Erythroblastosis Transformation-Specific Regulated Gene 1 (ERG) Immunohistochemistry in the Diagnosis of Acute Myeloid Leukemia.

INTRODUCTION: The erythroblastosis transformation-specific regulated gene 1 (ERG) is a transcription factor that can be used as an immunohistochemical (IHC) marker in the diagnosis and prognostication of malignancy. ERG was initially used in prostate cancer; however, it is a useful marker in extramedullary myeloid disease. Patients with acute myeloid leukemia (AML), dry bone marrow aspirate, and CD34, CD117-negative blast cells can be in a diagnostic dilemma. This audit aimed to (a) validate ERG IHC in bone marrow trephine samples, (b) quantify ERG IHC positivity in an AML cohort, and correlate concordance with CD34 and CD117 IHC, when available, and (c) to see whether ERG is a useful adjunct in the diagnosis of cases of AML. METHODS: A retrospective audit was completed of all new and relapsed cases of AML over one year at a single center. For inclusion, patients needed a trephine specimen at presentation, and all had a hematoxylin and eosin(H&E) specimen, ERG IHC, and at least one or both of CD34 and CD117 IHC. Four pathologists independently assessed the stains quantitatively and qualitatively in comparison to the morphology seen on the H&E sample. The kappa value was used to assess agreement. RESULTS: Seventeen patients with AML met the inclusion criteria. All specimens had H&E, CD34, and ERG stains; 9/17 (53%) had CD117 IHC. ERG demonstrated high concordance with blast cells on H&E morphology, with a high agreement among pathologists. Qualitatively, pathologists recognized that ERG spared lymphoid nodules; however, it also stained granulocytes at various maturation stages. CONCLUSION: ERG is a sensitive marker for the diagnosis of AML. ERG can help visualize blast cells that have been confirmed by ancillary tests. More research into the utility of ERG in AML diagnostics is recommended.

How military-related stress and family relationships are associated with perceptions of work-family impact for married male service members with adolescent children.

Family members' perceptions of challenges associated with military life can spillover to their relationships with one another and, in turn, inform service members' beliefs of how their work impacts family life. The current study examined connections between active-duty fathers', civilian mothers', and adolescents' perceptions of military-related stress, adolescents' perceptions of quality of family relationships (i.e. parent-adolescent relationships), and service members' perceived work-family impact (specifically work-related guilt and work-related enrichment). To examine these associations, a path analysis with secondary cross-sectional data was estimated using data from 228 Army families (each with an active-duty father, civilian mother, and adolescent offspring). The findings suggested that service members' perceptions of military-related stress and adolescents' relationship quality with both parents were related to service members' work-family impact, specifically work-related enrichment. Such associations highlight the importance of high-quality parent-adolescent relationships for active-duty fathers' work-family impact, which has implications for military families but, more broadly, for service members' readiness and retention.

Mental health profiles of depressive symptoms and personal well-being among active-duty military families.

Although some research has examined the mental health of individual family members in military families, additional research is needed that considers mental health among multiple members of the family system simultaneously and that characterizes subsets of families with distinct patterns. Mental health patterns of depressive symptoms and well-being in and among families were identified using latent profile analysis with a community sample of 236 military families with a service member (SM) parent, civilian partner, and adolescent. Drawing from the Family Adjustment and Adaptation Response model, we examined several military-related family demands (e.g., relocations, deployments) and capabilities (e.g., family cohesion, social support outside the family) as correlates of the family profiles. Three profiles emerged: thriving families (62.3% of the sample where all three family members reported relatively low depressive symptoms and high personal well-being), families with a relatively distressed SM (24.2%), and families with a relatively distressed adolescent (13.5%). Overall, there were no differences between the groups of families regarding military-related demands, yet there were differences between the groups regarding their capabilities, namely family cohesion and social support. In general, families in the thriving profile tended to have higher family cohesion and social support as reported by multiple family members compared to the other two profiles. Findings can inform the development of family needs assessments and tailored interventions (and intervention points) based on family profiles and current capabilities.

