373. Household transmission of SARS-CoV-2 B.1.1.7 lineage –2 U.S. States, 2021

Abstract Background In December 2020, B.1.1.7 lineage of SARS-CoV-2 was first detected in the United States and has since become the dominant lineage. Previous investigations involving B.1.1.7 suggested higher rates of transmission relative to non-B.1.1.7 lineages. We conducted a household transmission investigation to determine the secondary infection rates (SIR) of B.1.1.7 and non-B.1.1.7 SARS-CoV-2 lineages. Methods From January–April 2021, we enrolled members of households in San Diego County, CA, and Denver, CO metropolitan area (Tri-County), with a confirmed SARS-CoV-2 infection in a household member with illness onset date in the previous 10 days. CDC investigators visited households at enrollment and 14 days later at closeout to obtain demographic and clinical data and nasopharyngeal (NP) samples on all consenting household members. Interim visits, with collection of NP swabs, occurred if a participant became symptomatic during follow-up. NP samples were tested for SARS-CoV-2 using TaqPath™ RT-PCR test, where failure to amplify the spike protein results in S-Gene target failure (SGTF) may indicate B.1.1.7 lineage. Demographic characteristics and SIR were compared among SGTF and non-SGTF households using two-sided p-values with chi-square tests; 95% confidence intervals (CI) were calculated with Wilson score intervals. Results 552 persons from 151 households were enrolled. 91 (60%) households were classified as SGTF, 57 (38%) non-SGTF, and 3 (2%) indeterminant. SGTF and non-SGTF households had similar sex distribution (49% female and 52% female, respectively; P=0.54) and age (median 30 years, interquartile range (IQR 14–47) and 31 years (IQR 15–45), respectively). Hispanic people accounted for 24% and 32% of enrolled members of SGTF and non-SGTF households, respectively (p=0.04). At least one secondary case occurred in 61% of SGTF and 58% of non-SGTF households (P=0.66). SIR was 52% (95%[CI] 46%-59%) for SGTF and 45% (95% CI 37%-53%) for non-SGTF households (P=0.18). Conclusion SIRs were high in both SGTF and non-SGTF households; our findings did not support an increase in SIR for SGTF relative to non-SGTF households in this setting. Sequence confirmed SARS-CoV-2 samples will provide further information on lineage specific SIRs. Disclosures All Authors: No reported disclosures

Download Full-text

Effectiveness of Influenza Vaccine for Preventing Laboratory-Confirmed Influenza Hospitalizations in Immunocompromised Adults

10.1101/2020.10.08.20208579 ◽

2020 ◽

Author(s):

Kailey Hughes ◽

Donald B Middleton ◽

Mary Patricia Nowalk ◽

Goundappa K Balasubramani ◽

Emily T Martin ◽

...

Keyword(s):

Influenza Season ◽

Respiratory Illness ◽

The United States ◽

Onset Date ◽

Case Definitions ◽

Illness Onset ◽

Specimen Collection ◽

Negative Case ◽

Reported Health ◽

Immunocompetent Adults

ABSTRACTBackgroundYearly influenza immunization is recommended for immunocompromised (IC) individuals, although immune responses are lower than that for the non-immunocompromised and the data on vaccine effectiveness (VE) in the IC is scarce. We evaluated VE against influenza-associated hospitalization among IC adults.MethodsWe analyzed data from adults ≥ 18 years hospitalized with acute respiratory illness (ARI) during the 2017-2018 influenza season at 10 hospitals in the United States. IC adults were identified using pre-specified case-definitions, utilizing electronic medical record data. VE was evaluated with a test-negative case-control design using multivariate logistic regression with PCR-confirmed influenza as the outcome and vaccination status as the exposure, adjusting for age, enrolling site, illness onset date, race, days from onset to specimen collection, self-reported health, and self-reported hospitalizations.ResultsOf 3,524 adults hospitalized with ARI, 1,210 (34.3%) had an immunocompromising condition. IC adults were more likely to be vaccinated than non-IC (69.5% vs 65.2%), and less likely to have influenza (22% vs 27.8%). The mean age did not differ among IC and non-IC (61.4 vs 60.8 years old). The overall VE against influenza hospitalization, including immunocompetent adults, was 33% (95% CI, 21% to 44%). VE among IC vs non-IC adults was lower at 5% (−29% to 31%) vs. 41% (27% to 52%) (p<0.05 for interaction term).ConclusionsVE in one influenza season was very low among IC individuals. Future efforts should include evaluation of VE among the different immunocompromising conditions and whether enhanced vaccines improve the suboptimal effectiveness among the immunocompromised.

