Last data update: May 06, 2024. (Total: 46732 publications since 2009)
Records 1-30 (of 820 Records) |
Query Trace: Hall V[original query] |
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Carbapenem-resistant Acinetobacter baumannii complex in the United States - an epidemiological and molecular description of isolates collected through the Emerging Infections Program, 2019
Bulens SN , Campbell D , McKay SL , Vlachos N , Burgin A , Burroughs M , Padila J , Grass JE , Jacob JT , Smith G , Muleta DB , Maloney M , Macierowski B , Wilson LE , Vaeth E , Lynfield R , O'Malley S , Snippes Vagnone PM , Dale J , Janelle SJ , Czaja CA , Johnson H , Phipps EC , Flores KG , Dumyati G , Tsay R , Beldavs ZG , Maureen Cassidy P , Hall A , Walters MS , Guh AY , Magill SS , Lutgring JD . Am J Infect Control 2024 BACKGROUND: Understanding the epidemiology of carbapenem-resistant A. baumannii complex (CRAB) and the patients impacted is an important step towards informing better infection prevention and control practices and improving public health response. METHODS: Active, population-based surveillance was conducted for CRAB in 9 U.S. sites from January 1-December 31, 2019. Medical records were reviewed, isolates were collected and characterized including antimicrobial susceptibility testing and whole genome sequencing. RESULTS: Among 136 incident cases in 2019, 66 isolates were collected and characterized; 56.5% were from cases who were male, 54.5% were from persons of Black or African American race with non-Hispanic ethnicity, and the median age was 63.5 years. Most isolates, 77.2%, were isolated from urine, and 50.0% were collected in the outpatient setting; 72.7% of isolates harbored an acquired carbapenemase gene (aCP), predominantly bla(OXA-23) or bla(OXA-24/40); however, an isolate with bla(NDM) was identified. The antimicrobial agent with the most in vitro activity was cefiderocol (96.9% of isolates were susceptible). CONCLUSIONS: Our surveillance found that CRAB isolates in the U.S. commonly harbor an aCP, have an antimicrobial susceptibility profile that is defined as difficult-to-treat resistance, and epidemiologically are similar regardless of the presence of an aCP. |
Economic burden of acute gastroenteritis among members of integrated healthcare delivery system, United States, 2014-2016
Dickerson JF , Salas SB , Donald J , Groom HC , Lee MH , Mattison CP , Hall AJ , Schmidt MA . Emerg Infect Dis 2024 30 (5) 968-973 We conducted a large surveillance study among members of an integrated healthcare delivery system in Pacific Northwest of the United States to estimate medical costs attributable to medically attended acute gastroenteritis (MAAGE) on the day care was sought and during 30-day follow-up. We used multivariable regression to compare costs of MAAGE and non-MAAGE cases matched on age, gender, and index time. Differences accounted for confounders, including race, ethnicity, and history of chronic underlying conditions. Analyses included 73,140 MAAGE episodes from adults and 18,617 from children who were Kaiser Permanente Northwest members during 2014-2016. Total costs were higher for MAAGE cases relative to non-MAAGE comparators as were costs on the day care was sought and costs during follow-up. Costs of MAAGE are substantial relative to the cost of usual-care medical services, and much of the burden accrues during short-term follow-up. |
A programmatic update on COVID-19 vaccination in rural communities in the United States
Piasecki AM , Hall DM , Zajac J , Miller SA , Nilson JR . Vaccine 2024 When public health experts think of rural barriers to vaccines, they often initially focus on access, which makes sense with a new vaccine during a pandemic. This commentary highlights that there can be more complexity to vaccine uptake in rural communities. What follows are some examples of CDC's efforts to better understand rural health and learnings to inform ongoing vaccination efforts in rural communities. |
Evaluating acute viral gastroenteritis severity: Modified Vesikari and Clark scoring systems
Plancarte C , Stopczynski T , Hamdan L , Stewart LS , Rahman H , Amarin JZ , Chappell J , Wikswo ME , Dunn JR , Payne DC , Hall AJ , Spieker AJ , Halasa N . Hosp Pediatr 2024 OBJECTIVE: Acute gastroenteritis (AGE) is the second leading cause of death in children worldwide. Objectively evaluating disease severity is critical for assessing future interventions. We used data from a large, prospective surveillance study to assess risk factors associated with severe presentation using modified Vesikari score (MVS) and Clark score (CS) of severity. METHODS: From December 1, 2012 to June 30, 2016, AGE surveillance was performed for children between 15 days and 17 years old in the emergency, inpatient, and outpatient settings at Vanderbilt's Monroe Carell Jr. Children's Hospital in Nashville, TN. Stool specimens were tested for norovirus, sapovirus, rotavirus, and astrovirus. We compared demographic and clinical characteristics, along with the MVS and CS, by viral detection status and by setting. RESULTS: Of the 6309 eligible children, 4216 (67%) were enrolled, with 3256 (77%) providing a stool specimen. The median age was 1.9 years, 52% were male, and 1387 (43%) of the stool samples were virus positive. Younger age, male sex, hospitalization, and rotavirus detection were significantly associated with higher mean MVS and CS. Non-Hispanic Black race and ethnicity was associated with a lower mean MVS and CS as compared with non-Hispanic white race and ethnicity. Prematurity and enrollment in the ED were associated with higher mean CS. The 2 scoring systems were highly correlated. CONCLUSIONS: Rotavirus continues to be associated with more severe pediatric illness compared with other viral causes of AGE. MVS and CS systems yielded comparable results and can be useful tools to assess AGE severity. |
Health care utilization and clinical management of all-cause and norovirus-associated acute gastroenteritis within a US integrated health care system
