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1.
J Perinatol ; 2022 Aug 04.
Article in English | MEDLINE | ID: covidwho-1972567

ABSTRACT

OBJECTIVE: We examined the relationship between trimester of SARS-CoV-2 infection, illness severity, and risk for preterm birth. STUDY DESIGN: We analyzed data for 6336 pregnant persons with SARS-CoV-2 infection in 2020 in the United States. Risk ratios for preterm birth were calculated for illness severity, trimester of infection, and illness severity stratified by trimester of infection adjusted for age, selected underlying medical conditions, and pregnancy complications. RESULT: Pregnant persons with critical COVID-19 or asymptomatic infection, compared to mild COVID-19, in the second or third trimester were at increased risk of preterm birth. Pregnant persons with moderate-to-severe COVID-19 did not show increased risk of preterm birth in any trimester. CONCLUSION: Critical COVID-19 in the second or third trimester was associated with increased risk of preterm birth. This finding can be used to guide prevention strategies, including vaccination, and inform clinical practices for pregnant persons.

2.
JAMA Netw Open ; 5(8): e2227437, 2022 Aug 01.
Article in English | MEDLINE | ID: covidwho-1971189

ABSTRACT

Importance: Children aged 6 months through 4 years have become eligible for COVID-19 vaccination, but little is known about parental intentions regarding, concerns about, or facilitators to COVID-19 vaccination for this age group. Objectives: To evaluate parental intentions, concerns, and facilitators for COVID-19 vaccination for children aged 6 months through 4 years and to help inform the US Centers for Disease Control and Prevention Advisory Committee on Immunization Practices' deliberations and recommendations for COVID-19 vaccination for children aged 6 months through 4 years. Design, Setting, and Participants: This cross-sectional study fielded an online survey from February 2 to 10, 2022, among a nonprobability sample of US parents of children aged 6 months through 4 years who were recruited through Qualtrics using quota-based sampling for respondent gender, race and ethnicity, and child age group. Main Outcomes and Measures: COVID-19 vaccination intentions, time to COVID-19 vaccination, COVID-19 vaccination concerns and facilitators, and trusted COVID-19 vaccination locations for children aged 6 months through 4 years. Results: The final weighted sample of 2031 participants (73.5% participation rate) had more respondents who identified as male (985; weighted percentage, 54.8%) or White (696; weighted percentage, 66.2%), were aged 25 to 49 years (1628; weighted percentage, 85.6%), had at least a bachelor's degree (711; weighted percentage, 40.0%), lived in a metropolitan area (1743; weighted percentage, 82.9%) or the South (961; weighted percentage, 43.4%), or received at least 1 dose of a COVID-19 vaccine (1205; weighted percentage, 59.8%). Half of respondents (645; weighted percentage, 45.6%) indicated that they "definitely" or "probably" will vaccinate their child aged 6 months through 4 years once they became eligible. However, only one-fifth (396; weighted percentage, 19.0%) indicated they would get a COVID-19 vaccine for their child in this age group within 3 months of them becoming eligible for vaccination. Vaccine safety and efficacy were parents' top concerns, and receiving more information about safety and efficacy were the top facilitators to COVID-19 vaccination for this age group. A doctor's office or clinic and local pharmacy were the most trusted COVID-19 vaccination locations for this age group. Conclusions and Relevance: These results suggest that only a minority of parents of children in this age group are eager to vaccinate their children within the first few months of eligibility, with widespread concerns about COVID-19 vaccination for this age group. Thus, considerable efforts to increase parental COVID-19 vaccine confidence for children aged 6 months through 4 years may be needed to maximize COVID-19 vaccination for this age group in the United States.


Subject(s)
COVID-19 Vaccines , COVID-19 , Adult , COVID-19/epidemiology , COVID-19/prevention & control , COVID-19 Vaccines/therapeutic use , Child , Cross-Sectional Studies , Humans , Intention , Male , Parents , United States/epidemiology , Vaccination , Young Adult
3.
J Perinatol ; 2022 Jul 01.
Article in English | MEDLINE | ID: covidwho-1915263

ABSTRACT

OBJECTIVE: Describe 1-month outcomes among newborns of persons with perinatal COVID-19. STUDY DESIGN: Prospective observational study of pregnant persons who tested positive for SARS-CoV-2 between 14 days before and 3 days after delivery and their newborns, from 3/2020 to 3/2021 at two urban high-risk academic hospitals. Phone interviews were conducted to determine 1-month newborn outcomes. RESULTS: Among 9748 pregnant persons, 209 (2.1%) tested positive for perinatal SARS-CoV-2. Symptomatically infected persons were more likely to have a preterm delivery due to worsening maternal condition and their newborns were more likely to test positive for SARS-CoV-2 compared with asymptomatic persons. Six of 191 (3.1%) infants tested were positive for SARS-CoV-2; none had attributable illness before discharge. Of 169 eligible families, 132 (78.1%) participated in post-discharge interviews; none reported their newborn tested positive for SARS-CoV-2 by 1 month of age. CONCLUSION: Symptomatic perinatal COVID-19 had a substantial effect on maternal health but no apparent short-term effect on newborns.

