Last data update: Jan 27, 2025. (Total: 48650 publications since 2009)
Records 1-30 (of 79 Records) |
Query Trace: Ellington SR[original query] |
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Influenza vaccine effectiveness against medically attended outpatient illness, United States, 2023-24 season
Chung JR , Price AM , Zimmerman RK , Moehling Geffel K , House SL , Curley T , Wernli KJ , Phillips CH , Martin ET , Vaughn IA , Murugan V , Scotch M , Saade EA , Faryar KA , Gaglani M , Ramm JD , Williams OL , Walter EB , Kirby M , Keong LM , Kondor R , Ellington SR , Flannery B . Clin Infect Dis 2025 ![]() BACKGROUND: The 2023-24 U.S. influenza season was characterized by a predominance of A(H1N1)pdm09 virus circulation with co-circulation of A(H3N2) and B/Victoria viruses. We estimated vaccine effectiveness (VE) in the United States against mild-to-moderate medically attended influenza illness in the 2023-24 season. METHODS: We enrolled outpatients aged ≥8 months with acute respiratory illness in 7 states. Respiratory specimens were tested for influenza type/subtype by reverse-transcriptase polymerase chain reaction (RT-PCR). Influenza VE was estimated with a test-negative design comparing odds of testing positive for influenza among vaccinated versus unvaccinated participants. We estimated VE by virus sub-type/lineage and A(H1N1)pdm09 genetic subclades. RESULTS: Among 6,589 enrolled patients, 1,770 (27%) tested positive for influenza including 796 A(H1N1)pdm09, 563 B/Victoria, and 323 A(H3N2). Vaccine effectiveness against any influenza illness was 41% (95% Confidence Interval [CI]: 32 to 49): 28% (95% CI: 13 to 40) against influenza A(H1N1)pdm09, 68% (95% CI: 59 to 76) against B/Victoria, and 30% (95% CI: 9 to 47) against A(H3N2). Statistically significant protection against any influenza was found for all age groups except adults aged 50-64 years. Lack of protection in this age group was specific to influenza A-associated illness. We observed differences in VE by birth cohort and A(H1N1)pdm09 virus genetic subclade. CONCLUSIONS: Vaccination reduced outpatient medically attended influenza overall by 41% and provided protection overall against circulating influenza A and B viruses. Serologic studies would help inform differences observed by age groups. |
A new tool for estimating the number of pregnant people in the United States
Strid P , Simeone RM , Hall R , Meeker JR , Ellington SR . Obstet Gynecol 2024 BACKGROUND: Knowing the approximate number of women of reproductive age (ie, 15-49 years) who are pregnant at a point in time in the United States can aid in emergency preparedness resource allocation. The Centers for Disease Control and Prevention (CDC) released a pregnancy estimator toolkit in 2012, which could be used to estimate the number of pregnant people in a geographic area at a point in time. This original toolkit did not account for pregnancy losses before 20 weeks of gestation; however, an updated toolkit released by the CDC in May 2024 uses a ratio of live births to estimate the number of pregnancy losses before 20 weeks at a point in time for improved estimation of total pregnant people at a point in time. INSTRUMENT: We used the CDC's updated reproductive health tool, "Estimating the Number of Pregnant Women in a Geographic Area." EXPERIENCE: Using publicly available data for 2020, we gathered the necessary input values, including total births, fetal deaths, and induced abortions, and applied the equation available in the CDC toolkit to estimate the number of pregnant people in the United States at any point in time in 2020. CONCLUSION: In 2020, there were 75,582,028 women of reproductive age in the United States, and we estimate that approximately 2,962,052 or 3.9% of women of reproductive age were pregnant at any point in time in the United States. |
Timing of influenza vaccination during pregnancy
Olson SM , Sahni LC , Boom JA , Dawood FS , Muñoz FM , Ellington SR . Am J Obstet Gynecol MFM 2024 101427 |
CDC Division of Reproductive Health's emergency preparedness resources and activities for radiation emergencies: Public health considerations for women's reproductive health
Riser A , Perez M , Snead MC , Galang RR , Simeone RM , Salame-Alfie A , Rice ME , Sayyad A , Strid P , Yocca J , Meeker JR , Waits G , Hansen S , Hall R , Anstey E , House LD , Okoroh E , Zotti M , Ellington SR . J Womens Health (Larchmt) 2023 32 (12) 1271-1280 Pregnant, postpartum, and lactating people, and infants have unique needs during public health emergencies, including nuclear and radiological incidents. This report provides information on the CDC Division of Reproductive Health's emergency preparedness and response activities to address the needs of women of reproductive age (aged 15-49 years), people who are pregnant, postpartum, or lactating, and infants during a radiation emergency. Highlighted preparedness activities include: (1) development of a quick reference guide to inform key questions about pregnant, postpartum, and lactating people, and infants during radiation emergencies; and (2) exercising the role of reproductive health experts during nuclear and radiological incident preparedness activities. |
Communicating the value of influenza vaccines to patients: Translating vaccine effectiveness to acceptance
Tenforde MW , Dawood FS , Ellington SR , Grohskopf LA , Flannery B , Garg S , Reed C . Ann Intern Med 2023 176 (12) 1670-1671 Influenza vaccines have been routinely recommended in the United States for some groups since 1960 and for everyone 6 months of age or older for more than a decade. Yet, annual influenza vaccination coverage has rarely exceeded 50% in children and younger adults or 70% in adults aged 65 years or older (1). Long-standing barriers to influenza vaccine uptake include beliefs that influenza illness is mild or inconsequential and vaccines are not effective, concerns about safety and adverse effects, and distrust of the medical system and disparities in access to vaccines (1, 2). | | During the COVID-19 pandemic, influenza vaccination coverage rates remained low overall and declined in some groups (1, 3). Although the first year of the COVID-19 pandemic temporarily interrupted circulation of seasonal respiratory viruses, the United States experienced high levels of influenza virus, SARS-CoV-2, and respiratory syncytial virus co-circulation during the 2022 to 2023 influenza season, putting a strain on health care resources. As the 2023 to 2024 season begins, internal medicine physicians and other health care professionals play an important role in communicating the benefits of vaccinations against influenza and other respiratory viruses. A health care professional’s recommendation and offer of or referral for vaccination have been shown over many seasons to be one of the strongest factors associated with willingness to get vaccinated (2). |
Influenza, tdap, and COVID-19 vaccination coverage and hesitancy among pregnant women - United States, April 2023
Razzaghi H , Kahn KE , Calhoun K , Garacci E , Skoff TH , Ellington SR , Jatlaoui TC , Black CL . MMWR Morb Mortal Wkly Rep 2023 72 (39) 1065-1071 Influenza, tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap), and COVID-19 vaccines can reduce the risk for influenza, pertussis, and COVID-19 among pregnant women and their infants. To assess influenza, Tdap, and COVID-19 vaccination coverage among women pregnant during the 2022-23 influenza season, CDC analyzed data from an Internet panel survey conducted during March 28-April 16, 2023. Among 1,814 survey respondents who were pregnant at any time during October 2022-January 2023, 47.2% reported receiving influenza vaccine before or during their pregnancy. Among 776 respondents with a live birth by their survey date, 55.4% reported receiving Tdap vaccine during pregnancy. Among 1,252 women pregnant at the time of the survey, 27.3% reported receipt of a COVID-19 bivalent booster dose before or during the current pregnancy. Data from the same questions included in surveys conducted during influenza seasons 2019-20 through 2022-23 show that the proportion of pregnant women who reported being very hesitant about influenza and Tdap vaccinations during pregnancy increased from 2019-20 to 2022-23. Pregnant women who received a provider recommendation for vaccination were less hesitant about influenza and Tdap vaccines. Promotion of efforts to improve vaccination coverage among pregnant women, such as provider recommendation for vaccination and informative conversations with patients to address vaccine hesitancy, might reduce vaccine hesitancy and increase coverage with these important vaccines to protect mothers and their infants against severe respiratory diseases. |
