Lack of association between HLA and asymptomatic SARS-CoV-2 infection (preprint)

Human genetic studies of critical COVID-19 pneumonia have revealed the essential role of type I interferon-dependent innate immunity to SARS-CoV-2 infection. Conversely, an association between the HLA-B*15:01 allele and asymptomatic SARS-CoV-2 infection in unvaccinated individuals was recently reported, suggesting a contribution of pre-existing T cell-dependent adaptive immunity. We report a lack of association of classical HLA alleles, including HLA-B*15:01, with pre-omicron asymptomatic SARS-CoV-2 infection in unvaccinated participants in a prospective population-based study in the US (191 asymptomatic vs. 945 symptomatic COVID-19 cases). Moreover, we found no such association in the international COVID Human Genetic Effort cohort (206 asymptomatic vs. 574 mild or moderate COVID-19 cases and 1,625 severe or critical COVID-19 cases). Finally, in the Human Challenge Characterisation study, the three HLA-B*15:01 individuals infected with SARS-CoV-2 developed symptoms. As with other acute primary infections, no classical HLA alleles favoring an asymptomatic course of SARS-CoV-2 infection were identified. These findings suggest that memory T-cell immunity to seasonal coronaviruses does not strongly influence the outcome of SARS-CoV-2 infection in unvaccinated individuals.

Recruitment, Consent and DNA Sample Acquisition in a U.S. Precision Health Cohort During the COVID-19 Pandemic (preprint)

Aim: The Yale Generations Project (YGP) is a precision health cohort initiative that began enrollment in New Haven Connecticut USA in July 2019. In March 2020, after nine months of operation, pandemic restrictions prompted abrupt changes to staff availability as well as changes to the projects recruitment, consenting, and sample acquisition. This manuscript describes the successful addition of remote recruitment, consenting, and DNA sampling to YGP workflows during the initial 27-months of pandemic restrictions ending June 30, 2022. Methods: The initial YGP protocol established face-to-face workflow for recruiting, consenting and peripheral blood collection. A telemedicine consent protocol was initiated in April of 2020, and a remote saliva collection was established in October of 2020. De-identified data was extracted from YGP dataset and reported here. Results: At the completion of YGPs initial 36 months (9-months pre-pandemic and 27-months pandemic) YGP enrolled N=4949 volunteers. There were N=1,950 (216.7 per month) volunteers consented pre-pandemic and N=2,999 (111.1 per month) during pandemic. The peak consenting month was February 2020 with N=428. DNA sample acquisition peaked in the pre-pandemic month of February 2020 with N=291 peripheral blood draws, and in the pandemic period the peak DNA acquisition month was November 2020 with N=176 (N=68 peripheral blood draws and N=108 saliva samples). Conclusion: The YGP successfully transitioned from pre-pandemic recruiting, consenting and sample acquisition model that was exclusively face-to-face, to pandemic model that was predominantly remote. The added value of remote recruiting, consenting, and sampling has led to plans for an optimized hybrid model post-pandemic. Keywords: genomics, precision health, COVID-19, cohort

At the Confluence of COVID-19 and Anti-Black Racial Violence: Exploring Independent Schools' Diversity, Equity, and Inclusion Practice

The COVID-19 pandemic and heightened awareness of police violence against Black Americans in 2020 reverberated throughout educational institutions including private, non-religious schools. This survey study (n=242) sought to understand the impact of these crises on independent schools' Diversity, Equity, and Inclusion (DEI) leaders. Results indicate that while 45% of included schools had a robust DEI practice pre-2020, these crises created an environment of these competing crises. Many schools experienced reductions in resources and increasing resistance to DEI. Overall, pre-2020 robustness of a DEI practice did not predict school responses to the crises. Implications for DEI policy and leadership are discussed. [ FROM AUTHOR] Copyright of Journal of School Choice is the property of Taylor & Francis Ltd and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

Educator perspectives on non-technical, discipline-independent skill acquisition: An international, qualitative study.