Use of food distribution resources among military families with young children since the COVID-19 pandemic.

OBJECTIVE: The present study examined military families' use of food distribution resources and military (e.g. rank) and non-military (e.g. race/ethnicity) characteristics associated with using food distribution resources. DESIGN: Secondary data analyses from a cross-sectional survey in the first 6 months of 2021. SETTING: A national sample of eligible families completed an online survey. PARTICIPANTS: 8326 enlisted military families with an active duty service member in the United States Army or Air Force who applied for supplemental childcare funding distributed by National Military Family Association. RESULTS: 13·2 % of the families reported utilising a food distribution resource in the past 12 months. Those with lower financial well-being were more likely to utilise such resources. Older (OR = 1·04, 95 % CI = 1·02, 1·05, P < 0·001), single-earner (OR = 0·73, 95 % CI = 0·61, 0·89, P = 0·001) families with a lower rank (OR = 0·69, 95 % CI = 0·64, 0·75, P < 0·001) and Army affiliation (compared with Air Force) (OR = 2·31, 95 % CI = 2·01, 2·67, P < 0·001) were more likely to utilise food distribution resources. Members of certain racial/ethnic minority groups were more likely to utilise food distribution resources than White respondents (OR from 1·47 for multi-racial to 1·69 for Asians), as were families with more dependent children (OR = 1·35, 95 % CI = 1·25, 1·47, P < 0·001). CONCLUSIONS: These results identify the extent of food distribution resource utilisation in military families with young children approximately 1 year into the COVID-19 pandemic. The results also identify characteristics associated with their use of food distribution resources. Findings are discussed with an emphasis on prevention and intervention implications for military families.

Factors associated with antibody titer levels among an occupational cohort of fully vaccinated individuals and subsequent risk of COVID-19 infection: A cohort study.

This study (1) determined the association of time since initial vaccine regimen, booster dose receipt, and COVID-19 history with antibody titer, as well as change in titer levels over a defined period, and (2) determined risk of COVID-19 associated with low titer levels. This observational study used data from staff participating in the National Football League COVID-19 Monitoring Program. A cohort of staff consented to antibody-focused sub-study, during which detailed longitudinal data were collected. Among all staff in the program who received antibody testing, COVID-19 incidence following antibody testing was determined. Five hundred eighty-six sub-study participants completed initial antibody testing; 80% (469) completed follow-up testing 50-101 days later. Among 389 individuals who were not boosted at initial testing, the odds of titer < 1000 AU/mL (vs. ≥1000 AU/mL) increased 44% (odds ratio [OR] = 1.44, 95% confidence interval [CI]: 1.18-1.75) for every 30 days since final dose. Among 126 participants boosted before initial testing with no COVID-19 history, 125 (99%) had a value > 2500 AU/ml; 86 (96%) of 90 tested at follow-up and did not develop COVID-19 in the interim remained at that value. One thousand fifty-seven fully vaccinated (330 [29%] boosted at antibody test) individuals participating in the monitoring program were followed to determine COVID-19 status. Individuals with titer value < 1000 AU/mL had twice the risk of COVID-19 as those with >2500 AU/mL (HR = 2.02, 95% CI: 1.28-3.18). Antibody levels decrease postvaccination; boosting increases titer values. While antibody level is not a clear proxy for infection immunity, lower titer values are associated with higher COVID-19 incidence, suggesting increased protection from boosters.

Implementation and evaluation of a store-and-forward teledermatology workflow in a United States safety-net hospital urgent care emergency center: A retrospective cohort study.