Differences in delivery hospitalization experiences during the COVID-19 pandemic by maternal race and ethnicity, Pregnancy Risk Assessment Monitoring System, 2020
Simeone RM , Meghani M , Meeker JR , Zapata LB , Galang RR , Salvesen Von Essen B , Dieke A , Ellington SR . J Perinatol 2023 OBJECTIVE: We investigated maternal COVID-19 related experiences during delivery hospitalizations, and whether experiences differed by maternal race and ethnicity. STUDY DESIGN: Data from the Pregnancy Risk Assessment Monitoring System among women with live births between April-December 2020 were used. Adjusted prevalence ratios (aPR) and 95% confidence intervals (CI) estimated associations between maternal race and ethnicity and COVID-19 related delivery experiences. RESULTS: Among 12,879 women, 3.6% reported infant separation and 1.8% reported not being allowed support persons. Compared with non-Hispanic White women, American Indian/Alaska Native (AI/AN) (aPR = 2.7; CI: 1.2-6.2), Hispanic (aPR = 2.2; CI: 1.5-3.1), non-Hispanic Black (aPR = 2.4; CI: 1.7-3.6), and non-Hispanic Asian (aPR = 2.8; CI: 1.6-4.9) women reported more infant separation due to COVID-19. Not being allowed support persons was more common among AI/AN (aPR = 5.2; CI: 1.8-14.8) and non-Hispanic Black (aPR = 2.3; CI: 1.3-4.1) women. CONCLUSIONS: COVID-19 related delivery hospitalization experiences were unequally distributed among racial and ethnic minorities. |
Severe acute respiratory syndrome coronavirus 2 seroprevalence and longitudinal antibody response following natural infection in pregnancy: A prospective cohort study
Drake AL , Escudero JN , Aurelio MC , Wetzler EA , Ellington SR , Zapata LB , Galang RR , Snead MC , Yamamoto K , Salerno CC , Richardson BA , Greninger AL , Kachikis AB , Englund JA , LaCourse SM . Womens Health (Lond) 2023 19 17455057231190955 BACKGROUND: Antenatal care provides unique opportunities to assess severe acute respiratory syndrome coronavirus 2 seroprevalence and antibody response duration after natural infection detected during pregnancy; transplacental antibody transfer may inform peripartum and neonatal protection. We estimated seroprevalence and durability of antibodies from natural infection (anti-nucleocapsid immunoglobulin G) among pregnant people, and evaluated transplacental transfer efficiency. OBJECTIVE AND DESIGN: We conducted a cross-sectional study to measure severe acute respiratory syndrome coronavirus 2 seroprevalence, and a prospective cohort study to longitudinally measure anti-nucleocapsid immunoglobulin G responses and transplacental transfer of maternally derived anti-nucleocapsid antibodies. METHODS: We screened pregnant people for the seroprevalence study between 9 December 2020 and 19 June 2021 for anti-nucleocapsid immunoglobulin G in Seattle, Washington. We enrolled anti-nucleocapsid immunoglobulin G positive people from the seroprevalence study or identified through medical records with positive reverse transcription polymerase chain reaction or antigen positive results in a prospective cohort between 9 December 2020 and 9 August 2022. RESULTS: In the cross-sectional study (N = 1284), 5% (N = 65) tested severe acute respiratory syndrome coronavirus 2 anti-nucleocapsid immunoglobulin G positive, including 39 (60%) without prior positive reverse transcription polymerase chain reaction results and 42 (65%) without symptoms. In the prospective cohort study (N = 107 total; N = 65 from the seroprevalence study), 86 (N = 80%) had anti-nucleocapsid immunoglobulin G positive results during pregnancy. Among 63 participants with delivery samples and prior anti-nucleocapsid positive results, 29 (46%) were anti-nucleocapsid immunoglobulin G negative by delivery. Of 34 remaining anti-nucleocapsid immunoglobulin G positive at delivery with paired cord blood, 19 (56%) had efficient transplacental anti-nucleocapsid immunoglobulin G antibody transfer. Median time from first anti-nucleocapsid immunoglobulin G positive to below positive antibody threshold was 19 weeks and did not differ by prior positive reverse transcription polymerase chain reaction status. CONCLUSIONS: Maternally derived severe acute respiratory syndrome coronavirus 2 antibodies to natural infection may wane before delivery. Vaccines are recommended for pregnant persons to reduce severe illness and confer protection to infants. |
Epidemiologic and clinical features of mpox in adults aged >50 years - United States, May 2022-May 2023
Eustaquio PC , Salmon-Trejo LAT , McGuire LC , Ellington SR . MMWR Morb Mortal Wkly Rep 2023 72 (33) 893-896 During May 2022-May 2023, approximately 30,000 mpox cases were reported in the United States, predominantly among young adult men. Persons aged >50 years might experience more severe mpox disease because of a higher prevalence of comorbidities. Conversely, they could have residual protection from childhood smallpox vaccination against monkeypox virus infection and severe mpox, as has been suggested by investigation of some previous mpox outbreaks. To examine the characteristics of mpox cases among adults aged >50 years, analysts compared mpox epidemiology and clinical outcomes among all adults aged ≥18 years, by age group. Further, outcomes were compared among adults aged >50 years by JYNNEOS vaccination status. During May 10, 2022-May 17, 2023, among 29,984 adults with probable or confirmed mpox reported to CDC, 2,909 (9.7%) were aged >50 years, 96.3% of whom were cisgender men. Compared with adults aged 18-50 years, adults aged >50 years had higher prevalences of immunocompromising conditions (p<0.001) and HIV infection (p<0.001). Among adults with mpox aged >50 years, 27.6% had received JYNNEOS vaccination; this group had lower prevalences of constitutional symptoms (p<0.001), pruritus (p<0.001), and hospitalization (p = 0.002) compared with those who had not received JYNNEOS vaccine. Currently recommended JYNNEOS vaccination among all adults at risk for mpox should be encouraged, irrespective of childhood smallpox vaccination status. |
Disaster preparedness among women with a recent live birth in Hawaii, a cross-sectional study, results from the Pregnancy Risk Assessment Monitoring System (PRAMS), 2016 (preprint)