Gross anatomy education utilizing body donors and human specimens assists the acquisition of non-traditional, discipline-independent skills (NTDIS) such as teamwork, communication, and leadership. Alterations to anatomy curricula, such as those resulting from the COVID-19 pandemic, likely impact NTDIS acquisition, yet how this manifests is unclear. This study, therefore, explored anatomy educator perspectives on NTDIS acquisition as a response to changes in teaching delivery. Gross anatomy educators across different countries were recruited and took part in one-on-one, semi-structured interviews that were audio recorded and transcribed. Data were analyzed using the framework method. Basic statistical analyses were performed on demographic and categorical data. Fifteen educators from five continents were interviewed (average length 32.5 min, range 17-51 min). Educator experience ranged from 0-4 years (n = 3) to 20+ years (n = 7). Most taught using dissection (n = 14) with prosection use (n = 13) also common. Themes relating to NTDIS included expected content (respect for donors, teamwork, communication skills, humanistic values), assessable content, assessment challenges, and impact of curriculum changes; NTDIS unique to anatomy education included cultural, ethical, and social considerations around dead bodies, including boundaries, and social norms. Informed by curriculum alterations during the COVID-19 pandemic, this first empirical study of anatomy educator perspectives on NTDIS highlights the potentially adverse educational impacts of decreased interaction with body donors and human specimens on NTDIS acquisition and difficulties with NTDIS assessment. Findings support gross anatomy education as unique in providing NTDIS that cannot easily be replicated elsewhere. Recommendations around NTDIS-specific educator competencies and promoting NTDIS are provided.

Characteristics of nursing home residents and healthcare personnel with repeated severe acute respiratory coronavirus virus 2 (SARS-CoV-2) tests positive ≥90 days after initial infection: Four US jurisdictions, July 2020-March 2021.

One in six nursing home residents and staff with positive SARS-CoV-2 tests ≥90 days after initial infection had specimen cycle thresholds (Ct) <30. Individuals with specimen Ct<30 were more likely to report symptoms but were not different from individuals with high Ct value specimens by other clinical and testing data.

Prognostic peripheral blood biomarkers at ICU admission predict COVID-19 clinical outcomes.

The COVID-19 pandemic continues to challenge the capacities of hospital ICUs which currently lack the ability to identify prospectively those patients who may require extended management. In this study of 90 ICU COVID-19 patients, we evaluated serum levels of four cytokines (IL-1ß, IL-6, IL-10 and TNFα) as well as standard clinical and laboratory measurements. On 42 of these patients (binned into Initial and Replication Cohorts), we further performed CyTOF-based deep immunophenotyping of peripheral blood mononuclear cells with a panel of 38 antibodies. All measurements and patient samples were taken at time of ICU admission and retrospectively linked to patient clinical outcomes through statistical approaches. These analyses resulted in the definition of a new measure of patient clinical outcome: patients who will recover after short ICU stays (< 6 days) and those who will subsequently die or recover after long ICU stays (≥6 days). Based on these clinical outcome categories, we identified blood prognostic biomarkers that, at time of ICU admission, prospectively distinguish, with 91% sensitivity and 91% specificity (positive likelihood ratio 10.1), patients in the two clinical outcome groups. This is achieved through a tiered evaluation of serum IL-10 and targeted immunophenotyping of monocyte subsets, specifically, CD11clow classical monocytes. Both immune biomarkers were consistently elevated ( ≥15 pg/ml and ≥2.7 x107/L for serum IL-10 and CD11clow classical monocytes, respectively) in those patients who will subsequently die or recover after long ICU stays. This highly sensitive and specific prognostic test could prove useful in guiding clinical resource allocation.

Allied health clinical placements with a remote supervision model: Students' and clinical educators' perceptions

COVID-19 restrictions prompted change to clinical placements for students, including a move to a remote supervision model where students, clinical educators, and patients were geographically remote from each other but connected via videoconferencing technology. A total of seven students and 11 clinical educators from occupational therapy and speech pathology participated in focus groups, reflecting on their experiences and perceptions of the rapid transition to remote supervision. Qualitative data were analyzed using a thematic analysis approach. No participants had experience with remote supervision prior to COVID-19. Three key themes were generated from the data: (a) key considerations, processes, and suggestions for remote supervision, (b) impact of remote supervision on relationship development, and (c) development of student professional competencies within the model. This study provides insights and practical considerations for implementing remote supervision and confirms this model can effectively meet students' supervision needs and support the development of professional competencies. [ FROM AUTHOR] Copyright of Distance Education is the property of Routledge and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

Where There Is (No) Smoke, There Is Still Fire: a Review of Trends, Reasons for Use, Preferences and Harm Perceptions of Adolescent and Young Adult Electronic Cigarette Use.

