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Article: Influenza Vaccine Effectiveness: Analysis of the Impact of Repeated Vaccinations in Military Health System Beneficiaries.

Richard, Stephanie A / Fairchok, Mary / Coles, Christian / Burgess, Timothy H / Colombo, Rhonda E

2022 Volume 9, Issue 10, Page(s) ofac497

Abstract: Background: Influenza has long burdened the Military Health System (MHS). This study assesses the impact of repeated annual vaccination on influenza vaccine effectiveness (VE).: Methods: This retrospective, case control study using the test-negative ... ...

Abstract	Background: Influenza has long burdened the Military Health System (MHS). This study assesses the impact of repeated annual vaccination on influenza vaccine effectiveness (VE). Methods: This retrospective, case control study using the test-negative design utilized data extracted from the MHS Data Repository (MDR). Cases had a positive influenza test and controls sought care for an influenza-like illness within 2 weeks of a case, had no positive influenza tests, and were matched by sex, race, age, and location. Vaccine effectiveness was assessed using conditional logistic regression separately for those who received inactivated and live attenuated influenza vaccines (LAIV). Results: A total of 6860 cases and controls were identified in the MDR, among whom 53% were vaccinated in all 3 seasons. Among those who received inactivated influenza vaccine during the current season, VE ranged from 26% to 37% (2012/13 [A(H3N2)]: VE 26%, 95% confidence interval [CI] = 1%-45%; 2013/14 [A(H1N1)pdm09]: VE 37%, 95% CI = 18%-52%; 2014/15 [A(H3N2)]: VE 31%, 95% CI = 17%-42%). The VE ranged from 25% to 49% for those only vaccinated this season (2012/13 [A(H3N2)]: VE 38%, 95% CI = -3% to 63%; 2013/14 [A(H1N1)pdm09]: VE 49%, 95% CI = 11%-71%; 2014/15 [A(H3N2)]: VE 25%, 95% CI = -7% to 48%). The VE was more variable in those who received LAIV in the current season. No statistically significant differences in VE were observed between those frequently vaccinated and those vaccinated only during the current season. Conclusions: These results underscore the value of annual influenza vaccinations for preventing infection while highlighting the need for continued improvements in influenza vaccine effectiveness.
Language	English
Publishing date	2022-09-29
Publishing country	United States
Document type	Journal Article
ZDB-ID	2757767-3
ISSN	2328-8957
ISSN	2328-8957
DOI	10.1093/ofid/ofac497
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Article ; Online: Respiratory Infections Are More Common Than Healthcare Records Indicate: Results From an Anonymous Survey.

Richard, Stephanie A / Danaher, Patrick J / White, Brian / Mende, Katrin / Colombo, Rhonda E / Burgess, Timothy H / Coles, Christian L

Military medicine

2022

Abstract: Introduction: Influenza-like illnesses (ILIs) are common in military populations and can impair mission-readiness, particularly in the current severe acute respiratory syndrome coronavirus 2 pandemic; therefore, it is important to identify potential ... ...

Abstract	Introduction: Influenza-like illnesses (ILIs) are common in military populations and can impair mission-readiness, particularly in the current severe acute respiratory syndrome coronavirus 2 pandemic; therefore, it is important to identify potential risk factors for infection and better understand the burden of infection. Materials and methods: A survey was administered to military medical trainees living in a congregated setting on JBSA Fort Sam Houston, Texas, from January 2017 to February 2019. The survey included questions about ILI experience and potential ILI risk factors. Results: 2,121 individuals completed the survey. Respondents had a median age of 21 years, 46% were female, 32.6% were Air Force, 33.6% were Army, and 33.8% were Navy/Marines. Among the 815 (38%) who reported an ILI during training, 40% sought health care. The primary reasons for seeking healthcare included illness severity, concern about transmission, and accessibility of healthcare. Over half (54%) of the trainees who reported an ILI said the ILI had an impact on their performance, including reduced study time, missed physical training, and missed class. Multivariate model results indicate that women and younger trainees (<30 years) were more likely to report having had an ILI (women: OR 1.58, (95% CI 1.30, 1.92); age <30 years: OR 1.58, (1.06, 2.36)). In a subset analysis, those who reported washing their hands 10+ times per day were less likely to report an ILI (OR 0.61 (0.42, 0.89)). Conclusions: ILIs are likely to be more common during training than healthcare records indicate and may result in decreased training effectiveness. Increasing access to handwashing facilities and education about the importance of handwashing to prevent the spread of disease will likely reduce the ILI burden in this population.
Language	English
Publishing date	2022-02-03
Publishing country	England
Document type	Journal Article
ZDB-ID	391061-1
ISSN	1930-613X ; 0026-4075
ISSN (online)	1930-613X
ISSN	0026-4075
DOI	10.1093/milmed/usac016
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Article: Breath Biomarkers of Influenza Infection.