Background: Teledermatology (TD) is an important method for increasing access to care in outpatient settings. However, less is known regarding its use in emergency/urgent care centers. Objective: To evaluate the effect of TD on urgent care emergency center (UCEC) dwell time and postencounter utilization. Study type and methods: This retrospective cohort study evaluated patients in a safety-net hospital (Parkland Health, Dallas, Texas, USA) UCEC, who (1) received a TD consult in 2018, (2) were referred to dermatology clinic in 2017, or (3) were referred to dermatology clinic in 2018 without a TD consult. Results: We evaluated 2024 patients from 2017 to 2018. Of the 973 referred to dermatology clinic in 2018, 332 (34%) received TD consultations. Mean dwell time for patients receiving TD was longer versus the 2017 cohort (303 vs 204 minutes, respectively). Patients receiving TD consultation with inflammatory skin conditions had lower odds of dermatology clinic visits compared with those that did not (odds ratio, 0.5; 95% CI, 0.3-0.8). Teledermatology was not associated with differences in repeat UCEC utilization. Limitations: Single institution study and inability to account for differences in patient complexity. Conclusion: TD increases dwell time in a safety-net hospital's UCEC but can reduce dermatology clinic utilization for patients with inflammatory skin conditions.

Continuity in hostile family relationships mediated by family psychopathology: An application of systems perspective.

Grounded in the family systems theory within the life course systems perspective, this study sought to investigate (a) long-term transmission processes of hostility from interparental relationships to parent-young adult relationships and (b) the mediational roles of parents' and adolescents' psychopathology in these long-term processes. Research has examined the long-term transmission of hostility from interparental relationships to young adults' relationships with their parents. However, less is known about how this transmission process differs for father-young adult and mother-young adult relationships and if psychopathology is a mechanism that contributes to the transmission of hostility. Utilizing a structural equation model and prospective, longitudinal data from couples in enduring marriages and their offspring (n = 345 families), we examined long-term associations between interparental hostility when offspring were adolescents and young adults (1990 and 2001), adolescents' hostile relationships with their fathers and mothers (1991), and young adults' hostile relationships with their fathers and mothers (2003) as well as the mediating roles of fathers', mothers', and adolescents' psychopathology (1992 and 1994). Interparental hostility was more strongly linked to hostility between mothers (rather than fathers) and their young adult offspring. Fathers', mothers', and adolescents' psychopathology uniquely mediated the transmission processes. This study elucidated transmission processes of interparental hostility to young adults' relationship hostility with their parents and offers insights into the unique mediational roles of each family member's psychopathology. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Identifying Mental Health Profiles Among Adolescents Who Experienced a Recent Parental Deployment or Military-Related Family Separation.

Accessing two independent samples of adolescents in military families in the United States who recently experienced parental separation (N = 573; N = 186), this study sought to identify adolescent mental health profiles indexed on multiple indicators. In other words, we asked how military adolescents fare after parental separation in terms of mental health indicators. Proximal family processes (family cohesion, conflict, and marital adjustment) were also examined in relation to mental health profiles as well as core adolescent outcomes, self-rated health, and school enjoyment. In both samples, three profiles emerged identifying similar structures of mental health profiles. Two-thirds of adolescents were in the lowest risk mental health group. Poor family cohesion and greater conflict were associated with the moderate and highest risk groups. The lowest risk group reported better health and greater school enjoyment. Family nurses and other health care professionals are encouraged to inquire about military connectedness, structural changes occurring within the family system, and family processes in relation to adolescent well-being.

Implementation of MRSA Nasal Swabs as an Antimicrobial Stewardship Intervention to Decrease Anti-MRSA Therapy in COVID-19 Infection.

