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Article ; Online: Disparities in Multisystem Inflammatory Syndrome in Children and COVID-19 Across the Organ Dysfunction Continuum.

Martin, Blake / Rao, Suchitra / Bennett, Tellen D

JAMA network open

2023 Volume 6, Issue 1, Page(s) e2249552

MeSH term(s)	Child ; Humans ; COVID-19 ; Multiple Organ Failure ; Connective Tissue Diseases
Language	English
Publishing date	2023-01-03
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural ; Comment
ISSN	2574-3805
ISSN (online)	2574-3805
DOI	10.1001/jamanetworkopen.2022.49552
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Beyond Influenza Vaccination: Expanding Infrastructure for Hospital-based Pediatric COVID-19 Vaccine Delivery.

Hofstetter, Annika M / Rao, Suchitra / Jhaveri, Ravi

Clinical therapeutics

2022 Volume 44, Issue 3, Page(s) 450–455

Abstract: Controlling the spread of severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2), the virus that causes coronavirus disease 2019 (COVID-19), will rely on vaccination at increasing rates and in an equitable manner. The main reasons for under- ... ...

Abstract	Controlling the spread of severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2), the virus that causes coronavirus disease 2019 (COVID-19), will rely on vaccination at increasing rates and in an equitable manner. The main reasons for under-vaccination are varied among different segments of the population and include vaccine hesitancy and lack of access. While vaccine hesitancy is complicated and requires long-term solutions, access can be enhanced through evidence-based delivery strategies that augment conventional approaches. Hospital-based COVID-19 vaccination programs hold particular promise in reaching populations with decreased vaccine access and those at higher risk for adverse outcomes from SARS-CoV-2 infection. Hospitals have the necessary equipment and storage capabilities to maintain cold chain requirements-a common challenge in the primary care setting-and can serve as a central distribution point for delivering vaccines to patients in diverse hospital locations, including inpatient units, emergency departments, urgent care centers, perioperative areas, and subspecialty clinics. They also have the capacity for mass-vaccination programs and other targeted outreach efforts. Hospital-based programs that have been successful in implementing influenza and other routine vaccinations can leverage existing infrastructure, such as electronic health record-related tools. With the possibility of COVID-19 becoming endemic, much like seasonal influenza, these programs will require flexibility as well as planning for long-term sustainability. This commentary highlights existing vaccine delivery to children in hospital-based settings, including key advantages and important challenges, and outlines how these systems could be expanded to include the COVID-19 vaccine delivery.
MeSH term(s)	COVID-19/prevention & control ; COVID-19 Vaccines ; Child ; Hospitals ; Humans ; Influenza Vaccines ; Influenza, Human/epidemiology ; Influenza, Human/prevention & control ; SARS-CoV-2 ; Vaccination
Chemical Substances	COVID-19 Vaccines ; Influenza Vaccines
Language	English
Publishing date	2022-01-29
Publishing country	United States
Document type	Journal Article
ZDB-ID	603113-4
ISSN	1879-114X ; 0149-2918
ISSN (online)	1879-114X
ISSN	0149-2918
DOI	10.1016/j.clinthera.2022.01.013
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Article ; Online: SARS-CoV-2 infection in children evaluated in an ambulatory setting during Delta and Omicron time periods.

Smith, Hana / Mahon, Allison / Moss, Angela / Rao, Suchitra

Journal of medical virology

2022 Volume 95, Issue 1, Page(s) e28318

Abstract: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants and re-emergence of other respiratory viruses highlight the need to understand the presentation of and factors associated with SARS-CoV-2 in pediatric populations over time. The ... ...