4.
MMWR Morb Mortal Wkly Rep ; 71(26): 859-868, 2022 Jul 01.
Article in English | MEDLINE | ID: covidwho-1912316

ABSTRACT

On June 17, 2022, the Food and Drug Administration (FDA) issued Emergency Use Authorization (EUA) amendments for the mRNA-1273 (Moderna) COVID-19 vaccine for use in children aged 6 months-5 years, administered as 2 doses (25 µg [0.25 mL] each), 4 weeks apart, and BNT162b2 (Pfizer-BioNTech) COVID-19 vaccine for use in children aged 6 months-4 years, administered as 3 doses (3 µg [0.2 mL] each), at intervals of 3 weeks between doses 1 and 2 and ≥8 weeks between doses 2 and 3. On June 18, 2022, the Advisory Committee on Immunization Practices (ACIP) issued separate interim recommendations for use of the Moderna COVID-19 vaccine in children aged 6 months-5 years and the Pfizer-BioNTech COVID-19 vaccine in children aged 6 months-4 years for the prevention of COVID-19.* Both the Moderna and Pfizer-BioNTech COVID-19 vaccines met the criteria for immunobridging, which is the comparison of neutralizing antibody levels postvaccination in young children with those in young adults in whom efficacy had been demonstrated. Descriptive efficacy analyses were also conducted for both Moderna and Pfizer-BioNTech COVID-19 vaccines during the period when the Omicron variant of SARS-CoV-2 (the virus that causes COVID-19) predominated. No specific safety concerns were identified among recipients of either vaccine. ACIP recommendations for the use of the Moderna COVID-19 vaccine and the Pfizer-BioNTech COVID-19 vaccine in children aged 6 months-5 years and 6 months-4 years, respectively, are interim and will be updated as additional information becomes available. Vaccination is important for protecting children aged 6 months-5 years against COVID-19.


Subject(s)
COVID-19 Vaccines , COVID-19 , 2019-nCoV Vaccine mRNA-1273 , Advisory Committees , BNT162 Vaccine , COVID-19/epidemiology , COVID-19/prevention & control , Child , Child, Preschool , Humans , Immunization , SARS-CoV-2 , United States/epidemiology , Vaccination , Young Adult
5.
Clin Infect Dis ; 2022 Jun 19.
Article in English | MEDLINE | ID: covidwho-1901140

ABSTRACT

BACKGROUND: Information on the severity of COVID-19 attributable to the Delta variant in the United States among pregnant people is limited. We assessed the risk for severe COVID-19 by pregnancy status in the period of Delta variant predominance compared with the pre-Delta period. METHODS: Laboratory-confirmed SARS-CoV-2 infections among symptomatic women of reproductive age (WRA) were assessed. We calculated adjusted risk ratios for severe disease including intensive care unit (ICU) admission, receipt of invasive ventilation or extracorporeal membrane oxygenation (ECMO), and death comparing the pre-Delta period (January 1, 2020 - June 26, 2021) and the Delta period (June 27, 2021 - December 25, 2021) for pregnant and nonpregnant WRA. RESULTS: Compared with the pre-Delta period, the risk of ICU admission during the Delta period was 41% higher (adjusted risk ratio [aRR] 1.41; 95% CI, 1.17-1.69) for pregnant WRA and 9% higher (aRR 1.09; 95% CI, 1.00-1.18) for nonpregnant WRA. The risk of invasive ventilation or ECMO was higher for pregnant (aRR 1.83; 95% CI, 1.26-2.65) and nonpregnant WRA (aRR 1.34; 95% CI, 1.17-1.54) in the Delta period. During the Delta period, the risk of death was 3.33 (95% CI, 2.48-4.46) times the risk in the pre-Delta period among pregnant WRA and 1.62 (95% CI, 1.49-1.77) among nonpregnant WRA. CONCLUSIONS: Compared with the pre-Delta period, pregnant and nonpregnant WRA were at increased risk for severe COVID-19 in the Delta period.