Download Full-text

Household Transmission of SARS-CoV-2 in the United States

Clinical Infectious Diseases ◽

10.1093/cid/ciaa1166 ◽

2020 ◽

Cited By ~ 10

Author(s):

Nathaniel M Lewis ◽

Victoria T Chu ◽

Dongni Ye ◽

Erin E Conners ◽

Radhika Gharpure ◽

...

Keyword(s):

Secondary Infection ◽

The United States ◽

Evidence Base ◽

Elisa Test ◽

Enzyme Linked Immunosorbent Assay ◽

Respiratory Illnesses ◽

Household Contacts ◽

Household Transmission ◽

Secondary Infections ◽

Medical Histories

Abstract Background Although many viral respiratory illnesses are transmitted within households, the evidence base for SARS-CoV-2 is nascent. We sought to characterize SARS-CoV-2 transmission within US households and estimate the household secondary infection rate (SIR) to inform strategies to reduce transmission. Methods We recruited laboratory-confirmed COVID-19 patients and their household contacts in Utah and Wisconsin during March 22–April 25, 2020. We interviewed patients and all household contacts to obtain demographics and medical histories. At the initial household visit, 14 days later, and when a household contact became newly symptomatic, we collected respiratory swabs from patients and household contacts for testing by SARS-CoV-2 rRT-PCR and sera for SARS-CoV-2 antibodies testing by enzyme-linked immunosorbent assay (ELISA). We estimated SIR and odds ratios (OR) to assess risk factors for secondary infection, defined by a positive rRT-PCR or ELISA test. Results Thirty-two (55%) of 58 households had evidence of secondary infection among household contacts. The SIR was 29% (n = 55/188; 95% confidence interval [CI]: 23–36%) overall, 42% among children (<18 years) of the COVID-19 patient and 33% among spouses/partners. Household contacts to COVID-19 patients with immunocompromised conditions had increased odds of infection (OR: 15.9, 95% CI: 2.4–106.9). Household contacts who themselves had diabetes mellitus had increased odds of infection (OR: 7.1, 95% CI: 1.2–42.5). Conclusions We found substantial evidence of secondary infections among household contacts. People with COVID-19, particularly those with immunocompromising conditions or those with household contacts with diabetes, should take care to promptly self-isolate to prevent household transmission.

Download Full-text

Effectiveness of Influenza Vaccine for Preventing Laboratory-Confirmed Influenza Hospitalizations in Immunocompromised Adults

Clinical Infectious Diseases ◽

10.1093/cid/ciaa1927 ◽

2021 ◽

Author(s):

Kailey Hughes ◽

Donald B Middleton ◽

Mary Patricia Nowalk ◽

Goundappa K Balasubramani ◽

Emily T Martin ◽

...

Keyword(s):

Influenza Season ◽

Respiratory Illness ◽

The United States ◽

Onset Date ◽

Case Definitions ◽

Illness Onset ◽

Specimen Collection ◽

Negative Case ◽

Reported Health ◽

Immunocompetent Adults

Abstract Background Yearly influenza immunization is recommended for immunocompromised (IC) individuals, although immune responses are lower than that for the non-immunocompromised and the data on vaccine effectiveness (VE) in the IC is scarce. We evaluated VE against influenza-associated hospitalization among IC adults. Methods We analyzed data from adults ≥ 18 years hospitalized with acute respiratory illness (ARI) during the 2017-2018 influenza season at 10 hospitals in the United States. IC adults were identified using pre-specified case-definitions, utilizing electronic medical record data. VE was evaluated with a test-negative case-control design using multivariable logistic regression with PCR-confirmed influenza as the outcome and vaccination status as the exposure, adjusting for age, enrolling site, illness onset date, race, days from onset to specimen collection, self-reported health, and self-reported hospitalizations. Results Of 3,524 adults hospitalized with ARI, 1,210 (34.3%) had an immunocompromising condition. IC adults were more likely to be vaccinated than non-IC (69.5% vs 65.2%), and less likely to have influenza (22% vs 27.8%). The mean age did not differ among IC and non-IC (61.4 vs 60.8 years old). The overall VE against influenza hospitalization, including immunocompetent adults, was 33% (95% CI, 21% to 44%). VE among IC vs non-IC adults was lower at 5% (-29% to 31%) vs. 41% (27% to 52%) (p<0.05 for interaction term). Conclusions VE in one influenza season was very low among IC individuals. Future efforts should include evaluation of VE among the different immunocompromising conditions and whether enhanced vaccines improve the suboptimal effectiveness among the immunocompromised.