Abstract	Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants and re-emergence of other respiratory viruses highlight the need to understand the presentation of and factors associated with SARS-CoV-2 in pediatric populations over time. The objective of this study was to evaluate the sociodemographic characteristics, symptoms, and epidemiological risk factors associated with ambulatory SARS-CoV-2 infection in children and determine if factors differ by variant type. We conducted a retrospective cohort study of outpatient children undergoing SARS-CoV-2 polymerase chain reaction testing between November 2020 and January 2022. Test-positive were compared with test-negative children to evaluate symptoms, exposure risk, demographics, and comparisons between Omicron, Delta, and pre-Delta time periods. Among 2264 encounters, 361 (15.9%) were positive for SARS-CoV-2. The cohort was predominantly Hispanic (51%), 5-11 years (44%), and 53% male; 5% had received two coronavirus disease 2019 (COVID-19) vaccine doses. Factors associated with a positive test include loss of taste/smell (adjusted odds ratio [aOR]: 6.71, [95% confidence interval, CI: 2.99-15.08]), new cough (aOR: 2.38, [95% CI: 1.69-3.36]), headache (aOR: 1.90, [95% CI: 1.28-2.81), fever (aOR: 1.83, [95% CI: 1.29-2.60]), contact with a positive case (aOR: 5.12, [95% CI: 3.75-6.97]), or household contact (aOR: 2.66, [95% CI: 1.96-3.62]). Among positive children, loss of taste/smell was more predominant during the Delta versus Omicron and pre-Delta periods (12% vs. 2% and 3%, respectively, p = 0.0017), cough predominated during Delta/Omicron periods more than the pre-Delta period (69% and 65% vs. 41%, p = 0.0002), and there were more asymptomatic children in the pre-Delta period (30% vs. 18% and 10%, p = 0.0023). These findings demonstrate that the presentation of COVID-19 in children and most susceptible age groups has changed over time.
MeSH term(s)	Child ; Humans ; Male ; Female ; COVID-19/diagnosis ; COVID-19/epidemiology ; SARS-CoV-2/genetics ; Ageusia ; Cough ; Retrospective Studies ; COVID-19 Vaccines
Chemical Substances	COVID-19 Vaccines
Language	English
Publishing date	2022-11-24
Publishing country	United States
Document type	Journal Article
ZDB-ID	752392-0
ISSN	1096-9071 ; 0146-6615
ISSN (online)	1096-9071
ISSN	0146-6615
DOI	10.1002/jmv.28318
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Article ; Online: Influenza Vaccination in Perioperative Settings: A Teachable Moment.

Rao, Suchitra / Morrissey, Tyler / Ziniel, Sonja I / Mandler, Tessa / Yaster, Myron / Strupp, Kim M

Anesthesiology

2022 Volume 137, Issue 6, Page(s) 745–747

MeSH term(s)	Humans ; Influenza, Human/prevention & control ; Vaccination/adverse effects ; Motivation
Language	English
Publishing date	2022-10-13
Publishing country	United States
Document type	Journal Article
ZDB-ID	269-0
ISSN	1528-1175 ; 0003-3022
ISSN (online)	1528-1175
ISSN	0003-3022
DOI	10.1097/ALN.0000000000004341
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Article ; Online: Shifting Epidemiology and Severity of Respiratory Syncytial Virus in Children During the COVID-19 Pandemic.

Rao, Suchitra / Armistead, Isaac / Messacar, Kevin / Alden, Nisha B / Schmoll, Emma / Austin, Elizabeth / Dominguez, Samuel R

JAMA pediatrics

2023 Volume 177, Issue 7, Page(s) 730–732

MeSH term(s)	Child ; Humans ; Infant ; Pandemics ; COVID-19/epidemiology ; Respiratory Syncytial Virus, Human ; Respiratory Syncytial Virus Infections/epidemiology ; Respiratory Tract Infections/epidemiology
Language	English
Publishing date	2023-07-05
Publishing country	United States
Document type	Journal Article ; Research Support, U.S. Gov't, P.H.S.
ZDB-ID	2701223-2
ISSN	2168-6211 ; 2168-6203
ISSN (online)	2168-6211
ISSN	2168-6203
DOI	10.1001/jamapediatrics.2023.1088
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Article ; Online: Emergency Departments

Rebecca Hart / Yana Feygin / Theresa Kluthe / Katherine Quinn / Suchitra Rao / Shannon H. Baumer-Mouradian

Vaccines, Vol 11, Iss 1445, p

An Underutilized Resource for Expanding COVID-19 Vaccine Coverage in Children

2023 Volume 1445

Abstract: COVID-19 vaccine (CV) acceptance rates remain suboptimal in children. Emergency departments (EDs) represent a unique opportunity to improve vaccination rates, particularly in underserved children. Little is known about the presence or reach of CV ... ...

Abstract	COVID-19 vaccine (CV) acceptance rates remain suboptimal in children. Emergency departments (EDs) represent a unique opportunity to improve vaccination rates, particularly in underserved children. Little is known about the presence or reach of CV programs in US EDs. We assessed, via a cross-sectional survey of pediatric ED physicians, the number of EDs offering CVs to children, the approximate numbers of vaccines administered annually, and the perceived facilitators/barriers to vaccination. The proportion of EDs offering CVs is reported. Chi-square tests compared facilitators and barriers among frequent vaccinators (≥50 CVs/year), infrequent vaccinators (<50 CVs/year), and non-vaccinators. Among 492 physicians from 166 EDs, 142 responded (representing 61 (37.3%) EDs). Most EDs were in large, urban, academic, freestanding children’s hospitals. Only 11 EDs (18.0%) offer ≥1 CV/year, and only two (18.2%) of these gave ≥50 CVs. Common facilitators of vaccination included the electronic health record facilitation of vaccination, a strong provider/staff buy-in, storage/accessibility, and having a leadership team or champion. Barriers included patient/caregiver refusal, forgetting to offer vaccines, and, less commonly, a lack of buy-in/support and the inaccessibility of vaccines. Many (28/47, 59.6%) EDs expressed interest in establishing a CV program.
Keywords	COVID-19 ; vaccination ; pediatric ; emergency department ; healthcare disparities ; Medicine ; R
Language	English
Publishing date	2023-09-01T00:00:00Z
Publisher	MDPI AG
Document type	Article ; Online
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Article: Emergency Departments: An Underutilized Resource for Expanding COVID-19 Vaccine Coverage in Children.

