Publications by authors named "Mary P Nowalk"

While the number of immunocompromised (IC) individuals continues to rise, the existing literature on influenza vaccine effectiveness (VE) in IC populations is limited. Understanding the vaccine effectiveness (VE) of the seasonal influenza vaccines in immunocompromised (IC) populations remains paramount. Using 2017-2018 US Flu VE Network data, we examined the VE of the 2017-2018 seasonal influenza vaccine against symptomatic influenza in outpatient settings among IC adults.

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Introduction: The potential impact of an in-development 24-valent pneumococcal conjugate vaccine compared with that of currently recommended vaccines in older adults is unclear. Similar to most currently available pneumococcal conjugate vaccines, 24-valent pneumococcal conjugate vaccine's formulation is based on childhood pneumococcal disease epidemiology. Decision analysis techniques were used to estimate 24-valent pneumococcal conjugate vaccine cost-effectiveness and public health effects in U.

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Cigarette smoking confers additional risk from influenza. This study assessed the effect of smoking on humoral immune response to influenza vaccine. Adults ≥50 y of age were enrolled during the 2011-2016 influenza vaccination seasons in an observational prospective study.

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Article Synopsis
  • The study investigated the relationship between body mass index (BMI) and the effectiveness of influenza vaccines (VE) over seven seasons in adults and children.
  • Researchers analyzed data from over 40,000 patients, comparing vaccination status and BMI categories (normal, overweight, and obesity).
  • Findings showed that higher BMI did not significantly affect vaccine effectiveness against outpatient influenza, with VE rates remaining consistent across different BMI categories.
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Background: Human immunodeficiency virus (HIV) and hepatitis C (HCV) screening and human papillomavirus (HPV) vaccine uptake remain suboptimal. To improve HIV and HCV screening and HPV vaccination, the authors implemented a quality improvement project in three southwestern Pennsylvania family medicine residency practices.

Methods: From June 1 to November 30, 2021, participating practices used universal screening and vaccination guidelines and chose from multiple strategies at the office (for example, standing orders), provider (for example, multiple forms of provider reminders), and patient (for example, incentives) levels derived from published literature and tailored to local context.

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Background: The Advisory Committee on Immunization Practices (ACIP) uses the Evidence to Recommendations Framework that includes cost-effectiveness analyses (CEA) for determining vaccine recommendations. ACIP's preference for protecting adults ≥ 65 years is enhanced vaccines, including recombinant influenza vaccine (RIV4), adjuvanted or high dose influenza vaccine. Less is known about the CEA of enhanced vaccines for younger adults.

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Background: The 2022-23 US influenza season peaked early in fall 2022.

Methods: Late-season influenza vaccine effectiveness (VE) against outpatient, laboratory-confirmed influenza was calculated among participants of the US Influenza VE Network using a test-negative design.

Results: Of 2561 participants enrolled from December 12, 2022 to April 30, 2023, 91 laboratory-confirmed influenza cases primarily had A(H1N1)pdm09 (6B.

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Background: Multiple factors, such as less complex U.S. adult pneumococcal recommendations that could increase vaccination rates, childhood pneumococcal vaccination indirect effects that decrease adult vaccination impact, and increased vaccine hesitancy (particularly in underserved minorities), could diminish the cost-effectiveness of programs to increase pneumococcal vaccination in older adults.

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Indirect effects of childhood pneumococcal conjugate vaccines (PCV) have diminished the cost-effectiveness of current adult vaccine recommendations. An in-development adult-formulated 21-valent pneumococcal conjugate vaccine (PCV21) may play a critical role in reducing pneumococcal illness by targeting a larger number of serotypes responsible for adult pneumococcal infections. This study assesses the cost-effectiveness of PCV21 in US adults aged 50 years or older compared with currently recommended pneumococcal vaccines, from both the societal and healthcare perspectives.

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Objectives: This study assesses the impact of expanding pneumococcal vaccination to all 50-year-olds to decrease racial disparities by estimating from the societal perspective, the cost-effectiveness of 20-valent pneumococcal conjugate vaccine (PCV20) and 15-valent conjugate vaccine followed by 23-valent polysaccharide vaccine (PCV15/PPSV23) for 50-year-olds.

Methods: A Markov model compared the cost-effectiveness of PCV20 or PCV15/PPSV23 in all general population 50- and 65-years-olds compared with current US recommendations and with no vaccination in US Black and non-Black cohorts. US data informed model parameters.

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Objective: This study aimed to estimate the societal cost of racial disparities in pneumococcal disease among US adults aged ≥  50 years.

Methods: In a model-based analysis, societal costs of invasive pneumococcal disease (IPD) and hospitalized nonbacteremic pneumococcal pneumonia (NBP) were estimated using (1) direct medical costs plus indirect costs of acute illness; (2) indirect costs of pneumococcal mortality; and (3) direct and indirect costs of related disability. Disparities costs were calculated as differences in average per-person pneumococcal disease cost between Black and non-Black adults aged ≥  50 years multiplied by the Black population aged ≥  50 years.

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Both SARS-CoV-2 and influenza virus can be transmitted by asymptomatic, presymptomatic, or symptomatic infected persons. We assessed effects on work attendance while ill before and during the COVID-19 pandemic in the United States by analyzing data collected prospectively from persons with acute respiratory illnesses enrolled in a multistate study during 2018-2022. Persons with previous hybrid work experience were significantly less likely to work onsite on the day before through the first 3 days of illness than those without that experience, an effect more pronounced during the COVID-19 pandemic than during prepandemic influenza seasons.