Strid P , Fok CCT , Zotti M , Shulman HB , Awakuni J , House LD , Morrow B , Kern J , Shim M , Ellington SR . medRxiv 2021 2021.04.14.21255501 Objectives This study examines emergency preparedness behaviors among women with a recent live birth in Hawaii.Methods Using the 2016 Hawaii Pregnancy Risk Assessment Monitoring Survey we estimated weighted prevalence of eight preparedness behaviors.Results Among 1010 respondents (weighted response rate=56.3%), 79.3% reported at least one preparedness behavior and 11.2% performed all eight behaviors. The prevalence of women with a recent live birth in Hawaii reporting preparedness behaviors includes: 63.0% (95% CI: 58.7-67.1%) having enough supplies at home for at least seven days, 41.3% (95% CI: 37.1-45.6%) having an evacuation plan for their child(ren), 38.7% (95% CI: 34.5, 43.0) having methods to keep in touch, 37.8% (95% CI: 33.7, 42.1) having an emergency meeting place, 36.6% (95% CI: 32.6, 40.9) having an evacuation plan to leave home, 34.9% (95% CI: 30.9, 39.2) having emergencies supplies to take with if they have to leave quickly, 31.8% (95% CI: 27.9, 36.0) having copies of important documents, 31.6% (95% CI: 27.7, 35.8) having practiced what to do.Conclusion One in ten women practiced all eight behaviors indicating more awareness efforts are needed among this at-risk population in Hawaii. Hawaii can measure the effect of interventions to increase preparedness by tracking this question over time.“What is already known on this subject?”Preparedness is associated with reduced vulnerability, and postpartum women are considered an at-risk population in the post-disaster period with special clinical needs. One prior study has assessed disaster preparedness among postpartum women.“What this study adds?”This is the first study to describe a methodology to analyze the eight-part PRAMS emergency preparedness question. Among recently postpartum women in Hawaii, about 80% practiced at least one of eight emergency preparedness measures assessed and about 10% practiced all behaviors.Competing Interest StatementThe authors have declared no competing interest.Funding StatementCDC provides annual funding to participating PRAMS sites through a cooperative agreement.Author DeclarationsI confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.YesThe details of the IRB/oversight body that provided approval or exemption for the research described are given below:Ethics approval PRAMS protocol has been reviewed and approved by Centers for Disease Control and Preventions Institutional Review Board and approved as human subjects research (HSR #2233). Consent to participate All survey respondents provided verbal consent via phone or implied consent by returning a completed questionnaire. All necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived.YesI understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).Yes I have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable.Yes |
SARS-CoV-2 seroprevalence and longitudinal antibody response following natural infection in pregnancy: a prospective cohort study (preprint)
Drake AL , Escudero JN , Aurelio MC , Ellington SR , Zapata LB , Galang RR , Snead MC , Yamamoto K , Salerno C , Richardson BA , Greninger AL , Kachikis AB , Englund JA , LaCourse SM . medRxiv 2022 30 Importance: Antenatal care provides unique opportunities to assess SARS-CoV-2 seroprevalence and antibody response duration after natural infection detected during pregnancy; transplacental antibody transfer may inform peripartum and neonatal protection. Objective(s): Estimate seroprevalence and durability of antibodies from natural infection (anti-nucleocapsid (anti-N) IgG) among pregnant people, and evaluate transplacental transfer efficiency. Design(s): Seroprevalence study: cross-sectional SARS-CoV-2 antibody screening among pregnant people December 9, 2020-June 19, 2021. Cohort study: Pregnant people screened anti-N IgG+ by Abbott Architect chemiluminescent immunoassay in seroprevalence study or identified through medical records with RT-PCR+ or antigen positive results enrolled in a prospective cohort December 9, 2020-June 30, 2022 to longitudinally measure anti-N IgG responses. We collected cord blood and assessed transplacental transfer of maternally-derived anti-N antibodies. Setting(s): Three hospitals and 14 affiliated clinics providing antenatal and delivery care, Seattle, Washington metropolitan area. Participant(s): Seroprevalence study: pregnant people were screened for SAR-CoV-2 anti-N IgG during routine care. Cohort study: Pregnant people with evidence of prior SARS-CoV-2 infection (screened anti-N IgG+ from seroprevalence study or identified with a RT-PCR+ or antigen positive result from medical records) were enrolled in a cohort study to longitudinally measure anti-N IgG responses. Exposure(s) (for observational studies): COVID-19 diagnosis, symptoms, and disease severity. Main Outcome(s) and Measure(s): Presence and durability of SARS-CoV-2 anti-N IgG, transplacental transfer of maternally-derived anti-N IgG. Result(s): Of 1289 pregnant people screened in the seroprevalence study, 5% (65) tested SARS-CoV-2 anti-N IgG+, including 39 (60%) without prior RT-PCR+ or antigen positive results and 53 (82%) without symptoms. Among 89 participants enrolled in the cohort study, 73 (82%) had anti-N IgG+ results during pregnancy. Among 49 participants with delivery samples 33 (67%) were anti-N IgG negative by delivery. Of 24 remaining anti-N IgG+ at delivery with paired cord blood samples, 12 (50%) had efficient transplacental anti-N IgG antibody transfer. Median time from first anti-N IgG to below positive antibody threshold was 17 weeks and did not differ by prior RT-PCR+ or antigen positive status. Conclusions and Relevance: Maternally-derived SARS-CoV-2 antibodies to natural infection may wane before delivery. Vaccines are recommended for pregnant persons to reduce severe illness and confer protection to infants. Copyright The copyright holder for this preprint is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. This article is a US Government work. It is not subject to copyright under 17 USC 105 and is also made available for use under a CC0 license. |
Notes from the field: Exposures to mpox among cases in children aged 12 years - United States, September 25-December 31, 2022
Nemechek K , Stefanos R , Miller EL , Riser A , Kebede B , Galang RR , Hufstetler K , Descamps D , Balenger A , Hennessee I , Neelam V , Hutchins HJ , Labuda SM , Davis KM , McCormick DW , Marx GE , Kimball A , Ruberto I , Williamson T , Rzucidlo P , Willut C , Harold RE , Mangla AT , English A , Brikshavana D , Blanding J , Kim M , Finn LE , Marutani A , Lockwood M , Johnson S , Ditto N , Wilton S , Edmond T , Stokich D , Shinall A , Alravez B , Crawley A , Nambiar A , Gateley EL , Schuman J , White SL , Davis K , Milleron R , Mendez M , Kawakami V , Segaloff HE , Bower WA , Ellington SR , McCollum AM , Pao LZ . MMWR Morb Mortal Wkly Rep 2023 72 (23) 633-635 During May 17–December 31, 2022, 125 probable or confirmed U.S. monkeypox (mpox)† cases were reported among patients aged <18 years, including 45 (36%) in children aged ≤12 years. Eighty-three cases in persons aged <18 years diagnosed during May 17–September 24, 2022 were previously described (1); 28 (34%) of these were in children aged ≤12 years, 29% of whom did not have reported information on exposure. Among 20 (71%) of 28 patients with documented information on exposure, most were exposed by a household contact. This report updates the previous report using data collected during September 25–December 31, 2022, proposes possible mpox exposure routes in children aged ≤12 years, and describes three U.S. mpox cases in neonates. Household members or caregivers with mpox, including pregnant women and their health care providers, should be informed of the risk of transmission to persons aged <18 years, and strategies to protect persons aged <18 years at risk for exposure, including isolating household contacts with mpox, should be implemented immediately. | | During September 25–December 31, 2022, 17 children aged ≤12 years with probable or confirmed mpox were identified through national surveillance. CDC provided a questionnaire to state and local health departments for collection of the child’s history of exposure to any person with mpox§ during the previous 3 weeks, exposure settings, types of contact (e.g., skin-to-skin, being held or cuddled, diaper change, or toilet use), and precautions taken by the person with mpox (e.g., practiced isolation or covered lesions). This activity was reviewed by CDC and was conducted consistent with applicable federal law and CDC policy.¶ |
On Preliminary Findings of mRNA Covid-19 Vaccine Safety in Pregnant Persons. Reply.