Danaher, Patrick J / Phillips, Michael / Schmitt, Peter / Richard, Stephanie A / Millar, Eugene V / White, Brian K / Okulicz, Jason F / Coles, Christian L / Burgess, Timothy H

Open forum infectious diseases

2022 Volume 9, Issue 10, Page(s) ofac489

Abstract: Background: Volatile organic compounds (VOCs) are produced systemically due to varied physiological states such as oxidative stress and are excreted through the lungs. Benchtop and preliminary clinical data suggest that breath testing may be a useful ... ...

Abstract	Background: Volatile organic compounds (VOCs) are produced systemically due to varied physiological states such as oxidative stress and are excreted through the lungs. Benchtop and preliminary clinical data suggest that breath testing may be a useful diagnostic modality for viral respiratory tract infections. Methods: Patients with influenza-like illness (ILI) presenting to a single clinic in San Antonio, Texas, from 3/2017 to 3/2019 submitted a 2-minute breath sample in addition to a nasopharyngeal swab collected for polymerase chain reaction (PCR) assay for respiratory pathogens. VOCs were assayed with gas chromatography-mass spectrometry (GC-MS), and data were analyzed to identify breath VOC biomarkers that discriminated between ILI patients with and without a polymerase chain reaction (PCR) assay that was positive for influenza. Results: Demographic, clinical, PCR, and breath data were available for 237 episodes of ILI, among which 32 episodes (13.5%) were PCR positive for influenza. Twenty candidate VOCs identified patients with influenza with greater than random accuracy. A predictive algorithm using 4 candidate biomarkers identified this group with 78% accuracy (74% sensitivity, 70% specificity). Based on their mass spectra, most of these biomarkers were n-alkane derivatives, consistent with products of oxidative stress. Conclusions: A breath test for VOC biomarkers accurately identified ILI patients with PCR-proven influenza. These findings bolster those of others that a rapid, accurate, universal point-of-care influenza diagnostic test based on assay of exhaled-breath VOCs may be feasible. The next step will be a study of patients with ILI using a simplified method of breath collection that would facilitate translation for use in clinical practice.
Language	English
Publishing date	2022-09-21
Publishing country	United States
Document type	Journal Article
ZDB-ID	2757767-3
ISSN	2328-8957
ISSN	2328-8957
DOI	10.1093/ofid/ofac489
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Article ; Online: Introducing a drift and diffusion framework for childhood growth research.

Lewis, Fraser I / Guga, Godfrey / Mdoe, Paschal / Mduma, Esto / Mahopo, Cloupas / Bessong, Pascal / Richard, Stephanie A / McCormick, Benjamin J J

Gates open research

2020 Volume 4, Page(s) 71

Abstract: ... ...

Abstract	Background
Language	English
Publishing date	2020-11-26
Publishing country	United States
Document type	Journal Article
ISSN	2572-4754
ISSN (online)	2572-4754
DOI	10.12688/gatesopenres.13123.2
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Article ; Online: Characteristics associated with the transition to partial breastfeeding prior to 6 months of age: Data from seven sites in a birth cohort study.