Cates J , Mattison CP , Groom H , Donald J , Hall RP , Schmidt MA , Hall AJ , Naleway AL , Mirza SA . Open Forum Infect Dis 2024 11 (4) ofae151 BACKGROUND: Norovirus-associated acute gastroenteritis (AGE) exacts a substantial disease burden, yet the health care utilization for and clinical management of norovirus-associated AGE are not well characterized. METHODS: We describe the health care encounters and therapeutics used for patients with all-cause and norovirus-associated AGE in the Kaiser Permanente Northwest health system from 1 April 2014 through 30 September 2016. Medical encounters for patients with AGE were extracted from electronic health records, and encounters within 30 days of one another were grouped into single episodes. An age-stratified random sample of patients completed surveys and provided stool samples for norovirus testing. RESULTS: In total, 40 348 individuals had 52 509 AGE episodes; 460 (14%) of 3310 participants in the substudy tested positive for norovirus. An overall 35% of all-cause AGE episodes and 29% of norovirus-associated AGE episodes had ≥2 encounters. While 80% of norovirus-associated AGE episodes had at least 1 encounter in the outpatient setting, all levels of the health care system were affected: 10%, 22%, 10%, and 2% of norovirus-associated AGE episodes had at least 1 encounter in virtual, urgent care, emergency department, and inpatient settings, respectively. Corresponding proportions of therapeutic use between norovirus-positive and norovirus-negative episodes were 13% and 10% for intravenous hydration (P = .07), 65% and 50% for oral rehydration (P < .001), 7% and 14% for empiric antibiotic therapy (P < .001), and 33% and 18% for antiemetics (P < .001). CONCLUSIONS: Increased health care utilization and therapeutics are likely needed for norovirus-associated AGE episodes during peak norovirus winter seasons, and these data illustrate that effective norovirus vaccines will likely result in less health care utilization. |
Interlaboratory comparison of a multiplex immunoassay that measures human serum IgG antibodies against six-group B streptococcus polysaccharides
Le Doare K , Gaylord MA , Anderson AS , Andrews N , Baker CJ , Bolcen S , Felek A , Giardina PC , Grube CD , Hall T , Hallis B , Izu A , Madhi SA , Maniatis P , Matheson M , Mawas F , McKeen A , Rhodes J , Alston B , Patel P , Schrag S , Simon R , Tan CY , Taylor S , Kwatra G , Gorringe A . Hum Vaccin Immunother 2024 20 (1) 2330138 Measurement of IgG antibodies against group B streptococcus (GBS) capsular polysaccharide (CPS) by use of a standardized and internationally accepted multiplex immunoassay is important for the evaluation of candidate maternal GBS vaccines in order to compare results across studies. A standardized assay is also required if serocorrelates of protection against invasive GBS disease are to be established in infant sera for the six predominant GBS serotypes since it would permit the comparison of results across the six serotypes. We undertook an interlaboratory study across five laboratories that used standardized assay reagents and protocols with a panel of 44 human sera to measure IgG antibodies against GBS CPS serotypes Ia, Ib, II, III, IV, and V. The within-laboratory intermediate precision, which included factors like the lot of coated beads, laboratory analyst, and day, was generally below 20% relative standard deviation (RSD) for all six serotypes, across all five laboratories. The cross-laboratory reproducibility was < 25% RSD for all six serotypes, which demonstrated the consistency of results across the different laboratories. Additionally, anti-CPS IgG concentrations for the 44-member human serum panel were established. The results of this study showed assay robustness and that the resultant anti-CPS IgG concentrations were reproducible across laboratories for the six GBS CPS serotypes when the standardized assay was used. |
A survey of state and local practices encouraging pediatric COVID-19 vaccination of children ages 6 months through 11 years
Koneru A , Wells K , Amanda Carnes C , Drumhiller K , Chatham-Stephens K , Melton M , Oliphant H , Hall S , Dennison C , Fiscus M , Vogt T . Vaccine 2024 OBJECTIVE: This report highlights state and local practices for optimizing the pediatric COVID-19 vaccination program for children ages 6 months through 11 years. METHODS: State and local practices designed to optimize pediatric COVID-19 vaccine uptake were identified from a range of sources, including immunization program, CDC, and partner staff; and media stories or program descriptions identified via online searches. RESULTS: A range of practices were identified across different categories: provider-focused practices, school-based practices, jurisdiction or health department-based activities, community-focused practices involving partners, use of vaccination incentives, and Medicaid-related practices. CONCLUSIONS: Immunization programs and stakeholders implemented a variety of practices to meet the challenge of the pediatric COVID-19 vaccination program. The key findings may serve to inform not only the current pediatric COVID-19 vaccination program, but also future outbreak response work and routine immunization activities. |
Plasmodium falciparum pfhrp2 and pfhrp3 gene deletions among patients enrolled at 100 health facilities throughout Tanzania: February to July 2021
Rogier E , Battle N , Bakari C , Seth MD , Nace D , Herman C , Barakoti A , Madebe RA , Mandara CI , Lyimo BM , Giesbrecht DJ , Popkin-Hall ZR , Francis F , Mbwambo D , Garimo I , Aaron S , Lusasi A , Molteni F , Njau R , Cunningham JA , Lazaro S , Mohamed A , Juliano JJ , Bailey JA , Udhayakumar V , Ishengoma DS . Sci Rep 2024 14 (1) 8158 Plasmodium falciparum with the histidine rich protein 2 gene (pfhrp2) deleted from its genome can escape diagnosis by HRP2-based rapid diagnostic tests (HRP2-RDTs). The World Health Organization (WHO) recommends switching to a non-HRP2 RDT for P. falciparum clinical case diagnosis when pfhrp2 deletion prevalence causes ≥ 5% of RDTs to return false negative results. Tanzania is a country of heterogenous P. falciparum transmission, with some regions approaching elimination and others at varying levels of control. In concordance with the current recommended WHO pfhrp2 deletion surveillance strategy, 100 health facilities encompassing 10 regions of Tanzania enrolled malaria-suspected patients between February and July 2021. Of 7863 persons of all ages enrolled and providing RDT result and blood sample, 3777 (48.0%) were positive by the national RDT testing for Plasmodium lactate dehydrogenase (pLDH) and/or HRP2. A second RDT testing specifically for the P. falciparum LDH (Pf-pLDH) antigen found 95 persons (2.5% of all RDT positives) were positive, though negative by the national RDT for HRP2, and were selected for pfhrp2 and pfhrp3 (pfhrp2/3) genotyping. Multiplex antigen detection by laboratory bead assay found 135/7847 (1.7%) of all blood samples positive for Plasmodium antigens but very low or no HRP2, and these were selected for genotyping as well. Of the samples selected for genotyping based on RDT or laboratory multiplex result, 158 were P. falciparum DNA positive, and 140 had sufficient DNA to be genotyped for pfhrp2/3. Most of these (125/140) were found to be pfhrp2+/pfhrp3+, with smaller numbers deleted for only pfhrp2 (n = 9) or only pfhrp3 (n = 6). No dual pfhrp2/3 deleted parasites were observed. This survey found that parasites with these gene deletions are rare in Tanzania, and estimated that 0.24% (95% confidence interval: 0.08% to 0.39%) of false-negative HRP2-RDTs for symptomatic persons were due to pfhrp2 deletions in this 2021 Tanzania survey. These data provide evidence for HRP2-based diagnostics as currently accurate for P. falciparum diagnosis in Tanzania. |
Community testing practices for autism within the autism and developmental disabilities monitoring network
Robinson Williams A , Amoakohene E , Maenner MJ , Zahorodny W , DiRienzo M , Grzybowski A , Hall-Lande J , Pas ET , Bakian AV , Lopez M , Patrick M , Shenouda J , Shaw KA . Paediatr Perinat Epidemiol 2024 BACKGROUND: No data exist at the population level on what tests are used to aid in the diagnosis of autism spectrum disorder in community practice. OBJECTIVES: To describe autism spectrum disorder testing practices to inform autism spectrum disorder identification efforts. METHODS: Data are from the Autism and Developmental Disabilities Monitoring Network, a multi-site surveillance system reporting prevalence estimates and characteristics of 8-year-old children with autism spectrum disorder. Percentages of children with autism spectrum disorder who received any autism spectrum disorder test or a 'gold standard' test were calculated by site, sex, race, median household income, and intellectual ability status. Risk ratios were calculated to compare group differences. RESULTS: Of 5058 8-year-old children with autism spectrum disorder across 11 sites, 3236 (64.0%) had a record of any autism spectrum disorder test and 2136 (42.2%) had a 'gold standard' ADOS or ADI-R test. Overall, 115 children (2.3%) had both the ADOS and ADI-R in their records. Differences persisted across race, median household income, and intellectual ability status. Asian/Pacific Islander children had the highest percent receiving any ASD test (71.8%; other groups range: 57.4-66.0%) and White children had the highest percent receiving 'gold standard' tests (46.4%; other groups range: 35.6-43.2%). Children in low-income neighbourhoods had a lower percent of any test (62.5%) and 'gold standard' tests (39.4%) compared to medium (70.2% and 47.5%, respectively) and high (69.6% and 46.8%, respectively) income neighbourhoods. Children with intellectual disability had a lower percent of any ASD test (81.7%) and 'gold standard' tests (52.6%) compared to children without intellectual disability (84.0% and 57.6%, respectively). CONCLUSIONS: Autism spectrum disorder testing practices vary widely by site and differ by race and presence of co-occurring intellectual disability, suggesting opportunities to standardise and/or improve autism spectrum disorder identification practices. |
Prevalence of non-falciparum malaria infections among asymptomatic individuals in four regions of Mainland Tanzania
Popkin-Hall ZR , Seth MD , Madebe RA , Budodo R , Bakari C , Francis F , Pereus D , Giesbrecht DJ , Mandara CI , Mbwambo D , Aaron S , Lusasi A , Lazaro S , Bailey JA , Juliano JJ , Gutman JR , Ishengoma DS . Parasit Vectors 2024 17 (1) 153 BACKGROUND: Recent studies point to the need to incorporate the detection of non-falciparum species into malaria surveillance activities in sub-Saharan Africa, where 95% of the world's malaria cases occur. Although malaria caused by infection with Plasmodium falciparum is typically more severe than malaria caused by the non-falciparum Plasmodium species P. malariae, P. ovale spp. and P. vivax, the latter may be more challenging to diagnose, treat, control and ultimately eliminate. The prevalence of non-falciparum species throughout sub-Saharan Africa is poorly defined. Tanzania has geographical heterogeneity in transmission levels but an overall high malaria burden. METHODS: To estimate the prevalence of malaria species in Mainland Tanzania, we randomly selected 1428 samples from 6005 asymptomatic isolates collected in previous cross-sectional community surveys across four regions and analyzed these by quantitative PCR to detect and identify the Plasmodium species. RESULTS: Plasmodium falciparum was the most prevalent species in all samples, with P. malariae and P. ovale spp. detected at a lower prevalence (< 5%) in all four regions; P. vivax was not detected in any sample. CONCLUSIONS: The results of this study indicate that malaria elimination efforts in Tanzania will need to account for and enhance surveillance of these non-falciparum species. |
Pre-existing immunocompromising conditions and outcomes of acute COVID-19 patients admitted for pediatric intensive care