Hart, Rebecca / Feygin, Yana / Kluthe, Theresa / Quinn, Katherine / Rao, Suchitra / Baumer-Mouradian, Shannon H

Vaccines

2023 Volume 11, Issue 9

Abstract	COVID-19 vaccine (CV) acceptance rates remain suboptimal in children. Emergency departments (EDs) represent a unique opportunity to improve vaccination rates, particularly in underserved children. Little is known about the presence or reach of CV programs in US EDs. We assessed, via a cross-sectional survey of pediatric ED physicians, the number of EDs offering CVs to children, the approximate numbers of vaccines administered annually, and the perceived facilitators/barriers to vaccination. The proportion of EDs offering CVs is reported. Chi-square tests compared facilitators and barriers among frequent vaccinators (≥50 CVs/year), infrequent vaccinators (<50 CVs/year), and non-vaccinators. Among 492 physicians from 166 EDs, 142 responded (representing 61 (37.3%) EDs). Most EDs were in large, urban, academic, freestanding children's hospitals. Only 11 EDs (18.0%) offer ≥1 CV/year, and only two (18.2%) of these gave ≥50 CVs. Common facilitators of vaccination included the electronic health record facilitation of vaccination, a strong provider/staff buy-in, storage/accessibility, and having a leadership team or champion. Barriers included patient/caregiver refusal, forgetting to offer vaccines, and, less commonly, a lack of buy-in/support and the inaccessibility of vaccines. Many (28/47, 59.6%) EDs expressed interest in establishing a CV program.
Language	English
Publishing date	2023-09-01
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2703319-3
ISSN	2076-393X
ISSN	2076-393X
DOI	10.3390/vaccines11091445
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Article ; Online: The Power of the Nudge to Decrease Decision Fatigue and Increase Influenza Vaccination Rates.

Rao, Suchitra / Nyquist, Ann-Christine

JAMA network open

2018 Volume 1, Issue 5, Page(s) e181754

MeSH term(s)	Decision Making ; Electronic Health Records ; Fatigue ; Humans ; Influenza, Human ; Vaccination
Language	English
Publishing date	2018-09-07
Publishing country	United States
Document type	Journal Article ; Comment
ISSN	2574-3805
ISSN (online)	2574-3805
DOI	10.1001/jamanetworkopen.2018.1754
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Article ; Online: Emergency departments: An underutilized resource to address pediatric influenza vaccine coverage.

Hart, Rebecca / Feygin, Yana / Kluthe, Theresa / Quinn, Katherine G / Rao, Suchitra / Baumer-Mouradian, Shannon H

Vaccine

2023 Volume 41, Issue 47, Page(s) 7026–7032

Abstract: Background: Emergency department (ED) based influenza vaccine (IV) programs have been successful in adults; however, little is known about pediatric ED IV programs in terms of prevalence, feasibility, or successful implementation.: Aims: To describe ... ...

