia University Irving Medical Center (K.N., J.H.), and New York-Presbyterian Hospital (K.N.) - both in New York; the Vaccine Study Center, Division of Research, Kaiser Permanente Northern California, Oakland (N.L., K.G., B.F., O.Z., N.P.K.); and Baylor Scott and White Health, Texas A&M University College of Medicine, Temple, TX (M.G.)
| | - Maria Demarco
- From the Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta (M.G.T., C.H.B., S. Reynolds, J.F., P.P., E.P.G., R.M.P., L.B., A.S., N.O., S.J.S., J.R.V., A.F., E.A.-B.); the Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City (E.S., K.D., N.G., J.A.); the Center for Biomedical Informatics, Regenstrief Institute (S.G., B.E.D., W.F.F., N.R.V.), Indiana University School of Medicine (S.G.), and Indiana University Richard M. Fairbanks School of Public Health (B.E.D., W.F.F., N.R.V.) - all in Indianapolis; Westat, Rockville, MD (S.W.B., R.J.B., M.E.L., E.A.R., M.D., Y.Z., P.S.); the Kaiser Permanente Northwest Center for Health Research, Portland, OR (A.L.N., S.A.I.); the Department of Medicine, Anschutz Medical Campus, University of Colorado, Aurora (T.C.O., S. Rao, M.B.); HealthPartners Institute, Minneapolis (M.B.D., E.K.); the Department of Biomedical Informatics, Columbia University Irving Medical Center (K.N., J.H.), and New York-Presbyterian Hospital (K.N.) - both in New York; the Vaccine Study Center, Division of Research, Kaiser Permanente Northern California, Oakland (N.L., K.G., B.F., O.Z., N.P.K.); and Baylor Scott and White Health, Texas A&M University College of Medicine, Temple, TX (M.G.)
| | - Lenee Blanton
- From the Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta (M.G.T., C.H.B., S. Reynolds, J.F., P.P., E.P.G., R.M.P., L.B., A.S., N.O., S.J.S., J.R.V., A.F., E.A.-B.); the Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City (E.S., K.D., N.G., J.A.); the Center for Biomedical Informatics, Regenstrief Institute (S.G., B.E.D., W.F.F., N.R.V.), Indiana University School of Medicine (S.G.), and Indiana University Richard M. Fairbanks School of Public Health (B.E.D., W.F.F., N.R.V.) - all in Indianapolis; Westat, Rockville, MD (S.W.B., R.J.B., M.E.L., E.A.R., M.D., Y.Z., P.S.); the Kaiser Permanente Northwest Center for Health Research, Portland, OR (A.L.N., S.A.I.); the Department of Medicine, Anschutz Medical Campus, University of Colorado, Aurora (T.C.O., S. Rao, M.B.); HealthPartners Institute, Minneapolis (M.B.D., E.K.); the Department of Biomedical Informatics, Columbia University Irving Medical Center (K.N., J.H.), and New York-Presbyterian Hospital (K.N.) - both in New York; the Vaccine Study Center, Division of Research, Kaiser Permanente Northern California, Oakland (N.L., K.G., B.F., O.Z., N.P.K.); and Baylor Scott and White Health, Texas A&M University College of Medicine, Temple, TX (M.G.)
| | - Andrea Steffens
- From the Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta (M.G.T., C.H.B., S. Reynolds, J.F., P.P., E.P.G., R.M.P., L.B., A.S., N.O., S.J.S., J.R.V., A.F., E.A.-B.); the Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City (E.S., K.D., N.G., J.A.); the Center for Biomedical Informatics, Regenstrief Institute (S.G., B.E.D., W.F.F., N.R.V.), Indiana University School of Medicine (S.G.), and Indiana University Richard M. Fairbanks School of Public Health (B.E.D., W.F.F., N.R.V.) - all in Indianapolis; Westat, Rockville, MD (S.W.B., R.J.B., M.E.L., E.A.R., M.D., Y.Z., P.S.); the Kaiser Permanente Northwest Center for Health Research, Portland, OR (A.L.N., S.A.I.); the Department of Medicine, Anschutz Medical Campus, University of Colorado, Aurora (T.C.O., S. Rao, M.B.); HealthPartners Institute, Minneapolis (M.B.D., E.K.); the Department of Biomedical Informatics, Columbia University Irving Medical Center (K.N., J.H.), and New York-Presbyterian Hospital (K.N.) - both in New York; the Vaccine Study Center, Division of Research, Kaiser Permanente Northern California, Oakland (N.L., K.G., B.F., O.Z., N.P.K.); and Baylor Scott and White Health, Texas A&M University College of Medicine, Temple, TX (M.G.)
| | - Yan Zhuang
- From the Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta (M.G.T., C.H.B., S. Reynolds, J.F., P.P., E.P.G., R.M.P., L.B., A.S., N.O., S.J.S., J.R.V., A.F., E.A.-B.); the Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City (E.S., K.D., N.G., J.A.); the Center for Biomedical Informatics, Regenstrief Institute (S.G., B.E.D., W.F.F., N.R.V.), Indiana University School of Medicine (S.G.), and Indiana University Richard M. Fairbanks School of Public Health (B.E.D., W.F.F., N.R.V.) - all in Indianapolis; Westat, Rockville, MD (S.W.B., R.J.B., M.E.L., E.A.R., M.D., Y.Z., P.S.); the Kaiser Permanente Northwest Center for Health Research, Portland, OR (A.L.N., S.A.I.); the Department of Medicine, Anschutz Medical Campus, University of Colorado, Aurora (T.C.O., S. Rao, M.B.); HealthPartners Institute, Minneapolis (M.B.D., E.K.); the Department of Biomedical Informatics, Columbia University Irving Medical Center (K.N., J.H.), and New York-Presbyterian Hospital (K.N.) - both in New York; the Vaccine Study Center, Division of Research, Kaiser Permanente Northern California, Oakland (N.L., K.G., B.F., O.Z., N.P.K.); and Baylor Scott and White Health, Texas A&M University College of Medicine, Temple, TX (M.G.)