Purpose of the review: To review the current prevalence, trends, perceptions, and effects of e-cigarette or vaping product use associated lung injury (EVALI) on e-cigarette use among US adolescents and young adults. Recent findings: COVID-19 diagnosis was more likely among the current/ever dual cigarette and e-cigarettes users, as well as ever e-cigarette only users. Additionally, the EVALI outbreak may have influenced harm perceptions, as daily nicotine vaping declined significantly from 2019 to 2020, and more youth and young adults perceived vaping as harmful. Summary: The prevalence of e-cigarette use, specifically flavored use, remains high among adolescents and young adults, which is concerning due to the short-term and unknown long-term effects of e-cigarettes and their association with future cigarette and other substance use.

Implementation of a Telehealth Genetic Testing Station to Deliver Germline Testing for Men With Prostate Cancer.

PURPOSE: Germline testing for men with prostate cancer (PCa) poses numerous implementation barriers. Alternative models of care delivery are emerging, but implementation outcomes are understudied. We evaluated implementation outcomes of a hybrid oncologist- and genetic counselor-delivered model called the genetic testing station (GTS) created to streamline testing and increase access. METHODS: A prospective, single-institution, cohort study of men with PCa referred to the GTS from October 14, 2019, to October 14, 2021, was conducted. Using the Reach, Effectiveness, Adoption, Implementation, and Maintenance framework, we described patients referred to GTS (Reach), the association of GTS with germline testing completion rates within 60 days of a new oncology appointment in a pre- versus post-GTS multivariable logistic regression (Effectiveness), Adoption, Implementation, and Maintenance. Because GTS transitioned from an on-site to remote service during the COVID-19 pandemic, we also compared outcomes for embedded versus remote GTS. RESULTS: Overall, 713 patients were referred to and eligible for GTS, and 592 (83%) patients completed germline testing. Seventy-six (13%) patients had ≥ 1 pathogenic variant. Post-GTS was independently associated with higher odds of completing testing within 60 days than pre-GTS (odds ratio, 8.97; 95% CI, 2.71 to 29.75; P < .001). Black race was independently associated with lower odds of testing completion compared with White race (odds ratio, 0.35; 95% CI, 0.13 to 0.96; P = .042). There was no difference in test completion rates or patient-reported decisional conflict for embedded versus remote GTS. GTS has been adopted by 31 oncology providers across four clinics, and implementation fidelity was high with low patient loss to follow-up, but staffing costs are a sustainability concern. CONCLUSION: GTS is a feasible, effective model for high-volume germline testing in men with PCa, both in person and using telehealth. GTS does not eliminate racial disparities in germline testing access.

Developing Authentic Mentorship Through Professional Organizations

Harsh realities in pandemic fatigue, burnout, inequities, and isolation are impacting academic pharmacy. Mentoring programs, especially inter-institutional programs such as those provided within the Sections and Special Interest Groups (SIGs) of the American Association of Colleges of Pharmacy (AACP), may combat some of these issues. Unfortunately, year after year, Academy members continue to request information from these groups on mentoring, whether it be the opportunity to pair up, for advice on how to be better mentors, or for guidance on how to develop a program on mentoring for the Sections and SIGs without an existing program. The need for authentic mentoring is vital to the success and retention of faculty and staff within the Academy. Therefore, it may be appropriate to take a closer look at why, despite ongoing mentoring programs scattered within AACP Sections and SIGs, these programs are unable to fulfill the needs of participants. [ FROM AUTHOR] Copyright of American Journal of Pharmaceutical Education is the property of American Association of Colleges of Pharmacy and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

Asynchronous student engagement in analysis of climate data achieves learning objectives related to climate change understanding, statistical competence, and climate anxiety