Download Full-text

Household Transmission Study of Cryptosporidiosis in Bangladesh

10.1101/269985 ◽

2018 ◽

Author(s):

Poonum S. Korpe ◽

Carol Gilchrist ◽

Cecelia Burkey ◽

Emtiaz Ahmed ◽

Vikram Madan ◽

...

Keyword(s):

Young Children ◽

Attack Rate ◽

Secondary Infection ◽

High Rate ◽

Chi Square ◽

Cryptosporidium Spp ◽

Household Transmission ◽

Secondary Infections ◽

Transmission Study ◽

Duration Of Infection

ABSTRACTBackgroundCryptosporidium, an apicomplexan protozoa, is a leading contributor to diarrheal morbidity and mortality in children under five years old worldwide. As there is no vaccine and no approved drug for Cryptosporidium spp. in young children, preventing parasite transmission is crucial. We undertook a pilot case-control study to define the extent of person-to-person transmission of cryptosporidiosis within families in an urban and rural community in Bangladesh.MethodsWe enrolled 48 case families with a Cryptosporidium-infected child aged 6-18 months. Controls were age-sex matched Cryptosporidium-negative children (n=12). Once children were identified, we enrolled all household members. We then followed these individuals for 8 weeks, with weekly surveillance stools and testing with qPCR for Cryptosporidium spp.FindingsIn the 48 case families, the rate of secondary infections with Cryptosporidium was 18.6% (22/118) compared to 0 new infections (0/35) in the 12 control families. In the 22 urban Mirpur households, the secondary attack rate was 30% (18/60) in cases compared to 0% (0/14) in controls (chi-square p = 0.018). In contrast, in the 21 rural Mirzapur households, the secondary attack rate was 6.9% (4/58) in case households compared to 0% (0/21) in controls (chi-square p = 0.22). Genotyping by gp60 demonstrated infection with the same subspecies in five of six families. Serologic response to Cryptosporidium infection was associated with younger age, longer duration of infection, and C hominis gp60_IbA9G3R2 infection.InterpretationThe high rate of secondary infection in Mirpur suggests that person-to-person transmission is likely a major source of Cryptosporidium infection for young children living in this region. GP 60 genotyping demonstrated direction of infection in 2 households, and concurrent infection in five households. Further work is needed to understand the differences in parasite transmissibility and immunity to different genotypes.

Download Full-text

The Southern California Extracorporeal Membrane Oxygenation Consortium during the Coronavirus Disease 2019 Pandemic

Disaster Medicine and Public Health Preparedness ◽

10.1017/dmp.2021.179 ◽

2021 ◽

pp. 1-21

Author(s):

Mazen Odish ◽

Cassia Yi ◽

Juliann Eigner ◽

Amelia Kenner Brininger ◽

Kristi L. Koenig ◽

...

Keyword(s):

Extracorporeal Membrane Oxygenation ◽

San Diego ◽

Southern California ◽

Limited Resource ◽

The United States ◽

San Diego County ◽

Clinical Practices ◽

Membrane Oxygenation ◽

Effective Manner ◽

Share Data

Abstract In March 2020, at the onset of the coronavirus disease 2019 (COVID-19) pandemic in the United States, the Southern California Extracorporeal Membrane Oxygenation (ECMO) Consortium was formed. The consortium included physicians and coordinators from the four ECMO centers in San Diego County. Guidelines were created to ensure that ECMO was delivered equitably and in a resource effective manner across the county during the pandemic. A biomedical ethicist reviewed the guidelines to ensure ECMO utilization would provide maximal community benefit of this limited resource. The San Diego County Health and Human Services Agency further incorporated the guidelines into its plans for the allocation of scarce resources. The consortium held weekly video conferences to review countywide ECMO capacity (including census and staffing), share data, and discuss clinical practices and difficult cases. Equipment exchanges between ECMO centers maximized regional capacity. From March 1 to November 30, 2020, consortium participants placed 97 patients on ECMO. No eligible patients were denied ECMO due to lack of resources or capacity. The Southern California ECMO Consortium may serve as a model for other communities seeking to optimize ECMO resources during the current COVID-19 or future pandemics.