| | - Natalie Olson
- From the Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta (M.G.T., C.H.B., S. Reynolds, J.F., P.P., E.P.G., R.M.P., L.B., A.S., N.O., S.J.S., J.R.V., A.F., E.A.-B.); the Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City (E.S., K.D., N.G., J.A.); the Center for Biomedical Informatics, Regenstrief Institute (S.G., B.E.D., W.F.F., N.R.V.), Indiana University School of Medicine (S.G.), and Indiana University Richard M. Fairbanks School of Public Health (B.E.D., W.F.F., N.R.V.) - all in Indianapolis; Westat, Rockville, MD (S.W.B., R.J.B., M.E.L., E.A.R., M.D., Y.Z., P.S.); the Kaiser Permanente Northwest Center for Health Research, Portland, OR (A.L.N., S.A.I.); the Department of Medicine, Anschutz Medical Campus, University of Colorado, Aurora (T.C.O., S. Rao, M.B.); HealthPartners Institute, Minneapolis (M.B.D., E.K.); the Department of Biomedical Informatics, Columbia University Irving Medical Center (K.N., J.H.), and New York-Presbyterian Hospital (K.N.) - both in New York; the Vaccine Study Center, Division of Research, Kaiser Permanente Northern California, Oakland (N.L., K.G., B.F., O.Z., N.P.K.); and Baylor Scott and White Health, Texas A&M University College of Medicine, Temple, TX (M.G.)
| | - Michelle Barron
- From the Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta (M.G.T., C.H.B., S. Reynolds, J.F., P.P., E.P.G., R.M.P., L.B., A.S., N.O., S.J.S., J.R.V., A.F., E.A.-B.); the Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City (E.S., K.D., N.G., J.A.); the Center for Biomedical Informatics, Regenstrief Institute (S.G., B.E.D., W.F.F., N.R.V.), Indiana University School of Medicine (S.G.), and Indiana University Richard M. Fairbanks School of Public Health (B.E.D., W.F.F., N.R.V.) - all in Indianapolis; Westat, Rockville, MD (S.W.B., R.J.B., M.E.L., E.A.R., M.D., Y.Z., P.S.); the Kaiser Permanente Northwest Center for Health Research, Portland, OR (A.L.N., S.A.I.); the Department of Medicine, Anschutz Medical Campus, University of Colorado, Aurora (T.C.O., S. Rao, M.B.); HealthPartners Institute, Minneapolis (M.B.D., E.K.); the Department of Biomedical Informatics, Columbia University Irving Medical Center (K.N., J.H.), and New York-Presbyterian Hospital (K.N.) - both in New York; the Vaccine Study Center, Division of Research, Kaiser Permanente Northern California, Oakland (N.L., K.G., B.F., O.Z., N.P.K.); and Baylor Scott and White Health, Texas A&M University College of Medicine, Temple, TX (M.G.)
| | - Patricia Shifflett
- From the Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta (M.G.T., C.H.B., S. Reynolds, J.F., P.P., E.P.G., R.M.P., L.B., A.S., N.O., S.J.S., J.R.V., A.F., E.A.-B.); the Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City (E.S., K.D., N.G., J.A.); the Center for Biomedical Informatics, Regenstrief Institute (S.G., B.E.D., W.F.F., N.R.V.), Indiana University School of Medicine (S.G.), and Indiana University Richard M. Fairbanks School of Public Health (B.E.D., W.F.F., N.R.V.) - all in Indianapolis; Westat, Rockville, MD (S.W.B., R.J.B., M.E.L., E.A.R., M.D., Y.Z., P.S.); the Kaiser Permanente Northwest Center for Health Research, Portland, OR (A.L.N., S.A.I.); the Department of Medicine, Anschutz Medical Campus, University of Colorado, Aurora (T.C.O., S. Rao, M.B.); HealthPartners Institute, Minneapolis (M.B.D., E.K.); the Department of Biomedical Informatics, Columbia University Irving Medical Center (K.N., J.H.), and New York-Presbyterian Hospital (K.N.) - both in New York; the Vaccine Study Center, Division of Research, Kaiser Permanente Northern California, Oakland (N.L., K.G., B.F., O.Z., N.P.K.); and Baylor Scott and White Health, Texas A&M University College of Medicine, Temple, TX (M.G.)
| | - Stephanie J Schrag
- From the Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta (M.G.T., C.H.B., S. Reynolds, J.F., P.P., E.P.G., R.M.P., L.B., A.S., N.O., S.J.S., J.R.V., A.F., E.A.-B.); the Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City (E.S., K.D., N.G., J.A.); the Center for Biomedical Informatics, Regenstrief Institute (S.G., B.E.D., W.F.F., N.R.V.), Indiana University School of Medicine (S.G.), and Indiana University Richard M. Fairbanks School of Public Health (B.E.D., W.F.F., N.R.V.) - all in Indianapolis; Westat, Rockville, MD (S.W.B., R.J.B., M.E.L., E.A.R., M.D., Y.Z., P.S.); the Kaiser Permanente Northwest Center for Health Research, Portland, OR (A.L.N., S.A.I.); the Department of Medicine, Anschutz Medical Campus, University of Colorado, Aurora (T.C.O., S. Rao, M.B.); HealthPartners Institute, Minneapolis (M.B.D., E.K.); the Department of Biomedical Informatics, Columbia University Irving Medical Center (K.N., J.H.), and New York-Presbyterian Hospital (K.N.) - both in New York; the Vaccine Study Center, Division of Research, Kaiser Permanente Northern California, Oakland (N.L., K.G., B.F., O.Z., N.P.K.); and Baylor Scott and White Health, Texas A&M University College of Medicine, Temple, TX (M.G.)