Learning in asynchronous online environments has gained importance over the last several decades, and educational environment shifts from the COVID-19 pandemic appear to have increased this need. Science educators and students need information about which approaches work in the asynchronous environment where informal feedback tends to be reduced, compared to other teaching modalities. In this study, we asynchronously implemented a learning module across 5 institutions that guided students (N = 199) from prescriptive data analysis through guided inquiry and eventually to open inquiry. The module focuses on the science behind climate change. Students work with the same authentic data sets used by professional scientists to examine geologic history and causes of climate change. By analyzing contemporary atmospheric carbon dioxide and temperature data and then using the 800,000-year record available from the Vostok ice core proxy record of atmospheric properties, students identify the causes of climate change and discover the unprecedented nature of recent atmospheric changes. Using a pre/post-module assessment, we demonstrate improvement in students' understanding of climate change processes and statistical methods used to analyze data. However, there was no evidence that the module develops students' scientific reasoning about the relationship between causation and correlation. Students maintained that correlation is not causation, even when a robust causal mechanism (i.e., the greenhouse effect) explains the link between atmospheric carbon dioxide and temperature. Finally, our analysis indicated that generally, anxiety about climate change was reduced during the module, such that students become less anxious about the climate change the more they learn about it. However, science-denying students experienced much higher anxiety about climate change than students who accepted the scientific consensus about climate change. Climate science-dissenting students were so few in this study that a statistical comparison was not possible, but this intriguing finding warrants further investigation of the role of anxiety in science denial. Mainly, this study demonstrates how asynchronous online learning environments can indeed support the achievement of learning objectives related to conducting authentic science, such as increasing understanding of climate change and statistical concepts, all while not provoking anxiety about climate change. © 2023 The Author(s). Published with license by Taylor & Francis Group, LLC.

Digital health and telehealth in cancer care: a scoping review of reviews.

The COVID-19 pandemic necessitated remote cancer care delivery via the internet and telephone, rapidly accelerating an already growing care delivery model and associated research. This scoping review of reviews characterised the peer-reviewed literature reviews on digital health and telehealth interventions in cancer published from database inception up to May 1, 2022, from PubMed, Cumulated Index to Nursing and Allied Health Literature, PsycINFO, Cochrane Reviews, and Web of Science. Eligible reviews conducted a systematic literature search. Data were extracted in duplicate via a pre-defined online survey. Following screening, 134 reviews met the eligibility criteria. 77 of those reviews were published since 2020. 128 reviews summarised interventions intended for patients, 18 addressed family caregivers, and five addressed health-care providers. 56 reviews did not target a specific phase of the cancer continuum, whereas 48 reviews tended to address the active treatment phase. 29 reviews included a meta-analysis, with results showing positive effects on quality of life, psychological outcomes, and screening behaviours. 83 reviews did not report intervention implementation outcomes but when reported, 36 reported acceptability, 32 feasibility, and 29 fidelity outcomes. Several notable gaps were identified in these literature reviews on digital health and telehealth in cancer care. No reviews specifically addressed older adults, bereavement, or sustainability of interventions and only two reviews focused on comparing telehealth to in-person interventions. Addressing these gaps with rigorous systematic reviews might help guide continued innovation in remote cancer care, particularly for older adults and bereaved families, and integrate and sustain these interventions within oncology.

Obstetric Disorders and Critical Illness.

In this article, we discuss some of the more common obstetric-related conditions that can lead to critical illness and require management in an ICU. These include the hypertensive disorders of pregnancy, postpartum hemorrhage, hemolysis, elevated liver enzymes, and low platelet syndrome, acute fatty liver of pregnancy, amniotic fluid embolism, and peripartum cardiomyopathy. We also discuss pulmonary embolism and Covid-19. Despite not being specific to obstetric patients, pulmonary embolism is a common, life-threatening diagnosis in pregnancy with particular risks and management aspects. Covid-19 does not seem to occur with higher frequency in pregnant women, but it leads to higher rates of ICU admissions and mechanical ventilation in pregnant women than in their nonpregnant peers. Its prevalence during our current global pandemic makes it important to discuss in this article. We provide a basis for critical care physicians to be engaged in informed conversations and management in a multidisciplinary manner with other relevant providers in the care of critically ill pregnant and postpartum women.

