Publications by authors named "Kelsey N Womack"

Background: Assessments of COVID-19 vaccine effectiveness are needed to monitor the protection provided by updated vaccines against severe COVID-19. We evaluated the effectiveness of original monovalent and bivalent (ancestral strain and Omicron BA.4/5) COVID-19 vaccination against COVID-19-associated hospitalization and severe in-hospital outcomes.

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AbstractIn response to the Covid-19 pandemic, the National Heart, Lung, and Blood Institute launched five multisite clinical trials testing candidate host tissue-directed medical interventions to hasten recovery, improve function, and reduce morbidity and mortality. Speed, flexibility, and collaboration were essential. This article from the Steering and Executive committees describes the Collaborating Network of Networks for Evaluating Covid-19 and Therapeutic Strategies (CONNECTS) research program that enrolled 6690 participants and evaluated 18 intervention strategies using 10 molecular agents across the care continuum (outpatient, inpatient, and post discharge), and reports lessons learned from this initiative.

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Article Synopsis
  • The study assessed the effectiveness of the updated 2023-2024 COVID-19 vaccine against hospitalization for two variant lineages, XBB and JN, in hospitalized patients across 26 hospitals in the U.S. between October 2023 and March 2024.
  • The results indicated a vaccine effectiveness (VE) of 54.2% against XBB and 32.7% against JN, suggesting that the JN lineage may have some level of immune escape.
  • However, the severity of cases with the JN lineage was not significantly worse compared to those with the XBB lineage, indicating similar risks of severe outcomes like ICU admission and death.
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Importance: On June 21, 2023, the Centers for Disease Control and Prevention recommended the first respiratory syncytial virus (RSV) vaccines for adults aged 60 years and older using shared clinical decision-making. Understanding the severity of RSV disease in adults can help guide this clinical decision-making.

Objective: To describe disease severity among adults hospitalized with RSV and compare it with the severity of COVID-19 and influenza disease by vaccination status.

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Article Synopsis
  • Prolonged SARS-CoV-2 infections may pose a risk for the development of mutated variants, particularly in immunocompromised individuals, but the specific types of immunosuppressive conditions that increase this risk have not been extensively studied.
  • A study conducted across five US medical centers involved 150 immunocompromised patients to identify factors contributing to extended SARS-CoV-2 infections through regular testing and genetic sequencing.
  • Results showed that patients with B-cell dysfunction and those who had solid organ transplants or HIV had longer durations of infection compared to those with autoimmune conditions, indicating varying risks based on the type of immunosuppression.
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Background: Influenza circulation during the 2022-2023 season in the United States largely returned to pre-coronavirus disease 2019 (COVID-19)-pandemic patterns and levels. Influenza A(H3N2) viruses were detected most frequently this season, predominately clade 3C.2a1b.

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Article Synopsis
  • On June 21, 2023, the CDC recommended RSV vaccination for adults aged 60 and older based on shared clinical decision-making, highlighting the need for understanding RSV disease severity among this group.
  • A study involving 5,784 hospitalized adults aged 60+ with respiratory illnesses from February 2022 to May 2023 showed that although RSV was less common, it was associated with more severe health outcomes compared to COVID-19 and influenza.
  • The findings indicated that older adults hospitalized with RSV were more likely to require intensive oxygen support, ICU admission, and had higher rates of invasive mechanical ventilation or death compared to those hospitalized for influenza.
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  • The study focused on prolonged SARS-CoV-2 infections in immunocompromised patients, aiming to identify which types of immunosuppression might lead to longer infections and increased viral mutations.
  • Conducted at five hospitals, the research enrolled 150 adults with various immunocompromising conditions and monitored their nasal specimens for changes in viral presence and mutations over several months.
  • Results indicated that while prolonged infections were rare, individuals with infections lasting over 56 days developed unique spike mutations not commonly found in the broader population, highlighting the risk of viral evolution in these patients.
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Background: Whether video laryngoscopy as compared with direct laryngoscopy increases the likelihood of successful tracheal intubation on the first attempt among critically ill adults is uncertain.

Methods: In a multicenter, randomized trial conducted at 17 emergency departments and intensive care units (ICUs), we randomly assigned critically ill adults undergoing tracheal intubation to the video-laryngoscope group or the direct-laryngoscope group. The primary outcome was successful intubation on the first attempt.

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Background: Accurate determination of COVID-19 vaccination status is necessary to produce reliable COVID-19 vaccine effectiveness (VE) estimates. Data comparing differences in COVID-19 VE by vaccination sources (i.e.

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Introduction: Understanding the changing epidemiology of adults hospitalized with coronavirus disease 2019 (COVID-19) informs research priorities and public health policies.

Methods: Among adults (≥18 years) hospitalized with laboratory-confirmed, acute COVID-19 between 11 March 2021, and 31 August 2022 at 21 hospitals in 18 states, those hospitalized during the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Omicron-predominant period (BA.1, BA.