| | - Jennifer R Verani
- From the Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta (M.G.T., C.H.B., S. Reynolds, J.F., P.P., E.P.G., R.M.P., L.B., A.S., N.O., S.J.S., J.R.V., A.F., E.A.-B.); the Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City (E.S., K.D., N.G., J.A.); the Center for Biomedical Informatics, Regenstrief Institute (S.G., B.E.D., W.F.F., N.R.V.), Indiana University School of Medicine (S.G.), and Indiana University Richard M. Fairbanks School of Public Health (B.E.D., W.F.F., N.R.V.) - all in Indianapolis; Westat, Rockville, MD (S.W.B., R.J.B., M.E.L., E.A.R., M.D., Y.Z., P.S.); the Kaiser Permanente Northwest Center for Health Research, Portland, OR (A.L.N., S.A.I.); the Department of Medicine, Anschutz Medical Campus, University of Colorado, Aurora (T.C.O., S. Rao, M.B.); HealthPartners Institute, Minneapolis (M.B.D., E.K.); the Department of Biomedical Informatics, Columbia University Irving Medical Center (K.N., J.H.), and New York-Presbyterian Hospital (K.N.) - both in New York; the Vaccine Study Center, Division of Research, Kaiser Permanente Northern California, Oakland (N.L., K.G., B.F., O.Z., N.P.K.); and Baylor Scott and White Health, Texas A&M University College of Medicine, Temple, TX (M.G.)
| | - Alicia Fry
- From the Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta (M.G.T., C.H.B., S. Reynolds, J.F., P.P., E.P.G., R.M.P., L.B., A.S., N.O., S.J.S., J.R.V., A.F., E.A.-B.); the Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City (E.S., K.D., N.G., J.A.); the Center for Biomedical Informatics, Regenstrief Institute (S.G., B.E.D., W.F.F., N.R.V.), Indiana University School of Medicine (S.G.), and Indiana University Richard M. Fairbanks School of Public Health (B.E.D., W.F.F., N.R.V.) - all in Indianapolis; Westat, Rockville, MD (S.W.B., R.J.B., M.E.L., E.A.R., M.D., Y.Z., P.S.); the Kaiser Permanente Northwest Center for Health Research, Portland, OR (A.L.N., S.A.I.); the Department of Medicine, Anschutz Medical Campus, University of Colorado, Aurora (T.C.O., S. Rao, M.B.); HealthPartners Institute, Minneapolis (M.B.D., E.K.); the Department of Biomedical Informatics, Columbia University Irving Medical Center (K.N., J.H.), and New York-Presbyterian Hospital (K.N.) - both in New York; the Vaccine Study Center, Division of Research, Kaiser Permanente Northern California, Oakland (N.L., K.G., B.F., O.Z., N.P.K.); and Baylor Scott and White Health, Texas A&M University College of Medicine, Temple, TX (M.G.)
| | - Manjusha Gaglani
- From the Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta (M.G.T., C.H.B., S. Reynolds, J.F., P.P., E.P.G., R.M.P., L.B., A.S., N.O., S.J.S., J.R.V., A.F., E.A.-B.); the Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City (E.S., K.D., N.G., J.A.); the Center for Biomedical Informatics, Regenstrief Institute (S.G., B.E.D., W.F.F., N.R.V.), Indiana University School of Medicine (S.G.), and Indiana University Richard M. Fairbanks School of Public Health (B.E.D., W.F.F., N.R.V.) - all in Indianapolis; Westat, Rockville, MD (S.W.B., R.J.B., M.E.L., E.A.R., M.D., Y.Z., P.S.); the Kaiser Permanente Northwest Center for Health Research, Portland, OR (A.L.N., S.A.I.); the Department of Medicine, Anschutz Medical Campus, University of Colorado, Aurora (T.C.O., S. Rao, M.B.); HealthPartners Institute, Minneapolis (M.B.D., E.K.); the Department of Biomedical Informatics, Columbia University Irving Medical Center (K.N., J.H.), and New York-Presbyterian Hospital (K.N.) - both in New York; the Vaccine Study Center, Division of Research, Kaiser Permanente Northern California, Oakland (N.L., K.G., B.F., O.Z., N.P.K.); and Baylor Scott and White Health, Texas A&M University College of Medicine, Temple, TX (M.G.)
| | - Eduardo Azziz-Baumgartner
- From the Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta (M.G.T., C.H.B., S. Reynolds, J.F., P.P., E.P.G., R.M.P., L.B., A.S., N.O., S.J.S., J.R.V., A.F., E.A.-B.); the Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City (E.S., K.D., N.G., J.A.); the Center for Biomedical Informatics, Regenstrief Institute (S.G., B.E.D., W.F.F., N.R.V.), Indiana University School of Medicine (S.G.), and Indiana University Richard M. Fairbanks School of Public Health (B.E.D., W.F.F., N.R.V.) - all in Indianapolis; Westat, Rockville, MD (S.W.B., R.J.B., M.E.L., E.A.R., M.D., Y.Z., P.S.); the Kaiser Permanente Northwest Center for Health Research, Portland, OR (A.L.N., S.A.I.); the Department of Medicine, Anschutz Medical Campus, University of Colorado, Aurora (T.C.O., S. Rao, M.B.); HealthPartners Institute, Minneapolis (M.B.D., E.K.); the Department of Biomedical Informatics, Columbia University Irving Medical Center (K.N., J.H.), and New York-Presbyterian Hospital (K.N.) - both in New York; the Vaccine Study Center, Division of Research, Kaiser Permanente Northern California, Oakland (N.L., K.G., B.F., O.Z., N.P.K.); and Baylor Scott and White Health, Texas A&M University College of Medicine, Temple, TX (M.G.)