Trust in educational leadership in times of crisis: Trust between the superintendent and principals during COVID-19

Trust is never more important than during a crisis. For years, researchers have been studying trust in organizations and schools, focusing on the principal and teacher relationship and its impact on school climate. The literature has been less focused, however, on the superintendent and principal relationship-and the role trust plays within that relationship. Moreover, given the recency and continually evolving nature of COVID-19, there is little research about the actions superintendents and principals are taking to lead their school communities through this pandemic and even less research on how this crisis impacts the relational trust between the superintendent and the principal.The purpose of this study, therefore, is to examine how trust impacts the relationship between the superintendent and the principals in their district. Accordingly, this study will address the following research questions: 1) How do principals view their relationship with the superintendent and their schools during a crisis? and 2) What practices influence the role of trust in this relationship?To understand how principals view their relationships with their superintendent, as well as practices that influence trust, I conducted six interviews with five principals and the superintendent, and I observed a School Committee meeting where a principal presented on behalf of all principals in support of the superintendent. Principals highlighted how working for a benevolent, competent, and reliable superintendent over a long period of time helps them build trust in their superior while also leading a school during a time of crisis. Practices that appeared to build and sustain trust during the COVID-19 crisis and that support a trusting relationship between the superintendent and principals include length of time working together;perceived trust from the superintendent in the principals' competence, which led to reciprocal trust;the ability to advocate for systems-wide change;and acts of benevolence. This research emphasizes that the relationship between principals and the superintendent matters. It is essential that trust is developed between principals and the superintendent to ensure a stable working environment for staff, ultimately leading to greater consistency for students during trying times in school and beyond. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

CONVERSION OF AN INPATIENT UNIT TO AN ONCOLOGY BIOCONTAINMENT UNIT TO PROVIDE ONCOLOGIC NURSING CARE DURING THE COVID-19 PANDEMIC

Best practices for clinical care delivery among Covid-19 positive and negative patients within the same inpatient oncology unit were unknown in March of 2020. Oncology leadership collaborated with the hospital epidemiology and infection control department at this NCI designated Comprehensive Cancer at the start of the pandemic and determined that Covid-19 positive oncology patients requiring inpatient care be admitted to the biocontainment unit (BCU) in the main hospital. This meant non-oncology nurses cared for cancer patients. Covid-19 cases surged at this academic medical center starting in December 2021 due to the Omicron variant strain. This very contagious strain affected oncology patients much more than previous strains. Patient care challenges emerged, and the need for trained oncology nurses became evident. Since there was a lack of evidence regarding the safety of caring for Covid-19 positive and non-Covid inpatient oncology patients within the same unit, a five-bed inpatient oncology BCU was opened within the cancer center. Conversion of five beds to a negative pressure BCU was facilitated by infection control and clinical engineering. Inpatient oncologic care was anticipated for hematologic and solid tumor malignancies. Nurses with expertise from each of these areas was needed. The oncology nurse manager team met daily to plan staffing the beds based on the patients admitted. Resource coverage was provided by the clinical nurse specialist and oncology educator group. Workflows and education were developed and implemented related to the BCU especially donning/doffing personal protective equipment. Quality initiatives such as central line and safety rounds were maintained. This unit was operational for five weeks and treated 18 COVID-19 positive oncology patients. Oncology staff were cross-trained to this unit from five inpatient areas and included 35 oncology registered nurses and 44 support staff. Opening an oncology inpatient BCU in our cancer center allowed oncology nurses to provide safe, quality cancer care to COVID-19 positive oncology patients. This dedicated BCU closed when the number of Covid-19 oncology patients decreased. Covid-19 positive oncology patients are now safely cared for in the individual negative pressure rooms located on each oncology inpatient unit because of the best practices developed during this time. Staff expressed appreciation at coming together from different units to care for Covid-19 oncology patients during this crisis. This successful cross- coverage concept is now helping address staffing issues faced in this post-Covid era.