Rowan CM , LaBere B , Young CC , Zambrano LD , Newhams MM , Kucukak S , McNamara ER , Mack EH , Fitzgerald JC , Irby K , Maddux AB , Schuster JE , Kong M , Dapul H , Schwartz SP , Bembea MM , Loftis LL , Kolmar AR , Babbitt CJ , Nofziger RA , Hall MW , Gertz SJ , Cvijanovich NZ , Zinter MS , Halasa NB , Bradford TT , McLaughlin GE , Singh AR , Hobbs CV , Wellnitz K , Staat MA , Coates BM , Crandall HR , Maamari M , Havlin KM , Schwarz AJ , Carroll CL , Levy ER , Moffitt KL , Campbell AP , Randolph AG , Chou J . Clin Infect Dis 2024 BACKGROUND: We aimed to determine if pre-existing immunocompromising conditions (ICCs) were associated with the presentation or outcome of patients with acute coronavirus disease 2019 (COVID-19) admitted for pediatric intensive care. METHODS: 55 hospitals in 30 U.S. states reported cases through the Overcoming COVID-19 public health surveillance registry. Patients <21 years admitted March 12, 2020-December 30, 2021 to the pediatric intensive care unit (PICU) or high acuity unit for acute COVID-19 were included. RESULTS: Of 1,274 patients, 105 (8.2%) had an ICC including 33 (31.4%) hematologic malignancies, 24 (22.9%) primary immunodeficiencies and disorders of hematopoietic cells, 19 (18.1%) nonmalignant organ failure with solid organ transplantation, 16 (15.2%) solid tumors and 13 (12.4%) autoimmune disorders. Patients with ICCs were older, had more underlying renal conditions, and had lower white blood cell and platelet counts than those without ICCs, but had similar clinical disease severity upon admission. In-hospital mortality from COVID-19 was higher (11.4% vs. 4.6%, p = 0.005) and hospitalization was longer (p = 0.01) in patients with ICCs. New major morbidities upon discharge were not different between those with and without ICC (10.5% vs 13.9%, p = 0.40). In patients with ICC, bacterial co-infection was more common in those with life-threatening COVID-19. CONCLUSIONS: In this national case series of patients <21 years of age with acute COVID-19 admitted for intensive care, existence of a prior ICCs were associated with worse clinical outcomes. Reassuringly, most patients with ICCs hospitalized in the PICU for severe acute COVID-19 survived and were discharged home without new severe morbidities. |
Acute occupational inhalation injuries-United States, 2011-2022
Myers NT , Dodd KE , Hale JM , Blackley DJ , Scott Laney A , Hall NB . Am J Ind Med 2024 BACKGROUND: Inhalation injuries due to acute occupational exposures to chemicals are preventable. National surveillance of acute inhalation exposures is limited. This study identified the most common acute inhalation exposure-related incidents by industry sector among US workers. METHODS: To characterize inhalation-related injuries and their exposures during April 2011-March 2022, state and federal records from the Occupational Safety and Health Administration (OSHA) Occupational Safety and Health Information System (OIS) accident database were analyzed. Industry-specific injury, hospitalization, and fatality rates were calculated. RESULTS: The most frequent acute inhalation incidents investigated by OSHA were caused by inorganic gases (52.9%) such as carbon monoxide (CO) or acids, bases, and oxidizing chemical agents (12.9%) such as anhydrous ammonia. The largest number of fatal and nonfatal injuries were reported in the manufacturing (28.6%) and construction (17.2%) sectors. CONCLUSIONS: Workers were affected by acute inhalation exposures in most industries. Using this surveillance, employers can recognize frequently-occurring preventable acute inhalation exposures by industry, such as inorganic gases in the manufacturing sector, and implement prevention measures. Training of workers on exposure characteristics and limits, adverse health effects, and use of protective equipment by exposure agent can prevent inhalation injuries. |
Personal journeys to and in human genetics and dysmorphology
Schwartz CE , Aylsworth AS , Allanson J , Battaglia A , Carey JC , Curry CJ , Davies KE , Eichler EE , Graham JM Jr , Hall B , Hall JG , Holmes LB , Hoyme HE , Hunter A , Innis J , Johnson J , Keppler-Noreuil KM , Leroy JG , Moore C , Nelson DL , Neri G , Opitz JM , Picketts D , Raymond FL , Shalev SA , Stevenson RE , Stumpel Ctrm , Sutherland G , Viskochil DH , Weaver DD , Zackai EH . Am J Med Genet A 2024 e63514 Genetics has become a critical component of medicine over the past five to six decades. Alongside genetics, a relatively new discipline, dysmorphology, has also begun to play an important role in providing critically important diagnoses to individuals and families. Both have become indispensable to unraveling rare diseases. Almost every medical specialty relies on individuals experienced in these specialties to provide diagnoses for patients who present themselves to other doctors. Additionally, both specialties have become reliant on molecular geneticists to identify genes associated with human disorders. Many of the medical geneticists, dysmorphologists, and molecular geneticists traveled a circuitous route before arriving at the position they occupied. The purpose of collecting the memoirs contained in this article was to convey to the reader that many of the individuals who contributed to the advancement of genetics and dysmorphology since the late 1960s/early 1970s traveled along a journey based on many chances taken, replying to the necessities they faced along the way before finding full enjoyment in the practice of medical and human genetics or dysmorphology. Additionally, and of equal importance, all exhibited an ability to evolve with their field of expertise as human genetics became human genomics with the development of novel technologies. |
Social distancing and artful pandemic survival
Chorba T . Emerg Infect Dis 2020 26 (11) 2793-2794 Social distancing is a relatively novel term, recently popularized in strategies for disrupting transmission of newly identified airborne pathogens, including influenza virus variants, Ebola virus, and coronaviruses. An American cultural anthropologist, Edward T. Hall, Jr., coined the term “social distance” in 1963 to describe a zone of space customarily adopted in many cultures to minimize visual, olfactory, auditory, and tactile stimulation when meeting strangers or mere acquaintances. A PubMed search by term indicates that social distancing as an infectious disease intervention first appeared in a 2005 article about strategies for containing an emerging influenza pandemic. However, awareness of distancing oneself from others as a prevention tool against infection dates to biblical times; reference to removing persons with leprosy from the community was recorded in the Bible (Lev. 13:46, New Jerusalem Version) during the 6th–4th centuries bce. Later, for both plague and smallpox, avoiding contact between diseased and healthy persons became a method for disrupting disease transmission. Beginning in the 14th century, Italian port cities began isolating ships and travelers suspected of carrying plague for periods of 30 days (trentino) and later for 40 days (quarantino), thus, the English term “quarantine.” |