6.
EuropePMC; 2022.
Preprint in English | EuropePMC | ID: ppcovidwho-336015

ABSTRACT

Background: People with SARS-CoV-2 infection during pregnancy are at increased risk for adverse pregnancy outcomes, such as preterm birth and stillbirth. Few studies have assessed whether the risk of adverse pregnancy and infant outcomes varies by trimester of infection. Objectives: We describe clinical characteristics (i.e., treatment among pregnant people with moderate to critical illness) and pregnancy and infant outcomes in pregnant people with laboratory-confirmed SARS-CoV-2 infection by trimester of infection. Study Design: The Surveillance for Emerging Threats to Mothers and Babies Network (SET-NET) collects longitudinal data on people with confirmed SARS-CoV-2 infection during pregnancy and their infants. This analysis included people reported to SET-NET with infection in 2020, with known timing of infection and pregnancy outcome. Outcomes are described by trimester of infection. Pregnancy outcomes examined were live birth and pregnancy loss (<20 weeks gestation and ≥20 weeks gestation). Infant outcomes included preterm birth (<37 weeks gestation), small for gestational age (SGA), birth defects, and neonatal intensive care unit (NICU) admission. Adjusted prevalence ratios (aPR) were calculated for pregnancy and selected infant outcomes by trimester of infection, controlling for age, race/ethnicity and health insurance. Among those with moderate-to-critical COVID-19 illness, demographic and clinical characteristics of pregnant people by COVID-19 specific treatment status were described. Results: : Among 44,914 people with SARS-CoV-2 infection in pregnancy, 35,200 (78.3%) people with known timing of infection and pregnancy outcome were included. There were 35,574 liveborn infants and 193 pregnancy losses (<20 weeks (n=52) and ≥20 weeks (n=141)) reported. Half (50.8%) of pregnant people had infection in the third trimester, 30.8% in the second, and 18.3% in the first. Third trimester infection was associated with a higher frequency of preterm birth compared to first or second trimester infection combined (17.8% vs. 11.8%;aPR 1.44 95% CI: 1.35-1.54). For term infants, those born to people with third trimester infection were more likely to be admitted to the NICU compared to those born to people with first or second trimester infections (6.7% vs. 4.5%, aPR 1.29, 95% CI: 1.16-1.36). Approximately five percent of infants were born SGA, with a higher frequency among infants born to people with third trimester infection (aPR 1.16, 95% CI: 1.06-1.27). Prevalence of birth defects was 553.4/10,000 live births, with no difference by trimester of infection. Of 1,732 pregnant people with moderate-to-critical illness, 24.4% (422 cases) were reported to have received any treatment, with 15.3% (265) receiving COVID-19 specific treatment. The most common COVID-19 treatments were remdesivir (57.0%), dexamethasone (45.8%), and azithromycin with hydroxychloroquine (15.4%). Conclusions: : There were no signals for increased birth defects or SGA among infants in this population relative to national baseline estimates, regardless of timing of infection. However, the prevalence of preterm birth in people with SARS-CoV-2 infection in pregnancy in our analysis was higher relative to national baseline data (10.0-10.2%), particularly among people with third trimester infection. Consequences of COVID-19 during pregnancy, including preterm birth, support recommended COVID-19 prevention strategies, including vaccination for people who are pregnant or may become pregnant. The findings in this report further highlight gaps in COVID-19 treatment for pregnant people.

7.
Paediatr Perinat Epidemiol ; 36(4): 476-484, 2022 07.
Article in English | MEDLINE | ID: covidwho-1794581

ABSTRACT

BACKGROUND: Multiple reports have described neonatal SARS-CoV-2 infection, including likely in utero transmission and early postnatal infection, but published estimates of neonatal infection range by geography and design type. OBJECTIVES: To describe maternal, pregnancy and neonatal characteristics among neonates born to people with SARS-CoV-2 infection during pregnancy by neonatal SARS-CoV-2 testing results. METHODS: Using aggregated data from the Surveillance for Emerging Threats to Mothers and Babies Network (SET-NET) describing infections from 20 January 2020 to 31 December 2020, we identified neonates who were (1) born to people who were SARS-CoV-2 positive by RT-PCR at any time during their pregnancy, and (2) tested for SARS-CoV-2 by RT-PCR during the birth hospitalisation. RESULTS: Among 28,771 neonates born to people with SARS-CoV-2 infection during pregnancy, 3816 (13%) underwent PCR testing and 138 neonates (3.6%) were PCR positive. Ninety-four per cent of neonates testing positive were born to people with infection identified ≤14 days of delivery. Neonatal SARS-CoV-2 infection was more frequent among neonates born preterm (5.7%) compared to term (3.4%). Neonates testing positive were born to both symptomatic and asymptomatic pregnant people. CONCLUSIONS: Jurisdictions reported SARS-CoV-2 RT-PCR results for only 13% of neonates known to be born to people with SARS-CoV-2 infection during pregnancy. These results provide evidence of neonatal infection identified through multi-state systematic surveillance data collection and describe characteristics of neonates with SARS-CoV-2 infection. While perinatal SARS-CoV-2 infection was uncommon among tested neonates born to people with SARS-CoV-2 infection during pregnancy, nearly all cases of tested neonatal infection occurred in pregnant people infected around the time of delivery and was more frequent among neonates born preterm. These findings support the recommendation for neonatal SARS-CoV-2 RT-PCR testing, especially for people with acute infection around the time of delivery.