Sars_Cov2 Experience in the West Australian Heart Transplant Population

To describe the COVID-19 experience among the heart transplant recipient cohort at the West Australian Advanced Heart Failure Cardiac Transplant Unit. Retrospective observational cohort study between January 2020 and October 2022. Primary outcome measures reviewed in digital medical records included hospital admission numbers, disease severity, prevalence of COVID-19 deterioration risk factors, immunisation status, severity of infection, graft function, immunosuppression and treatment regime. The unit supports 152 heart transplant recipients. A total of 35 patients, (23.0%) contracted COVID-19 during the study period. Infection all occurred during the local Omicron wave from February 2022. The cohort had a median age of 55 years (IQR 49-63.5) with a male gender predominance (74.3%). Most patients were classified as mild COVID-19 (n=32, 91.4%) and 74.3% of the cohort were managed in the community with remote monitoring of clinical status. COVID-19 vaccination status at the time of infection up-to-date according to national guidelines for 80.0% of the transplant patients. Only one patient was unvaccinated. Antiviral treatment was predominantly with Molnupiravir (74.3%) with 22.9% of COVID-19 positive heart transplant patients receiving pre-exposure prophylaxis with Evusheld. Of the cohort admitted to hospital (n=9) the mode of oxygen therapy was dominated by nasal cannula (n=4)) followed by non-invasive ventilation (n=1). The median length of stay for the admitted cohort was 4 days (IQR 3-8.5). Four patients had repeat hospital admissions due to COVID-19 throughout the study period. Most patients had stable graft function demonstrated as stable left ventricular ejection fraction on trans-thoracic echocardiogram within six months of COVID-19. 18 patients had monitoring of donor-specific antibody profiling post COVID-19 which demonstrate no antibody increase. COVID-19 in heart transplant recipients in WA was predominately of mild severity, due to infection occurring in a highly vaccinated population with a milder variant. [ FROM AUTHOR] Copyright of Journal of Heart & Lung Transplantation is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

Heart and Lung Transplant Unit - Western Australia Covid-19 Experience

To describe the COVID-19 experience among the highly immunosuppressed heart and lung transplant patient cohort at the West Australian Heart and Lung Transplant Unit. Retrospective observational cohort study between January 2020 and October 2022 at the states only quaternary hospital. The WA state heart-lung transplant service supports 297 recipients, 152 under the advanced heart failure unit and 145 patients under the care of the advanced lung disease unit. WA was in a unique position with COVID-19 secondary to border closures, high vaccination rates and community transmission with the Omicron wave. A total of 74 patients (24.9%) across the WA unit contracted COVID-19 during the study period. The median age was 53 years (IQR 42-60) with a male gender predominance (63.5%). The heart transplant cohort had a 23.0% (n=35) COVID-19 infection prevalence. The lung transplant cohort had 31.0% (n=45) COVID-19 positive patients across the study period. Bilateral sequential lung transplants BLST (n=38, 84.4%) was the most common transplant type, followed by heart-lung transplant (n=5, 11.1%) and then single lung transplant (n=2, 4.5%). Most patients across both units were classified as mild COVID-19, with only a small proportion of patients requiring hospitalisation (n=24, 32.4%). Cough (60.0%) and sore throat (55.6%) were the most common initial symptoms reported by the patients. COVID-19 vaccination status at the time of infection was higher than 80%. Pre-exposure prophylaxis was given to 35% of the patients who had COVID-19 infection. Most patients had stable graft function despite COVID-19 as measured by left ventricular ejection fraction on trans-thoracic echocardiogram or forced expiratory volume. Overall the WA COVID-19 case numbers and disease severity in the highly immunocompromised transplant cohort were minimal. Disease severity, morbidity and mortality were low when compared to the predicted modelling for this at-risk cohort released by the Department of Health. [ FROM AUTHOR] Copyright of Journal of Heart & Lung Transplantation is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

Outbreaks of SARS-CoV-2 Infections in Nursing Homes during Periods of Delta and Omicron Predominance, United States, July 2021-March 2022.

SARS-CoV-2 infections among vaccinated nursing home residents increased after the Omicron variant emerged. Data on booster dose effectiveness in this population are limited. During July 2021-March 2022, nursing home outbreaks in 11 US jurisdictions involving >3 infections within 14 days among residents who had received at least the primary COVID-19 vaccine(s) were monitored. Among 2,188 nursing homes, 1,247 outbreaks were reported in the periods of Delta (n = 356, 29%), mixed Delta/Omicron (n = 354, 28%), and Omicron (n = 536, 43%) predominance. During the Omicron-predominant period, the risk for infection within 14 days of an outbreak start was lower among boosted residents than among residents who had received the primary vaccine series alone (risk ratio [RR] 0.25, 95% CI 0.19-0.33). Once infected, boosted residents were at lower risk for all-cause hospitalization (RR 0.48, 95% CI 0.40-0.49) and death (RR 0.45, 95% CI 0.34-0.59) than primary vaccine-only residents.