Abstract Background The impact of SARS-CoV-2 infection and vaccination on menstruation is unclear. The goal of this study is to quantify the relationships between history of SARS-CoV-2 vaccination and infection and incident, clinically documented menstrual irregularities using data from the EPICC study in Military Health System (MHS) beneficiaries.Figure 1.Odds of menstrual irregularities associated with having been infected with or vaccinated against SARS-CoV-2 in certain timeframes (30, 90, 180, and 365 days prior to diagnosis or matched timepoint), after controlling for comorbidities in cases and controls matched on race/ethnicity, five-year age group, and BMI category in the Epidemiology, Immunology, and Clinical Characteristics of emerging infectious diseases with pandemic potential (EPICC) cohort. Methods This study included 18–50-year-old women who did not have pre-specified characteristics (e.g., pregnancy, breastfeeding, menopause) or pre-existing diagnoses of menstrual irregularities prior to the pandemic in their electronic medical record (MHS Data Repository (MDR)). Cases had a new diagnosis of a menstrual irregularity in the MDR between 3/2020 and 12/2022 and were matched 1:1 with a control of the same race/ethnicity, BMI category, and age category who did not have a menstrual irregularity diagnosis during that same time. Proportions with/without a history of SARS-CoV-2 infection and/or vaccination were compared. A logistic regression model provided estimates of the associations between SARS-CoV-2 infection or vaccination (in 30-, 90-, 180- or 365-days prior to diagnosis or matched timepoint) and diagnosis of menstrual irregularities.Table 1.Matched characteristics in those with and without menstrual irregularities in EPICC (N=249 cases, 249 controls) Results There were 270 participants (out of 1,156 women) with incident clinically documented menstrual irregularities identified over 2.8 years (8.3% per year from 3/20 to 12/22). Based on individual matching, 249 cases and controls were included in analyses (N=498, 21 cases did not have a matched control and were dropped) (Tables 1 & 2). Fewer controls than cases had a positive SARS-CoV-2 test in the prior 30, 180, and 365 days, whereas more controls reported being vaccinated in all time periods, but these were not statistically different (p >0.2) (Table 3). No statistically significant associations between 30, 90, 180, or 365-day history of SARS-CoV-2 infection or vaccination and menstrual irregularities were identified (Figure 1).Table 2.Incident menstrual-associated irregularities reported in 249 EPICC participants1 - 11 (4.4%) of the participants had more than one diagnosis Conclusion No relationship between recent SARS-CoV-2 infection/vaccination and clinically attended menstrual irregularities was observed in this analysis, but further studies are needed to confirm these findings. Future work will include analyses based on each vaccination and infection event using Cox proportional hazards models.Table 3.Participants’ history of SARS-CoV-2 infection and vaccination among those with and without menstrual irregularities in EPICC. P-values generated using Pearson’s Chi-squared tests. Disclosures Ryan C. Maves, MD, AiCuris: Grant/Research Support|Biotest: Grant/Research Support|GeoVax: Grant/Research Support|Shionogi: Advisor/Consultant|Shionogi: Honoraria|Sound Pharmaceuticals: Grant/Research Support Mark Simons, PhD, Astrazeneca: Grant/Research Support Timothy Burgess, MD, MPH, AstraZeneca: The IDCRP and HJF were funded to conduct an unrelated phase III COVID-19 monoclonal antibody immunoprophylaxis trial as part of US Govt COVID Response Simon Pollett, MBBS, AstraZeneca: The IDCRP and HJF were funded to conduct an unrelated phase III COVID-19 monoclonal antibody immunoprophylaxis trial as part of US Govt COVID Response
Little is known about diarrhea etiology and antibiotic resistance in developing countries where diarrhea is a major public health problem.To describe diarrhea etiology and antibiotic resistance patterns in Cambodia, 600 children aged 3 months to 5 years with acute diarrhea (cases) and 578 children without diarrhea (controls) were enrolled from a hospital in Phnom Penh. Stool samples were collected, and pathogens and antibiotic resistance patterns were described.The most frequently isolated pathogens in these cases were enteroaggregative Escherichia coli (20%) and rotavirus (26%). Enterotoxigenic E. coli, enteroaggregative E. coli, Shigella, Aeromonas, rotavirus, and adenovirus were statistically significantly associated with diarrhea. Among cases, vomiting was associated with viral infections, whereas bloody stool was associated with Shigella. Enterotoxigenic E. coli isolates were highly resistant to ampicillin, sulfonamides, and tetracycline. Approximately 50% of Campylobacter coli and 30% of Campylobacter jejuni isolates were resistant to nalidixic acid and ciprofloxacin. Over 33% of Salmonella isolates were resistant to ampicillin and tetracycline, and almost 100% of Shigella isolates were resistant to trimethoprim/sulfamethoxazole.These data on the etiology of diarrhea and antibiotic resistance patterns in Cambodia will have significant effect on local public health policies and on local resource prioritization practices.