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Article Synopsis
  • - As of April 2023, the COVID-19 pandemic resulted in 1.1 million deaths in the U.S., with 75% of those being adults aged 65 and older.
  • - A study evaluated the effectiveness of 2-4 doses of monovalent mRNA COVID-19 vaccines on preventing severe outcomes, finding a 62% effectiveness against invasive mechanical ventilation and in-hospital death for adults aged 18+, and 69% for those 65+.
  • - The vaccine effectiveness varied over time: 76% within the first 180 days after the last dose, dropping to 54% after 180-364 days and 56% after a year, emphasizing the importance of staying updated
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  • SARS-CoV-2 RNA levels, specifically total nucleocapsid (N) and subgenomic N (sgN), are commonly used indicators of how infectious someone with COVID-19 might be, but the influence of various host factors and virus variants on these levels was uncertain.
  • Researchers analyzed RNA levels in samples from over 3,200 hospitalized COVID-19 patients using RT-qPCR, examining how factors like time of sampling, virus variant, age, and vaccination impacted the RNA viral load.
  • Results indicated that RNA levels varied primarily by the type of SARS-CoV-2 variant and timing of symptom onset, but not based on patient age or vaccination, suggesting that subgenomic RNA measurements may not provide significant additional
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Introduction: Among critically ill patients undergoing orotracheal intubation in the emergency department (ED) or intensive care unit (ICU), failure to visualise the vocal cords and intubate the trachea on the first attempt is associated with an increased risk of complications. Two types of laryngoscopes are commonly available: direct laryngoscopes and video laryngoscopes. For critically ill adults undergoing emergency tracheal intubation, it remains uncertain whether the use of a video laryngoscope increases the incidence of successful intubation on the first attempt compared with the use of a direct laryngoscope.

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Monovalent COVID-19 mRNA vaccines, designed against the ancestral strain of SARS-CoV-2, successfully reduced COVID-19-related morbidity and mortality in the United States and globally (1,2). However, vaccine effectiveness (VE) against COVID-19-associated hospitalization has declined over time, likely related to a combination of factors, including waning immunity and, with the emergence of the Omicron variant and its sublineages, immune evasion (3). To address these factors, on September 1, 2022, the Advisory Committee on Immunization Practices recommended a bivalent COVID-19 mRNA booster (bivalent booster) dose, developed against the spike protein from ancestral SARS-CoV-2 and Omicron BA.

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Article Synopsis
  • The COVID-19 pandemic led to a decrease in influenza cases in 2020-2021, but there was a resurgence in 2021-2022 with a strain that was different from the vaccine used that season.
  • A study analyzed the effectiveness of the 2021-2022 influenza vaccine by comparing vaccinated and unvaccinated hospitalized patients across different age groups and health conditions using a multistate surveillance network.
  • Results showed that the vaccine reduced hospitalization risk for younger adults without health issues, but was ineffective for seniors aged 65 and older, highlighting the need for better vaccines and prevention methods.
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Background: Coronavirus disease 2019 (COVID-19) messenger RNA (mRNA) vaccines were authorized in the United States in December 2020. Although vaccine effectiveness (VE) against mild infection declines markedly after several months, limited understanding exists on the long-term durability of protection against COVID-19-associated hospitalization.

Methods: Case-control analysis of adults (≥18 years) hospitalized at 21 hospitals in 18 states 11 March-15 December 2021, including COVID-19 case patients and reverse transcriptase-polymerase chain reaction-negative controls.

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Background: The study objective was to evaluate 2- and 3-dose coronavirus disease 2019 (COVID-19) mRNA vaccine effectiveness (VE) in preventing COVID-19 hospitalization among adult solid organ transplant (SOT) recipients.

Methods: We conducted a 21-site case-control analysis of 10 425 adults hospitalized in March to December 2021. Cases were hospitalized with COVID-19; controls were hospitalized for an alternative diagnosis (severe acute respiratory syndrome coronavirus 2-negative).

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Background: We sought to assess whether persistent COVID-19 symptoms beyond 6 months (Long-COVID) among patients with mild COVID-19 is associated with poorer health status, quality of life, and psychological distress.

Methods: This was a multicenter prospective cohort study that included adult outpatients with acute COVID-19 from eight sites during 2-week sampling periods from April 1 and July 28, 2020. Participants were contacted 6-11 months after their first positive SARS-CoV-2 to complete a survey, which collected information on the severity of eight COVID-19 symptoms using a 4-point scale ranging from 0 (not present) to 3 (severe) at 1 month before COVID-19 (pre-illness) and at follow-up; the difference for each was calculated as an attributable persistent symptom severity score.

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COVID-19 mRNA vaccines (BNT162b2 [Pfizer-BioNTech] and mRNA-1273 [Moderna]) are effective at preventing COVID-19-associated hospitalization (1-3). However, how well mRNA vaccines protect against the most severe outcomes of these hospitalizations, including invasive mechanical ventilation (IMV) or death is uncertain. Using a case-control design, mRNA vaccine effectiveness (VE) against COVID-19-associated IMV and in-hospital death was evaluated among adults aged ≥18 years hospitalized at 21 U.

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Article Synopsis
  • The study aimed to evaluate the severity of COVID-19 caused by the alpha, delta, and omicron variants in hospitalized adults and assess how effective mRNA vaccines are in preventing hospital admissions related to each variant.
  • A total of 11,690 adults were included, with 5,728 COVID-19 patients classified by variant through genomic sequencing or predominant variant during admission times.
  • Results showed mRNA vaccines had an effectiveness of 85% against alpha and delta with two doses, while effectiveness dropped to 65% for omicron with two doses; delta variant patients displayed higher disease severity compared to those infected with alpha.
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Article Synopsis
  • - The study analyzed clinical severity of COVID-19 caused by Alpha, Delta, and Omicron variants among nearly 12,000 hospitalized adults across 21 U.S. hospitals, comparing hospitalized COVID-19 patients with a control group without the virus.
  • - mRNA vaccines showed varying effectiveness in preventing hospitalizations: 85% for Alpha and Delta variants with two doses, 94% for Delta with three doses, and 65% for Omicron with two doses, while effectiveness improved to 86% for Omicron with three doses.
  • - The severity of illness for unvaccinated patients was found to be higher in Delta cases compared to Alpha and lower in Omicron cases compared to Delta, indicating that vaccination generally leads to less
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