Infectious Disease

Bhalala, U.S., Gist, K.M., Tripathi, S., Boman, K., Kumar, V.K., Retford, L., Chiotos, K., Blatz, A.M., Dapul, H., Verma, S., Sayed, I.A., Gharpure, V.P., Bjornstad, E., Tofil, N., Irby, K., Sanders, R.C., Jr., Heneghan, J.A., Thomas, M., Gupta, M.K., Oulds, F.E., Arteaga, G.M., Levy, E.R., Gupta, N., Kaufman, M., Abdelaty, A., Shlomovich, M., Medar, S.S., Iqbal O’Meara, A.M., Kuehne, J., Menon, S., Khandhar, P.B., Miller, A.S., Barry, S.M., Danesh, V.C., Khanna, A.K., Zammit, K., Stulce, C., McGonagill, P.W., Bercow, A., Amzuta, I.G., Gupta, S., Almazyad, M.A., Pierre, L., Sendi, P., Ishaque, S., Anderson, H.L., 3rd, Nawathe, P., Akhter, M., Lyons, P.G., Chen, C., Walkey, A.J., Bihorac, A., Wada Bello, I., Ben Ari, J., Kovacevic, T., Bansal, V., Brinton, J.T., Zimmerman, J.J. and Kashyap, R. (2022). “Characterization and Outcomes of Hospitalized Children With Coronavirus Disease 2019: A Report From a Multicenter, Viral Infection and Respiratory Illness Universal Study (Coronavirus Disease 2019) Registry.” Crit Care Med 50(1): e40-e51.

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OBJECTIVES: Multicenter data on the characteristics and outcomes of children hospitalized with coronavirus disease 2019 are limited. Our objective was to describe the characteristics, ICU admissions, and outcomes among children hospitalized with coronavirus disease 2019 using Society of Critical Care Medicine Discovery Viral Infection and Respiratory Illness Universal Study: Coronavirus Disease 2019 registry. DESIGN: Retrospective study. SETTING: Society of Critical Care Medicine Viral Infection and Respiratory Illness Universal Study (Coronavirus Disease 2019) registry. PATIENTS: Children (< 18 yr) hospitalized with coronavirus disease 2019 at participating hospitals from February 2020 to January 2021. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: The primary outcome was ICU admission. Secondary outcomes included hospital and ICU duration of stay and ICU, hospital, and 28-day mortality. A total of 874 children with coronavirus disease 2019 were reported to Viral Infection and Respiratory Illness Universal Study registry from 51 participating centers, majority in the United States. Median age was 8 years (interquartile range, 1.25-14 yr) with a male:female ratio of 1:2. A majority were non-Hispanic (492/874; 62.9%). Median body mass index (n = 817) was 19.4 kg/m2 (16-25.8 kg/m2), with 110 (13.4%) overweight and 300 (36.6%) obese. A majority (67%) presented with fever, and 43.2% had comorbidities. A total of 238 of 838 (28.2%) met the Centers for Disease Control and Prevention criteria for multisystem inflammatory syndrome in children, and 404 of 874 (46.2%) were admitted to the ICU. In multivariate logistic regression, age, fever, multisystem inflammatory syndrome in children, and pre-existing seizure disorder were independently associated with a greater odds of ICU admission. Hospital mortality was 16 of 874 (1.8%). Median (interquartile range) duration of ICU (n = 379) and hospital (n = 857) stay were 3.9 days (2-7.7 d) and 4 days (1.9-7.5 d), respectively. For patients with 28-day data, survival was 679 of 787, 86.3% with 13.4% lost to follow-up, and 0.3% deceased. CONCLUSIONS: In this observational, multicenter registry of children with coronavirus disease 2019, ICU admission was common. Older age, fever, multisystem inflammatory syndrome in children, and seizure disorder were independently associated with ICU admission, and mortality was lower among children than mortality reported in adults.

Adams, J., Mauldin, T., Yates, K., Zumwalt, C., Ashe, T., Cervantes, D. and Tao, M.H. (2022). “Factors related to the accurate application of NHSN surveillance definitions for CAUTI and CLABSI in Texas hospitals: A cross-sectional survey.” Am J Infect Control 50(1): 111-113.

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Previous studies indicate variability in the accurate application of National Healthcare Safety Network surveillance criteria with limited data on possible contributing factors. In this cross-sectional, convenience sampled web-based survey sent to members of Texas infection prevention and control organizations, training, experience, and time spent on surveillance was collected and assessed including 2 case studies. Our results indicate correct identification of catheter-associated urinary tract infection (CAUTI) and central line-associated bloodstream infection (CLABSI) criteria may be associated with 2019 National Healthcare Safety Network training (CAUTI: aOR = 0.17, 95% CI: 0.04, 0.80; CLABSI: aOR = 0.45, 95% CI: 0.045, 4.56) and increased years of infection prevention experience (CAUTI: aOR = 1.35, 95% CI: 0.42, 4.33; CLABSI: aOR = 1.23, 95% CI: 0.24, 6.38). Routinely performing more hours of surveillance may increase accuracy of CLABSI identification, but not CAUTI.