Download Full-text

Training Preferences of School Food Service Staff Vary by Role in the School Nutrition Program

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18010050 ◽

2020 ◽

Vol 18 (1) ◽

pp. 50

Author(s):

Leia Flure ◽

Melissa Pflugh Prescott ◽

Whitney Ajie ◽

Trinity Allison ◽

Jennifer McCaffrey

Keyword(s):

Professional Development ◽

The United States ◽

School Nutrition ◽

Training Needs ◽

Learning Method ◽

Learning Methods ◽

Chi Square ◽

Job Experience ◽

Training Topic ◽

And Training

Professional development has been identified as a critical component for school nutrition professionals (SNPs) to successfully implement school meal standards in the United States. However, training needs may vary based on different factors. This study examined (1) the topics of highest priority for SNPs; (2) preferred learning methods; (3) where and when trainings should be conducted; and (4) whether responses differ according to important factors including position type, school locale (urban vs. rural), or job experience. Participants completed surveys that included questions on demographics and preferences for learning methods and training topics (n = 492). Descriptive statistics characterized survey responses. Chi square tests assessed differences in learning method and training topic preferences by participant role, locale, and job experience; Cramer’s V assessed the strength of association for each chi square result. Qualitative responses to open-ended questions were analyzed using an inductive thematic analysis method. Nearly all training topic preferences were significantly different (p < 0.001 using Bonferroni method) when stratified by role. Significant differences were also observed for school locale and years of experience, but to a lesser degree. There was less variation in learning method preferences across staff role. Qualitative results (n = 93) identified three key themes related to training needs: role-specific trainings, innovative learning methods, and geographic access. The combination of quantitative and qualitative analysis indicate that professional development for SNPs should mostly be conducted in-person, be easily accessible, and include hands-on activities. Further, training should be tailored by job role and address situational barriers unique to the geographic area.

Download Full-text

Gastric Cancer Treatments and Survival Trends in the United States

Current Oncology ◽

10.3390/curroncol28010017 ◽

2020 ◽

Vol 28 (1) ◽

pp. 138-151

Author(s):

Kelly A. Stahl ◽

Elizabeth J. Olecki ◽

Matthew E. Dixon ◽

June S. Peng ◽

Madeline B. Torres ◽

...

Keyword(s):

Gastric Cancer ◽

Overall Survival ◽

Stage Iv ◽

The United States ◽

Current Treatment ◽

Stage I ◽

Stage Ii ◽

Chi Square ◽

Specific Guideline ◽

Kaplan Meier

Gastric cancer is the third most common cause of cancer deaths worldwide. Despite evidence-based recommendation for treatment, the current treatment patterns for all stages of gastric cancer remain largely unexplored. This study investigates trends in the treatments and survival of gastric cancer. The National Cancer Database was used to identify gastric adenocarcinoma patients from 2004–2016. Chi-square tests were used to examine subgroup differences between disease stages: Stage I, II/III and IV. Multivariate analyses identified factors associated with the receipt of guideline concordant care. The Kaplan–Meier method was used to assess three-year overall survival. The final cohort included 108,150 patients: 23,584 Stage I, 40,216 Stage II/III, and 44,350 Stage IV. Stage specific guideline concordant care was received in only 73% of patients with Stage I disease and 51% of patients with Stage II/III disease. Patients who received guideline consistent care had significantly improved survival compared to those who did not. Overall, we found only moderate improvement in guideline adherence and three-year overall survival during the 13-year study time period. This study showed underutilization of stage specific guideline concordant care for stage I and II/III disease.

Download Full-text

Implementing a small media intervention to increase colorectal cancer screening in primary care clinics

Translational Behavioral Medicine ◽

10.1093/tbm/iby063 ◽

2018 ◽

Vol 9 (4) ◽

pp. 605-616 ◽

Cited By ~ 1

Author(s):

Cathy L Melvin ◽

Anissa I Vines ◽

Allison M Deal ◽

Holly O Pierce ◽

William R Carpenter ◽

...

Keyword(s):

Colorectal Cancer ◽

Task Force ◽

Controlled Trial ◽

Preventive Services ◽

Patient Characteristics ◽

The United States ◽

Chi Square ◽

Return Rates ◽

The Usa ◽

Participant Characteristics

Abstract Colorectal cancer (CRC) is one of the most common cancers in the USA. In 2017, an estimated 135,420 people were diagnosed with CRC and 50,260 people died from CRC. Several screening modalities are recommended by the United States Preventive Services Task Force (USPSTF), including annual stool tests that are usually completed at home and under-used compared with colonoscopy despite stated patient preferences for an alternative to colonoscopy. The Community Preventive Services Task Force recommends use of small media interventions (SMIs) to increase CRC screening and calls for a greater understanding of its independent impact on screening participation. This study tested whether a SMI increased the likelihood of participant return of a USPSTF recommended Fecal Immunochemical Test (FIT). In total, 804 individuals participated in a two-group, prospective randomized controlled trial. Descriptive statistics with chi-square tests compared differences in participant characteristics and return rates. Multivariable log-binomial modeling estimated combined effects of patient characteristics with FIT return rates. No differences in return rates were observed overall or by participant characteristics other than the year of enrollment. A multivariable model controlling for all covariates, found gender, insurance type, and regular place for healthcare to be significantly associated with return rates. Receipt of the SMI did not independently increase overall return rates but it may have improved the ease of completing the FIT by some participants, particularly women, those with insurance, and those with a regular place for healthcare.