Meaney-Delman DM , Ellington SR , Shimabukuro TT . N Engl J Med 2021 385 (16) 1536 The authors reply: Sun appropriately raises questions about the proportion of women reporting spontaneous abortion in our recent article. We agree that the denominator used in that proportion — 827 completed pregnancies — is not an appropriate denominator for the calculation of a risk estimate or rate. | | The number of spontaneous abortions (104) reflects data reported by the participants as of March 30, 2021, during telephone follow-up. In this preliminary report, follow-up information was missing for the majority of pregnancies in which exposure to vaccination occurred in early pregnancy. Among the 1224 women who had been vaccinated before conception or in the first trimester, follow-up through 20 weeks of gestation had been completed for only 204 pregnancies that were known to be ongoing and for 1 pregnancy that resulted in stillbirth. Among the pregnancies that had not yet reached 20 weeks of gestation, there were 10 pregnancies with other outcomes before 20 weeks of gestation, including 8 ectopic pregnancies and 2 induced abortions. For the other 905 pregnancies, follow-up had not occurred to establish whether these pregnancies were ongoing past 20 weeks of gestation. We have amended Table 4 in our earlier publication and have clarified the text. | | Subsequently, we completed telephone follow-up for the 905 pregnancies and enrolled additional persons in the v-safe pregnancy registry. To determine the cumulative risk of spontaneous abortion from 6 to less than 20 weeks of gestation, we used life-table methods to perform an updated analysis, now reported in the Journal, involving 2456 women who received at least one dose of an mRNA Covid-19 vaccine before conception or before 20 weeks of gestation.1 The estimated risks (14.1% overall and 12.8% in age-standardized analyses) are consistent with the risks of spontaneous abortion reported in the general population.1 |
Safety and effectiveness of maternal COVID-19 vaccines among pregnant people and infants
Fleming-Dutra KE , Zauche LH , Roper LE , Ellington SR , Olson CK , Sharma AJ , Woodworth KR , Tepper N , Havers F , Oliver SE , Twentyman E , Jatlaoui TC . Obstet Gynecol Clin North Am 2023 50 (2) 279-297 Evidence has consistently demonstrated that COVID-19 messenger RNA (mRNA) vaccines are safe when given during pregnancy. COVID-19 mRNA vaccines protect pregnant people and their infants who are too young to receive COVID-19 vaccines. Although generally protective, monovalent vaccine effectiveness was lower during SARS-CoV-2 Omicron variant predominance, in part due to changes in the Omicron spike protein. Bivalent vaccines, that combine ancestral strain and Omicron variant, may improve protection against Omicron variants. Everyone, including pregnant people, should stay up to date with recommended COVID-19 vaccines and bivalent booster, when eligible. |
Maternal and newborn hospital outcomes of perinatal SARS-CoV-2 infection: A national registry
Hudak ML , Flannery DD , Barnette K , Getzlaff T , Gautam S , Dhudasia MB , Mukhopadhyay S , Pfeifer MR , Ellington SR , Galang RR , Snead MC , Woodworth KR , Zapata LB , Puopolo KM . Pediatrics 2023 151 (2) OBJECTIVES: The American Academy of Pediatrics National Registry for the Surveillance and Epidemiology of Perinatal coronavirus disease 2019 (COVID-19) (NPC-19) was developed to provide information on the effects of perinatal severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. METHODS: National Registry for the Surveillance and Epidemiology of Perinatal COVID-19 participating centers entered maternal and newborn data for pregnant persons who tested positive for SARS-CoV-2 infection between 14 days before and 10 days after delivery. Incidence of and morbidities associated with maternal and newborn SARS-CoV-2 infection were assessed. RESULTS: From April 6, 2020 to March 19, 2021, 242 centers in the United States centers reported data for 7524 pregnant persons; at the time of delivery, 78.1% of these persons were asymptomatic, 18.2% were symptomatic but not hospitalized specifically for COVID-19, 3.4% were hospitalized for COVID-19 treatment, and 18 (0.2%) died in the hospital of COVID-related complications. Among 7648 newborns, 6486 (84.8%) were tested for SARS-CoV-2, and 144 (2.2%) were positive; the highest rate of newborn infection was observed when mothers first tested positive in the immediate postpartum period (17 of 125, 13.6%). No newborn deaths were attributable to SARS-CoV-2 infection. Overall, 15.6% of newborns were preterm: among tested newborns, 30.1% of polymerase chain reaction-positive and 16.2% of polymerase chain reaction-negative were born preterm (P < .001). Need for mechanical ventilation did not differ by newborn SARS-CoV-2 test result, but those with positive tests were more likely to be admitted to a NICU. CONCLUSIONS: Early in the pandemic, SARS-CoV-2 infection was acquired by newborns at variable rates and without apparent short-term effects. During a period that preceded widespread availability of vaccines, we observed higher than expected numbers of preterm births and maternal in-hospital deaths. |
Emergency preparedness in Tennessee women with a recent live birth
Miller AM , Galang RR , Hall LE , Strid P , Leverett U , Ellington SR . Matern Child Health J 2023 1-8 OBJECTIVES: To assess emergency preparedness (EP) actions in women with a recent live birth. METHODS: Weighted survey procedures were used to evaluate EP actions taken by women with a recent live birth responding to an EP question assessing eight preparedness actions as part of the 2016 Tennessee Pregnancy Risk Assessment and Monitoring System (PRAMS) survey. Factor analysis was used to group preparedness actions. RESULTS: Overall, 82.7% [95% Confidence Interval (CI) 79.3%, 86.1%] of respondents reported any preparedness actions, with 51.8% (95% CI 47.2%, 56.4%) completing 1-4 actions. The most common actions were having supplies at home (63.0%; 95% CI 58.5%, 67.4%), an evacuation plan for children (48.5%; 95% CI 43.9%, 53.2%), supplies in another location (40.2%; 95% CI 35.6%, 44.7%), and a communication plan (39.7%; 95% CI 35.1%, 44.2%). Having personal evacuation plans (31.6%; 95% CI 27.3%, 36.0%) and copies of documents in alternate locations (29.3%; 95% CI 25.0%, 33.5%) were least common. Factor analysis yielded three factors: having plans, having copies of documents, and having supplies. Specific preparedness actions varied by education and income level. CONCLUSIONS FOR PRACTICE: Most Tennessee women (about 8 in 10 women) with a recent live birth reported at least one EP action. A three-part EP question may be sufficient for assessing preparedness in this population. These findings highlight opportunities to improve public health education efforts around EP. |