Pregnancy and infant outcomes following SARS-CoV-2 infection in pregnancy during Delta variant predominance - surveillance for emerging threats to pregnant people and infants: Pregnancy and infant outcomes during SARS-CoV-2 Delta variant predominance
Reeves EL , Neelam V , Carlson JM , Olsen EO , Fox CJ , Woodworth KR , Nestoridi E , Mobley E , Montero Castro S , Dzimira P , Sokale A , Sizemore L , Hall AJ , Ellington S , Cohn A , Gilboa SM , Tong VT . Am J Obstet Gynecol MFM 2023 6 (2) 101265 BACKGROUND: SARS-CoV-2 infection in pregnancy is associated with an increased risk of adverse birth outcomes such as preterm birth, stillbirth, and maternal and infant complications. Previous research suggests an increased risk of severe COVID-19 illness and stillbirth in pregnant people during delta variant predominance in 2021; however, those studies did not assess timing of infection during pregnancy, and few of them described COVID-19 vaccination status. OBJECTIVE: Using a large population-based cohort, this study compared pregnancy and infant outcomes and described demographic and clinical characteristics of pregnant people with SARS-CoV-2 infection prior to and during the delta variant period. STUDY DESIGN: This retrospective cohort analysis included persons with confirmed SARS-CoV-2 infection in pregnancy from 6 US jurisdictions reporting to the Surveillance for Emerging Threats to Pregnant People and Infants Network. Data were collected through case reports of polymerase chain reaction-positive pregnant persons and linkages to birth certificates, fetal death records, and immunization records. We described clinical characteristics and compared frequency of spontaneous abortion (<20 weeks of gestation), stillbirth (≥20 weeks), preterm birth (<37 weeks), small for gestational age, and term infant neonatal intensive care unit admission between the time periods of pre-delta and delta variant predominance. Study time periods were determined by when variants constituted more than 50% of sequences isolated according to regional SARS-CoV-2 genomic surveillance data, with time periods defined for pre-delta (March 3, 2020-June 25, 2021) and Delta (June 26, 2021-December 25, 2021). Adjusted prevalence ratios were estimated for each outcome measure using Poisson regression and were adjusted for continuous maternal age, race and ethnicity, and insurance status at delivery. RESULTS: Among 57,563 pregnancy outcomes, 57,188 (99.3%) were liveborn infants, 65 (0.1%) were spontaneous abortions, and 310 (0.5%) were stillbirths. Most pregnant persons were unvaccinated at the time of SARS-CoV-2 infection, with a higher proportion in pre-delta (99.4%) than in the delta period (78.4%). Of those with infections during delta and who were previously vaccinated, the timing from last vaccination to infection was a median of 183 days. Compared to pre-delta, infections during delta were associated with a higher frequency of stillbirths (0.7% vs 0.4%; adjusted prevalence ratio, 1.55; 95% confidence interval, 1.14-2.09) and preterm births (12.8% vs 11.9%; adjusted prevalence ratio, 1.14; 95% confidence interval, 1.07-1.20). The delta period was associated with a lower frequency of neonatal intensive care unit admission (adjusted prevalence ratio, 0.74; 95% confidence interval, 0.67-0.82) than in the pre-delta period. During the delta period, infection during the third trimester was associated with a higher frequency of preterm birth (adjusted prevalence ratio, 1.41; 95% confidence interval, 1.28-1.56) and neonatal intensive care unit admission (adjusted prevalence ratio, 1.21; 95% confidence interval, 1.01-1.45) compared to the first and second trimester combined. CONCLUSION: In this US-based cohort of persons with SARS-CoV-2 infection in pregnancy, the majority were unvaccinated, and frequencies of stillbirth and preterm birth were higher during the delta variant predominance period than in the pre-delta period. During the delta period, frequency of preterm birth and neonatal intensive care unit admission was higher among infections occurring in the third trimester vs those earlier in pregnancy. These findings demonstrate population-level increases of adverse fetal and infant outcomes, specifically in the presence of a COVID-19 variant with more severe presentation. |
Respiratory syncytial virus-associated hospitalizations among children <5 years old: 2016 to 2020
Curns AT , Rha B , Lively JY , Sahni LC , Englund JA , Weinberg GA , Halasa NB , Staat MA , Selvarangan R , Michaels M , Moline H , Zhou Y , Perez A , Rohlfs C , Hickey R , Lacombe K , McHenry R , Whitaker B , Schuster J , Pulido CG , Strelitz B , Quigley C , Dnp GW , Avadhanula V , Harrison CJ , Stewart LS , Schlaudecker E , Szilagyi PG , Klein EJ , Boom J , Williams JV , Langley G , Gerber SI , Hall AJ , McMorrow ML . Pediatrics 2024 BACKGROUND: Respiratory syncytial virus (RSV) is the leading cause of hospitalization in US infants. Accurate estimates of severe RSV disease inform policy decisions for RSV prevention. METHODS: We conducted prospective surveillance for children <5 years old with acute respiratory illness from 2016 to 2020 at 7 pediatric hospitals. We interviewed parents, reviewed medical records, and tested midturbinate nasal ± throat swabs by reverse transcription polymerase chain reaction for RSV and other respiratory viruses. We describe characteristics of children hospitalized with RSV, risk factors for ICU admission, and estimate RSV-associated hospitalization rates. RESULTS: Among 13 524 acute respiratory illness inpatients <5 years old, 4243 (31.4%) were RSV-positive; 2751 (64.8%) of RSV-positive children had no underlying condition or history of prematurity. The average annual RSV-associated hospitalization rate was 4.0 (95% confidence interval [CI]: 3.8-4.1) per 1000 children <5 years, was highest among children 0 to 2 months old (23.8 [95% CI: 22.5-25.2] per 1000) and decreased with increasing age. Higher RSV-associated hospitalization rates were found in premature versus term children (rate ratio = 1.95 [95% CI: 1.76-2.11]). Risk factors for ICU admission among RSV-positive inpatients included: age 0 to 2 and 3 to 5 months (adjusted odds ratio [aOR] = 1.97 [95% CI: 1.54-2.52] and aOR = 1.56 [95% CI: 1.18-2.06], respectively, compared with 24-59 months), prematurity (aOR = 1.32 [95% CI: 1.08-1.60]) and comorbid conditions (aOR = 1.35 [95% CI: 1.10-1.66]). CONCLUSIONS: Younger infants and premature children experienced the highest rates of RSV-associated hospitalization and had increased risk of ICU admission. RSV prevention products are needed to reduce RSV-associated morbidity in young infants. |
