Publications by authors named "William F Fadel"

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.

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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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  • 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.
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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.

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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.

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  • 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.
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  • The study aims to evaluate the effectiveness of COVID-19 booster doses in preventing hospitalizations and emergency department visits, providing insight for public health policies.
  • Data was collected from over 1.2 million adults at five health systems during the Omicron variant's rise, showing that approximately 37% received a booster dose.
  • The median number needed to vaccinate (NNV) to prevent one hospitalization was 205, with lower NNV for adults aged 65 and older and those with health conditions, indicating booster effectiveness varies by age and health status.
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On September 1, 2022, CDC's Advisory Committee on Immunization Practices (ACIP) recommended a single bivalent mRNA COVID-19 booster dose for persons aged ≥12 years who had completed at least a monovalent primary series. Early vaccine effectiveness (VE) estimates among adults aged ≥18 years showed receipt of a bivalent booster dose provided additional protection against COVID-19-associated emergency department and urgent care visits and hospitalizations compared with that in persons who had received only monovalent vaccine doses (1); however, insufficient time had elapsed since bivalent vaccine authorization to assess the durability of this protection. The VISION Network* assessed VE against COVID-19-associated hospitalizations by time since bivalent vaccine receipt during September 13, 2022-April 21, 2023, among adults aged ≥18 years with and without immunocompromising conditions.

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  • A study evaluated the effectiveness of the BNT162b2 COVID-19 vaccine on children and adolescents during the Omicron BA.4/BA.5 period, focusing on its ability to protect against mild to moderate and severe cases of COVID-19.
  • The research compared data from nearly 10,000 emergency department cases and over 70,000 controls, finding that vaccine effectiveness decreased over time, especially during the Omicron variant's spread.
  • It concluded that while the vaccine offered significant protection initially, especially against hospitalizations, booster doses enhanced effectiveness, highlighting the importance of completing the vaccination schedule for children and adolescents.
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  • The Omicron sublineages BA.4 and BA.5 show increased immune evasion, reducing the effectiveness of COVID-19 mRNA vaccines in preventing illness among immunocompetent adults.
  • A study across 10 states focused on vaccinated adults, assessing the effectiveness of 2 to 4 vaccine doses during periods of BA.4 and BA.5 circulation, and examining the severity of COVID-19 in hospitalized patients across different Omicron sublineages.
  • Results indicated that in a large sample of emergency department and hospitalized patients, a significant portion tested positive for SARS-CoV-2, highlighting ongoing challenges in vaccine effectiveness and patient outcomes during these variant periods.
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  • A study was conducted in the U.S. to evaluate the effectiveness of COVID-19 mRNA vaccines and previous SARS-CoV-2 infections during Delta and Omicron variant periods.
  • The research found that both 2- or 3-dose vaccinated individuals and those with a prior infection had high protection against hospitalizations and emergency care during the Delta period (91%-97%), but this protection decreased during the Omicron period (77%-90%).
  • The results highlight that staying up-to-date with COVID-19 vaccinations continues to offer significant protection against severe illness, regardless of prior exposure to the virus.
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Objectives: Diagnosis of Clostridium difficile infection (CDI) can be challenging due to high colonization rates. Unlike PCR-only testing, two-step algorithm testing (that includes toxin and PCR) may help differentiate colonization from active infection, but it is unknown if this type of testing impacts treatment decisions. We examined the association between changing CDI diagnostic methods, the way the testing results were displayed, and the rates of CDI-specific treatment.

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Background: Coronavirus disease 2019 (COVID-19) vaccination coverage remains lower in communities with higher social vulnerability. Factors such as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) exposure risk and access to healthcare are often correlated with social vulnerability and may therefore contribute to a relationship between vulnerability and observed vaccine effectiveness (VE). Understanding whether these factors impact VE could contribute to our understanding of real-world VE.

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Background: We assessed coronavirus disease 2019 (COVID-19) vaccination impact on illness severity among adults hospitalized with COVID-19, August 2021-March 2022.

Methods: We evaluated differences in intensive care unit (ICU) admission, in-hospital death, and length of stay among vaccinated (2 or 3 mRNA vaccine doses) versus unvaccinated patients aged ≥18 years hospitalized for ≥24 hours with COVID-19-like illness and positive severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) molecular testing. We calculated odds ratios (ORs) for ICU admission and death and subdistribution hazard ratios (SHR) for time to hospital discharge adjusted for age, geographic region, calendar time, and local virus circulation.