| | - Nicola P Klein
- From the Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta (M.G.T., C.H.B., S. Reynolds, J.F., P.P., E.P.G., R.M.P., L.B., A.S., N.O., S.J.S., J.R.V., A.F., E.A.-B.); the Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City (E.S., K.D., N.G., J.A.); the Center for Biomedical Informatics, Regenstrief Institute (S.G., B.E.D., W.F.F., N.R.V.), Indiana University School of Medicine (S.G.), and Indiana University Richard M. Fairbanks School of Public Health (B.E.D., W.F.F., N.R.V.) - all in Indianapolis; Westat, Rockville, MD (S.W.B., R.J.B., M.E.L., E.A.R., M.D., Y.Z., P.S.); the Kaiser Permanente Northwest Center for Health Research, Portland, OR (A.L.N., S.A.I.); the Department of Medicine, Anschutz Medical Campus, University of Colorado, Aurora (T.C.O., S. Rao, M.B.); HealthPartners Institute, Minneapolis (M.B.D., E.K.); the Department of Biomedical Informatics, Columbia University Irving Medical Center (K.N., J.H.), and New York-Presbyterian Hospital (K.N.) - both in New York; the Vaccine Study Center, Division of Research, Kaiser Permanente Northern California, Oakland (N.L., K.G., B.F., O.Z., N.P.K.); and Baylor Scott and White Health, Texas A&M University College of Medicine, Temple, TX (M.G.)
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Dixon BE, Wools-Kaloustian KK, Fadel WF, Duszynski TJ, Yiannoutsos C, Halverson PK, Menachemi N. Symptoms and symptom clusters associated with SARS-CoV-2 infection in community-based populations: Results from a statewide epidemiological study. PLoS One 2021; 16:e0241875. [PMID: 33760821 PMCID: PMC7990210 DOI: 10.1371/journal.pone.0241875] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [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: 10/26/2020] [Accepted: 02/26/2021] [Indexed: 01/16/2023] Open
Abstract
Background Prior studies examining symptoms of COVID-19 are primarily descriptive and measured among hospitalized individuals. Understanding symptoms of SARS-CoV-2 infection in pre-clinical, community-based populations may improve clinical screening, particularly during flu season. We sought to identify key symptoms and symptom combinations in a community-based population using robust methods. Methods We pooled community-based cohorts of individuals aged 12 and older screened for SARS-CoV-2 infection in April and June 2020 for a statewide prevalence study. Main outcome was SARS-CoV-2 positivity. We calculated sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for individual symptoms as well as symptom combinations. We further employed multivariable logistic regression and exploratory factor analysis (EFA) to examine symptoms and combinations associated with SARS-CoV-2 infection. Results Among 8214 individuals screened, 368 individuals (4.5%) were RT-PCR positive for SARS-CoV-2. Although two-thirds of symptoms were highly specific (>90.0%), most symptoms individually possessed a PPV <50.0%. The individual symptoms most greatly associated with SARS-CoV-2 positivity were fever (OR = 5.34, p<0.001), anosmia (OR = 4.08, p<0.001), ageusia (OR = 2.38, p = 0.006), and cough (OR = 2.86, p<0.001). Results from EFA identified two primary symptom clusters most associated with SARS-CoV-2 infection: (1) ageusia, anosmia, and fever; and (2) shortness of breath, cough, and chest pain. Moreover, being non-white (13.6% vs. 2.3%, p<0.001), Hispanic (27.9% vs. 2.5%, p<0.001), or living in an Urban area (5.4% vs. 3.8%, p<0.001) was associated with infection. Conclusions Symptoms can help distinguish SARS-CoV-2 infection from other respiratory viruses, especially in community or urgent care settings where rapid testing may be limited. Symptoms should further be structured in clinical documentation to support identification of new cases and mitigation of disease spread by public health. These symptoms, derived from asymptomatic as well as mildly infected individuals, can also inform vaccine and therapeutic clinical trials.
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Affiliation(s)
- Brian E. Dixon
- Department of Epidemiology, IU Fairbanks School of Public Health, Indianapolis, Indiana, United States of America
- Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, Indiana, United States of America
- * E-mail:
| | - Kara K. Wools-Kaloustian
- Department of Medicine, IU School of Medicine, Indianapolis, Indiana, United States of America
- Center for Global Health, Indiana University, Indianapolis, Indiana, United States of America
| | - William F. Fadel
- Department of Biostatistics, IU Fairbanks School of Public Health, Indianapolis, Indiana, United States of America
| | - Thomas J. Duszynski
- Department of Epidemiology, IU Fairbanks School of Public Health, Indianapolis, Indiana, United States of America
| | - Constantin Yiannoutsos
- Department of Biostatistics, IU Fairbanks School of Public Health, Indianapolis, Indiana, United States of America
| | - Paul K. Halverson
- Department of Health Policy and Management, IU Fairbanks School of Public Health, Indianapolis, Indiana, United States of America
- Department of Family Medicine, IU School of Medicine, Indianapolis, Indiana, United States of America
| | - Nir Menachemi
- Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, Indiana, United States of America
- Department of Health Policy and Management, IU Fairbanks School of Public Health, Indianapolis, Indiana, United States of America
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Fadel WF, Urbanek JK, Glynn NW, Harezlak J. Use of Functional Linear Models to Detect Associations between Characteristics of Walking and Continuous Responses Using Accelerometry Data. Sensors (Basel) 2020; 20:s20216394. [PMID: 33182460 PMCID: PMC7665147 DOI: 10.3390/s20216394] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 11/03/2020] [Accepted: 11/06/2020] [Indexed: 11/16/2022]
Abstract
Various methods exist to measure physical activity. Subjective methods, such as diaries and surveys, are relatively inexpensive ways of measuring one’s physical activity; however, they are prone to measurement error and bias due to self-reporting. Wearable accelerometers offer a non-invasive and objective measure of one’s physical activity and are now widely used in observational studies. Accelerometers record high frequency data and each produce an unlabeled time series at the sub-second level. An important activity to identify from the data collected is walking, since it is often the only form of activity for certain populations. Currently, most methods use an activity summary which ignores the nuances of walking data. We propose methodology to model specific continuous responses with a functional linear model utilizing spectra obtained from the local fast Fourier transform (FFT) of walking as a predictor. Utilizing prior knowledge of the mechanics of walking, we incorporate this as additional information for the structure of our transformed walking spectra. The methods were applied to the in-the-laboratory data obtained from the Developmental Epidemiologic Cohort Study (DECOS).