In the early stages of treating patients with SARS-CoV-2, limited information was available to guide antimicrobial stewardship interventions. The COVID-19 Task Force and Antimicrobial Stewardship Committee, at a 988-bed academic medical center, implemented the use of methicillin-resistant Staphylococcus aureus (MRSA) nasal swab polymerase chain reaction (PCR) testing to assist with the de-escalation of anti-MRSA therapy in patients with suspected superimposed bacterial pneumonia in COVID-19. A retrospective study was conducted to evaluate the impact of MRSA nasal swab PCR testing on the rate of anti-MRSA therapy between 13 April 2020 and 26 July 2020. A total of 122 patients were included in the analysis. Of the patients included in the final analysis, 58 (47.5%) had anti-MRSA therapy discontinued and 41 (33.6%) avoided anti-MRSA therapy completely due to a negative swab result. With the implementation of MRSA nasal swab PCR testing in COVID-19 patients, anti-MRSA therapy was reduced in 81% of patients in this study. In patients who continued with anti-MRSA therapy, nasal swabs were either positive for MRSA or an alternative indication for anti-MRSA therapy was noted. Only three patients in the cohort had MRSA identified in a sputum culture, all of whom had anti-MRSA therapy continued. MRSA nasal swab PCR testing may serve as an effective antimicrobial stewardship tool in COVID-19 pneumonia.

Life transition events and depressive symptom trajectories during young adulthood: The influence of adverse family and individual contexts in adolescence.

Because sequential patterns of multiple transition events (i.e., college graduation, full-time employment, marriage, and parenthood) are associated with turning points in depressive symptom trajectories during young adulthood, the present study used a sample of 446 White adolescents (52.3% females; 15.58 years old, on average) over 18 years (1992 to 2010) to (a) identify distinct longitudinal joint processes between these sequential patterns of life transition events and turning points of depressive symptom trajectories by using a person-centered modeling approach and (b) investigate the influence of adverse family and individual contexts (negative family economic events, hostile relationships with parents, and impulsive sensation seeking) in adolescence on these longitudinal joint processes. We identified six longitudinal joint processes: (a) traditional transition pattern with no turning points in depressive symptom trajectories, (b) traditional transition pattern with turning points in depressive symptom trajectories in the mid-to-late 20s, (c) early parenthood transition pattern with no turning points in depressive symptom trajectories, (d) early parenthood transition pattern with turning points in depressive symptom trajectories in the mid-to-late 20s, (e) precocious transition pattern with no turning points in depressive symptom trajectories, and (f) precocious transition pattern with depressive symptom turning points (or fluctuations) throughout young adulthood. Negative family economic events, hostile relationships with parents, and impulsive sensation seeking in adolescence influenced these longitudinal joint processes. Hostile relationships with parents also uniquely influenced turning points in depressive symptoms during young adulthood while impulsive sensation seeking uniquely influence sequential patterns of life transition events. Clinical implications are discussed. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Red blood cell alloantibodies in the context of critical bleeding and massive transfusion.

BACKGROUND: In the context of critical bleeding and massive transfusion (CB/MT), little is known about the development of new red blood cell (RBC) alloantibodies. We performed a retrospective, observational study to examine the frequency of RBC alloantibodies (pre-existent, anamnestic, or new) in patients with CB/MT, defined as transfusion of five or more RBC units in any 4-hour period, for any cause of CB. MATERIALS AND METHODS: Data on 2,585 New Zealand patients (date/time of MT initiation, demographic data, blood group, clinical context, and transfused RBCs) were obtained from the Australian and New Zealand Massive Transfusion Registry. RBC alloantibody screening/identification data were extracted from the New Zealand Blood Service database. We calculated summary statistics, compared proportions between different independent groups using the Chi-squared test, and performed logistic regression analysis to examine the effects of variables on alloantibody presence or formation. We also determined the immunogenicities of selected RBC antigens in the context of CB/MT. RESULTS: Of 1,234 assessable patients, 1,166 (94.5%) showed no evidence of any alloantibody. Pre-existent, anamnestic, and new alloantibodies were found, respectively, in 4.3%, 0.4%, and 7.2% of assessable patients. By multivariable regression analysis, transfusion of D-positive RBC to D-negative patients was independently associated with new alloantibody formation. Neither the quantum of RBC transfused nor trauma as clinical context were so associated although the latter trended towards a predisposition. "Antibodies of undetermined specificity" were the commonest pre-existent and new alloantibodies. The immunogenicity of Jka was the highest in this setting. DISCUSSION: RBC alloantibodies of any type were rare in this CB/MT population. Patients undergoing CB/MT appear to have low risks of re-stimulating anamnestic alloantibodies, or of developing new RBC alloantibodies.

