Publications by authors named "Adi Gundlapalli"

Background: Understanding the risk of hospitalization from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections can guide effective public health interventions and severity assessments. This study calculated infection-hospitalization ratios (IHRs) and infection-case ratios (ICRs) to understand the relationship between SARS-CoV-2 infections, cases, and hospitalizations among different age groups during periods of Delta and Omicron variant predominance.

Methods: After calculating antinucleocapsid SARS-CoV-2 antibody seroprevalence using residual commercial laboratory serum specimens, 2 ratios were computed: (1) IHRs using coronavirus disease 2019 hospitalization data and (2) ICRs using Centers for Disease Control and Prevention surveillance data.

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People with immunocompromising conditions (IC) are at increased risk of severe COVID-19 and death. These individuals show weaker immunogenicity following vaccination than individuals without IC, yet immunogenicity after SARS-CoV-2 infection is poorly understood. To address this gap, the presence of infection-induced antibodies in sera following a positive COVID-19 test result was compared between patients with and without IC.

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We studied SARS-CoV-2 binding and neutralizing antibody titers among previously infected persons in the United States over time. We assayed SARS-CoV-2 spike protein receptor-binding domain and neutralizing antibody titers for a convenience sample of residual clinical serum specimens that had evidence of prior SARS-CoV-2 infection gathered during January 2021-February 2022. We correlated titers and examined them by age group (<18, 18-49, 50-64, and >65 years) across 4 different SARS-CoV-2 variant epochs.

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Objectives: To propose a framework for adoption of privacy-preserving record linkage (PPRL) for public health applications.

Methods: Twelve interviews with subject matter experts (SMEs) were conducted virtually and coded using an inductive approach. A collaborative session was conducted with SMEs to identify key steps in the PPRL project lifecycle which informed development of a PPRL implementation checklist.

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Article Synopsis
  • * A survey of 643 infectious disease providers revealed that 74% had used advanced molecular testing recently, with 16S rRNA gene sequencing being the most common method employed.
  • * Major barriers to using these tests included the lack of national guidelines and high costs, but there's potential for improvement in clinical practice and public health with better access and clear protocols.
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Mortality surveillance systems can have limitations, including reporting delays, incomplete reporting, missing data, and insufficient detail on important risk or sociodemographic factors that can impact the accuracy of estimates of current trends, disease severity, and related disparities across subpopulations. The Centers for Disease Control and Prevention used multiple data systems during the COVID-19 emergency response-line-level case‒death surveillance, aggregate death surveillance, and the National Vital Statistics System-to collectively provide more comprehensive and timely information on COVID-19‒associated mortality necessary for informed decisions. This article will review in detail the line-level, aggregate, and National Vital Statistics System surveillance systems and the purpose and use of each.

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Objectives: To understand the landscape of privacy preserving record linkage (PPRL) applications in public health, assess estimates of PPRL accuracy and privacy, and evaluate factors for PPRL adoption.

Materials And Methods: A literature scan examined the accuracy, data privacy, and scalability of PPRL in public health. Twelve interviews with subject matter experts were conducted and coded using an inductive approach to identify factors related to PPRL adoption.

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Article Synopsis
  • PCORnet is a major research network that standardizes clinical data from various health systems and expanded its infrastructure in 2018 to support public health surveillance of chronic diseases and COVID-19.
  • Enhancements included a new table for patient zip codes and a modular program for generating population health statistics; case studies showed significant findings for conditions like atrial fibrillation and cirrhosis.
  • By August 2023, most PCORnet sites were able to provide detailed patient data, demonstrating its potential to improve public health surveillance with comprehensive data across different health conditions.
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To better identify emerging or reemerging pathogens in patients with difficult-to-diagnose infections, it is important to improve access to advanced molecular testing methods. This is particularly relevant for cases where conventional microbiologic testing has been unable to detect the pathogen and the patient's specimens test negative. To assess the availability and utility of such testing for human clinical specimens, a literature review of published biomedical literature was conducted.

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Timely case notifications following the introduction of an uncommon pathogen, such as mpox, are critical for understanding disease transmission and for developing and implementing effective mitigation strategies. When Massachusetts public health officials notified the Centers for Disease Control and Prevention (CDC) about a confirmed orthopoxvirus case on May 17, 2023, which was later confirmed as mpox at CDC, mpox was not a nationally notifiable disease. Because existing processes for new data collections through the National Notifiable Disease Surveillance System were not well suited for implementation during emergency responses at the time of the mpox outbreak, several interim notification approaches were established to capture case data.

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The surveillance and identification of emerging, reemerging, and unknown infectious disease pathogens is essential to national public health preparedness and relies on fluidity, coordination, and interconnectivity between public and private pathogen surveillance systems and networks. Developing a national sentinel surveillance network with existing resources and infrastructure could increase efficiency, accelerate the identification of emerging public health threats, and support coordinated intervention strategies that reduce morbidity and mortality. However, implementing and sustaining programs to detect emerging and reemerging pathogens in humans using advanced molecular methods, such as metagenomic sequencing, requires making large investments in testing equipment and developing networks of clinicians, laboratory scientists, and bioinformaticians.

