Research Spotlight

Russo, M.J., Thourani, V.H., Cohen, D.J., Malaisrie, S.C., Szeto, W.Y., George, I., Kodali, S.K., Makkar, R., Lu, M., Williams, M., Nguyen, T., Aldea, G., Genereux, P., Fang, H.K., Alu, M.C., Rogers, E., Okoh, A., Herrmann, H.C., Kapadia, S., Webb, J.G., Smith, C.R., Leon, M.B. and Mack, M.J. (2021). “Minimally Invasive versus Full Sternotomy for Isolated Aortic Valve Replacement in Low-risk Patients.” Ann Thorac Surg Dec 24;S0003-4975(21)02134-2. [Epub ahead of print].

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BACKGROUND: Surgical aortic valve replacement can be performed either through a minimally invasive (MI) or full sternotomy (FS) approach. The present study compared outcomes of MI versus FS for isolated surgery among patients enrolled in the PARTNER 3 low-risk trial. METHODS: Patients with severe, symptomatic aortic stenosis at low surgical risk with anatomy suitable for transfemoral access were eligible for PARTNER 3 enrollment. The primary outcome was the composite endpoint of death, stroke, or rehospitalization (valve-, procedure-, or heart-failure-related) at 1 year. Secondary outcomes included the individual components of the primary endpoint as well as patient-reported health status at 30 days and 1 year. RESULTS: In the PARTNER 3 study, 358 patients underwent isolated surgery at 68 centers through an MI (n=107) or FS (n=251) approach (8 patients were converted from MI to FS). Mean age and Society of Thoracic Surgeons score were similar between groups. The Kaplan-Meier estimate of the primary outcome was similar in the MI versus FS groups (16.9% versus 14.9%; hazard ratio [95% CI]: 1.15 [0.66 – 2.03]; P=0.618). There were no significant differences in the 1-year rates of all-cause death (2.8% versus 2.8%), all stroke (1.9% versus 3.6%), or rehospitalization (13.3% versus 10.6%, P > 0.05 for all). Quality of life as assessed by the Kansas City Cardiomyopathy Questionnaire score at 30 days or 1 year was comparable in both groups. CONCLUSIONS: For patients at low risk for isolated surgery, MI and FS approaches were associated with similar in-hospital and 1-year outcomes.

Embi, P.J., Levy, M.E., Naleway, A.L., Patel, P., Gaglani, M., Natarajan, K., Dascomb, K., Ong, T.C., Klein, N.P., Liao, I.C., Grannis, S.J., Han, J., Stenehjem, E., Dunne, M.M., Lewis, N., Irving, S.A., Rao, S., McEvoy, C., Bozio, C.H., Murthy, K., Dixon, B.E., Grisel, N., Yang, D.H., Goddard, K., Kharbanda, A.B., Reynolds, S., Raiyani, C., Fadel, W.F., Arndorfer, J., Rowley, E.A., Fireman, B., Ferdinands, J., Valvi, N.R., Ball, S.W., Zerbo, O., Griggs, E.P., Mitchell, P.K., Porter, R.M., Kiduko, S.A., Blanton, L., Zhuang, Y., Steffens, A., Reese, S.E., Olson, N., Williams, J., Dickerson, M., McMorrow, M., Schrag, S.J., Verani, J.R., Fry, A.M., Azziz-Baumgartner, E., Barron, M.A., Thompson, M.G. and DeSilva, M.B. (2022). “Effectiveness of two-dose vaccination with mRNA COVID-19 vaccines against COVID-19-associated hospitalizations among immunocompromised adults-Nine States, January-September 2021.” Am J Transplant 22(1): 306-314.

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What is already known about this topic?
Studies suggest that immunocompromised persons who receive COVID-19 vaccination might not develop high neutralizing antibody titers or be as protected against severe COVID-19 outcomes as are immunocompetent persons.
What is added by this report?
The effectiveness of mRNA vaccination against laboratory-confirmed COVID-19–associated hospitalization was lower (77%) among immunocompromised adults than among immunocompetent adults (90%). Vaccine effectiveness varied considerably among immunocompromised patient subgroups.
What are the implications for public health practice?
Immunocompromised persons benefit from COVID-19 mRNA vaccination but are less protected from severe COVID-19 outcomes than are immunocompetent persons. Immunocompromised persons receiving mRNA COVID-19 vaccines should receive three doses and a booster, consistent with CDC recommendations, practice nonpharmaceutical interventions, and, if infected, be monitored closely and considered early for proven therapies that can prevent severe outcomes. [No abstract; excerpt from article].

Hughes, K., Middleton, D.B., Nowalk, M.P., Balasubramani, G.K., Martin, E.T., Gaglani, M., Talbot, H.K., Patel, M.M., Ferdinands, J.M., Zimmerman, R.K. and Silveira, F.P. (2021). “Effectiveness of Influenza Vaccine for Preventing Laboratory-Confirmed Influenza Hospitalizations in Immunocompromised Adults.” Clin Infect Dis 73(11): e4353-e4360.