Subject(s)
COVID-19 , Pregnancy Complications, Infectious , COVID-19/diagnosis , COVID-19/epidemiology , COVID-19 Testing , Female , Humans , Infant, Newborn , Infectious Disease Transmission, Vertical , Pregnancy , Pregnancy Complications, Infectious/diagnosis , Pregnancy Complications, Infectious/epidemiology , Pregnancy Outcome/epidemiology , SARS-CoV-2
8.
Emerg Infect Dis ; 28(4): 873-876, 2022 Apr.
Article in English | MEDLINE | ID: covidwho-1771002

ABSTRACT

The Surveillance for Emerging Threats to Mothers and Babies Network conducts longitudinal surveillance of pregnant persons in the United States with laboratory-confirmed severe acute respiratory syndrome coronavirus 2 infection during pregnancy. Of 6,551 infected pregnant persons in this analysis, 142 (2.2%) had positive RNA tests >90 days and up to 416 days after infection.


Subject(s)
COVID-19 , Pregnancy Complications, Infectious , COVID-19/diagnosis , Female , Humans , Laboratories , Pregnancy , Pregnancy Complications, Infectious/epidemiology , RNA, Viral , SARS-CoV-2/genetics , Serologic Tests , United States
9.
EuropePMC; 2022.
Preprint in English | EuropePMC | ID: ppcovidwho-331559

ABSTRACT

Objective: To describe prevalence of breastmilk feeding among people with SARS-CoV-2 infection during pregnancy and examine associations between breastmilk feeding, timing of maternal infection before delivery, and rooming-in status during delivery hospitalization. Methods Retrospective cohort using data from five states reporting initiation of breastmilk feeding of infants at birth among people with confirmed SARS-CoV-2 infection during pregnancy in 2020. Results Among 9760 (weighted N) people with SARS-CoV-2 infection in pregnancy, 86.0% (95% confidence interval [CI]: 83.3%-88.7%) initiated breastmilk feeding during birth hospitalization. People with infection ≤ 14 days before delivery had significantly lower prevalence of breastmilk feeding (adjusted prevalence ratio [aPR] 0.90, 95% CI: 0.82, 0.97) compared to those with infection > 14 days before delivery. When stratified by rooming-in status, the association between timing of infection and breastmilk feeding remained only among infants who did not room-in with their mother (aPR 0.78, 95% CI: 0.66, 0.92). Conclusion Pregnant and postpartum people with SARS-CoV-2 infection should be advised about the importance of breastmilk feeding, how to safely feed their infants in the same room, and have access to lactation support.

10.
EuropePMC; 2022.
Preprint in English | EuropePMC | ID: ppcovidwho-330969

ABSTRACT

Background: Pregnant persons with Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection are at increased risk of preterm birth, and evidence suggests this risk may be higher among pregnant persons with severe coronavirus disease 2019 (COVID-19) or among those infected later in pregnancy. However, the relationship between trimester of SARS-CoV-2 infection, severity of COVID-19, and preterm birth is not fully understood. Objective: This study examined the relationship between trimester of SARS-CoV-2 infection, illness severity, and risk for preterm birth after adjusting for maternal age, selected underlying conditions, and pregnancy complications. Study Design: Using a cohort of 6,396 pregnant persons with SARS-CoV-2 infection in 2020 identified through the Surveillance for Emerging Threats to Mothers and Babies Network, we analyzed data for those with infection at <37 weeks gestation who delivered a singleton liveborn infant. Illness severity groups (asymptomatic infection, mild, moderate-to-severe, and critical) were adapted from National Institutes of Health and World Health Organization criteria. Risk ratios for preterm birth (<37 weeks) were calculated for illness severity categories (referent=mild), trimester of SARS-CoV-2 infection (referent=first trimester), and illness severity stratified by trimester of infection adjusted for age, selected underlying medical conditions, and pregnancy complications. Results: : Pregnant persons with critical COVID-19, compared to mild COVID-19, in the second (aRR 3.9;95% CI: 1.7-9.0) or third (aRR 4.6;95% CI: 3.2-6.6) trimester were at increased risk of preterm birth. Among persons infected in the second or third trimester, those with critical COVID-19 delivered sooner after infection compared with persons with mild COVID-19 (p<0.001 for second trimester and p=0.02 for third trimester). Nearly half of those with moderate-to-severe or critical COVID-19 delivered by cesarean, with most critical COVID-19 cesarean deliveries as emergent (76.6% weighted [65/96 unweighted]). Conclusion: When infection occurred in the second or third trimester, critical COVID-19 was associated with increased risk of preterm birth, and those with critical COVID-19 delivered sooner after infection compared to those with mild COVID-19. These findings can be used to guide prevention strategies, including vaccination, and inform clinical practices for pregnant persons, particularly those presenting with critical COVID-19 later in pregnancy.