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Affiliation(s)
- William F. Fadel
- Department of Biostatistics, Fairbanks School of Public Health, Indiana University, Indianapolis, IN 46202, USA
- Correspondence: (W.F.F.); (J.H.)
| | - Jacek K. Urbanek
- Department of Medicine, Division of Geriatric Medicine and Gerontology, School of Medicine, Johns Hopkins University, Baltimore, MD 21205, USA;
| | - Nancy W. Glynn
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA 15261, USA;
| | - Jaroslaw Harezlak
- Department of Epidemiology and Biostatistics, Indiana University, Bloomington, IN 47405, USA
- Correspondence: (W.F.F.); (J.H.)
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Dixon BE, Wools-Kaloustian K, Fadel WF, Duszynski TJ, Yiannoutsos C, Halverson PK, Menachemi N. Symptoms and symptom clusters associated with SARS-CoV-2 infection in community-based populations: Results from a statewide epidemiological study. medRxiv 2020. [PMID: 33106813 PMCID: PMC7587833 DOI: 10.1101/2020.10.11.20210922] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Background: Prior studies examining symptoms of COVID-19 are primarily descriptive and measured among hospitalized individuals. Understanding symptoms of SARS-CoV-2 infection in pre-clinical, community-based populations may improve clinical screening, particularly during flu season. We sought to identify key symptoms and symptom combinations in a community-based population using robust methods. Methods: We pooled community-based cohorts of individuals aged 12 and older screened for SARS-CoV-2 infection in April and June 2020 for a statewide seroprevalence study. Main outcome was SARS-CoV-2 positivity. We calculated sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for individual symptoms as well as symptom combinations. We further employed multivariable logistic regression and exploratory factor analysis (EFA) to examine symptoms and combinations associated with SARS-CoV-2 infection. Results: Among 8214 individuals screened, 368 individuals (4.5%) were RT-PCR positive for SARS-CoV-2. Although two-thirds of symptoms were highly specific (>90.0%), most symptoms individually possessed a PPV <50.0%. The individual symptoms most greatly associated with SARS-CoV-2 positivity were fever (OR=5.34, p<0.001), anosmia (OR=4.08, p<0.001), ageusia (OR=2.38, p=0.006), and cough (OR=2.86, p<0.001). Results from EFA identified two primary symptom clusters most associated with SARS-CoV-2 infection: (1) ageusia, anosmia, and fever; and (2) shortness of breath, cough, and chest pain. Moreover, being non-white (13.6% vs. 2.3%, p<0.001), Hispanic (27.9% vs. 2.5%, p<0.001), or living in an Urban area (5.4% vs. 3.8%, p<0.001) was associated with infection. Conclusions: Symptoms can help distinguish SARS-CoV-2 infection from other respiratory viruses, especially in community or urgent care settings where rapid testing may be limited. Symptoms should further be structured in clinical documentation to support identification of new cases and mitigation of disease spread by public health. These symptoms, derived from asymptomatic as well as mildly infected individuals, can also inform vaccine and therapeutic clinical trials.
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Affiliation(s)
- Brian E Dixon
- Department of Epidemiology, IU Fairbanks School of Public Health, Center for Biomedical Informatics, Regenstrief Institute, Inc., 1101 W. 10th St., RF 336, Indianapolis, IN 46202
| | | | - William F Fadel
- Department of Biostatistics, IU Fairbanks School of Public Health
| | | | | | - Paul K Halverson
- Department of Health Policy and Management, IU Fairbanks School of Public Health
| | - Nir Menachemi
- Department of Health Policy & Management, IU Fairbanks School of Public Health
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Moorthi RN, Fadel WF, Cranor A, Hindi J, Avin KG, Lane KA, Thadhani RI, Moe SM. Mobility Impairment in Patients New to Dialysis. Am J Nephrol 2020; 51:705-714. [PMID: 32781443 DOI: 10.1159/000509225] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 04/23/2020] [Accepted: 06/08/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND Impaired mobility is associated with functional dependence, frailty, and mortality in prevalent patients undergoing dialysis. We investigated risk factors for mobility impairment, (poor gait speed) in patients incident to dialysis, and changes in gait speed over time in a 2-year longitudinal study. METHODS One hundred eighty-three patients enrolled within 6 months of dialysis initiation were followed up 6, 12, and 24 months later. Grip strength, health-related quality of life, and comorbidities were assessed at baseline. Outcomes were (a) baseline gait speed and (b) change in gait speed over time. Gait speed was assessed by 4-meter walk. Multivariate linear regression was used to identify risk factors for low gait speed at baseline. For longitudinal analyses, linear mixed effects modeling with gait speed modeled over time was used as the outcome. RESULTS Participants were 54.7 ± 12.8 years old, 52.5% men, 73.9% black with mean dialysis vintage of 100.1 ± 46.9 days and median gait speed 0.78 (0.64-0.094) m/s. Lower health utility and grip strength, diabetic nephropathy, and walking aids were associated with lower baseline gait speed. Loss of 0.1 m/s gait speed occurred in 24% of subjects at 1 year. In multivariate mixed effects models, only age, walking aid use, lower health utility, and lower handgrip strength were significantly associated with gait speed loss. CONCLUSIONS In our cohort of incident dialysis patients, overall gait speed is very low and 54.2% of the subjects continue to lose gait speed over 2 years. Older age, lower handgrip strength, and quality of life are risk factors for slowness. Patients at highest risk of poor gait speed can be identified at dialysis initiation to allow targeted implementation of therapeutic options.