Abstract Background The SARS-CoV-2 pandemic has spotlighted respiratory infections and the value of effective vaccines. The SARS-CoV-2 vaccine has been remarkably effective; however, influenza vaccine effectiveness has been reported to be lower among active duty military populations than in the general public (18% vs 36%). The Pragmatic Assessment of Influenza Vaccine Effectiveness in the DoD (PAIVED) study compares 3 FDA-licensed influenza vaccine types (egg-based, cell-based, and recombinant) to assess differences in immunogenicity and effectiveness in adults. Methods Participants in the 3rd year of PAIVED (2020/21 influenza season) were enrolled from October 2020 through January 2021. Participants received weekly surveys about influenza-like-illnesses (ILI) experienced in the past week; if they reported an ILI, they were queried about symptom duration and severity, and asked to self-collect a nasal swab and dried blood sample. Four weeks later, more information about symptom duration and illness burden was obtained via telephone interview, and the participant collected a second blood sample. Results PAIVED year 3 enrolled 3,269 participants (Table 1). 278 participants reported 1 ILI , while 60 reported 2 ILIs, and 18 reported 3 ILIs. No pathogen was identified for most processed ILI samples (78%); the most common viruses were SARS-CoV-2 (25, 12%), rhinovirus (24, 12%), and seasonal coronaviruses (4, 2%). No influenza has been identified thus far. Among those participants who had convalescent ILI visits (275), the median duration of the reported ILIs was 9 days (IQR 5, 15), with a median of 4 days (IQR 2, 7) of limited activity, and 2 days (IQR 0, 3) with fever. Three individuals were hospitalized. Conclusion There have been relatively low rates of ILI identified in this study during this season, with only 11% of the participants reporting an ILI so far, consistent with low rates of non-COVID-19 ILI reported elsewhere during the current pandemic. We anticipate some influenza cases may be identified as more samples are processed. Planned analyses include calculating comparative influenza vaccine effectiveness to inform future vaccine purchasing decisions, as well as comparing serological response to the different vaccines. Disclosures Ryan C. Maves, MD, EMD Serono (Advisor or Review Panel member)Heron Therapeutics (Advisor or Review Panel member) Jitu Modi, MD, GSK (Speaker’s Bureau)
The associations between clinical phenotypes of coronavirus disease 2019 (COVID-19) and the host inflammatory response during the transition from peak illness to convalescence are not yet well understood. Blood plasma samples were collected from 129 adult SARS-CoV-2 positive inpatient and outpatient participants between April 2020 and January 2021, in a multi-center prospective cohort study at 8 military hospitals across the United States. Plasma inflammatory protein biomarkers were measured in samples from 15 to 28 days post symptom onset. Topological Data Analysis (TDA) was used to identify patterns of inflammation, and associations with peak severity (outpatient, hospitalized, ICU admission or death), Charlson Comorbidity Index (CCI), and body mass index (BMI) were evaluated using logistic regression. The study population (n = 129, 33.3% female, median 41.3 years of age) included 77 outpatient, 31 inpatient, 16 ICU-level, and 5 fatal cases. Three distinct inflammatory biomarker clusters were identified and were associated with significant differences in peak disease severity (p < 0.001), age (p < 0.001), BMI (p < 0.001), and CCI (p = 0.001). Host-biomarker profiles stratified a heterogeneous population of COVID-19 patients during the transition from peak illness to convalescence, and these distinct inflammatory patterns were associated with comorbid disease and severe illness due to COVID-19.