11.
EuropePMC; 2021.
Preprint in English | EuropePMC | ID: ppcovidwho-318348

ABSTRACT

Background: Multiple reports have described neonatal SARS-CoV-2 infection, including likely in utero transmission and early postnatal infection. Most neonatal infections reported to date have been asymptomatic or mild disease;however, severe cases, including respiratory failure requiring intensive care unit admission, have been described. Objectives: To describe maternal, pregnancy and infant characteristics among neonates born to women with SARS-CoV-2 infection during pregnancy by neonatal SARS-CoV-2 testing results. Methods: : Using aggregated data from the Surveillance for Emerging Threats to Mothers and Babies Network (SET-NET) from March 29, 2020–August 6, 2021, we identified neonates who were: 1) born to women who were SARS-CoV-2 positive by RT-PCR at any time during their pregnancy, and 2) tested for SARS-CoV-2 by RT-PCR during the birth hospitalization. Results: : Among 25,896 neonates of mothers with SARS-CoV-2-infection, 3,381 (13%) underwent PCR testing. One hundred thirty-six neonates (4%) were PCR-positive. Neonates testing positive were born to both symptomatic and asymptomatic women, and 95% were born to women with infection identified ≤ with 14 days of delivery. Conclusions: : While perinatal SARS-CoV-2 infection was uncommon among neonates born to women with SARS-CoV-2 infection during pregnancy, nearly all cases of neonatal infection occurred in pregnant women infected around the time of delivery. These findings underline the need for infection prevention and control measures in delivery and outpatient pediatric settings, as well as counselling for persons who acquire COVID-19 during pregnancy about potential risk to their neonates. Moreover, pregnant people and those wanting to become pregnant should be vaccinated against COVID-19 in order to protect themselves and their infants.

12.
EuropePMC; 2020.
Preprint in English | EuropePMC | ID: ppcovidwho-324093

ABSTRACT

Introduction: Public health responses often lack the infrastructure to capture the impact of public health emergencies on pregnant women and infants, with limited mechanisms for linking pregnant women with their infants nationally to monitor long-term effects. In 2019, the Centers for Disease Control and Prevention (CDC), in close collaboration with state, local, and territorial health departments, began a five-year initiative to establish population-based mother-baby linked longitudinal surveillance, the Surveillance for Emerging Threats to Mothers and Babies Network (SET-NET). Objectives: The objective of this report is to describe an expanded surveillance approach that leverages and modernizes existing surveillance systems to address the impact of emerging health threats during pregnancy on pregnant women and their infants. Methods: Mother-baby pairs are identified prospectively during pregnancy and/or retrospectively after birth of the infant. All data are obtained from existing data sources (e.g., electronic medical records, vital statistics, laboratory reports, and health department investigations and case reporting). Results: Variables were selected for inclusion to address key surveillance questions proposed by CDC and health department subject matter experts. General variables include maternal demographics and health history, pregnancy and infant outcomes, maternal and infant laboratory results, and child health outcomes up to the second birthday. Exposure-specific modular variables are included for hepatitis C, syphilis, and Coronavirus Disease 2019 (COVID-19). The system is structured into four relational datasets (maternal, pregnancy outcomes and birth, infant/child follow-up, and laboratory testing). Discussion: SET-NET provides a population-based mother-baby linked longitudinal surveillance approach and has demonstrated rapid adaptation for use during COVID-19. This innovative approach leverages existing data sources and rapidly collects data to inform clinical guidance and practice. These data can help to reduce exposure risk and adverse outcomes among pregnant women and their infants, direct public health action, and strengthen public health systems.

13.
Emerg Infect Dis ; 28(3): 510-517, 2022 Mar.
Article in English | MEDLINE | ID: covidwho-1686417

ABSTRACT

Severe coronavirus disease in neonates is rare. We analyzed clinical, laboratory, and autopsy findings from a neonate in the United States who was delivered at 25 weeks of gestation and died 4 days after birth; the mother had asymptomatic severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and preeclampsia. We observed severe diffuse alveolar damage and localized SARS-CoV-2 by immunohistochemistry, in situ hybridization, and electron microscopy of the lungs of the neonate. We localized SARS-CoV-2 RNA in neonatal heart and liver vascular endothelium by using in situ hybridization and detected SARS-CoV-2 RNA in neonatal and placental tissues by using reverse transcription PCR. Subgenomic reverse transcription PCR suggested viral replication in lung/airway, heart, and liver. These findings indicate that in utero SARS-CoV-2 transmission contributed to this neonatal death.