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Affiliation(s)
- Ranjani N Moorthi
- Division of Nephrology, Indiana University School of Medicine, Indianapolis, Indiana, USA,
| | - William F Fadel
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Alissa Cranor
- Division of Nephrology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Judy Hindi
- Division of Nephrology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Keith G Avin
- Division of Nephrology, Indiana University School of Medicine, Indianapolis, Indiana, USA
- School of Health & Human Sciences, Indiana University, Indianapolis, Indiana, USA
| | - Kathleen A Lane
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | | | - Sharon M Moe
- Division of Nephrology, Indiana University School of Medicine, Indianapolis, Indiana, USA
- Roudebush Veterans Affairs Medical Center, Indianapolis, Indiana, USA
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Menachemi N, Yiannoutsos CT, Dixon BE, Duszynski TJ, Fadel WF, Wools-Kaloustian KK, Unruh Needleman N, Box K, Caine V, Norwood C, Weaver L, Halverson PK. Population Point Prevalence of SARS-CoV-2 Infection Based on a Statewide Random Sample - Indiana, April 25-29, 2020. MMWR Morb Mortal Wkly Rep 2020; 69:960-964. [PMID: 32701938 PMCID: PMC7377824 DOI: 10.15585/mmwr.mm6929e1] [Citation(s) in RCA: 135] [Impact Index Per Article: 33.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Population prevalence of persons infected with SARS-CoV-2, the virus that causes coronavirus disease 2019 (COVID-19), varies by subpopulation and locality. U.S. studies of SARS-CoV-2 infection have examined infections in nonrandom samples (1) or seroprevalence in specific populations* (2), which are limited in their generalizability and cannot be used to accurately calculate infection-fatality rates. During April 25-29, 2020, Indiana conducted statewide random sample testing of persons aged ≥12 years to assess prevalence of active infection and presence of antibodies to SARS-CoV-2; additional nonrandom sampling was conducted in racial and ethnic minority communities to better understand the impact of the virus in certain racial and ethnic minority populations. Estimates were adjusted for nonresponse to reflect state demographics using an iterative proportional fitting method. Among 3,658 noninstitutionalized participants in the random sample survey, the estimated statewide point prevalence of active SARS-CoV-2 infection confirmed by reverse transcription-polymerase chain reaction (RT-PCR) testing was 1.74% (95% confidence interval [CI] = 1.10-2.54); 44.2% of these persons reported no symptoms during the 2 weeks before testing. The prevalence of immunoglobulin G (IgG) seropositivity, indicating past infection, was 1.09% (95% CI = 0.76-1.45). The overall prevalence of current and previous infections of SARS-CoV-2 in Indiana was 2.79% (95% CI = 2.02-3.70). In the random sample, higher overall prevalences were observed among Hispanics and those who reported having a household contact who had previously been told by a health care provider that they had COVID-19. By late April, an estimated 187,802 Indiana residents were currently or previously infected with SARS-CoV-2 (9.6 times higher than the number of confirmed cases [17,792]) (3), and 1,099 residents died (infection-fatality ratio = 0.58%). The number of reported cases represents only a fraction of the estimated total number of infections. Given the large number of persons who remain susceptible in Indiana, adherence to evidence-based public health mitigation and containment measures (e.g., social distancing, consistent and correct use of face coverings, and hand hygiene) is needed to reduce surge in hospitalizations and prevent morbidity and mortality from COVID-19.
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Tonismae TR, Tucker Edmonds B, Bhamidipalli SS, Fadel WF, Carlos C, Andrews B, Fritz KA, Leuthner SR, Lawrence C, Laventhal N, Hayslett D, Coleman T, Famuyide M, Feltman D. Intention to treat: obstetrical management at the threshold of viability. Am J Obstet Gynecol MFM 2020; 2:100096. [PMID: 33345962 DOI: 10.1016/j.ajogmf.2020.100096] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 02/17/2020] [Accepted: 02/18/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Despite medical advances in the care of extremely preterm neonates and growing acceptance of resuscitation at 23 and even 22 weeks gestation, controversy remains concerning the use of antepartum obstetric intervention s that are intended to improve outcomes in the setting of anticipated extremely preterm birth. In the absence of demonstrated benefit at <23 weeks gestation and with uncertain benefit at 23 weeks gestation, previous obstetric committee opinions have advised against their use at these gestational ages. OBJECTIVE The purpose of this study was to review the use of obstetric intervention s at the threshold of viability based on neonatal resuscitation plan and to review the odds of survival to neonatal intensive care unit discharge based on use of obstetric intervention s with adjustment for neonatal factors. STUDY DESIGN This retrospective study of 6 study centers reviewed pregnant patients who were admitted between 22+0/7 and 24+6/7 weeks gestation facing delivery from 2011-2015. Patients with known anomalies or missing data were excluded. Records were reviewed for demographics, resuscitation plan, and obstetric intervention s. Mode of delivery, delivery room care, and final infant dispositions were recorded. Multiple gestations were included as 1 pregnancy in regard to the use of obstetric intervention s and were excluded from survival analysis. RESULTS Four hundred seventy-eight mothers met the inclusion criteria. When resuscitation was planned, mothers were more likely to receive all conventional obstetric intervention s (antenatal steroids, magnesium sulfate for neuroprotection, tocolytics, and Group Beta Streptococcus prophylaxis), regardless of gestational age at admission, and were more likely to be delivered by cesarean section (P<.05). Analyzed as a group, when antenatal steroids, magnesium sulfate, tocolytics and Group Beta Streptococcus prophylaxis were administered, the odds of survival to neonatal intensive care unit discharge increased for newborn infants who were born at 22 (odds ratio, 11.33; 95% confidence interval, 1.405-91.4) and 23 weeks gestation (odds ratio, 15.5; 95% confidence interval, 3.747-64.11; P<.05). In singletons, the odds of survival to neonatal intensive care unit discharge was not improved by cesarean delivery vs vaginal delivery, even after adjustment for the use of additional interventions, weight, gender, and gestational age (odds ratio, 1.0; 95% confidence interval, 0.59-1.8; P=.912). CONCLUSION In this study, when postnatal resuscitation was planned at 22 and 23 weeks gestation, women were more likely to receive antenatal steroids, magnesium sulfate, and antibiotics; provision of this bundle imparted survival benefit at 23 weeks gestation but could not be demonstrated at 22 weeks gestation because of the small sample size. These findings support of neonate-oriented obstetric interventions in the setting of delivery at 23 weeks gestation when resuscitation is planned and further exploration of optimal obstetric care when resuscitation of infants who were born at 22 weeks gestation is anticipated.