Richard, Stephanie A / McCormick, Benjamin J J / Murray-Kolb, Laura E / Patil, Crystal L / Chandyo, Ram K / Mahopo, Cloupas / Maciel, Bruna L / Bose, Anuradha / Mahfuz, Mustafa / Ambikapathi, Ramya / Olortegui, Maribel Paredes / Caulfield, Laura E

Maternal & child nutrition

2021 Volume 17, Issue 3, Page(s) e13166

Abstract: The WHO recommends exclusive breastfeeding for the first 6 months of life. However, the transition of the infants' diet to partial breastfeeding with the addition of animal milks and/or solids typically occurs earlier than this. Here, we explored factors ...

Abstract	The WHO recommends exclusive breastfeeding for the first 6 months of life. However, the transition of the infants' diet to partial breastfeeding with the addition of animal milks and/or solids typically occurs earlier than this. Here, we explored factors associated with the timing of an early transition to partial breastfeeding across seven sites of a birth cohort study in which twice weekly information on infant feeding practices was collected. Infant (size, sex, illness and temperament), maternal (age, education, parity and depressive symptoms), breastfeeding initiation practices (time of initiation, colostrum and pre-lacteal feeding) and household factors (food security, crowding, assets, income and resources) were considered. Three consecutive caregiver reports of feeding animal milks and/or solids (over a 10-day period) were characterized as a transition to partial breastfeeding, and Cox proportional hazard models with time (in days) to partial breastfeeding were used to evaluate associations with both fixed and time-varying characteristics. Overall, 1470 infants were included in this analysis. Median age of transition to partial breastfeeding ranged from 59 days (South Africa and Tanzania) to 178 days (Bangladesh). Overall, higher weight-for-length z-scores were associated with later transitions to partial breastfeeding, as were food insecurity, and infant cough in the past 30 days. Maternal depressive symptoms (evaluated amongst 1227 infants from six sites) were associated with an earlier transition to partial breastfeeding. Relative thinness or heaviness within each site was related to breastfeeding transitions, as opposed to absolute z-scores. Further research is needed to understand relationships between local perceptions of infant body size and decisions about breastfeeding.
MeSH term(s)	Animals ; Bangladesh ; Breast Feeding ; Cohort Studies ; Female ; Humans ; Infant ; Pregnancy ; South Africa ; Tanzania
Language	English
Publishing date	2021-03-04
Publishing country	England
Document type	Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
ZDB-ID	2175105-5
ISSN	1740-8709 ; 1740-8695
ISSN (online)	1740-8709
ISSN	1740-8695
DOI	10.1111/mcn.13166
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Article ; Online: SARS-CoV-2 infection is associated with self-reported post-acute neuropsychological symptoms within six months of follow-up.

Andronescu, Liana R / Richard, Stephanie A / Scher, Ann I / Lindholm, David A / Mende, Katrin / Ganesan, Anuradha / Huprikar, Nikhil / Lalani, Tahaniyat / Smith, Alfred / Mody, Rupal M / Jones, Milissa U / Bazan, Samantha E / Colombo, Rhonda E / Colombo, Christopher J / Ewers, Evan / Larson, Derek T / Maves, Ryan C / Berjohn, Catherine M / Maldonado, Carlos J /

English, Caroline / Sanchez Edwards, Margaret / Rozman, Julia S / Rusiecki, Jennifer / Byrne, Celia / Simons, Mark P / Tribble, David / Burgess, Timothy H / Pollett, Simon D / Agan, Brian K

PloS one

2024 Volume 19, Issue 4, Page(s) e0297481

Abstract: Background: Chronic neuropsychological sequelae following SARS-CoV-2 infection, including depression, anxiety, fatigue, and general cognitive difficulties, are a major public health concern. Given the potential impact of long-term neuropsychological ... ...