Explaining Physical Health Disparities and Inequalities Over the First Half of the Life Course: An Integrative Review of Add Health Studies.

This integrative review of research utilizing the National Longitudinal Study of Adolescent to Adult Health draws on previous research detailing pathways linking early socioeconomic adversity in childhood and adolescence (Wave 1 in 1995 and prior) to physical health outcomes in young adulthood (Wave 5 in 2015). Health outcomes considered included specific diseases, disease risk, and morbidity as prospectively measured by parent-reported and self-reported health outcomes as well as clinical biomarkers. A heuristic research framework was developed from the comprehensive review focused on 4 study designs and identifying total associations, physiological pathways, stress pathways, and resources pathways linking early socioeconomic adversity to physical health outcomes for young adults, as well as potential modifiers of these pathways. The appropriateness of different analytical strategies used in these research studies including approaches for analysis of change in health are discussed. Taken together, review findings suggest the merit of an integrated perspective taking a long view over early life course to explain cumulative physical health risk over the first half of the life course by assessing multiple pathways simultaneously. Looking forward, the review findings also emphasize the need for the investigation of the continuity and change in these pathways over the second half of the life course.

Clinical characteristics and outcomes of SARS-Cov-2 B.1.1.529 infections in hospitalized patients and multi-surge comparison in Louisiana.

BACKGROUND: Peer reviewed data describing SARS-CoV-2 Omicron variant symptoms and clinical outcomes as compared to prior surges in the United States is thus far limited. We sought to determine disease severity, presenting features, and epidemiologic factors of the SARS-CoV-2 Omicron variant compared to prior surges. METHODS: Retrospective cohort analysis was performed on patients admitted during five surges in Louisiana between March 2020 and January 2022. Patient data was pulled from the medical record and a subset of patients during Surge 5 were manually abstracted. Patients who were admitted to one of six Louisiana hospitals with a positive SARS-CoV-2 test during the 5 defined surge periods were included. Surges were compared using chi-squared tests and one way ANOVA for age, sex, vaccination status, length of stay, ICU status, ventilation requirement, and disposition at discharge. The records of patients admitted during the omicron surge were analyzed for presenting symptoms and incidental SARS-CoV-2 diagnosis. RESULTS: With each subsequent surge, a smaller proportion of patients presenting to the emergency department were admitted. Patients admitted during surge 5 had shorter lengths of stay and fewer comorbidities than prior surges. Fewer patients in surge 5 presented with a respiratory condition and fewer required ICU admission. In surges 4 and 5, fewer vaccinated patients were admitted compared to their unvaccinated counterparts. Overall mortality was lower in surge 5 (9%) than in surge 4 (15%) p < .0005. Of the SARS-Cov-2 admissions in surge 5, 22.3% were felt to be incidental diagnoses. CONCLUSIONS: As the COVID-19 pandemic progressed, a younger and less vaccinated population was associated with higher risk for severe disease, fewer patients required ICU admission and overall mortality decreased. Vaccinations seemed to be protective for overall risk of hospitalization but once admitted did not seem to confer additional protection against severe illness during the omicron surge. Age also contributed to patient outcomes.

Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Infections and Reinfections Among Fully Vaccinated and Unvaccinated University Athletes-15 States, January-November 2021.

