Publications by authors named "Malini DeSilva"
Background: Electronic health record (EHR) data are an underused source for lactation-related research. The validity of ICD-10-CM-coded lactational mastitis is unknown.
Methods: We assessed lactational mastitis diagnosis code validity by medical record review.
Background: The 2023-2024 influenza season had predominant influenza A(H1N1)pdm09 virus activity, but A(H3N2) and B viruses co-circulated. Seasonal influenza vaccine strains were well-matched to these viruses.
Methods: Using health care encounters data from health systems in 8 states, we evaluated influenza vaccine effectiveness (VE) against influenza-associated medical encounters from October 2023-April 2024.
Background: The JYNNEOS vaccine (two doses given 28 days apart) was recommended in the United States for people at high risk of exposure to monkeypox virus during the 2022 mpox outbreak. Our objective was to assess the safety of JYNNEOS using two complementary epidemiologic methods.
Methods: This observational cohort included patients of eight large integrated healthcare organizations who received JYNNEOS.
Background: Respiratory syncytial virus vaccines first recommended for use during 2023 were efficacious against lower respiratory tract disease in clinical trials. Limited real-world data regarding respiratory syncytial virus vaccine effectiveness are available. To inform vaccine policy and address gaps in evidence from the clinical trials, we aimed to assess the effectiveness against respiratory syncytial virus-associated hospitalisations and emergency department encounters among adults aged at least 60 years.
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- Disparities in COVID-19 vaccination rates among different racial and ethnic groups are known, but less research has focused on the impact of primary language on vaccine uptake.
- This study looked at how primary language and country of origin affected the timing of receiving primary COVID-19 vaccinations and booster shots among patients from a healthcare system in Minnesota and Wisconsin over four years.
- Results showed that while the majority of the 1,001,235 participants were English speakers, those with non-English primary languages had significantly lower vaccine coverage rates for both initial doses and boosters.
Article Synopsis
- The HealthPartners' Vaccine Safety Datalink team is using information from a Minnesota vaccination database to track vaccine safety better.
- They checked how many vaccines were recorded from this new source compared to older ones and found that a lot were only tracked through the Minnesota system.
- This helps them monitor the safety of both new and common vaccines more effectively, making sure more people’s vaccination records are up to date.
Purpose: Vaccine-associated enhanced disease (VAED) is a theoretical concern with new vaccines, although trials of authorized vaccines against SARS-CoV-2 have not identified markers for VAED. The purpose of this study was to detect any signals for VAED among adults vaccinated against coronavirus disease 2019 (COVID-19).
Methods: In this cross-sectional study, we assessed COVID-19 severity as a proxy for VAED among 400 adults hospitalized for COVID-19 from March through October 2021 at eight US healthcare systems.
Article Synopsis
- The 2022-2023 influenza season in the U.S. experienced high hospitalization rates and early influenza activity, primarily driven by A(H3N2) viruses, with some A(H1N1)pdm09 cases.
- A study using the test-negative design assessed the effectiveness of the influenza vaccine by comparing cases of influenza-positive patients to those who tested negative among adults with respiratory illness from October 2022 to March 2023.
- The results showed moderate vaccine effectiveness of 44% for emergency department visits and 35% for hospitalizations, indicating that vaccination helps reduce the impact of influenza during a challenging season with other circulating respiratory viruses.
Importance: COVID-19 vaccination is recommended throughout pregnancy to prevent pregnancy complications and adverse birth outcomes associated with COVID-19 disease. To date, data on birth defects after first-trimester vaccination are limited.
Objective: To evaluate the associated risks for selected major structural birth defects among live-born infants after first-trimester receipt of a messenger RNA (mRNA) COVID-19 vaccine.
Article Synopsis
- The study investigated the potential link between COVID-19 vaccination during pregnancy and the risk of stillbirth, addressing concerns of vaccine hesitancy among pregnant individuals.
- A matched case-control approach was used, analyzing data from 276 confirmed stillbirths and 822 live births to assess any significant associations with vaccination status.
- Results indicated no significant association between COVID-19 vaccination and stillbirth risk, regardless of vaccine type, number of doses, or timing of vaccination, suggesting that vaccination does not increase the risk of stillbirth in pregnant individuals.
Article Synopsis
- - This study aimed to assess whether getting vaccinated with mRNA COVID-19 vaccines during pregnancy affects the risk of adverse pregnancy outcomes like preterm birth and small-for-gestational age infants.
- - Researchers analyzed data from over 55,000 individuals with live singleton pregnancies and found that 42.3% received one or two doses of the vaccine, with the vaccination rate varying across maternal demographics.
- - The results indicated that vaccinated individuals had a lower risk of preterm birth compared to unvaccinated individuals, but the vaccination did not significantly impact the risks of small-for-gestational age infants, gestational diabetes, gestational hypertension, or preeclampsia.
Background: In the United States (US), COVID-19 vaccination rates among non-US-born individuals (i.e., refugees, immigrants, and migrants [RIM]) are variable.
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- The CDC recommended the updated 2023-2024 COVID-19 vaccination (monovalent XBB.1.5) for everyone aged 6 months and older to help prevent severe disease caused by COVID-19.
- For individuals with immunocompromising conditions, additional vaccine doses may be needed due to their increased risk of severe illness and potentially weaker vaccine responses.
- Vaccine effectiveness for the updated dose was about 38% for hospitalized adults with immunocompromising conditions 7-59 days post-vaccination and 34% between 60-119 days, but only 18% of this high-risk group had received the updated vaccine.
Background: Although psychiatric disorders have been associated with reduced immune responses to other vaccines, it remains unknown whether they influence COVID-19 vaccine effectiveness (VE). This study evaluated risk of COVID-19 hospitalization and estimated mRNA VE stratified by psychiatric disorder status.