Abstract	Background: Chronic neuropsychological sequelae following SARS-CoV-2 infection, including depression, anxiety, fatigue, and general cognitive difficulties, are a major public health concern. Given the potential impact of long-term neuropsychological impairment, it is important to characterize the frequency and predictors of this post-infection phenotype. Methods: The Epidemiology, Immunology, and Clinical Characteristics of Emerging Infectious Diseases with Pandemic Potential (EPICC) study is a longitudinal study assessing the impact of SARS-CoV-2 infection in U.S. Military Healthcare System (MHS) beneficiaries, i.e. those eligible for care in the MHS including active duty servicemembers, dependents, and retirees. Four broad areas of neuropsychological symptoms were assessed cross-sectionally among subjects 1-6 months post-infection/enrollment, including: depression (Patient Health Questionnaire-9), anxiety (General Anxiety Disorder-7), fatigue (PROMIS® Fatigue 7a), and cognitive function (PROMIS® Cognitive Function 8a and PROMIS® Cognitive Function abilities 8a). Multivariable Poisson regression models compared participants with and without SARS-CoV-2 infection history on these measures, adjusting for sex, ethnicity, active-duty status, age, and months post-first positive or enrollment of questionnaire completion (MPFP/E); models for fatigue and cognitive function were also adjusted for depression and anxiety scores. Results: The study population included 2383 participants who completed all five instruments within six MPFP/E, of whom 687 (28.8%) had at least one positive SARS-CoV-2 test. Compared to those who had never tested positive for SARS-CoV-2, the positive group was more likely to meet instrument-based criteria for depression (15.4% vs 10.3%, p<0.001), fatigue (20.1% vs 8.0%, p<0.001), impaired cognitive function (15.7% vs 8.6%, p<0.001), and impaired cognitive function abilities (24.3% vs 16.3%, p<0.001). In multivariable models, SARS-CoV-2 positive participants, assessed at an average of 2.7 months after infection, had increased risk of moderate to severe depression (RR: 1.44, 95% CI 1.12-1.84), fatigue (RR: 2.07, 95% CI 1.62-2.65), impaired cognitive function (RR: 1.64, 95% CI 1.27-2.11), and impaired cognitive function abilities (RR: 1.41, 95% CI 1.15-1.71); MPFP/E was not significant. Conclusions: Participants with a history of SARS-CoV-2 infection were up to twice as likely to report cognitive impairment and fatigue as the group without prior SARS-CoV-2 infection. These findings underscore the continued importance of preventing SARS-CoV-2 infection and while time since infection/enrollment was not significant through 6 months of follow-up, this highlights the need for additional research into the long-term impacts of COVID-19 to mitigate and reverse these neuropsychological outcomes.
MeSH term(s)	Humans ; Self Report ; COVID-19/complications ; COVID-19/epidemiology ; SARS-CoV-2 ; Follow-Up Studies ; Longitudinal Studies ; Fatigue/epidemiology ; Fatigue/etiology ; Anxiety Disorders
Language	English
Publishing date	2024-04-16
Publishing country	United States
Document type	Journal Article
ZDB-ID	2267670-3
ISSN	1932-6203 ; 1932-6203
ISSN (online)	1932-6203
ISSN	1932-6203
DOI	10.1371/journal.pone.0297481
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Article ; Online: Evaluating SARS-CoV-2 Saliva and Dried Blood Spot Surveillance Strategies in a Congregate Population.

Andronescu, Liana R / Richard, Stephanie A / Laing, Eric D / Pisanic, Nora / Coggins, Si'Ana A / Rivera, Magdielis Gregory / Kruczynski, Kate / Saperstein, Adam K / Modi, Jitendrakumar / Fraser, Jamie A / Shaikh, Saira / Broder, Christopher C / Burgess, Timothy H / Heaney, Christopher D / Pollett, Simon D / Millar, Eugene / Coles, Christian L / Simons, Mark P

Emerging infectious diseases

2023 Volume 29, Issue 9, Page(s) 1925–1928

Abstract: The optimal approach to COVID-19 surveillance in congregate populations remains unclear. Our study at the US Naval Academy in Annapolis, Maryland, USA, assessed the concordance of antibody prevalence in longitudinally collected dried blood spots and ... ...