Pregnant women's experiences during and after hurricanes Irma and Maria, pregnancy risk assessment monitoring system, Puerto Rico, 2018
Simeone RM , House LD , Salvesen von Essen B , Kortsmit K , Hernandez Virella W , Vargas Bernal MI , Galang RR , D'Angelo DV , Shapiro-Mendoza CK , Ellington SR . Public Health Rep 2023 138 (6) 333549221142571 OBJECTIVE: Exposure to natural disasters during and after pregnancy may increase adverse mental health outcomes. Hurricanes Irma and Maria struck Puerto Rico in September 2017. Our objectives were to understand hurricane-related experiences, maternal health concerns, and the impact of hurricane experiences on postpartum depressive symptoms (PDS). METHODS: We used data from the 2018 Pregnancy Risk Assessment Monitoring System to describe differences in maternal hurricane experiences among women who were pregnant during and after the 2017 hurricanes. We assessed maternal concerns and PDS. We estimated adjusted prevalence ratios (aPRs) and 95% CIs for the associations between hurricane experiences and PDS. RESULTS: The most frequently reported hurricane experiences were losing power for ≥1 week (97%) and feeling unsafe due to lack of order/security (70%). Almost 30% of women who were pregnant during the hurricanes reported missing prenatal care. PDS were reported by 13% of women. Most hurricane experiences were associated with an increased prevalence of PDS. Feeling unsafe (aPR = 2.4; 95% CI, 1.2-4.9) and having difficulty getting food (aPR = 2.1; 95% CI, 1.1-4.1) had the strongest associations. CONCLUSIONS: Most women who were pregnant during or after hurricanes Irma and Maria struck Puerto Rico reported negative hurricane experiences, and most experiences were associated with an increased prevalence of PDS. Understanding the experiences of pregnant women during and after disasters and identifying risks for adverse mental health outcomes after pregnancy are important to inform emergency preparedness and prenatal and postpartum care. |
Epidemiologic and clinical features of mpox in transgender and gender-diverse adults - United States, May-November 2022
Blackburn D , Roth NM , Gold JAW , Pao LZ , Olansky E , Torrone EA , McClung RP , Ellington SR , Delaney KP , Carnes N , Dawson P . MMWR Morb Mortal Wkly Rep 2022 71 (5152) 1605-1609 As of November 9, 2022, a total of 28,730 cases of monkeypox (mpox) had been reported in the United States,* primarily among adult cisgender men reporting recent male-to-male sexual contact (1). Transgender and gender-diverse persons, who constitute an estimated 0.5% of the U.S. adult population,(†) face unique health disparities and barriers to care (2-4). However, data on the epidemiologic and clinical features of Monkeypox virus infections in this population are limited (5). CDC analyzed U.S. case surveillance data on mpox cases in transgender and gender-diverse adults reported during May 17-November 4, 2022. During this period, 466 mpox cases in transgender and gender-diverse adults were reported, accounting for 1.7% of reported cases among adults. Most were in transgender women (43.1%) or gender-diverse persons (42.1%); 14.8% were in transgender men. Among 374 (80.3%) mpox cases in transgender and gender-diverse adults with information available on sexual or close intimate contact, 276 (73.8%) reported sexual or close intimate contact with a cisgender male partner during the 3 weeks preceding symptom onset. During the ongoing outbreak, transgender and gender-diverse persons have been disproportionately affected by mpox. Members of this population frequently reported recent sexual or close intimate contact with cisgender men, who might be in sexual networks experiencing the highest incidence of mpox. These findings highlight the importance of tailoring public health prevention and outreach efforts to transgender and gender-diverse communities and could guide strategies to reduce mpox transmission. |
Epidemiologic and clinical features of children and adolescents aged <18 years with monkeypox - United States, May 17-September 24, 2022
Hennessee I , Shelus V , McArdle CE , Wolf M , Schatzman S , Carpenter A , Minhaj FS , Petras JK , Cash-Goldwasser S , Maloney M , Sosa L , Jones SA , Mangla AT , Harold RE , Beverley J , Saunders KE , Adams JN , Stanek DR , Feldpausch A , Pavlick J , Cahill M , O'Dell V , Kim M , Alarcón J , Finn LE , Goss M , Duwell M , Crum DA , Williams TW , Hansen K , Heddy M , Mallory K , McDermott D , Cuadera MKQ , Adler E , Lee EH , Shinall A , Thomas C , Ricketts EK , Koonce T , Rynk DB , Cogswell K , McLafferty M , Perella D , Stockdale C , Dell B , Roskosky M , White SL , Davis KR , Milleron RS , Mackey S , Barringer LA , Bruce H , Barrett D , D'Angeli M , Kocharian A , Klos R , Dawson P , Ellington SR , Mayer O , Godfred-Cato S , Labuda SM , McCormick DW , McCollum AM , Rao AK , Salzer JS , Kimball A , Gold JAW . MMWR Morb Mortal Wkly Rep 2022 71 (44) 1407-1411 Data on monkeypox in children and adolescents aged <18 years are limited (1,2). During May 17-September 24, 2022, a total of 25,038 monkeypox cases were reported in the United States,(dagger) primarily among adult gay, bisexual, and other men who have sex with men (3). During this period, CDC and U.S. jurisdictional health departments identified Monkeypox virus (MPXV) infections in 83 persons aged <18 years, accounting for 0.3% of reported cases. Among 28 children aged 0-12 years with monkeypox, 64% were boys, and most had direct skin-to-skin contact with an adult with monkeypox who was caring for the child in a household setting. Among 55 adolescents aged 13-17 years, most were male (89%), and male-to-male sexual contact was the most common presumed exposure route (66%). Most children and adolescents with monkeypox were non-Hispanic Black or African American (Black) (47%) or Hispanic or Latino (Hispanic) (35%). Most (89%) were not hospitalized, none received intensive care unit (ICU)-level care, and none died. Monkeypox in children and adolescents remains rare in the United States. Ensuring equitable access to monkeypox vaccination, testing, and treatment is a critical public health priority. Vaccination for adolescents with risk factors and provision of prevention information for persons with monkeypox caring for children might prevent additional infections. |
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.