Subject(s)
COVID-19 , Pregnancy Complications, Infectious , Autopsy , Female , Humans , Infant, Newborn , Infectious Disease Transmission, Vertical , Lung , Placenta , Pregnancy , RNA, Viral/genetics , SARS-CoV-2
14.
Pediatr Infect Dis J ; 41(3): e81-e86, 2022 03 01.
Article in English | MEDLINE | ID: covidwho-1594109

ABSTRACT

BACKGROUND: Previous studies of severe acute respiratory syndrome coronavirus 2 infection in infants have incompletely characterized factors associated with severe illness or focused on infants born to mothers with coronavirus disease 2019 (COVID-19). Here we highlight demographics, clinical characteristics and laboratory values that differ between infants with and without severe acute COVID-19. METHODS: Active surveillance was performed by the Overcoming COVID-19 network to identify children and adolescents with severe acute respiratory syndrome coronavirus 2-related illness hospitalized at 62 sites in 31 states from March 15 to December 27, 2020. We analyzed patients >7 days to <1 year old hospitalized with symptomatic acute COVID-19. RESULTS: We report 232 infants >7 days to <1 year of age hospitalized with acute symptomatic COVID-19 from 37 US hospitals in our cohort from March 15 to December 27, 2020. Among 630 cases of severe COVID-19 in patients >7 days to <18 years old, 128 (20.3%) were infants. In infants with severe illness from the entire study period, the median age was 2 months, 66% were from racial and ethnic minority groups, 66% were previously healthy, 73% had respiratory complications, 13% received mechanical ventilation and <1% died. CONCLUSIONS: Infants accounted for over a fifth of children <18 years of age hospitalized for severe acute COVID-19, commonly manifesting with respiratory symptoms and complications. Although most infants hospitalized with COVID-19 did not suffer significant complications, longer term outcomes remain unclear. Notably, 75% of infants with severe disease were <6 months of age in this cohort study period, which predated maternal COVID-19 vaccination, underscoring the importance of maternal vaccination for COVID-19 in protecting the mother and infant.


Subject(s)
COVID-19/complications , COVID-19/epidemiology , Child, Hospitalized/statistics & numerical data , Adolescent , Child , Child, Preschool , Female , Humans , Infant , Infant, Newborn , Infectious Disease Transmission, Vertical , Male , Pandemics , Pregnancy , Pregnancy Complications, Infectious/virology , SARS-CoV-2 , United States/epidemiology
15.
2021.
Preprint in English | Other preprints | ID: ppcovidwho-294751

ABSTRACT

Background Pregnant women with coronavirus disease 2019 (COVID-19) are at increased risk for severe illness compared with nonpregnant women. Data to assess risk factors for illness severity among pregnant women with COVID-19 are limited. This study aimed to determine risk factors associated with COVID-19 illness severity among pregnant women with SARS-CoV-2 infection. Methods Pregnant women with SARS-CoV-2 infection confirmed by molecular testing were reported during March 29, 2020–January 8, 2021 through the Surveillance for Emerging Threats to Mothers and Babies Network (SET-NET). Criteria for illness severity (asymptomatic, mild, moderate-to-severe, or critical) were adapted from National Institutes of Health and World Health Organization criteria. Crude and adjusted risk ratios for moderate-to-severe or critical COVID-19 illness were calculated for selected demographic and clinical characteristics. Results Among 5,963 pregnant women with SARS-CoV-2 infection, moderate-to-severe or critical COVID-19 illness was associated with age 30–39 years, Black/Non-Hispanic race/ethnicity, healthcare occupation, pre-pregnancy obesity, chronic lung disease, chronic hypertension, cardiovascular disease, and pregestational diabetes mellitus. Risk of moderate-to-severe or critical illness increased with the number of underlying medical or pregnancy-related conditions. Conclusions Pregnant women with moderate-to-severe or critical COVID-19 illness were more likely to be older and have underlying medical conditions compared to pregnant women with asymptomatic infection or mild COVID-19 illness. This information might help pregnant women understand their risk for moderate-to-severe or critical COVID-19 illness and inform targeted public health messaging. Summary Among pregnant women with COVID-19, older age and underlying medical conditions were risk factors for increased illness severity. These findings can be used to inform pregnant women about their risk for severe COVID-19 illness and public health messaging.