Volatile organic compounds (VOCs) are produced systemically due to varied physiological states such as oxidative stress and are excreted through the lungs. Benchtop and preliminary clinical data suggest that breath testing may be a useful diagnostic modality for viral respiratory tract infections.Patients with influenza-like illness (ILI) presenting to a single clinic in San Antonio, Texas, from 3/2017 to 3/2019 submitted a 2-minute breath sample in addition to a nasopharyngeal swab collected for polymerase chain reaction (PCR) assay for respiratory pathogens. VOCs were assayed with gas chromatography-mass spectrometry (GC-MS), and data were analyzed to identify breath VOC biomarkers that discriminated between ILI patients with and without a polymerase chain reaction (PCR) assay that was positive for influenza.Demographic, clinical, PCR, and breath data were available for 237 episodes of ILI, among which 32 episodes (13.5%) were PCR positive for influenza. Twenty candidate VOCs identified patients with influenza with greater than random accuracy. A predictive algorithm using 4 candidate biomarkers identified this group with 78% accuracy (74% sensitivity, 70% specificity). Based on their mass spectra, most of these biomarkers were n-alkane derivatives, consistent with products of oxidative stress.A breath test for VOC biomarkers accurately identified ILI patients with PCR-proven influenza. These findings bolster those of others that a rapid, accurate, universal point-of-care influenza diagnostic test based on assay of exhaled-breath VOCs may be feasible. The next step will be a study of patients with ILI using a simplified method of breath collection that would facilitate translation for use in clinical practice.
Abstract Background Influenza-like illness (ILI) causes significant morbidity. This study aims to compare ILI incidence and severity of current tobacco smokers, former smokers, and non-smokers enrolled in a randomized clinical trial, comparing influenza vaccine effectiveness in a military population over 4 influenza seasons (2018-2022).Table 1.Selected characteristics of the PAIVED study population who responded to >50% of surveillance, by smoking status as reported at enrollment into the study. Methods Participants in the Pragmatic Assessment of Influenza Vaccine Effectiveness in the DoD (PAIVED) study responded to weekly surveillance and reported ILIs. Demographic information was collected at enrollment and the Influenza Patient-Reported Outcome (FLU-PRO) instrument was used to measure ILI severity. Analyses included Pearson’s Chi-squared test, ANOVA, and Kruskal-Wallis to compare selected characteristics (Table 1) and FLU-PRO scores based on smoking status. Poisson regression was used to assess the impact of smoking on ILI.Table 2:Risk of ILI was compared using a modified Poisson approach. Models were run separately for each variable, and the adjusted model includes all the variables listed in the table. Results Over half (56%) of PAIVED participants (8,596/15,432) responded to ≥50% of the ILI surveys and had complete demographic data. The demographic characteristics were different among current smokers, former smokers, and non-smokers (p< 0.001) (Table 1), with smokers more likely to be male and have lower educational levels, among other differences. Over one third (36%) of participants experienced an ILI during the influenza season in which they were enrolled. After adjusting for sex, age, military status, influenza season, and healthcare worker status, former smokers were 14% more likely to report an ILI (aRR 1.14, 95% CI 1.05-1.25) compared to non-smokers, while no difference was observed for current smokers (aRR 0.98, 95% CI 0.84-1.14) (Table 2). Among those with ILIs (N=3,117) who filled out a FLU-PRO survey (N=2,111), FLU-PRO severity scores in the respiratory and eye symptoms domains were different by smoking status, with current smokers reporting the highest scores (p< 0.02) (Table 3).Table 3:Maximum FLU-PRO scores (mean (SD)) by smoking status for ILIs reported in the PAIVED study. Conclusion Former smokers were more likely to report ILI compared to non-smokers. Current and former smokers diagnosed with ILI reported higher respiratory and eye symptom scores than non-smokers. Future analysis will include smoking history (number in the past 7 days, years of smoking), reported electronic cigarette use, and an exploration of asthma and COPD as contributing factors. Disclosures Ryan C. Maves, MD, AiCuris: Grant/Research Support|Biotest: Grant/Research Support|GeoVax: Grant/Research Support|Shionogi: Advisor/Consultant|Shionogi: Honoraria|Sound Pharmaceuticals: Grant/Research Support Mark Simons, PhD, Astrazeneca: Grant/Research Support Simon Pollett, MBBS, AstraZeneca: The IDCRP and HJF were funded to conduct an unrelated phase III COVID-19 monoclonal antibody immunoprophylaxis trial as part of US Govt COVID Response Timothy Burgess, MD, MPH, AstraZeneca: The IDCRP and HJF were funded to conduct an unrelated phase III COVID-19 monoclonal antibody immunoprophylaxis trial as part of US Govt COVID Response