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Background: Data are lacking regarding the risk of viral SARS-CoV-2 transmission during a large indoor sporting event involving fans utilizing a controlled environment. We sought to describe case characteristics, mitigation protocols used, variants detected, and secondary infections detected during the 2021 National Collegiate Athletic Association (NCAA) Men's Basketball Tournament involving collegiate athletes from across the U.S.

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  • The Advisory Committee on Immunization Practices (ACIP) recommended a 3-dose primary series and subsequent booster doses of mRNA COVID-19 vaccines specifically for immunocompromised adults, acknowledging the rise of the Omicron variant.
  • Data from a study indicate that the effectiveness of the vaccines varies, with a 36% effectiveness against hospitalization after 2 doses, increasing to 69% after 3 doses, but dropping to 44% after more than 90 days post-3rd dose during the Omicron variant period.
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Objective: To estimate the effectiveness of mRNA vaccines against moderate and severe covid-19 in adults by time since second, third, or fourth doses, and by age and immunocompromised status.

Design: Test negative case-control study.

Setting: Hospitals, emergency departments, and urgent care clinics in 10 US states, 17 January 2021 to 12 July 2022.

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Importance: Pregnant people are at high risk for severe COVID-19 but were excluded from mRNA vaccine trials; data on COVID-19 vaccine effectiveness (VE) are needed.

Objective: To evaluate the estimated effectiveness of mRNA vaccination against medically attended COVID-19 among pregnant people during Delta and Omicron predominance.

Design, Setting, And Participants: This test-negative, case-control study was conducted from June 2021 to June 2022 in a network of 306 hospitals and 164 emergency department and urgent care (ED/UC) facilities across 10 US states, including 4517 ED/UC encounters and 975 hospitalizations among pregnant people with COVID-19-like illness (CLI) who underwent SARS-CoV-2 molecular testing.

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Introduction: Understanding interests in and preferences for multipurpose technology (MPT) for the co-administration of contraception and antiretroviral therapy (ART) and alternative, non-oral ART methods among women living with HIV (WLHIV) is vital to successful implementation of future treatment options, such as long-acting injectable ART.

Methods: Between May 2016 and March 2017 we conducted a cross-sectional telephone survey of 1,132 WLHIV of reproductive potential with prior experience using intermediate- or long-acting contraceptive methods in western Kenya. We present descriptive statistics and multinomial logistic regression to evaluate predictors of interest in specific MPT and non-oral ART methods.

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  • CDC recommends a single COVID-19 booster dose for individuals aged 18 and older who received the Janssen vaccine, ideally with a different mRNA vaccine for better protection.
  • This recommendation is based on observed serious risk factors associated with the Janssen vaccine and data showing improved immunity with heterologous boosters.
  • A study comparing vaccine effectiveness showed that booster strategies significantly increased protection against COVID-19-related emergency visits and hospitalizations, particularly during the Omicron variant surge.
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  • - The BNT162b2 (Pfizer-BioNTech) vaccine showed over 90% efficacy in clinical trials for children and adolescents aged 5-17, but real-world effectiveness, especially against the Omicron variant, is still being evaluated.
  • - In a study analyzing data from over 39,000 encounters, vaccine effectiveness (VE) for children aged 5-11 was 46% shortly after the second dose, while adolescents aged 12-15 had a VE of 83% and those aged 16-17 had a VE of 76% during similar timeframes.
  • - VE significantly decreased after 150 days post-second dose during the Omicron variant's dominance, but improved to
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CDC recommends that all persons aged ≥12 years receive a booster dose of COVID-19 mRNA vaccine ≥5 months after completion of a primary mRNA vaccination series and that immunocompromised persons receive a third primary dose.* Waning of vaccine protection after 2 doses of mRNA vaccine has been observed during the period of the SARS-CoV-2 B.1.

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  • Estimates of COVID-19 mRNA vaccine effectiveness (VE) are declining due to factors such as waning immunity and increased immune evasion by variants like Delta and Omicron.
  • The CDC recommends a booster for everyone aged 12 and over, highlighting that the third dose can significantly enhance antibody levels and overall vaccine efficacy.
  • A study analyzing data from multiple states found that while VE against COVID-19 was high during the Delta variant phase, effectiveness dropped significantly during the Omicron phase, especially after two doses.
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