Download Full-text

Feel the Burn! Fireworks-related Otolaryngologic Trauma

Annals of Otology Rhinology & Laryngology ◽

10.1177/00034894211008100 ◽

2021 ◽

pp. 000348942110081

Author(s):

Alexander J. Straughan ◽

Luke J. Pasick ◽

Vrinda Gupta ◽

Daniel A. Benito ◽

Joseph F. Goodman ◽

...

Keyword(s):

United States ◽

Head And Neck ◽

Emergency Departments ◽

Closed Head Injury ◽

Penetrating Trauma ◽

The United States ◽

Neck Injuries ◽

Chi Square ◽

Injury Surveillance System ◽

Cross Sectional

Objectives: Fireworks are used commonly for celebrations in the United States, but can lead to severe injury to the head and neck. We aim to assess the incidence, types, and mechanisms of head and neck injuries associated with fireworks use from 2010 to 2019. Methods: A retrospective cross-sectional study, using data from the National Electronic Injury Surveillance System, of individuals presenting to United States Emergency Departments with head and neck injuries caused by fireworks and flares from 2010 to 2019. Incidence, types, and mechanisms of injury related to fireworks use in the US population were assessed. Results: A total of 541 patients (349 [64.5%] male, and 294 [54%] under 18 years of age) presented to emergency departments with fireworks-related head and neck injuries; the estimated national total was 20 584 patients (13 279 male, 9170 white, and 11 186 under 18 years of age). The most common injury diagnoses were burns (44.7% of injuries), laceration/avulsion/penetrating trauma (21.1%), and otologic injury (15.2%), which included hearing loss, otalgia, tinnitus, unspecified acoustic trauma, and tympanic membrane perforation. The remaining 19% of injuries were a mix, including contusion, abrasion, hematoma, fracture, and closed head injury. Associations between fireworks type and injury diagnosis (chi-square P < .001), as well as fireworks type by age group (chi-square P < .001) were found. Similarly, associations were found between age groups and injury diagnoses (chi-square P < .001); these included children 5 years and younger and adults older than 30 years. Conclusions: Fireworks-related head and neck injuries are more likely to occur in young, white, and male individuals. Burns are the most common injury, while otologic injury is a significant contributor. Annual rates of fireworks-related head and neck injuries have not changed or improved significantly in the United States in the past decade, suggesting efforts to identify and prevent these injuries are insufficient.

Download Full-text

Cannabis Growers in the United States: Findings From a National Household Survey 2010−2014

Journal of Drug Issues ◽

10.1177/00220426211000457 ◽

2021 ◽

pp. 002204262110004

Author(s):

Alejandro Azofeifa ◽

Rosalie L. Pacula ◽

Margaret E. Mattson

Keyword(s):

Logistic Regression Model ◽

Geographical Location ◽

Household Survey ◽

The United States ◽

Multivariable Logistic Regression Model ◽

Chi Square ◽

Prevention Education ◽

The Past ◽

National Household Survey ◽

Using Data

Given the rapidly changing U.S. cannabis legislation landscape, the aim of this article is to describe individuals who self-reported growing cannabis in the past year by selected characteristics and geographical location. Using data from 2010 to 2014 National Survey on Drug Use and Health, we conducted bivariate chi-square tests and ran a multivariable logistic regression model to examine the indicators associated with growing cannabis. Approximately, 484,000 individuals aged 12+ self-reported growing cannabis in the past year (1.6% of marijuana users). Predictors of growing cannabis included being male and self-reported reporting using cannabis for a greater number of days. Data showed differences in the proportion of cannabis growers by the state of residence. Obtaining a baseline estimate of cannabis growing practices prior to recreational cannabis markets emerging (2014) is important because such practices may undermine efforts to discourage diversion to youth. Tracking these acquisition patterns will better inform content for public health messaging and prevention education, particularly those targeting youth.

Download Full-text