Abstract	The optimal approach to COVID-19 surveillance in congregate populations remains unclear. Our study at the US Naval Academy in Annapolis, Maryland, USA, assessed the concordance of antibody prevalence in longitudinally collected dried blood spots and saliva in a setting of frequent PCR-based testing. Our findings highlight the utility of salivary-based surveillance.
MeSH term(s)	Humans ; SARS-CoV-2 ; COVID-19/diagnosis ; COVID-19/epidemiology ; Saliva ; COVID-19 Testing ; Clinical Laboratory Techniques
Language	English
Publishing date	2023-08-14
Publishing country	United States
Document type	Journal Article ; Research Support, U.S. Gov't, Non-P.H.S. ; Research Support, N.I.H., Extramural
ZDB-ID	1380686-5
ISSN	1080-6059 ; 1080-6040
ISSN (online)	1080-6059
ISSN	1080-6040
DOI	10.3201/eid2909.230417
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Article ; Online: Antigenic cartography using hamster sera identifies SARS-CoV-2 JN.1 evasion seen in human XBB.1.5 booster sera

Wang, Wei / Bhushan, Gitanjali L. / Paz, Stephanie / Stauft, Charles B. / Selvaraj, Prabhu / Goguet, Emilie / Bishop-Lilly, Kimberly A. / Subramanian, Rahul / Vassell, Russell / Lusvarghi, Sabrina / Cong, Yu / Agan, Brian / Richard, Stephanie A. / Epsi, Nusrat J. / Fries, Anthony / Fung, Christian K. / Conte, Matthew A. / Holbrook, Michael R. / Wang, Tony T. /

Burgess, Timothy H. / Mitre, Edward / Pollett, Simon D. / Katzelnick, Leah C. / Weiss, Carol D.

bioRxiv

Abstract: Antigenic assessments of SARS-CoV-2 variants inform decisions to update COVID-19 vaccines. Primary infection sera are often used for assessments, but such sera are rare due to population immunity from SARS-CoV-2 infections and COVID-19 vaccinations. Here, ...

Abstract	Antigenic assessments of SARS-CoV-2 variants inform decisions to update COVID-19 vaccines. Primary infection sera are often used for assessments, but such sera are rare due to population immunity from SARS-CoV-2 infections and COVID-19 vaccinations. Here, we show that neutralization titers and breadth of matched human and hamster pre-Omicron variant primary infection sera correlate well and generate similar antigenic maps. The hamster antigenic map shows modest antigenic drift among XBB sub-lineage variants, with JN.1 and BA.4/BA.5 variants within the XBB cluster, but with five to six-fold antigenic differences between these variants and XBB.1.5. Compared to sera following only ancestral or bivalent COVID-19 vaccinations, or with post-vaccination infections, XBB.1.5 booster sera had the broadest neutralization against XBB sub-lineage variants, although a five-fold titer difference was still observed between JN.1 and XBB.1.5 variants. These findings suggest that antibody coverage of antigenically divergent JN.1 could be improved with a matched vaccine antigen.
Keywords	covid19
Language	English
Publishing date	2024-04-06
Publisher	Cold Spring Harbor Laboratory
Document type	Article ; Online
DOI	10.1101/2024.04.05.588359
Database	COVID19

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Article ; Online: Revisiting the relationship of weight and height in early childhood.

Richard, Stephanie A / Black, Robert E / Checkley, William

Advances in nutrition (Bethesda, Md.)

2012 Volume 3, Issue 2, Page(s) 250–254

Abstract: Ponderal and linear growth of children has been widely studied; however, epidemiologic evidence of a relationship between the two is inconsistent. Child undernutrition in the form of low height for age and low weight for height continues to burden the ... ...