Tenforde, M.W., Self, W.H., Adams, K., Gaglani, M., Ginde, A.A., McNeal, T., Ghamande, S., Douin, D.J., Talbot, H.K., Casey, J.D., Mohr, N.M., Zepeski, A., Shapiro, N.I., Gibbs, K.W., Files, D.C., Hager, D.N., Shehu, A., Prekker, M.E., Erickson, H.L., Exline, M.C., Gong, M.N., Mohamed, A., Henning, D.J., Steingrub, J.S., Peltan, I.D., Brown, S.M., Martin, E.T., Monto, A.S., Khan, A., Hough, C.L., Busse, L.W., Ten Lohuis, C.C., Duggal, A., Wilson, J.G., Gordon, A.J., Qadir, N., Chang, S.Y., Mallow, C., Rivas, C., Babcock, H.M., Kwon, J.H., Halasa, N., Chappell, J.D., Lauring, A.S., Grijalva, C.G., Rice, T.W., Jones, I.D., Stubblefield, W.B., Baughman, A., Womack, K.N., Rhoads, J.P., Lindsell, C.J., Hart, K.W., Zhu, Y., Olson, S.M., Kobayashi, M., Verani, J.R. and Patel, M.M. (2021). “Association Between mRNA Vaccination and COVID-19 Hospitalization and Disease Severity.” Jama 326(20): 2043-2054.

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IMPORTANCE: A comprehensive understanding of the benefits of COVID-19 vaccination requires consideration of disease attenuation, determined as whether people who develop COVID-19 despite vaccination have lower disease severity than unvaccinated people. OBJECTIVE: To evaluate the association between vaccination with mRNA COVID-19 vaccines-mRNA-1273 (Moderna) and BNT162b2 (Pfizer-BioNTech)-and COVID-19 hospitalization, and, among patients hospitalized with COVID-19, the association with progression to critical disease. DESIGN, SETTING, AND PARTICIPANTS: A US 21-site case-control analysis of 4513 adults hospitalized between March 11 and August 15, 2021, with 28-day outcome data on death and mechanical ventilation available for patients enrolled through July 14, 2021. Date of final follow-up was August 8, 2021. EXPOSURES: COVID-19 vaccination. MAIN OUTCOMES AND MEASURES: Associations were evaluated between prior vaccination and (1) hospitalization for COVID-19, in which case patients were those hospitalized for COVID-19 and control patients were those hospitalized for an alternative diagnosis; and (2) disease progression among patients hospitalized for COVID-19, in which cases and controls were COVID-19 patients with and without progression to death or mechanical ventilation, respectively. Associations were measured with multivariable logistic regression. RESULTS: Among 4513 patients (median age, 59 years [IQR, 45-69]; 2202 [48.8%] women; 23.0% non-Hispanic Black individuals, 15.9% Hispanic individuals, and 20.1% with an immunocompromising condition), 1983 were case patients with COVID-19 and 2530 were controls without COVID-19. Unvaccinated patients accounted for 84.2% (1669/1983) of COVID-19 hospitalizations. Hospitalization for COVID-19 was significantly associated with decreased likelihood of vaccination (cases, 15.8%; controls, 54.8%; adjusted OR, 0.15; 95% CI, 0.13-0.18), including for sequenced SARS-CoV-2 Alpha (8.7% vs 51.7%; aOR, 0.10; 95% CI, 0.06-0.16) and Delta variants (21.9% vs 61.8%; aOR, 0.14; 95% CI, 0.10-0.21). This association was stronger for immunocompetent patients (11.2% vs 53.5%; aOR, 0.10; 95% CI, 0.09-0.13) than immunocompromised patients (40.1% vs 58.8%; aOR, 0.49; 95% CI, 0.35-0.69) (P < .001) and weaker at more than 120 days since vaccination with BNT162b2 (5.8% vs 11.5%; aOR, 0.36; 95% CI, 0.27-0.49) than with mRNA-1273 (1.9% vs 8.3%; aOR, 0.15; 95% CI, 0.09-0.23) (P < .001). Among 1197 patients hospitalized with COVID-19, death or invasive mechanical ventilation by day 28 was associated with decreased likelihood of vaccination (12.0% vs 24.7%; aOR, 0.33; 95% CI, 0.19-0.58). CONCLUSIONS AND RELEVANCE: Vaccination with an mRNA COVID-19 vaccine was significantly less likely among patients with COVID-19 hospitalization and disease progression to death or mechanical ventilation. These findings are consistent with risk reduction among vaccine breakthrough infections compared with absence of vaccination.