Abstract Background Genomic surveillance of acute respiratory infections (ARIs) is conventionally limited to nasopharyngeal PCR swab sequencing, missing many ARIs. “Acute Respiratory Infections at the Academy” (ARIA) is an augmented surveillance study of medically attended ARIs (MAARIs) at the United States Naval Academy (USNA). We leveraged this study to examine whether rapid antigen (Ag) tests performed for SARS-CoV-2 (SC2) could serve to detect and sequence SC2 and influenza viruses. Methods ARIA began accruing data and specimens on 3/20/23 from individuals who presented to an onsite clinic with an acute illness for which a respiratory specimen (i.e., nasal or nasopharyngeal) was collected. Per standard of care (SOC), patients with suspected ARI undergo rapid Ag testing (Binax Now) for SC2 upon presentation to the clinic; if the Ag test is negative, PCR testing for SC2, influenza, and RSV is also performed. For ARIA, all swabs (including nasal swabs obtained for rapid Ag testing) are retained and sent to a partner laboratory (USAFSAM) for expanded multiplex molecular testing plus genomic sequencing of all SC2 and influenza positive specimens. Results In the first 2 weeks of the study, 228 MAARI cases were identified, of which 14 (6.1%) were positive for SC2 or influenza by SOC rapid antigen testing (n=6) or PCR testing (n=8). Further molecular analysis at USAFSAM through multiplex PCR identified ≥ 1 pathogen in an additional 74 (32.5%) cases, most commonly rhinovirus/enterovirus (n=38) or human coronavirus NL63 (n=14) (Table 1). Among Ag swabs that had any virus detected via FluSC2 rRT-PCR testing at USAFSAM, we successfully performed viral genomic sequencing on the first 8; 1 case of influenza H1N1 clade 6B.1A.5a.2a.1 and 7 cases of SC2 variant Omicron XBB.1.5 were identified, including from one Ag swab that had low concentration of SC2 viral RNA (8.5 viral genome equivalents/reaction; PCR Ct 35.0). Conclusion We demonstrated the feasibility of sequencing and genotyping influenza and SC2 from a residual anterior nasal swab after use in rapid SC2 Ag testing. Further, a SC2 variant was determinable on Ag swabs with low quantities of SC2 viral RNA. This is a key proof-of-concept for ARI surveillance, especially as rapid SC2 Ag testing is increasingly used in clinical practice. Disclosures Simon Pollett, MBBS, AstraZeneca: The IDCRP and the Henry M. Jackson Foundation (HJF) were funded to conduct an unrelated phase III COVID-19 monoclonal antibody immunoprophylaxis trial Timothy Burgess, MD, MPH, AstraZeneca: The IDCRP and the Henry M. Jackson Foundation (HJF) were funded to conduct an unrelated phase III COVID-19 monoclonal antibody immunoprophylaxis trial Mark P. Simons, PhD, AstraZeneca: The IDCRP and HJF were funded to conduct an unrelated phase III COVID-19 monoclonal antibody immunoprophylaxis trial as part of US Govt COVID Response
Nous presentons dans ce memoire les applications de l'imagerie par resonance magnetique (irm) a l'etude de la peau in vivo. La haute resolution spatiale, indispensable pour visualiser les differentes couches de la peau, est obtenue a l'aide d'un module specialement concu par les laboratoires de recherche fondamentale a l'oreal et l'institut d'electronique fondamentale (orsay), qui a ete adapte a l'imageur corps entier du centre inter-etablissement de resonance magnetique (cierm). Dans une premiere partie, nous rappelons les bases physiques de l'irm et nous decrivons la structure de la peau ainsi que sa composition. La deuxieme partie du memoire est consacree a l'imagerie, nous decrivons quelles ont ete les etapes de calibration (evaluation de la resolution) et d'optimisation de ces images avant de montrer quel type d'information est accessible sur la peau saine pour differents sites topographqiues puis pour quelques cas de pathologies dermatologiques. Dans une troisieme partie, nous presentons l'irm en tant qu'outil de caracterisation tissulaire applique a l'etude de la peau. Les protocoles de mesure des temps de relaxation t1 et t2 et de la densite relative de protons n(h), une fois definis et valides, nous ont permis de caracteriser les differentes couches de la peau in vivo. Le derme est caracterise par des valeurs faibles de t2 et de n(h), qui sont liees a la quantite comme a la qualite du collagene dermique. Les premiers resultats obtenus dans le cadre de l'etude du vieillissement montrent que cet outil, non invasif, d'imagerie et de caracterisation tissulaire fournit des informations susceptibles d'interesser la dermatologie comme la cosmetologie