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 . JAMA Netw Open 2022 5 (9) e2233273 ![]() 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. |
Characteristics and treatment of hospitalized pregnant women with COVID-19.
Sekkarie A , Woodruff R , Whitaker M , Kramer MR , Zapata LB , Ellington SR , Meaney-Delman DM , Pham H , Patel K , Taylor CA , Chai SJ , Kawasaki B , Meek J , Openo KP , Weigel A , Leegwater L , Como-Sabetti K , Ropp SL , Muse A , Bennett NM , Billing LM , Sutton M , Talbot HK , Hill M , Havers FP . Am J Obstet Gynecol MFM 2022 4 (6) 100715 BACKGROUND: Pregnant women less frequently receive Coronavirus Disease 2019 (COVID-19) vaccination and are at increased risk for adverse pregnancy outcomes from COVID-19. OBJECTIVES: First, describe the vaccination status, treatment, and outcomes of hospitalized, symptomatic pregnant women with COVID-19 and second, estimate whether treatment differs by pregnancy status among treatment-eligible (i.e., requiring supplemental oxygen per National Institutes of Health guidelines at the time of the study) women. STUDY DESIGN: During January-November 2021, the COVID-19-Associated Hospitalization Surveillance Network completed medical chart abstraction for a probability sample of 2,715 hospitalized women aged 15-49 years with laboratory-confirmed SARS-CoV-2 infection. Of these, 1,950 women had symptoms of COVID-19 upon admission; 336 were pregnant. We calculated weighted prevalence estimates of demographic and clinical characteristics, vaccination status, and outcomes among pregnant women with symptoms of COVID-19 upon admission. We used propensity score matching to estimate prevalence ratios (PR), and 95% confidence intervals (CI) of treatment-eligible patients who received remdesivir or systemic steroids by pregnancy status. RESULTS: Among 336 hospitalized pregnant women with symptomatic COVID-19, 39.6% were non-Hispanic Black, 24.8% were Hispanic or Latino, and 61.9% were aged 25-34 years. Among those with known COVID-19 vaccination status, 92.9% were unvaccinated. One-third (32.7%) were treatment-eligible. Among treatment-eligible pregnant women, 74.1% received systemic steroids and 61.4% received remdesivir. Among those that were no longer pregnant at discharge (n=180), 5.4% had spontaneous abortions and 3.5% had stillbirths. Of the 159 live births, 29.0% were pre-term. Among a propensity score-matched cohort of treatment-eligible hospitalized women of reproductive age, pregnant women were less likely than non-pregnant women to receive remdesivir (PR: 0.82, 95% CI 0.69-0.97) and systemic steroids (PR: 0.80, 95% CI 0.73-0.87). CONCLUSION: Most hospitalized pregnant patients with symptomatic COVID-19 were unvaccinated. Hospitalized pregnant patients were less likely to receive recommended remdesivir and systemic steroids compared to similar hospitalized non-pregnant women. Our results underscore the need to identify opportunities for improving COVID-19 vaccination, implementation of treatment of pregnant women, and the inclusion of pregnant women in clinical trials. |
Condom use among women of reproductive age (18-49 years) in Puerto Rico during the 2016 Zika virus outbreak: secondary analysis of data from a cross-sectional, population-based, cell-phone survey
Chang KT , Snead MC , SerranoRodriguez RA , Bish C , Shapiro-Mendoza CK , Ellington SR . BMJ Open 2022 12 (7) e065592 OBJECTIVES: Zika virus (ZIKV) can be sexually transmitted, and ZIKV infection during pregnancy can cause birth defects. Contraception is a medical countermeasure to reduce unintended pregnancy and ZIKV-associated birth defects. We estimated the prevalence of condom use and associated factors among women at risk for unintended pregnancy in Puerto Rico during the 2016 ZIKV outbreak. DESIGN: Secondary analysis of a cross-sectional, population-based, cell-phone survey. SETTING AND PARTICIPANTS: Women, 18-49 years, living in Puerto Rico during July-November 2016. We limited our analytical sample (n=1840) to women at risk for unintended pregnancy, defined as those who were sexually active with a man in the last 3 months and did not report menopause, hysterectomy, current pregnancy or desiring pregnancy. OUTCOME MEASURES: We estimated the weighted prevalence of any condom use among women at risk for unintended pregnancy. We calculated crude and adjusted prevalence ratios (aPRs) to examine the association between condom use and ZIKV-related factors, stratified by use of more effective versus less effective or no contraception. RESULTS: Overall, 32.7% (95% CI: 30.2% to 35.1%) of women reported any condom use in the last 3 months. Among women using more effective contraception, condom use was higher for women who received ZIKV counselling (aPR: 1.61, 95% CI: 1.15 to 2.25) and those worried about having a child with a ZIKV-associated birth defect (aPR: 1.47, 95% CI: 1.03 to 2.10). Among women using less effective or no contraception, condom use was associated with being worried (aPR: 1.20, 95% CI: 1.01 to 1.43) compared with those not worried about ZIKV infection or with a previous known infection. CONCLUSIONS: During the 2016 ZIKV outbreak, one in three women at risk for unintended pregnancy reported any condom use. Counselling to promote consistent and correct condom use may address concerns regarding ZIKV among women of reproductive age, which may differ by use of effective contraception. |
Perinatal COVID-19 maternal and neonatal outcomes at two academic birth hospitals.