The U.S. COVID-19 vaccination program: A look back and future directions
Hall E , Mahon BE , Peacock G . Vaccine 2024 |
Malaria species prevalence among asymptomatic individuals in four regions of Mainland Tanzania
Popkin Hall ZR , Seth MD , Madebe RA , Budodo R , Bakari C , Francis F , Pereus D , Giesbrecht DJ , Mandara CI , Mbwambo D , Aaron S , Lusasi A , Lazaro S , Bailey JA , Juliano JJ , Gutman JR , Ishengoma DS . medRxiv 2023 Recent studies point to the need to incorporate non-falciparum species detection into malaria surveillance activities in sub-Saharan Africa, where 95% of malaria cases occur. Although Plasmodium falciparum infection is typically more severe, diagnosis, treatment, and control for P. malariae, P. ovale spp., and P. vivax may be more challenging. The prevalence of these species throughout sub-Saharan Africa is poorly defined. Tanzania has geographically heterogeneous transmission levels but an overall high malaria burden. In order to estimate the prevalence of malaria species in Mainland Tanzania, 1,428 samples were randomly selected from 6,005 asymptomatic isolates collected in cross-sectional community surveys across four regions and analyzed via qPCR to detect each Plasmodium species. P. falciparum was most prevalent, with P. malariae and P. ovale spp. detected at lower prevalence (<5%) in all four regions. P. vivax was not detected. Malaria elimination efforts in Tanzania will need to account for these non-falciparum species. |
Multimorbidity clusters in adults 50 years or older with and without a history of cancer: National Health Interview Survey, 2018
Plasencia G , Gray SC , Hall IJ , Smith JL . BMC Geriatr 2024 24 (1) 50 BACKGROUND: Multimorbidity is increasing among adults in the United States. Yet limited research has examined multimorbidity clusters in persons aged 50 years and older with and without a history of cancer. An increased understanding of multimorbidity clusters may improve the cancer survivorship experience for survivors with multimorbidity. METHODS: We identified 7580 adults aged 50 years and older with 2 or more diseases-including 811 adults with a history of primary breast, colorectal, cervical, prostate, or lung cancer-from the 2018 National Health Interview Survey. Exploratory factor analysis identified clusters of multimorbidity among cancer survivors and individuals without a history of cancer (controls). Frequency tables and chi-square tests were performed to determine overall differences in sociodemographic characteristics, health-related characteristics, and multimorbidity between groups. RESULTS: Cancer survivors reported a higher prevalence of having 4 or more diseases compared to controls (57% and 38%, respectively). Our analysis identified 6 clusters for cancer survivors and 4 clusters for controls. Three clusters (pulmonary, cardiac, and liver) included the same diseases for cancer survivors and controls. CONCLUSIONS: Diseases clustered differently across adults ≥ 50 years of age with and without a history of cancer. Findings from this study may be used to inform clinical care, increase the development and dissemination of multilevel public health interventions, escalate system improvements, and initiate innovative policy reform. |
Long-term follow-up of persons diagnosed with multidrug-resistant TB in Chennai, India, 2013-2020
Surie D , Sathyanarayanan MK , Lavanya J , Smith JP , Shanmugam SK , Tamilzhalagan S , Selvaraj A , Ramesh G , Tripathy S , Khaparde SD , Ho CS , Hall-Eidson PJ , Ranganathan UDK , Selvaraju S , Moonan PK . Int J Tuberc Lung Dis 2024 28 (1) 54-56 India has the largest number of multidrug-resistant TB | (MDR-TB) cases, defined as Mycobacterium tuberculosis | resistant to at least isoniazid (INH) and rifampicin (RIF).1 | However, less than half of all persons with MDR-TB in | India successfully complete treatment.1 Although initial | end-of-treatment outcomes offer a standardised time point | to assess the effect of treatment, these tend to | underestimate the overall burden of unfavourable longterm outcomes among persons treated for TB.2,3 The longterm outcomes of persons diagnosed with MDR-TB in | India, including the proportion with recurrent TB disease | or mortality, are unknown. This analysis was conducted | under programmatic conditions in a high-burden setting, | with no regular check-ups after treatment. The results can | be used to show the burden of recurrent illness and death | following treatment, and can be used as a benchmark to | measure improvement. |
Challenges and opportunities during the COVID-19 vaccination efforts in long-term care
Stone ND , Parker Fiebelkorn A , Guo A , Mothershed E , Moccia L , Bell J , Yassanye D , Hall E , Duggar C , Srinivasan A , Meyer SA , Link-Gelles R . Vaccine 2024 From December 2020 through March 2023, the COVID-19 vaccination efforts in long-term care (LTC) settings, identified many gaps and opportunities to improve public health capacity to support vaccine distribution, education, and documentation of COVID-19 vaccines administered to LTC residents and staff. Partner engagement at the local, state, and federal levels helped establish pathways for dissemination of information, improve access and delivery of vaccines, and expand reporting of vaccine administration data to monitor the impact of COVID-19 vaccination in LTC settings. Sustaining the improvements to the vaccine infrastructure in LTC settings that were created or enhanced during the COVID-19 vaccination efforts is critical for the protection of residents and staff against COVID-19 and other vaccine preventable respiratory outbreaks in the future. |
Progressive massive fibrosis identified at federally funded black lung clinics in the US