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Affiliation(s)
- Tiffany R Tonismae
- Department of Obstetrics and Gynecology, Indiana University School of Medicine, Indianapolis, IN; Johns Hopkins All Children's Hospital; Maternal, Fetal, & Neonatal Institute; St. Petersburg, FL.
| | - Brownsyne Tucker Edmonds
- Department of Obstetrics and Gynecology, Indiana University School of Medicine, Indianapolis, IN
| | - Surya Sruthi Bhamidipalli
- Department of Biostatistics, Indiana University Richard M. Fairbanks School of Public Health and School of Medicine, Indianapolis, IN
| | - William F Fadel
- Department of Biostatistics, Indiana University Richard M. Fairbanks School of Public Health and School of Medicine, Indianapolis, IN
| | | | - Bree Andrews
- University of Chicago Comer, Children's Hospital, Chicago, IL
| | | | | | | | - Naomi Laventhal
- University of Michigan C.S. Mott Children's Hospital, Ann Arbor, MI
| | - Drew Hayslett
- University of Mississippi Medical Center, Jackson, MS
| | - Tasha Coleman
- University of Mississippi Medical Center, Jackson, MS
| | | | - Dalia Feltman
- NorthShore University Health System Evanston Hospital, Evanston, IN
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Fadel WF, Urbanek JK, Albertson SR, Li X, Chomistek AK, Harezlak J. Differentiating Between Walking and Stair Climbing Using Raw Accelerometry Data. Stat Biosci 2019; 11:334-354. [PMID: 32863979 DOI: 10.1007/s12561-019-09241-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Wearable accelerometers provide an objective measure of human physical activity. They record high frequency unlabeled three-dimensional time series data. We extract meaningful features from the raw accelerometry data and based on them develop and evaluate a classification method for the detection of walking and its sub-classes, i.e. level walking, descending stairs and ascending stairs. Our methodology is tested on a sample of 32 middle-aged subjects for whom we extracted features based on the Fourier and wavelet transforms. We build subject-specific and group-level classification models utilizing a tree-based methodology. We evaluate the effects of sensor location and tuning parameters on the classification accuracy of the tree models. In the group-level classification setting, we propose a robust feature inter-subject normalization and evaluate its performance compared to unnormalized data. The overall classification accuracy for the three activities at the subject-specific level was on average 87.6%, with the ankle-worn accelerometers showing the best performance with an average accuracy 90.5%. At the group-level, the average overall classification accuracy for the three activities using the normalized features was 80.2% compared to 72.3% for the unnormalized features. In summary, a framework is provided for better use and feature extraction from raw accelerometry data to differentiate among different walking modalities as well as considerations for study design.
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Affiliation(s)
- William F Fadel
- 410 West 10th Street, Suite 3000, Indianapolis, IN 46202, Department of Biostatistics, School of Medicine & Richard M. Fairbanks School of Public Health, Indiana University
| | - Jacek K Urbanek
- 2024 E. Monument Street, Suite 2-700, Baltimore, MD 21205, Division of Geriatric Medicine and Gerontology, Department of Medicine, School of Medicine, Johns Hopkins University
| | - Steven R Albertson
- 723 W. Michigan St., SL280, Indianapolis, IN 46202, Department of Computer and Information Science, Indiana University-Purdue University Indianapolis
| | - Xiaochun Li
- 410 West 10th Street, Suite 3000, Indianapolis, IN 46202, Department of Biostatistics, School of Medicine & Richard M. Fairbanks School of Public Health, Indiana University
| | - Andrea K Chomistek
- 1025 E. 7th Street, Bloomington, IN 47405, Department of Epidemiology and Biostatistics, Indiana University Bloomington
| | - Jaroslaw Harezlak
- 1025 E. 7th Street, Suite C107, Bloomington, IN 47405, Department of Epidemiology and Biostatistics, Indiana University Bloomington
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Abstract
Measuring physical activity using wearable devices has become increasingly popular. Raw data collected from such devices is usually summarized as 'activity counts', which combine information of human activity with environmental vibrations. Driving is a major sedentary activity that artificially increases the activity counts due to various car and body vibrations that are not connected to human movement. Thus, it has become increasingly important to identify periods of driving and quantify the bias induced by driving in activity counts. To address these problems, we propose a detection algorithm of driving via accelerometry (DADA), designed to detect time periods when an individual is driving a car. DADA is based on detection of vibrations generated by a moving vehicle and recorded by an accelerometer. The methodological approach is based on short-time Fourier transform (STFT) applied to the raw accelerometry data and identifies and focuses on frequency vibration ranges that are specific to car driving. We test the performance of DADA on data collected using wrist-worn ActiGraph devices in a controlled experiment conducted on 24 subjects. The median area under the receiver-operating characteristic curve (AUC) for predicting driving periods was 0.94, indicating an excellent performance of the algorithm. We also quantify the size of the bias induced by driving and obtain that per unit of time the activity counts generated by driving are, on average, 16% of the average activity counts generated during walking.