Flannery DD , Zevallos Barboza A , Pfeifer MR , Hudak ML , Barnette K , Getzlaff TR , Ellington SR , Woodworth KR , Dhudasia MB , Mukhopadhyay S , Weinberg DD , Foglia EE , Puopolo KM . J Perinatol 2022 42 (10) 1-8 OBJECTIVE: Describe 1-month outcomes among newborns of persons with perinatal COVID-19. STUDY DESIGN: Prospective observational study of pregnant persons who tested positive for SARS-CoV-2 between 14 days before and 3 days after delivery and their newborns, from 3/2020 to 3/2021 at two urban high-risk academic hospitals. Phone interviews were conducted to determine 1-month newborn outcomes. RESULTS: Among 9748 pregnant persons, 209 (2.1%) tested positive for perinatal SARS-CoV-2. Symptomatically infected persons were more likely to have a preterm delivery due to worsening maternal condition and their newborns were more likely to test positive for SARS-CoV-2 compared with asymptomatic persons. Six of 191 (3.1%) infants tested were positive for SARS-CoV-2; none had attributable illness before discharge. Of 169 eligible families, 132 (78.1%) participated in post-discharge interviews; none reported their newborn tested positive for SARS-CoV-2 by 1 month of age. CONCLUSION: Symptomatic perinatal COVID-19 had a substantial effect on maternal health but no apparent short-term effect on newborns. |
Fertility and contraception among women of reproductive age following a disaster: a scoping review
Strid P , Snead MC , Galang RR , Bish CL , Ellington SR . Reprod Health 2022 19 (1) 147 BACKGROUND: The prevalence and severity of disasters triggered by natural hazards has increased over the last 20 years. Women of reproductive age may encounter unique reproductive health challenges following a disaster. In this scoping review we identify gaps in literature to inform future research and search for potential associations between disasters by natural hazards and post-disaster fertility and contraception among women of reproductive age. METHODS: Medline (OVID), Embase (OVID), PsycInfo (OVID), CINAHL (Ebsco), Scopus, Environmental Science Collection (ProQuest Central), and Sociological Abstracts (ProQuest Central) were searched for articles published from 1980 through March 3, 2022 in English or Spanish language. Search terms were related to fertility, contraception, and disasters. We included original research that described a discrete natural hazard exposure, a population of women of reproductive age (15-49 years), and outcomes of fertility or contraception use or access, with pre- and post-disaster measures. RESULTS: Among 9788 citations, after initial exclusion 5121 remained for title and abstract review. One hundred and eighteen citations underwent full-text review and 26 articles met the inclusion criteria. Following critical appraisal, 20 articles were included in this review. Eighteen articles described outcomes related to fertility, five articles described contraception access, and three articles described contraception use. CONCLUSIONS: Clearly defined exposure measures, robust analyses, and methodical post-disaster assessment periods, may address the current gaps within disaster research on fertility and contraception among women of reproductive age. Consistent patterns in fertility following a disaster triggered by natural hazards were not identified between or within disaster types. Studies that assessed contraception found no change in use, while some studies found a decrease in contraceptive access overall. |
COVID-19 Severity among Women of Reproductive Age with Symptomatic Laboratory-Confirmed SARS-CoV-2 by Pregnancy Status - United States, Jan 1, 2020 - Dec 25, 2021.
Strid P , Zapata LB , Tong VT , Zambrano LD , Woodworth KR , Riser AP , Galang RR , Gilboa SM , Ellington SR . Clin Infect Dis 2022 75 S317-S325 ![]() BACKGROUND: Information on the severity of COVID-19 attributable to the Delta variant in the United States among pregnant people is limited. We assessed the risk for severe COVID-19 by pregnancy status in the period of Delta variant predominance compared with the pre-Delta period. METHODS: Laboratory-confirmed SARS-CoV-2 infections among symptomatic women of reproductive age (WRA) were assessed. We calculated adjusted risk ratios for severe disease including intensive care unit (ICU) admission, receipt of invasive ventilation or extracorporeal membrane oxygenation (ECMO), and death comparing the pre-Delta period (January 1, 2020 - June 26, 2021) and the Delta period (June 27, 2021 - December 25, 2021) for pregnant and nonpregnant WRA. RESULTS: Compared with the pre-Delta period, the risk of ICU admission during the Delta period was 41% higher (adjusted risk ratio [aRR] 1.41; 95% CI, 1.17-1.69) for pregnant WRA and 9% higher (aRR 1.09; 95% CI, 1.00-1.18) for nonpregnant WRA. The risk of invasive ventilation or ECMO was higher for pregnant (aRR 1.83; 95% CI, 1.26-2.65) and nonpregnant WRA (aRR 1.34; 95% CI, 1.17-1.54) in the Delta period. During the Delta period, the risk of death was 3.33 (95% CI, 2.48-4.46) times the risk in the pre-Delta period among pregnant WRA and 1.62 (95% CI, 1.49-1.77) among nonpregnant WRA. CONCLUSIONS: Compared with the pre-Delta period, pregnant and nonpregnant WRA were at increased risk for severe COVID-19 in the Delta period. |
SARS-CoV-2 infections among neonates born to pregnant people with SARS-CoV-2 infection: Maternal, pregnancy and birth characteristics.
Olsen EO , Roth NM , Aveni K , Santos P , Sizemore L , Halai UA , Nestoridi E , Barton JE , Mobley E , Siebman S , Fussman C , Mbotha D , Dzimira P , Silcox KM , Khuwaja S , Roscom D , Lush M , Chicchelly S , Delgado-López C , Schlosser L , Read J , Ellington SR , Hall AJ , Gilboa SM , Tong VT , Woodworth KR . Paediatr Perinat Epidemiol 2022 36 (4) 476-484 BACKGROUND: Multiple reports have described neonatal SARS-CoV-2 infection, including likely in utero transmission and early postnatal infection, but published estimates of neonatal infection range by geography and design type. OBJECTIVES: To describe maternal, pregnancy and neonatal characteristics among neonates born to people with SARS-CoV-2 infection during pregnancy by neonatal SARS-CoV-2 testing results. METHODS: Using aggregated data from the Surveillance for Emerging Threats to Mothers and Babies Network (SET-NET) describing infections from 20 January 2020 to 31 December 2020, we identified neonates who were (1) born to people who were SARS-CoV-2 positive by RT-PCR at any time during their pregnancy, and (2) tested for SARS-CoV-2 by RT-PCR during the birth hospitalisation. RESULTS: Among 28,771 neonates born to people with SARS-CoV-2 infection during pregnancy, 3816 (13%) underwent PCR testing and 138 neonates (3.6%) were PCR positive. Ninety-four per cent of neonates testing positive were born to people with infection identified ≤14 days of delivery. Neonatal SARS-CoV-2 infection was more frequent among neonates born preterm (5.7%) compared to term (3.4%). Neonates testing positive were born to both symptomatic and asymptomatic pregnant people. CONCLUSIONS: Jurisdictions reported SARS-CoV-2 RT-PCR results for only 13% of neonates known to be born to people with SARS-CoV-2 infection during pregnancy. These results provide evidence of neonatal infection identified through multi-state systematic surveillance data collection and describe characteristics of neonates with SARS-CoV-2 infection. While perinatal SARS-CoV-2 infection was uncommon among tested neonates born to people with SARS-CoV-2 infection during pregnancy, nearly all cases of tested neonatal infection occurred in pregnant people infected around the time of delivery and was more frequent among neonates born preterm. These findings support the recommendation for neonatal SARS-CoV-2 RT-PCR testing, especially for people with acute infection around the time of delivery. |
Changes in rates of adverse pregnancy outcomes during the COVID-19 pandemic: a cross-sectional study in the United States, 2019-2020.