Abstract	Ponderal and linear growth of children has been widely studied; however, epidemiologic evidence of a relationship between the two is inconsistent. Child undernutrition in the form of low height for age and low weight for height continues to burden the developing world. A downward shift in the distribution of height for age in the first 2 y of life is commonly observed in many developing countries and is usually summarized as the percentage stunted (height for age Z-score <-2). Similar shifts are seen in weight for height; however, weight-for-height shifts are often less extreme, perhaps because weight for height is more tightly biologically controlled. Low height for age and low weight for height in childhood share some common factors, including food insecurity, infectious diseases, and inappropriate feeding practices. Reductions in weight for height, generally seen as a short-term response to inadequate dietary intake or utilization, are thought to precede decreases in height for age; however, given an adequate diet and no further insults, catch-up linear growth can occur. Serial instances of decreased weight for height, however, are thought to limit the degree of catch-up growth attained, contributing to linear growth retardation. Additional research is needed to identify the factors associated with recovery of linear growth after a child experiences decreased weight for height. Although the direct relationship between weight for height and height for age is likely limited, each of these measurements indicates important information about the general health of children and their risk of the development of illness or dying; therefore, eliminating the downward shift of height for age and weight for height in developing countries should be prioritized as a public policy.
MeSH term(s)	Body Height/physiology ; Body Weight/physiology ; Child, Preschool ; Developing Countries ; Health Status ; Humans ; Infant ; Infant, Newborn ; Risk Factors
Language	English
Publishing date	2012-03-01
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't ; Review
ZDB-ID	2583634-1
ISSN	2156-5376 ; 2156-5376
ISSN (online)	2156-5376
ISSN	2156-5376
DOI	10.3945/an.111.001099
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Article ; Online: Impact of early-onset persistent stunting on cognitive development at 5 years of age: Results from a multi-country cohort study.

Alam, Md Ashraful / Richard, Stephanie A / Fahim, Shah Mohammad / Mahfuz, Mustafa / Nahar, Baitun / Das, Subhasish / Shrestha, Binod / Koshy, Beena / Mduma, Estomih / Seidman, Jessica C / Murray-Kolb, Laura E / Caulfield, Laura E / Ahmed, Tahmeed

PloS one

2020 Volume 15, Issue 1, Page(s) e0227839

Abstract: Background: Globally more than 150 million children under age 5 years were stunted in 2018, primarily in low- and middle-income countries (LMICs), and the impact of early-onset, persistent stunting has not been well explored. To explore the association ... ...

Abstract	Background: Globally more than 150 million children under age 5 years were stunted in 2018, primarily in low- and middle-income countries (LMICs), and the impact of early-onset, persistent stunting has not been well explored. To explore the association between early-onset persistent stunting in children and cognitive development at 5 years of age, and to identify the factors associated with early-onset stunting. Methods and findings: Children from the MAL-ED cohort study were followed from birth to 5 years of age in six LMICs. The Wechsler Preschool Primary Scales of Intelligence (WPPSI) was used to assess cognitive abilities (fluid reasoning) at 5 years and was adapted for each culture. Stunting was categorized as early-onset persistent (first stunted at 1-6 months and persisting at 60 months), early-onset recovered (first stunted at 1-6 months and not stunted at 60 months), late-onset persistent (first stunted at 7-24 months and persisting at 60 months), late-onset recovered (first stunted at 7-24 months and not stunted at 60 months), and never (never stunted). Mixed effects linear models were used to estimate the relationship between stunting status and cognitive development. Children with early-onset persistent stunting had significantly lower cognitive scores (-2.10 (95% CI: -3.85, -0.35)) compared with those who were never stunted. Transferrin receptor (TfR) was also negatively associated with cognitive development (-0.31 (95% CI: -0.49, -0.13)), while the HOME inventory, an index of quality of the home environment (0.46 (95% CI: 0.21, 0.72)) and socio-economic status (1.50 (95% CI: 1.03, 1.98)) were positively associated with cognitive development. Conclusions: Early-onset persistent stunting was associated with lower cognitive development in children at 5 years of age in this cohort of children.
MeSH term(s)	Birth Weight/physiology ; Breast Feeding ; Child ; Child, Preschool ; Cognition/physiology ; Cognitive Dysfunction/epidemiology ; Cognitive Dysfunction/physiopathology ; Cohort Studies ; Female ; Growth Disorders/epidemiology ; Growth Disorders/physiopathology ; Humans ; Infant ; Inflammation/epidemiology ; Inflammation/physiopathology ; Intelligence Tests ; Linear Models ; Male ; Poverty ; Sanitation ; Social Class
Language	English
Publishing date	2020-01-24
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
ISSN	1932-6203
ISSN (online)	1932-6203
DOI	10.1371/journal.pone.0227839
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