Harris DA , Almberg KS , Blackley DJ , Cohen RA , Edwards C , Johnson B , Hall NB . JAMA 2024 This study of US Black Lung Clinics (established to treat coal miners) reports the prevalence of progressive massive fibrosis identified through June 2023. | eng |
Development of COVID-19 vaccine policy - United States, 2020-2023
Oliver SE , Wallace M , Twentyman E , Moulia DL , Godfrey M , Link-Gelles R , Meyer S , Fleming-Dutra KE , Hall E , Wolicki J , MacNeil J , Bell BP , Lee GM , Daley MF , Cohn A , Wharton M . Vaccine 2023 COVID-19 vaccines represent a great scientific and public health achievement in the face of overwhelming pressures from a global pandemic, preventing millions of hospitalizations and deaths due to COVID-19 vaccines in the United States. Over 675 million doses of COVID-19 vaccines have been administered in the United States, and over 80% of the U.S. population has had at least 1 dose of a COVID-19 vaccine. Over the course of the COVID-19 pandemic in the United States, over one million people died from COVID-19, and over six million were hospitalized. It has been estimated that COVID-19 vaccines prevented more than 18 million additional hospitalizations and more than 3 million additional deaths due to COVID-19 in the United States. From the beginning of the COVID-19 pandemic in 2020 through June 2023, ACIP had 35 COVID-19 focused meetings and 24 votes for COVID-19 vaccine recommendations. ACIP had the critical task of rapidly and thoroughly reviewing emerging and evolving data on COVID-19 epidemiology and vaccines, as well as making comprehensive population-based recommendations for vaccine policy and considerations for implementation through a transparent and evidence-based framework. Safe and effective COVID-19 vaccines, recommended through transparent policy discussions with ACIP, remain the best tool we have to prevent serious illness, hospitalization and death from COVID-19. |
Risk factors for serogroup B meningococcal disease among college students
Weil LM , Crowe SJ , Rubis AB , Soeters HM , Meyer SA , Hariri S , McNamara LA . Open Forum Infect Dis 2023 10 (12) ofad607 BACKGROUND: College students are at increased risk for invasive meningococcal disease, but which students are most at risk is unclear. METHODS: US meningococcal disease cases in persons aged 18-24 years during 2014-2017 were included. Patients were classified as undergraduate students or other persons. Incidence in different student and non-student populations was compared. RESULTS: During 2014-2017, 229 meningococcal disease cases were reported in persons aged 18-24 years; 120 were in undergraduate students. Serogroup B accounted for 74% of cases in students. Serogroup B disease incidence was 4-fold higher in undergraduate students, 11.8-fold higher among first-year undergraduate students, and 8.6-fold higher among residence hall residents versus non-undergraduates. During outbreaks, students affiliated with Greek life had a 9.8-fold higher risk of disease compared to other students. A significantly higher party school ranking was observed for schools with sporadic or outbreak cases when compared to schools with no cases. CONCLUSIONS: The findings of increased disease risk among first-year students and those living on campus or affiliated with Greek life can inform shared clinical decision-making for serogroup B vaccines to prevent this rare but serious disease. These data also can inform school serogroup B vaccination policies and outbreak response measures. |
Coverage with influenza, respiratory syncytial virus, and updated COVID-19 vaccines among nursing home residents - National Healthcare Safety Network, United States, December 2023
Reses HE , Dubendris H , Haas L , Barbre K , Ananth S , Rowe T , Mothershed E , Hall E , Wiegand RE , Lindley MC , Meyer S , Patel SA , Benin A , Kroop S , Srinivasan A , Bell JM . MMWR Morb Mortal Wkly Rep 2023 72 (51) 1371-1376 Nursing home residents are at risk for becoming infected with and experiencing severe complications from respiratory viruses, including SARS-CoV-2, influenza, and respiratory syncytial virus (RSV). Fall 2023 is the first season during which vaccines are simultaneously available to protect older adults in the United States against all three of these respiratory viruses. Nursing homes are required to report COVID-19 vaccination coverage and can voluntarily report influenza and RSV vaccination coverage among residents to CDC's National Healthcare Safety Network. The purpose of this study was to assess COVID-19, influenza, and RSV vaccination coverage among nursing home residents during the current 2023-24 respiratory virus season. As of December 10, 2023, 33.1% of nursing home residents were up to date with vaccination against COVID-19. Among residents at 20.2% and 19.4% of facilities that elected to report, coverage with influenza and RSV vaccines was 72.0% and 9.8%, respectively. Vaccination varied by U.S. Department of Health and Human Services region, social vulnerability index level, and facility size. There is an urgent need to protect nursing home residents against severe outcomes of respiratory illnesses by continuing efforts to increase vaccination against COVID-19 and influenza and discussing vaccination against RSV with eligible residents during the ongoing 2023-24 respiratory virus season. |
Continued progress in the development of safe and effective RSV immunizations
Cohn AC , Hall AJ . N Engl J Med 2023 389 (24) 2289-2290 Before 2023, there were no immunizing tools to protect older adults and all infants from illness and death due to respiratory syncytial virus (RSV). In 2023, two RSV vaccines for older adults, one of which is also approved for use in pregnant persons, and a long-acting monoclonal antibody to protect infants and some toddlers up to 19 months of age were approved by the Food and Drug Administration and recommended by the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention.1-3 These major developments occurred nearly 60 years after a formalin-inactivated RSV vaccine that had been administered to children in clinical trials resulted in enhanced respiratory disease in seronegative children who had been vaccinated, and hopes for a safe and effective RSV vaccine were dashed, or at least postponed. Investigation into why this vaccine failed ultimately led to identification of the stabilized prefusion conformation of the fusion (F) glycoprotein target, which propelled the scientific community to subsequently make remarkable progress in the development of RSV vaccines.4 | | Furthermore, the discovery of the RSV prefusion F protein as a stable antigen was foundational to the work on vaccine development for coronaviruses before the Covid-19 pandemic, and researchers were able to quickly pivot to targeting SARS-CoV-2 spike protein when it emerged.5 In December 2020, the first mRNA vaccines against SARS-CoV-2 were authorized, 1 year after the disease and causative virus were first recognized. The development of these vaccines benefited from the head start provided by previous research on RSV vaccines and the mRNA platform that allows for fast production of large quantities of vaccine. Both factors were critical in controlling the Covid-19 pandemic, but they also show the immense potential for the rapid introduction of new vaccines worldwide. |