BACKGROUND: Limited data currently exist on severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections among fully vaccinated persons or reinfections in college-aged populations. Centers for Disease Control and Prevention (CDC) partnered with National Collegiate Athletic Association (NCAA) institutions to analyze retrospective data and present characteristics of positive coronavirus disease 2019 (COVID-19) cases among student athletes 18 years of age and older. METHODS: De-identified, individual-level data contributed by 21 universities on 1378 student athletes who tested positive for SARS-CoV-2 from January through November 2021 (pre-Omicron) were examined to determine percentages of infection among unvaccinated, partially vaccinated, and fully vaccinated individuals (breakthrough infections) as well as reinfections. Comparisons by demographic characteristics and regions were also made to further characterize these infections. RESULTS: Among the 1378 student athletes positive for SARS-CoV-2, 1070 (77.6%) were infected when unvaccinated and 22.4% (n = 308) were infected after full vaccination. There was a significant difference between Black (14.7%, n = 40) and White (23.9%, n = 168) student athletes who experienced a SARS-CoV-2 infection after being fully vaccinated (P < .01). Proportions of infections among fully vaccinated individuals did not differ statistically by sex (p = 0.06). CONCLUSIONS: This article adds to the knowledge of SARS-CoV-2 infections among fully vaccinated individuals in college-aged populations. The level of infections among fully vaccinated student athletes indicates the need for maintaining precautions to prevent infection. Further study of COVID-19 vaccination, infection, and reinfection among the well-resourced and diverse population of student athletes might contribute further understanding of factors that play a role in health equity among young adults.

Patterns of Co-occurring Developmental Failures in Adolescence: Socioeconomic and Genetic Antecedents and Health Outcomes in Adulthood.

This study investigates (1) conjoint latent classes of adolescent co-occurring developmental problems (obesity, depressive symptoms, and low educational attainment), (2) socioeconomic and genetic influences on these classes of adolescents' problem trajectories, and (3) physical health consequences of those latent classes. Data from the National Longitudinal Study of Adolescent to Adult Health (Add Health; N = 9,107; mean age = 15.5 years; Female = 52.9 per cent) were used to identify classes of early socioeconomic adversity and conjoint trajectory groups of co-occurring developmental problems. Profiles of social antecedents, genetic endowments (polygenic scores), and physical health outcomes in young adulthood were compared across identified four conjoint trajectory risk groups (overall high-risk, overall low-risk, BMI-risk or obesity, low education-risk). The results showed that youth with overall high-risk and BMI/education-specific risk trajectory groups were more likely to be Black or Hispanic, reported more adverse socioeconomic characteristics and genetic endowment, and averaged significantly poorer physical health in young adulthood compared with youth in the overall low-risk problem trajectory group. Less pronounced differences emerged between the high-risk and problem-specific-risk groups. The findings highlight heterogeneity in adolescent co-occurring developmental problems. Adolescent heterogeneous problem co-development is associated with background socioeconomic and genetic characteristics and physical health in young adulthood.

Assessment of a cellular host response test to risk-stratify suspected COVID-19 patients in the Emergency Department setting.