16.
EuropePMC; 2021.
Preprint in English | EuropePMC | ID: ppcovidwho-292709

ABSTRACT

Importance: Pregnant people are at increased risk for severe COVID-19 compared with nonpregnant people. Limited information is available on the severity of COVID-19 attributable to the Delta variant, the predominant variant in the United States as of late June 2021, among pregnant persons.Objective: To assess risk for severe COVID-19 by pregnancy status and time period relative to Delta variant predominance.Design: Using a cross-sectional design, we describe characteristics of symptomatic women of reproductive age (WRA) with COVID-19 and calculate adjusted risk ratios for severe disease comparing pregnant with nonpregnant WRA during the pre-Delta period (January 1, 2020 – June 26, 2021) and the Delta period (June 27, 2021 – September 30, 2021). Additionally, we calculate adjusted risk ratios for severe disease comparing the Delta period with the pre-Delta period for pregnant and nonpregnant WRA.Setting: Reports of COVID-19 in the United States occurring from January 1, 2020 ─ September 30, 2021, submitted to the CDC. Participants: Pregnant and nonpregnant women aged 15-44 years. Exposure(s): Laboratory-confirmed, symptomatic SARS-CoV-2 infection. Main Outcome(s): Severe disease: (intensive care unit [ICU] admission, receipt of invasive ventilation or extracorporeal membrane oxygenation [ECMO], and death).Results:: Among 1,856,428 cases of symptomatic COVID-19 in WRA, the risk for severe disease was increased among pregnant compared with nonpregnant WRA during the pre-Delta and Delta periods. Compared with the pre-Delta period, the risk of ICU admission during the Delta period was 66% higher (adjusted risk ratio [aRR] 1.66, 95% CI: 1.34-2.06) for pregnant WRA and 23% higher (aRR 1.23, 95% CI: 1.12-1.35) for nonpregnant WRA. The risk of invasive ventilation or ECMO was higher for pregnant and nonpregnant WRA in the Delta period. During the Delta period, the risk of death was 3.40 (95% CI: 2.36-4.91) times the risk in the pre-Delta period among pregnant WRA and 1.96 (95% CI: 1.75-2.18) among nonpregnant WRA.Conclusions: and Relevance: The overall risk for severe COVID-19 among WRA remains low;however, symptomatic pregnant WRA remain at increased risk for severe outcomes compared with symptomatic nonpregnant WRA during Delta variant predominance. Compared with the pre-Delta period, pregnant and nonpregnant WRA are at increased risk for severe COVID-19 in the Delta period.

17.
MMWR Morb Mortal Wkly Rep ; 70(45): 1579-1583, 2021 Nov 12.
Article in English | MEDLINE | ID: covidwho-1513271

ABSTRACT

The Pfizer-BioNTech COVID-19 (BNT162b2) vaccine is a lipid nanoparticle-formulated, nucleoside-modified mRNA vaccine encoding the prefusion spike glycoprotein of SARS-CoV-2, the virus that causes COVID-19. On August 23, 2021, the Food and Drug Administration (FDA) approved a Biologics License Application (BLA) for use of the Pfizer-BioNTech COVID-19 vaccine, marketed as Comirnaty (Pfizer, Inc.), in persons aged ≥16 years (1). The Pfizer-BioNTech COVID-19 vaccine is also recommended for adolescents aged 12-15 years under an Emergency Use Authorization (EUA) (1). All persons aged ≥12 years are recommended to receive 2 doses (30 µg, 0.3 mL each), administered 3 weeks apart (2,3). As of November 2, 2021, approximately 248 million doses of the Pfizer-BioNTech COVID-19 vaccine had been administered to persons aged ≥12 years in the United States.* On October 29, 2021, FDA issued an EUA amendment for a new formulation of Pfizer-BioNTech COVID-19 vaccine for use in children aged 5-11 years, administered as 2 doses (10 µg, 0.2 mL each), 3 weeks apart (Table) (1). On November 2, 2021, the Advisory Committee on Immunization Practices (ACIP) issued an interim recommendation† for use of the Pfizer-BioNTech COVID-19 vaccine in children aged 5-11 years for the prevention of COVID-19. To guide its deliberations regarding recommendations for the vaccine, ACIP used the Evidence to Recommendation (EtR) Framework§ and incorporated a Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach.¶ The ACIP recommendation for the use of the Pfizer-BioNTech COVID-19 vaccine in children aged 5-11 years under an EUA is interim and will be updated as additional information becomes available. The Pfizer-BioNTech COVID-19 vaccine has high efficacy (>90%) against COVID-19 in children aged 5-11 years, and ACIP determined benefits outweigh risks for vaccination. Vaccination is important to protect children against COVID-19 and reduce community transmission of SARS-CoV-2.


Subject(s)
COVID-19 Vaccines/administration & dosage , Practice Guidelines as Topic , Advisory Committees , COVID-19/epidemiology , COVID-19/prevention & control , Centers for Disease Control and Prevention, U.S. , Child , Drug Approval , Humans , Immunization/standards , Immunization Schedule , United States/epidemiology , United States Food and Drug Administration
18.
Journal of perinatology : official journal of the California Perinatal Association ; : 1-8, 2021.
Article in English | EuropePMC | ID: covidwho-1498850

ABSTRACT

Objective To better understand COVID-19 in newborns, we compared in-hospital illness severity indicators by COVID-19 status during birth hospitalization. Study design In a retrospective cohort of newborns born March–December 2020 in the Premier Healthcare Database Special COVID-19 Release, we classified COVID-19 status and severe illness indicators using ICD-CM-10 codes, laboratory data, and billing records. Illness severity indicators were compared by COVID-19 status, stratified by gestational age and race/ethnicity. Result Among 701,777 newborns, 209 had a COVID-19 diagnosis during the birth hospitalization. COVID-19 status differed significantly by race/ethnicity, gestational age, payor, and region. Late preterm/term newborns with COVID-19 had increased intensive care unit admission and sepsis risk;early preterm newborns with COVID-19 had increased risk for invasive ventilation. Risk for illness severity varied among racial/ethnic strata. Conclusion From March to December 2020, COVID-19 diagnosis in newborns was rare. More clinical data are needed to describe the risk profiles of newborns with COVID-19.