Methods: In a retrospective cohort analysis of the VISION Network in four US states, the rate of laboratory-confirmed COVID-19-associated hospitalization between December 2021 and August 2022 was compared across psychiatric diagnoses and by monovalent mRNA COVID-19 vaccination status using Cox proportional hazards regression.
Interim Effectiveness of Updated 2023-2024 (Monovalent XBB.1.5) COVID-19 Vaccines Against COVID-19-Associated Emergency Department and Urgent Care Encounters and Hospitalization Among Immunocompetent Adults Aged ≥18 Years - VISION and IVY Networks, September 2023-January 2024.
MMWR Morb Mortal Wkly Rep
February 2024
Article Synopsis
- In September 2023, the CDC recommended the updated 2023-2024 monovalent XBB.1.5 COVID-19 vaccine for everyone aged 6 months and older to help prevent COVID-19, including severe cases.
- An analysis of vaccine effectiveness (VE) found that during the first 59 days after vaccination, the VE against COVID-19-related emergency department visits was 51%, which dropped to 39% after 60-119 days.
- The updated COVID-19 vaccine showed increased protection, with VE against hospitalizations being 52% and 43% between two networks, supporting CDC's guidelines for vaccination.
Interim Estimates of 2023-24 Seasonal Influenza Vaccine Effectiveness - United States.
MMWR Morb Mortal Wkly Rep
February 2024
In the United States, annual influenza vaccination is recommended for all persons aged ≥6 months. Using data from four vaccine effectiveness (VE) networks during the 2023-24 influenza season, interim influenza VE was estimated among patients aged ≥6 months with acute respiratory illness-associated medical encounters using a test-negative case-control study design. Among children and adolescents aged 6 months-17 years, VE against influenza-associated outpatient visits ranged from 59% to 67% and against influenza-associated hospitalization ranged from 52% to 61%.
View Article and Find Full Text PDFBackground: Understanding the long-term impact of the COVID-19 pandemic on health care utilization is important to health care organizations and policy makers for strategic planning, as well as to researchers when designing studies that use observational electronic health record data during the pandemic period.
Objective: This study aimed to evaluate the changes in health care utilization across all care settings among a large, diverse, and insured population in the United States during the COVID-19 pandemic.
Methods: We conducted a retrospective cohort study within 8 health care organizations participating in the Vaccine Safety Datalink Project using electronic health record data from members of all ages from January 1, 2017, to December 31, 2021.
COVID-19 disproportionately affects people experiencing homelessness or incarceration. While homelessness or incarceration alone may not impact vaccine effectiveness, medical comorbidities along with social conditions associated with homelessness or incarceration may impact estimated vaccine effectiveness. COVID-19 vaccines reduce rates of hospitalization and death; vaccine effectiveness (VE) against severe outcomes in people experiencing homelessness or incarceration is unknown.
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- The 2022-2023 influenza season in the U.S. saw the highest rate of pediatric hospitalization since 2010-2011, primarily caused by Influenza A/H3N2 infections.
- A study analyzed nearly 45,000 emergency department visits and hospitalizations for children aged 6 months to 17 years, focusing on the effectiveness of the influenza vaccine using a comparison between vaccinated and unvaccinated patients.
- Results showed that vaccination significantly reduced the risk of influenza-related emergency visits and hospitalizations by approximately 40-48%, emphasizing the importance of flu shots in preventing severe illness in kids and teens.
Article Synopsis
- - A study analyzed COVID-19 vaccine effectiveness among 521,206 emergency department visits and 139,548 hospitalizations between June 2021 and September 2022, focusing on adults with disabilities.
- - Of the encounters, only 2% had documented disabilities, but those individuals represent a significant portion of hospitalizations (12%).
- - The results showed that COVID-19 vaccines worked similarly for both disabled and non-disabled adults, highlighting the need for disabled individuals to keep their vaccinations current to protect against severe disease.
Background: The epidemiology of coronavirus disease 2019 (COVID-19) continues to develop with emerging variants, expanding population-level immunity, and advances in clinical care. We describe changes in the clinical epidemiology of COVID-19 hospitalizations and risk factors for critical outcomes over time.
Methods: We included adults aged ≥18 years from 10 states hospitalized with COVID-19 June 2021-March 2023.
Effectiveness of Monovalent and Bivalent mRNA Vaccines in Preventing COVID-19-Associated Emergency Department and Urgent Care Encounters Among Children Aged 6 Months-5 Years - VISION Network, United States, July 2022-June 2023.
MMWR Morb Mortal Wkly Rep
August 2023
Article Synopsis
- - On June 19, 2022, the FDA approved mRNA COVID-19 vaccines for young children based on safety and efficacy data from trials, with Pfizer-BioNTech for ages 6 months-4 years and Moderna for ages 6 months-5 years.
- - The CDC updated vaccine recommendations on December 9, 2022, including the use of bivalent vaccines for children aged 6 months and older, after assessing their effectiveness against hospital visits for COVID-19-like illness.
- - Effectiveness of two Moderna doses was found to be 29%, while three Pfizer doses showed 43% effectiveness; however, children who received at least one bivalent dose had an 80% effectiveness in preventing
Article Synopsis
- Immunocompromised (IC) individuals face a higher risk of severe COVID-19 and have reduced vaccine effectiveness compared to non-immunocompromised (non-IC) individuals.
- A study analyzed emergency department visits and hospitalizations among IC and non-IC adults, finding that vaccine effectiveness was significantly lower in IC patients, particularly for those who received 3 doses of mRNA vaccines or 1-2 doses of viral-vector vaccines.
- Despite some protection from vaccines, the results indicate a pressing need for additional safeguards for IC adults, especially transplant recipients who showed the lowest vaccine effectiveness.