Edwards, L.J., Fowlkes, A.L., Wesley, M.G., Kuntz, J.L., Odean, M.J., Caban-Martinez, A.J., Dunnigan, K., Phillips, A.L., Grant, L., Herring, M.K., Groom, H.C., Respet, K., Beitel, S., Zunie, T., Hegmann, K.T., Kumar, A., Joseph, G., Poe, B., Louzado-Feliciano, P., Smith, M.E., Thiese, M.S., Schaefer-Solle, N., Yoo, Y.M., Silvera, C.A., Mayo Lamberte, J., Mak, J., McDonald, L.C., Stuckey, M.J., Kutty, P., Arvay, M.L., Yoon, S.K., Tyner, H.L., Burgess, J.L., Hunt, D.R., Meece, J., Gaglani, M., Naleway, A.L. and Thompson, M.G. (2021). “Research on the Epidemiology of SARS-CoV-2 in Essential Response Personnel (RECOVER): Protocol for a Multisite Longitudinal Cohort Study.” JMIR Res Protoc 10(12): e31574.

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BACKGROUND: Workers critical to emergency response and continuity of essential services during the COVID-19 pandemic are at a disproportionally high risk of SARS-CoV-2 infection. Prospective cohort studies are needed for enhancing the understanding of the incidence of symptomatic and asymptomatic SARS-CoV-2 infections, identifying risk factors, assessing clinical outcomes, and determining the effectiveness of vaccination. OBJECTIVE: The Research on the Epidemiology of SARS-CoV-2 in Essential Response Personnel (RECOVER) prospective cohort study was designed to estimate the incidence of symptomatic and asymptomatic SARS-CoV-2 infections, examine the risk factors for infection and clinical spectrum of illness, and assess the effectiveness of vaccination among essential workers. METHODS: The RECOVER multisite network was initiated in August 2020 and aims to enroll 3000 health care personnel (HCP), first responders, and other essential and frontline workers (EFWs) at 6 US locations. Data on participant demographics, medical history, and vaccination history are collected at baseline and throughout the study. Active surveillance for the symptoms of COVID-19-like illness (CLI), access of medical care, and symptom duration is performed by text messages, emails, and direct participant or medical record reports. Participants self-collect a mid-turbinate nasal swab weekly, regardless of symptoms, and 2 additional respiratory specimens at the onset of CLI. Blood is collected upon enrollment, every 3 months, approximately 28 days after a reverse transcription polymerase chain reaction (RT-PCR)-confirmed SARS-CoV-2 infection, and 14 to 28 days after a dose of any COVID-19 vaccine. From February 2021, household members of RT-PCR-confirmed participants are self-collecting mid-turbinate nasal swabs daily for 10 days. RESULTS: The study observation period began in August 2020 and is expected to continue through spring 2022. There are 2623 actively enrolled RECOVER participants, including 280 participants who have been found to be positive for SARS-CoV-2 by RT-PCR. Enrollment is ongoing at 3 of the 6 study sites. CONCLUSIONS: Data collected through the cohort are expected to provide important public health information for essential workers at high risk for occupational exposure to SARS-CoV-2 and allow early evaluation of COVID-19 vaccine effectiveness. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/31574.

Hall, L. R., K. Sanchez, B. da Graca, M. M. Bennett, M. Powers and A. M. Warren (2021). “Income Differences and COVID-19: Impact on Daily Life and Mental Health.” Popul Health Manag Oct 14. [Epub ahead of print].

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The COVID-19 pandemic has caused disproportionate suffering among vulnerable and socioeconomically disadvantaged portions of the population. Low-income and minority populations are likely to experience disparate disease and mental health burdens. Currently, there is little evidence regarding how the experience of the early months of the US COVID-19 outbreak differed by income level, and how that related to mental health symptoms. The present study used data from a national sample of US adults (n = 5023) who completed measures related to the COVID experience, the COVID-19 Fear Scale, the Generalized Anxiety Disorder-7 (GAD-7), and the Patient Health Questionnaire-8 (PHQ-8). Multivariable regression was performed to determine whether income level (low: <$45,000 vs high: ≥$75,000) was significantly associated with COVID experience measures, PHQ-8, GAD-7, and COVID fear scores. Among the low-income group, COVID-19 had a significantly greater negative impact on: family income/employment, access to food, access to mental health treatment, and stress and discord in the family. Participants in the low-income group also had greater odds of a PHQ-8 score ≥10 (odds ratio [OR] = 1.38, 95% confidence interval [CI] 1.08, 1.77) and a GAD-7 score ≥10 (OR = 1.65, 95% CI 1.27, 2.14) compared to those in the high-income group. Study findings suggest substantial differences in how COVID-19 impacted daily life and mental health between adults living in low-income households compared to high-earning households during the early months of the pandemic.