OBJECTIVE: Assess the IntelliSep Index (ISI) for risk stratification of patients presenting to the Emergency Department (ED) with respiratory symptoms suspected of COVID-19 during the pandemic. METHODS: An observational single-center study of prospective cohort of patients presenting to the ED during the early COVID-19 pandemic with respiratory symptoms and a CBC drawn within 4.5 hours of initial vital signs. A sample of this blood was aliquoted for performance of the ISI, and patients were followed for clinical outcomes. The study required no patient-centered activity beyond standard of care and treating clinicians were unaware of study enrollment and ISI test results. MAIN FINDINGS: 282 patients were included. The ISI ranges 0.1 to 10.0, with three interpretation bands indicating risk of adverse outcome: low (green), 0.1-4.9; intermediate (yellow), 5.0-6.2; and high (red), 6.3-10.0. Of 193 (68.4%) tested for SARS-CoV-2, 96 (49.7%) were positive. The ISI resulted in 182 (64.5%) green, 54 (18.1%) yellow, and 46 (15.6%) red band patients. Green band patients had a 1.1% (n = 2) 3-day mortality, while yellow and red band had 3.7% (n = 2, p > .05) and 10.9% (n = 5, p < .05) 3-day mortalities, respectively. Fewer green band patients required admission (96 [52.7%]) vs yellow (44 [81.5%]) and red (43 [93.5%]). Green band patients had more hospital free days (median 23 (Q1-Q3 20-25) than yellow (median 22 [Q1-Q3 0-23], p < 0.05) and red (median 21 [Q1-Q3 0-24], p < 0.01). SOFA increased with interpretation band: green (2, [Q1-Q3 0-4]) vs yellow (4, [Q1-Q3 2-5], p < 0.001) and red (5, [Q1-Q3 3-6]) p < 0.001). CONCLUSIONS: The ISI rapidly risk-stratifies patients presenting to the ED during the early COVID-19 pandemic with signs or suspicion of respiratory infection.

Retrospective identification of infection in the emergency department: A significant challenge in sepsis clinical trials.

BACKGROUND: This study examined three methods for retrospectively identifying infection in emergency department (ED) patients: modified objective definitions of infection (MODI) from the CDC/NHSN, physician adjudication determination of infection, and ED treating physician behavior. METHODS: This study used a subset of data from a prospective sepsis trial. We used Fleiss's Kappa to compare agreement between two physicians retrospectively adjudicating infection based on the patient's medical record, modified infection definition from the CDC/NHSN, and ED treating physician behavior. RESULTS: Overall, there was similar agreement between physician adjudication of infection and MODI criteria (Kappa=0.59) compared to having two physicians independently identify infection through retrospective chart review (Kappa=0.58). ED treating physician behavior was a poorer proxy for infection when compared to the MODI criteria (0.41) and physician adjudication (Kappa = 0.50). CONCLUSIONS: Retrospective identification of infection poses a significant challenge in sepsis clinical trials. Using modified definitions of infection provides a standardized, less time consuming, and equally effective means of identifying infection compared to having multiple physicians adjudicate a patient's chart.

Results from a Test-to-Release from Isolation Strategy Among Fully Vaccinated National Football League Players and Staff Members with COVID-19 - United States, December 14-19, 2021.

During December 2021, the United States experienced a surge in COVID-19 cases, coinciding with predominance of the SARS-CoV-2 B.1.1.529 (Omicron) variant (1). During this surge, the National Football League (NFL) and NFL Players Association (NFLPA) adjusted their protocols for test-to-release from COVID-19 isolation on December 16, 2021, based on analytic assessments of their 2021 test-to-release data. Fully vaccinated* persons with COVID-19 were permitted to return to work once they were asymptomatic or fever-free and experiencing improving symptoms for ≥24 hours, and after two negative or high cycle-threshold (Ct) results (Ct≥35) from either of two reverse transcription-polymerase chain reaction (RT-PCR) tests† (2). This report describes data from NFL's SARS-CoV-2 testing program (3) and time to first negative or Ct≥35 result based on serial COVID-19 patient testing during isolation. Among this occupational cohort of 173 fully vaccinated adults with confirmed COVID-19 during December 14-19, 2021, a period of Omicron variant predominance, 46% received negative test results or had a subsequent RT-PCR test result with a Ct≥35 by day 6 postdiagnosis (i.e., concluding 5 days of isolation) and 84% before day 10. The proportion of persons with positive test results decreased with time, with approximately one half receiving positive RT-PCR test results after postdiagnosis day 5. Although this test result does not necessarily mean these persons are infectious (RT-PCR tests might continue to return positive results long after an initial positive result) (4), these findings indicate that persons with COVID-19 should continue taking precautions, including correct and consistent mask use, for a full 10 days after symptom onset or initial positive test result if they are asymptomatic.