19.
J Perinatol ; 42(4): 446-453, 2022 04.
Article in English | MEDLINE | ID: covidwho-1500442

ABSTRACT

OBJECTIVE: To better understand COVID-19 in newborns, we compared in-hospital illness severity indicators by COVID-19 status during birth hospitalization. STUDY DESIGN: In a retrospective cohort of newborns born March-December 2020 in the Premier Healthcare Database Special COVID-19 Release, we classified COVID-19 status and severe illness indicators using ICD-CM-10 codes, laboratory data, and billing records. Illness severity indicators were compared by COVID-19 status, stratified by gestational age and race/ethnicity. RESULT: Among 701,777 newborns, 209 had a COVID-19 diagnosis during the birth hospitalization. COVID-19 status differed significantly by race/ethnicity, gestational age, payor, and region. Late preterm/term newborns with COVID-19 had increased intensive care unit admission and sepsis risk; early preterm newborns with COVID-19 had increased risk for invasive ventilation. Risk for illness severity varied among racial/ethnic strata. CONCLUSION: From March to December 2020, COVID-19 diagnosis in newborns was rare. More clinical data are needed to describe the risk profiles of newborns with COVID-19.


Subject(s)
COVID-19 , COVID-19/epidemiology , COVID-19 Testing , Ethnicity , Humans , Infant, Newborn , Patient Acuity , Retrospective Studies , United States/epidemiology
20.
MMWR Morb Mortal Wkly Rep ; 69(25): 769-775, 2020 Jun 26.
Article in English | MEDLINE | ID: covidwho-1389845

ABSTRACT

As of June 16, 2020, the coronavirus disease 2019 (COVID-19) pandemic has resulted in 2,104,346 cases and 116,140 deaths in the United States.* During pregnancy, women experience immunologic and physiologic changes that could increase their risk for more severe illness from respiratory infections (1,2). To date, data to assess the prevalence and severity of COVID-19 among pregnant U.S. women and determine whether signs and symptoms differ among pregnant and nonpregnant women are limited. During January 22-June 7, as part of COVID-19 surveillance, CDC received reports of 326,335 women of reproductive age (15-44 years) who had positive test results for SARS-CoV-2, the virus that causes COVID-19. Data on pregnancy status were available for 91,412 (28.0%) women with laboratory-confirmed infections; among these, 8,207 (9.0%) were pregnant. Symptomatic pregnant and nonpregnant women with COVID-19 reported similar frequencies of cough (>50%) and shortness of breath (30%), but pregnant women less frequently reported headache, muscle aches, fever, chills, and diarrhea. Chronic lung disease, diabetes mellitus, and cardiovascular disease were more commonly reported among pregnant women than among nonpregnant women. Among women with COVID-19, approximately one third (31.5%) of pregnant women were reported to have been hospitalized compared with 5.8% of nonpregnant women. After adjusting for age, presence of underlying medical conditions, and race/ethnicity, pregnant women were significantly more likely to be admitted to the intensive care unit (ICU) (aRR = 1.5, 95% confidence interval [CI] = 1.2-1.8) and receive mechanical ventilation (aRR = 1.7, 95% CI = 1.2-2.4). Sixteen (0.2%) COVID-19-related deaths were reported among pregnant women aged 15-44 years, and 208 (0.2%) such deaths were reported among nonpregnant women (aRR = 0.9, 95% CI = 0.5-1.5). These findings suggest that among women of reproductive age with COVID-19, pregnant women are more likely to be hospitalized and at increased risk for ICU admission and receipt of mechanical ventilation compared with nonpregnant women, but their risk for death is similar. To reduce occurrence of severe illness from COVID-19, pregnant women should be counseled about the potential risk for severe illness from COVID-19, and measures to prevent infection with SARS-CoV-2 should be emphasized for pregnant women and their families.


Subject(s)
Betacoronavirus/isolation & purification , Coronavirus Infections/diagnosis , Pandemics , Pneumonia, Viral/diagnosis , Pregnancy Complications, Infectious/virology , Adolescent , Adult , COVID-19 , Coronavirus Infections/epidemiology , Female , Humans , Laboratories , Pneumonia, Viral/epidemiology , Pregnancy , Pregnancy Complications, Infectious/epidemiology , Prevalence , Risk Assessment , SARS-CoV-2 , Severity of Illness Index , United States/epidemiology , Young Adult
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