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Background: An increasing number of studies have described new and persistent symptoms and conditions as potential post-acute sequelae of SARS-CoV-2 infection (PASC). However, it remains unclear whether certain symptoms or conditions occur more frequently among persons with SARS-CoV-2 infection compared with those never infected with SARS-CoV-2. We compared the occurrence of specific COVID-associated symptoms and conditions as potential PASC 31- to 150-day following a SARS-CoV-2 test among adults and children with positive and negative test results.

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COVID-19 has highlighted challenges in the measurement quality and comparability of serological binding and neutralization assays. Due to many different assay formats and reagents, these measurements are known to be highly variable with large uncertainties. The development of the WHO international standard (WHO IS) and other pool standards have facilitated assay comparability through normalization to a common material but does not provide assay harmonization nor uncertainty quantification.

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Background: Because COVID-19 case data do not capture most SARS-CoV-2 infections, the actual risk of severe disease and death per infection is unknown. Integrating sociodemographic data into analysis can show consequential health disparities.

Methods: Data were merged from September 2020 to November 2021 from 6 national surveillance systems in matched geographic areas and analyzed to estimate numbers of COVID-19-associated cases, emergency department visits, and deaths per 100 000 infections.

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Hospitalizations involving fungal infections increased 8.5% each year in the United States during 2019-2021. During 2020-2021, patients hospitalized with COVID-19-associated fungal infections had higher (48.

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Primary immunodeficiencies (PIs) are a group of diseases that increase susceptibility to infectious diseases. Few studies have examined the relationship between PI and COVID-19 outcomes. In this study, we used Premier Healthcare Database, which contains information on inpatient discharges, to analyze COVID-19 outcomes among 853 adult PI and 1,197,430 non-PI patients who visited the emergency department.

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Article Synopsis
  • * The CDC conducted simulations to determine how the levels of immunity among MSM (from vaccination or past infections) can influence the risk and potential size of future mpox outbreaks.
  • * Jurisdictions with higher immunity (50%-100%) face minimal risk of recurrence, while those with lower immunity (below 25%) are more likely to experience larger outbreaks, highlighting the importance of ongoing access to mpox vaccinations.
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Monkeypox (mpox) is a serious viral zoonosis endemic in west and central Africa. An unprecedented global outbreak was first detected in May 2022. CDC activated its emergency outbreak response on May 23, 2022, and the outbreak was declared a Public Health Emergency of International Concern on July 23, 2022, by the World Health Organization (WHO),* and a U.

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As of March 7, 2023, a total of 30,235 confirmed and probable monkeypox (mpox) cases were reported in the United States, predominantly among cisgender men who reported recent sexual contact with another man (1). Although most mpox cases during the current outbreak have been self-limited, cases of severe illness and death have been reported (2-4). During May 10, 2022-March 7, 2023, 38 deaths among persons with probable or confirmed mpox (1.

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Article Synopsis
  • From May 2022 to January 2023, around 30,000 monkeypox cases were reported in the U.S. and over 86,000 globally, prompting recommendations for the JYNNEOS vaccine for those at increased risk.
  • The FDA authorized an Emergency Use Authorization (EUA) to allow the vaccine to be given intradermally, using about one-fifth of the subcutaneous dose while still generating an effective immune response.
  • As of January 31, 2023, over 1.1 million doses of JYNNEOS were administered, achieving approximately 36.7% first dose and 22.7% full vaccination coverage among at-risk individuals, with continued vaccination efforts necessary to prevent potential
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Article Synopsis
  • - Early in the COVID-19 pandemic, the CDC adapted its existing surveillance system to monitor cases and deaths efficiently, implementing a new aggregate case surveillance system for quicker data collection and emergency response.
  • - This new system enabled the CDC to gather and analyze COVID-19 data at national, state, and county levels, using innovative methods like web scraping and algorithms to streamline data accuracy and validation.
  • - The review emphasizes the importance of having a robust aggregate surveillance system ready for future health emergencies, providing near-real-time data to enhance response efforts beyond traditional individual case reporting.
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  • A survey of U.S.-based infectious disease physicians in March 2022 explored their perspectives on the clinical application of SARS-CoV-2 antibody tests during the COVID-19 pandemic.
  • *Out of nearly 1,900 surveyed, 40% responded; most had ordered antibody tests and felt comfortable interpreting results, primarily for diagnosing post-COVID conditions and identifying prior infections.
  • *There is a recognized need for clearer guidelines from professional societies and government agencies to enhance the appropriate use of these antibody tests in clinical settings.*
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Background And Objectives: Common variable immunodeficiency is a systemic disease and not solely a disease of humoral immunity. Neurologic symptoms associated with common variable immunodeficiency are underrecognized and warrant further study. This work aimed to characterize the neurologic symptoms reported by people living with common variable immunodeficiency.

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Background: An increasing number of studies have described new and persistent symptoms and conditions as potential post-acute sequelae of SARS-CoV-2 infection (PASC). However, it remains unclear whether certain symptoms or conditions occur more frequently among persons with SARS-CoV-2 infection compared with those never infected with SARS-CoV-2. We compared the occurrence of specific COVID-associated symptoms and conditions as potential PASC 31 to 150 days following a SARS-CoV-2 test among adults (≥20 years) and children (<20 years) with positive and negative test results documented in the electronic health records (EHRs) of institutions participating in PCORnet, the National Patient-Centered Clinical Research Network.

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