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Affiliation(s)
- M Strączkiewicz
- Faculty of Mechanical Engineering and Robotics, AGH University of Science and Technology, Krakow, Poland
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Guzek LM, Fadel WF, Golomb MR. A Pilot Study of Reasons and Risk Factors for "No-Shows" in a Pediatric Neurology Clinic. J Child Neurol 2015; 30:1295-9. [PMID: 25503257 DOI: 10.1177/0883073814559098] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Accepted: 10/14/2014] [Indexed: 11/15/2022]
Abstract
Missed clinic appointments lead to decreased patient access, worse patient outcomes, and increased healthcare costs. The goal of this pilot study was to identify reasons for and risk factors associated with missed pediatric neurology outpatient appointments ("no-shows"). This was a prospective cohort study of patients scheduled for 1 week of clinic. Data on patient clinical and demographic information were collected by record review; data on reasons for missed appointments were collected by phone interviews. Univariate and multivariate analyses were conducted using chi-square tests and multiple logistic regression to assess risk factors for missed appointments. Fifty-nine (25%) of 236 scheduled patients were no-shows. Scheduling conflicts (25.9%) and forgetting (20.4%) were the most common reasons for missed appointments. When controlling for confounding factors in the logistic regression, Medicaid (odds ratio 2.36), distance from clinic, and time since appointment was scheduled were associated with missed appointments. Further work in this area is needed.
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Affiliation(s)
- Lindsay M Guzek
- Division of Pediatric Neurology, Department of Neurology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - William F Fadel
- Department of Biostatistics, Indiana University Richard M. Fairbanks School of Public Health, Indianapolis, IN, USA
| | - Meredith R Golomb
- Division of Pediatric Neurology, Department of Neurology, Indiana University School of Medicine, Indianapolis, IN, USA
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Abstract
Children with chronic diseases are at risk for low bone mineral density (BMD). There are no studies of BMD in children with congenital heart disease and particularly single ventricle (SV). Children with this defect are often treated with warfarin, suspected to negatively impact BMD in adults. We assessed BMD in patients with SV physiology and compared the BMD of subjects taking warfarin to those who were not. Subjects 5-12 years with SV were included. BMD z scores by dual-energy X-ray absorptiometry of the spine and total body less head (TBLH) were obtained. Calcium intake, activity level, height, and Tanner stage were assessed. Linear regression models and t tests were used to investigate differences between participants and normative data as well as between subjects' subgroups. Twenty-six subjects were included and 16 took warfarin. Mean BMD z score at the spine was significantly lower than expected at -1.0 ± 0.2 (p < 0.0001), as was the BMD z score for TBLH at -0.8 ± 0.2 (p < 0.0001). Those results remained significant after adjusting for height. Subjects who were on warfarin tended to have lower BMD at both the spine and TBLH than those who were not, with a z score difference of 0.6 ± 0.46 at the spine (p = 0.106) and a difference of 0.4 ± 0.34 at TBLH (p = 0.132). BMD is significantly reduced in children with SV. Warfarin appears to lower BMD but the effect is less conclusive. Continued evaluation is recommended for these patients at risk for reduced bone density. Evaluation of other cardiac patients on warfarin therapy should also be considered.
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Affiliation(s)
- Edgard A Bendaly
- Section of Pediatric Cardiology, Department of Pediatrics, Sanford Children's Hospital, University of South Dakota, 1600 W 22nd Street, PO Box 5039, Sioux Falls, SD, 57117, USA,
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Friedman AN, Moe S, Fadel WF, Inman M, Mattar SG, Shihabi Z, Quinney SK. Predicting the glomerular filtration rate in bariatric surgery patients. Am J Nephrol 2013; 39:8-15. [PMID: 24356416 PMCID: PMC3945154 DOI: 10.1159/000357231] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.2] [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: 11/04/2013] [Accepted: 11/12/2013] [Indexed: 12/14/2022]
Abstract
BACKGROUND/AIMS Identifying the best method to estimate the glomerular filtration rate (GFR) in bariatric surgery patients has important implications for the clinical care of obese patients and research into the impact of obesity and weight reduction on kidney health. We therefore performed such an analysis in patients before and after surgical weight loss. METHODS Fasting measured GFR (mGFR) by plasma iohexol clearance before and after bariatric surgery was obtained in 36 severely obese individuals. Estimated GFR was calculated using the Modification of Diet in Renal Disease equation, the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation using serum creatinine only, the CKD-EPI equation using serum cystatin C only and a recently derived equation that uses both serum creatinine and cystatin C (CKD-EPIcreat-cystC) and then compared to mGFR. RESULTS Participants were primarily middle-aged white females with a mean baseline body mass index of 46 ± 9, serum creatinine of 0.81 ± 0.24 mg/dl and mGFR of 117 ± 40 ml/min. mGFR had a stronger linear relationship with inverse cystatin C before (r = 0.28, p = 0.09) and after (r = 0.38, p = 0.02) surgery compared to the inverse of creatinine (before: r = 0.26, p = 0.13; after: r = 0.11, p = 0.51). mGFR fell by 17 ± 35 ml/min (p = 0.007) following surgery. The CKD-EPIcreat-cystC was unquestionably the best overall performing estimating equation before and after surgery, revealing very little bias and a capacity to estimate mGFR within 30% of its true value over 80% of the time. This was true whether or not mGFR was indexed for body surface area. CONCLUSIONS In severely obese bariatric surgery patients with normal kidney function, cystatin C is more strongly associated with mGFR than is serum creatinine. The CKD-EPIcreat-cystC equation best predicted mGFR both before and after surgery.
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Affiliation(s)
- Allon N Friedman
- Department of Medicine, Indiana University School of Medicine, Indianapolis, Ind., USA
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