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BACKGROUND: Yearly influenza immunization is recommended for immunocompromised (IC) individuals, although immune responses are lower than that for the nonimmunocompromised 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 prespecified case definitions using electronic medical record data. VE was evaluated with a test-negative case-control design using multivariable logistic regression with polymerase chain reaction-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 3524 adults hospitalized with ARI, 1210 (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 of age). The overall VE against influenza hospitalization, including immunocompetent adults, was 33% (95% confidence interval [CI], 21-44). VE among IC vs non-IC adults was lower at 5% (95% CI, -29% to 31%) vs 41% (95% CI, 27-52) (P < .05 for interaction term). CONCLUSIONS: VE in 1 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.

Lewis, N.M., Naioti, E.A., Self, W.H., Ginde, A.A., Douin, D.J., Talbot, H.K., Casey, J.D., Mohr, N.M., Zepeski, A., Gaglani, M., Ghamande, S.A., McNeal, T.A., Shapiro, N.I., Gibbs, K.W., Files, D.C., Hager, D.N., Shehu, A., Prekker, M.E., Erickson, H.L., Gong, M.N., Mohamed, A., Henning, D.J., Steingrub, J.S., Peltan, I.D., Brown, S.M., Martin, E.T., Hubel, K., 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., Exline, M.C., Halasa, N., Chappell, J.D., Lauring, A.S., Grijalva, C.G., Rice, T.W., Rhoads, J.P., Stubblefield, W.B., Baughman, A., Womack, K.N., Lindsell, C.J., Hart, K.W., Zhu, Y., Schrag, S.J., Kobayashi, M., Verani, J.R., Patel, M.M. and Tenforde, M.W. (2021). “Effectiveness of mRNA vaccines in preventing COVID-19 hospitalization by age and burden of chronic medical conditions among immunocompetent US adults, March-August 2021.” J Infect Dis Dec 21;jiab619. [Epub ahead of print].

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In a multi-state network, vaccine effectiveness (VE) against COVID-19 hospitalizations was evaluated among immunocompetent adults (≥18-years) during March-August 2021 using a case-control design. Among 1669 hospitalized COVID-19 cases (11% fully vaccinated) and 1950 RT-PCR-negative controls (54% fully vaccinated), VE was higher at 96% (95% CI: 93-98%) among patients with no chronic medical conditions than patients with ≥3 categories of conditions (83% [95% CI: 76-88%]). VE was similar between those aged 18-64 years vs ≥65 years (p>0.05). Vaccine effectiveness against severe COVID-19 was very high among adults without chronic conditions and lessened with increasing burden of comorbidities.

Lutrick, K., Groom, H., Fowlkes, A.L., Groover, K.D., Gaglani, M., Rivers, P., Naleway, A.L., Nguyen, K., Herring, M., Dunnigan, K., Phillips, A., Parker, J., Mayo Lamberte, J., Prather, K., Thiese, M.S., Baccam, Z., Tyner, H. and Yoon, S. (2021). “COVID-19 vaccine perceptions and uptake in a national prospective cohort of essential workers.” Vaccine 40(3): 494-502.

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INTRODUCTION: In a multi-center prospective cohort of essential workers, we assessed knowledge, attitudes, and practices (KAP) by vaccine intention, prior SARS-CoV-2 positivity, and occupation, and their impact on vaccine uptake over time. METHODS: Initiated in July 2020, the HEROES-RECOVER cohort provided socio-demographics and COVID-19 vaccination data. Using two follow-up surveys approximately three months apart, COVID-19 vaccine KAP, intention, and receipt was collected; the first survey categorized participants as reluctant, reachable, or endorser. RESULTS: A total of 4,803 participants were included in the analysis. Most (70%) were vaccine endorsers, 16% were reachable, and 14% were reluctant. By May 2021, 77% had received at least one vaccine dose. KAP responses strongly predicted vaccine uptake, particularly positive attitudes about safety (aOR = 5.46, 95% CI: 1.4-20.8) and effectiveness (aOR = 5.0, 95% CI: 1.3-19.1). Participants’ with prior SARS-CoV-2 infection were 22% less likely to believe the COVID-19 vaccine was effective compared with uninfected participants (aOR 0.78, 95% CI: 0.64-0.96). This was even more pronounced in first responders compared with other occupations, with first responders 42% less likely to believe in COVID-19 vaccine effectiveness (aOR = 0.58, 95% CI 0.40-0.84). Between administrations of the two surveys, 25% of reluctant, 56% reachable, and 83% of endorser groups received the COVID-19 vaccine. The reachable group had large increases in positive responses for questions about vaccine safety (10% of vaccinated, 34% of unvaccinated), and vaccine effectiveness (12% of vaccinated, 27% of unvaccinated). DISCUSSION: Our study demonstrates attitudes associated with COVID-19 vaccine uptake and a positive shift in attitudes over time. First responders, despite potential high exposure to SARS-CoV-2, and participants with a history of SARS-CoV-2 infection were more vaccine reluctant. CONCLUSIONS: Perceptions of the COVID-19 vaccine can shift over time. Targeting messages about the vaccine’s safety and effectiveness in reducing SARS-CoV-2 virus infection and illness severity may increase vaccine uptake for reluctant and reachable participants.