Abstract	Background: Emergency department (ED) based influenza vaccine (IV) programs have been successful in adults; however, little is known about pediatric ED IV programs in terms of prevalence, feasibility, or successful implementation. Aims: To describe the reach and effectiveness of IV practices in pediatric EDs, and identify IV facilitators and barriers. Methods: We assessed, via cross-sectional survey of pediatric ED physicians, number of EDs offering IV to children, vaccines administered annually, and perceived facilitators/barriers to vaccination. The proportion of EDs offering IV is reported. Chi-square tests compared facilitators and barriers among high performers (≥50 IV/year), low performers (<50 IV/yr), and non-vaccinators. We calculated an area of missed effect for the number of children who could be vaccinated if non-vaccinating EDs offered IV. Results: Among 492 physicians from 166 EDs, 142 responded (representing 61 (37.3 %) EDs). Most EDs were in large, urban, academic, freestanding children's hospitals (Table 1). Only twenty-six EDs (44.3 %) offer ≥ 1 IV/yr. Seventeen (65.4 %) were low performers, five (19.2 %) high performers, and four (15.4 %) were model programs. High/model performers used establish workflows more commonly than lower performers (78 % vs. 33 %), although this was not statistically significant (p = 0.077). Common facilitators included: strong provider and administration buy-in, electronic health record facilitation, storage/accessibility, and having a leadership team/champion (Fig. 1). Non-vaccinators commonly perceived lack of these factors as barriers. Many (24/61, 39.3 %) EDs expressed interested in establishing or growing IV programs. Up to 18,250 unvaccinated children could receive IV annually if non-vaccinating EDs offered IV during influenza season. Conclusions: Over half of EDs participating in the Pediatric Emergency Medicine Collaborative Research Committee do not currently offer pediatric IV. Addressing identified barriers/facilitators to develop IV programs in EDs has potential to improve vaccination rates, especially among minority and underserved children.
MeSH term(s)	Adult ; Humans ; Child ; Influenza Vaccines ; Cross-Sectional Studies ; Vaccination ; Emergency Service, Hospital ; Physicians
Chemical Substances	Influenza Vaccines
Language	English
Publishing date	2023-10-19
Publishing country	Netherlands
Document type	Journal Article
ZDB-ID	605674-x
ISSN	1873-2518 ; 0264-410X
ISSN (online)	1873-2518
ISSN	0264-410X
DOI	10.1016/j.vaccine.2023.10.039
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Article ; Online: Respiratory Syncytial Virus, Influenza, and Coronavirus Disease 2019 Hospitalizations in Children in Colorado During the 2021-2022 Respiratory Virus Season.

Rao, Suchitra / Armistead, Isaac / Tyler, Amy / Lensing, Madelyn / Dominguez, Samuel R / Alden, Nisha B

The Journal of pediatrics

2023 Volume 260, Page(s) 113491

Abstract: Objective: To compare demographic characteristics, clinical features, and outcomes of children hospitalized with respiratory syncytial virus (RSV), influenza, or severe acute respiratory syndrome coronavirus 2 during their cocirculation 2021-2022 ... ...

Abstract	Objective: To compare demographic characteristics, clinical features, and outcomes of children hospitalized with respiratory syncytial virus (RSV), influenza, or severe acute respiratory syndrome coronavirus 2 during their cocirculation 2021-2022 respiratory virus season. Methods: We conducted a retrospective cohort study using Colorado's hospital respiratory surveillance data comparing coronavirus disease 2019 (COVID-19)-, influenza-, and RSV-hospitalized cases < 18 years of age admitted and undergoing standardized molecular testing between October 1, 2021, and April 30, 2022. Multivariable log-binomial regression modeling evaluated associations between pathogen type and diagnosis, intensive care unit admission, hospital length of stay, and highest level of respiratory support received. Results: Among 847 hospitalized cases, 490 (57.9%) were RSV associated, 306 (36.1%) were COVID-19 associated, and 51 (6%) were influenza associated. Most RSV cases were <4 years of age (92.9%), whereas influenza hospitalizations were observed in older children. RSV cases were more likely to require oxygen support higher than nasal cannula compared with COVID-19 and influenza cases (P < .0001), although COVID-19 cases were more likely to require invasive mechanical ventilation than influenza and RSV cases (P < .0001). Using multivariable log-binomial regression analyses, compared with children with COVID-19, the risk of intensive care unit admission was highest among children with influenza (relative risk, 1.97; 95% CI, 1.22-3.19), whereas the risk of pneumonia, bronchiolitis, longer hospital length of stay, and need for oxygen were more likely among children with RSV. Conclusions: In a season with respiratory pathogen cocirculation, children were hospitalized most commonly for RSV, were younger, and required higher oxygen support and non-invasive ventilation compared with children with influenza and COVID-19.
MeSH term(s)	Humans ; Child ; Infant ; Influenza, Human/diagnosis ; Respiratory Syncytial Virus Infections/epidemiology ; Respiratory Syncytial Virus Infections/therapy ; Respiratory Syncytial Virus Infections/diagnosis ; Retrospective Studies ; Seasons ; Colorado/epidemiology ; COVID-19/epidemiology ; Respiratory Syncytial Virus, Human ; Hospitalization ; Oxygen
Chemical Substances	Oxygen (S88TT14065)
Language	English
Publishing date	2023-05-16
Publishing country	United States
Document type	Journal Article ; Research Support, U.S. Gov't, P.H.S.
ZDB-ID	3102-1
ISSN	1097-6833 ; 0022-3476
ISSN (online)	1097-6833
ISSN	0022-3476
DOI	10.1016/j.jpeds.2023.113491
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