Interstate mobility of people with diagnosed HIV in the United States, 2011-2019
Okello A , Song R , Hall HI , Dailey A , Satcher Johnson A . Public Health Rep 2023 333549231208488 OBJECTIVE: Assessing mobility among people with HIV is an important consideration when measuring HIV incidence, prevalence, and the care continuum in the United States. Our aims were to measure mobility among people with HIV compared with the general population and to examine factors associated with migration among people with HIV. METHODS: We calculated state-to-state move-in and move-out migration rates for 2011 through 2019 using National HIV Surveillance System data for people with HIV and using US Census data for the general population. For people with HIV, we also assessed the association between migration and HIV care outcomes. RESULTS: From 2011 through 2019, the US general population had stable migration, whereas migration rates among people with HIV fluctuated and were higher than among the general population. Among people with HIV, migration rates in 2019 were higher among people assigned male sex at birth versus female sex at birth, among people aged ≤24 years versus ≥25 years, among people with HIV infection attributed to male-to-male sexual contact versus other transmission categories, and among non-Hispanic Other people (ie, American Indian or Alaska Native, Asian, Native Hawaiian or Other Pacific Islander, or multiple races) versus Hispanic, non-Hispanic Black, and non-Hispanic White people. Receipt of HIV medical care (90.3% vs 75.5%) and achieving viral suppression (72.1% vs 65.3%) were higher among people with HIV who migrated versus those who did not. CONCLUSIONS: People with HIV in the United States are more mobile than the general population. Determining the mobility of people with HIV can help with strategic allocation of HIV prevention and care resources. |
Longitudinal population-level HIV epidemiologic and genomic surveillance highlights growing gender disparity of HIV transmission in Uganda
Monod M , Brizzi A , Galiwango RM , Ssekubugu R , Chen Y , Xi X , Kankaka EN , Ssempijja V , Abeler-Dörner L , Akullian A , Blenkinsop A , Bonsall D , Chang LW , Dan S , Fraser C , Golubchik T , Gray RH , Hall M , Jackson JC , Kigozi G , Laeyendecker O , Mills LA , Quinn TC , Reynolds SJ , Santelli J , Sewankambo NK , Spencer SEF , Ssekasanvu J , Thomson L , Wawer MJ , Serwadda D , Godfrey-Faussett P , Kagaayi J , Grabowski MK , Ratmann O . Nat Microbiol 2023 9 (1) 35-54 HIV incidence in eastern and southern Africa has historically been concentrated among girls and women aged 15-24 years. As new cases decline with HIV interventions, population-level infection dynamics may shift by age and gender. Here, we integrated population-based surveillance of 38,749 participants in the Rakai Community Cohort Study and longitudinal deep-sequence viral phylogenetics to assess how HIV incidence and population groups driving transmission have changed from 2003 to 2018 in Uganda. We observed 1,117 individuals in the incidence cohort and 1,978 individuals in the transmission cohort. HIV viral suppression increased more rapidly in women than men, however incidence declined more slowly in women than men. We found that age-specific transmission flows shifted: whereas HIV transmission to girls and women (aged 15-24 years) from older men declined by about one-third, transmission to women (aged 25-34 years) from men that were 0-6 years older increased by half in 2003 to 2018. Based on changes in transmission flows, we estimated that closing the gender gap in viral suppression could have reduced HIV incidence in women by half in 2018. This study suggests that HIV programmes to increase HIV suppression in men are critical to reduce incidence in women, close gender gaps in infection burden and improve men's health in Africa. |
Genome-based prediction of cross-protective, HLA-DR-presented epitopes as putative vaccine antigens for multiple Bordetella species
Natrajan MS , Hall JM , Weigand MR , Peng Y , Williams MM , Momin M , Damron FH , Dubey P , Tondella ML , Pawloski LC . Microbiol Spectr 2023 e0352723 Pertussis, caused by Bordetella pertussis, can cause debilitating respiratory symptoms, so whole-cell pertussis vaccines (wPVs) were introduced in the 1940s. However, reactogenicity of wPV necessitated the development of acellular pertussis vaccines (aPVs) that were introduced in the 1990s. Since then, until the COVID-19 pandemic began, reported pertussis incidence was increasing, suggesting that aPVs do not induce long-lasting immunity and may not effectively prevent transmission. Additionally, aPVs do not provide protection against other Bordetella species that are observed during outbreaks. The significance of this work is in determining potential new vaccine antigens for multiple Bordetella species that are predicted to elicit long-term immune responses. Genome-based approaches have aided the development of novel vaccines; here, these methods identified Bordetella vaccine candidates that may be cross-protective and predicted to induce strong memory responses. These targets can lead to an improved vaccine with a strong safety profile while also strengthening the longevity of the immune response. |
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. |
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