Simeone RM , Downing KF , Wallace B , Galang RR , DeSisto CL , Tong VT , Zapata LB , Ko JY , Ellington SR . J Perinatol 2022 42 (5) 617-623 OBJECTIVE: Our objective was to assess differences inpregnancy outcomes during the COVID-19 pandemic compared to the previous year. STUDY DESIGN: In a cross-sectional study of delivery hospitalizations in the Premier Healthcare Database Special COVID-19 Release, we assessed differences in selected maternal and pregnancy outcomes occurring April-December in 2019 and 2020 in the United States. RESULT: Among 663,620 deliveries occurring in 2019 and 614,093 deliveries occurring in 2020, we observed an increase in in-hospital maternal death from 2019 to 2020, which was no longer statistically significant after excluding deliveries with a COVID-19 diagnosis. Intensive care unit admission and preterm birth decreased from 2019 to 2020. There was no difference in the prevalence of most other outcomes examined. CONCLUSION: The full impact of the COVID-19 pandemic on maternal and pregnancy outcomes remains to be understood. Most outcomes investigated experienced minimal change from 2019 to 2020. |
Risk for Stillbirth Among Women With and Without COVID-19 at Delivery Hospitalization - United States, March 2020-September 2021.
DeSisto CL , Wallace B , Simeone RM , Polen K , Ko JY , Meaney-Delman D , Ellington SR . MMWR Morb Mortal Wkly Rep 2021 70 (47) 1640-1645 ![]() Pregnant women are at increased risk for severe COVID-19-related illness, and COVID-19 is associated with an increased risk for adverse pregnancy outcomes and maternal and neonatal complications (1-3). To date, studies assessing whether COVID-19 during pregnancy is associated with increased risk for stillbirth have yielded mixed results (2-4). Since the B.1.617.2 (Delta) variant of SARS-CoV-2 (the virus that causes COVID-19) became the predominant circulating variant,* there have been anecdotal reports of increasing rates of stillbirths in women with COVID-19.(†) CDC used the Premier Healthcare Database Special COVID-19 Release (PHD-SR), a large hospital-based administrative database,(§) to assess whether a maternal COVID-19 diagnosis documented at delivery hospitalization was associated with stillbirth during March 2020-September 2021 as well as before and during the period of Delta variant predominance in the United States (March 2020-June 2021 and July-September 2021, respectively). Among 1,249,634 deliveries during March 2020-September 2021, stillbirths were rare (8,154; 0.65%): 273 (1.26%) occurred among 21,653 deliveries to women with COVID-19 documented at the delivery hospitalization, and 7,881 (0.64%) occurred among 1,227,981 deliveries without COVID-19. The adjusted risk for stillbirth was higher in deliveries with COVID-19 compared with deliveries without COVID-19 during March 2020-September 2021 (adjusted relative risk [aRR] = 1.90; 95% CI = 1.69-2.15), including during the pre-Delta (aRR = 1.47; 95% CI = 1.27-1.71) and Delta periods (aRR = 4.04; 95% CI = 3.28-4.97). COVID-19 documented at delivery was associated with increased risk for stillbirth, with a stronger association during the period of Delta variant predominance. Implementing evidence-based COVID-19 prevention strategies, including vaccination before or during pregnancy, is critical to reducing the impact of COVID-19 on stillbirths. |
Economic evaluation of Zika Contraception Access Network in Puerto Rico during the 2016-17 Zika virus outbreak
Li R , Ellington SR , Galang RR , Grosse SD , Mendoza Z , Hurst S , Vale Y , Lathrop E , Romero L . Contraception 2021 107 68-73 OBJECTIVE: During the 2016-2017 Zika virus (ZIKV) outbreak, the prevention of unintended pregnancies was identified as a primary strategy to prevent birth defects. This study estimated the cost-effectiveness of the Zika Contraception Access Network (Z-CAN), an emergency response intervention that provided women in Puerto Rico with access to the full range of reversible contraception at no cost and compared results with a pre-implementation hypothetical cost-effectiveness analysis (CEA). STUDY DESIGN: We evaluated costs and outcomes of Z-CAN from a health sector perspective compared to no intervention using a decision tree model. Number of people served, contraception methods mix, and costs under Z-CAN were from actual program data and other input parameters were from the literature. Health outcome measures included the number of Zika-associated microcephaly (ZAM) cases and unintended pregnancies. The economic benefits of the Z-CAN intervention were ZIKV-associated direct costs avoided, including lifetime medical and supportive costs associated with ZAM cases, costs of monitoring ZIKV-exposed pregnancies and infants born from Zika-virus infected mothers, and the costs of unintended pregnancies prevented during the outbreak as a result of increased contraception use through the Z-CAN intervention. RESULTS: The Z-CAN intervention cost a total of $26.1 million, including costs for the full range of reversible contraceptive methods, contraception related services, and programmatic activities. The program is estimated to have prevented 85% of cases of estimated ZAM cases and unintended pregnancies in the absence of Z-CAN. The intervention cost was projected to have been more than offset by $79.9 million in ZIKV-associated costs avoided, 96% of which were lifetime ZAM-associated costs, as well as $137.0 million from avoided unintended pregnancies, with total net savings in one year of $216.9 million. The results were consistent with the previous CEA study. CONCLUSION: Z-CAN was likely cost-saving in the context of a public health emergency response setting. |
Illness severity indicators in newborns by COVID-19 status in the United States, March-December 2020.
Wallace B , Chang D , Woodworth K , DeSisto CL , Simeone R , Ko JY , Tong VT , Gilboa SM , Ellington SR . J Perinatol 2021 42 (4) 1-8 OBJECTIVE: To better understand COVID-19 in newborns, we compared in-hospital illness severity indicators by COVID-19 status during birth hospitalization. STUDY DESIGN: In a retrospective cohort of newborns born March-December 2020 in the Premier Healthcare Database Special COVID-19 Release, we classified COVID-19 status and severe illness indicators using ICD-CM-10 codes, laboratory data, and billing records. Illness severity indicators were compared by COVID-19 status, stratified by gestational age and race/ethnicity. RESULT: Among 701,777 newborns, 209 had a COVID-19 diagnosis during the birth hospitalization. COVID-19 status differed significantly by race/ethnicity, gestational age, payor, and region. Late preterm/term newborns with COVID-19 had increased intensive care unit admission and sepsis risk; early preterm newborns with COVID-19 had increased risk for invasive ventilation. Risk for illness severity varied among racial/ethnic strata. CONCLUSION: From March to December 2020, COVID-19 diagnosis in newborns was rare. More clinical data are needed to describe the risk profiles of newborns with COVID-19. |
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