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Background: Cell-based quadrivalent-inactivated influenza vaccine has been shown to have higher vaccine effectiveness than traditional egg-based quadrivalent-inactivated influenza vaccine. This is observed despite similar levels of serum hemagglutinin antibodies induced by each vaccine.

Methods: In this study, we examine peripheral immune activation after egg-based or cell-based influenza vaccination in a clinical trial in children.

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Introduction: CDC pneumococcal vaccination recommendations for older adults now include either 15- or 20-valent pneumococcal conjugate vaccine (PCV15/PCV20). However, an in-development 21-valent vaccine (PCV21), formulated based on adult pneumococcal disease epidemiology, could substantially increase coverage of disease-causing pneumococcal serotypes, particularly in Black older adults, who are at greater risk. The potential public health impact and cost-effectiveness of PCV21 compared to currently recommended vaccines in older adults is unclear.

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Article Synopsis
  • Few studies have examined the immune responses to recent influenza vaccines like cell-cultured inactivated influenza vaccine (ccIIV4) and live-attenuated influenza vaccine (LAIV4) in older children and young adults, especially using advanced antibody detection technology.
  • In a study with participants aged 4-21, those receiving ccIIV4 showed a greater immune response (particularly in IgG antibodies) compared to LAIV4, with younger participants responding best to LAIV4.
  • Results indicate that age and previous vaccinations influence immune responses to these vaccines, suggesting that while various immunoglobulin tests are useful, hemagglutination inhibition (HAI) titers are also significant for assessing post
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  • A study estimated the effectiveness of two and three mRNA COVID-19 vaccine doses against symptomatic illness due to SARS-CoV-2 Delta and Omicron variants in adults seeking outpatient care between October 2021 and February 2022.
  • The research involved 3,847 participants and found that vaccine effectiveness (VE) against symptoms was significantly higher for three doses compared to two doses, especially during the Delta variant period.
  • The results indicated that the three-dose regimen offered substantial protection against symptomatic illness when the Omicron variant was predominant, reinforcing the recommendation for a third vaccine dose.
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  • A study was conducted to assess the effectiveness of a newer influenza vaccine, recombinant influenza vaccine (RIV4), compared to standard dose vaccines (SD) during the 2018-2019 and 2019-2020 seasons.
  • The research involved a retrospective analysis of 5,515 patients aged 18-64 from electronic medical records, focusing on their vaccination status and influenza test results.
  • Overall vaccine effectiveness was found to be moderate at 37% for preventing medically attended outpatient visits, with RIV4 showing slightly higher effectiveness than SD, but the results were not statistically significant due to wide confidence intervals indicating limited power to draw conclusive comparisons.
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Article Synopsis
  • - The study investigated how mild SARS-CoV-2 infections affect health-related quality of life by comparing physical and mental health scores between COVID-19 and non-COVID patients after 6-8 weeks.
  • - Both groups showed improved physical health, but only COVID-19 patients experienced a boost in mental health, while the non-COVID group reported a decline.
  • - Key findings indicated that male sex and COVID-19 status were significant predictors of better health outcomes, with males with COVID-19 scoring higher in both physical and mental health compared to females.
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Persons with COVID-19-like illnesses are advised to stay home to reduce the spread of SARS-CoV-2. We assessed relationships between telework experience and COVID-19 illness with work attendance when ill. Adults experiencing fever, cough, or loss of taste or smell who sought healthcare or COVID-19 testing in the United States during March-November 2020 were enrolled.

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Background: In the United States, influenza activity during the 2021-2022 season was modest and sufficient enough to estimate influenza vaccine effectiveness (VE) for the first time since the beginning of the coronavirus disease 2019 pandemic. We estimated influenza VE against laboratory-confirmed outpatient acute illness caused by predominant A(H3N2) viruses.

Methods: Between October 2021 and April 2022, research staff across 7 sites enrolled patients aged ≥6 months seeking outpatient care for acute respiratory illness with cough.

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Background: Acute respiratory infections (ARIs) result in millions of illnesses and hundreds of thousands of hospitalizations annually in the United States. The responsible viruses include influenza, parainfluenza, human metapneumovirus, coronaviruses, respiratory syncytial virus (RSV), and human rhinoviruses. This study estimated the population-based hospitalization burden of those respiratory viruses (RVs) over 4 years, from July 1, 2015 to June 30, 2019, among adults ≥18 years of age for Allegheny County (Pittsburgh), Pennsylvania.

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Introduction: US pneumococcal vaccination recommendations for adults aged 65 years or older recently changed, with options for either 20-valent pneumococcal conjugate vaccine (PCV20) or the combination of 15-valent conjugate vaccine (PCV15) followed by 23-valent polysaccharide vaccine (PPSV23) 1 year later. Underserved minority adults are at higher risk for pneumococcal disease.

Methods: A Markov decision analysis model estimated the incremental cost-effectiveness of the newly adopted general population pneumococcal vaccination strategies in older underserved minority adults.

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Influenza vaccines can mitigate illness severity, including reduced risk of ICU admission and death, in people with breakthrough infection. Less is known about vaccine attenuation of mild/moderate influenza illness. We compared subjective severity scores in vaccinated and unvaccinated persons with medically attended illness and laboratory-confirmed influenza.

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Background: Numerous studies in the U.S. have made estimates of the RSV burden among adults that vary widely due to differences in methodology, reliance on influenza surveillance, which does not adequately capture all RSV clinical symptoms, and lack of diagnostic methods to identify RSV when viral loads are low.

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