December 2024 Dallas Medical Journal

DECEMBER 2024 | DALLAS COUNTY MEDICAL SOCIETY

THE VALUE OF BEING A MEMBER of the Dallas County Medical Society

December 2024

Vol. 110 No. 12

EXECUTIVE VICE PRESIDENT & CEO

Jon R. Roth, MS, CAE

E D I TO R I A L S TA F F EDITOR, PRINT & WEB CONTENT

Lauren S. Williams

DESIGNED BY Morganne Stewart ADVERTISING Strategic Partnerships Manager

Janet Fyock

COMMUNICATIONS COMMITTEE Michelle Caraballo, MD, Chair Drew Alexander, MD Ravindra Bharadwaj, MD Joy Chen, MD Ann Leitch, MD Ravina Linenfelser, DO David Miller, MD Sina Najafi, DO

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Erin Roe, MD, MBA BOARD OF DIRECTORS

HOUSE CALL

Deborah Fuller, MD, President

The Value of Being a Member of the Dallas County Medical Society

Shaina Drummond, MD, President-Elect Gates Colbert, MD, Secretary/Treasurer Donna Casey, MD, Immediate Past President Neerja Bhardwaj, MD Sheila Chhutani, MD Philip Huang, MD, MPH

IN EVERY ISSUE

Anil Tibrewal, MD

02 P R E S I D E N T ’ S PAG E | 0 5 EV P/C EO L E T T E R

Rajeev Jain, MD

26 DCMS PHYSICIAN NETWORK | 28 PARTNER’S PROGRAM SPOTLIGHTS

Raghu Krishnamurthy, MD Aekta Malhotra, MD Marcial Oquendo-Rincon, MD Articles represent the opinions of the authors and do not necessarily reflect official policy of the Dallas County Medical Society (DCMS) or the institution with which the author is affiliated. Dallas County Medical Society does not endorse or evaluate advertised products, services, or companies nor any of

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LEGAL CORNER

New AMA Series on Proper Coding and Billing

RESEARCH

of Respiratory 13 Burden Syncytial Virus

the claims made by advertisers. Claims made by any advertiser or by any company advertising in the Dallas Medical Journal do not constitute legal or other professional advice. You should consult your professional advisor. ©2022 DCMS. According to Tex. Gov’t. Code Ann. 305.027, all articles in Dallas Medical Journal that mention DCMS’s stance on state legislation are defined as “legislative advertising.” The law requires disclosure of the name and address of the person who contracts with the printer to publish legislative advertising in the DMJ: Jon R. Roth, MS, CAE, Executive Vice President & CEO, DCMS, PO Box 4680, Dallas, TX 75208-0680. Dallas Medical Journal (ISSN 0011-586X) is published monthly by Dallas County Medical Society, 140 E. 12th St., Dallas, TX 75203. (214) 948-3622. Postmaster - Send address changes to: Dallas Medical Journal | PO Box 4680 | Dallas, TX 75208-0680. Periodicals postage paid at

H E A LT H A L L I E S

Vaccine and Toxin

to Look for 10 Injuries as a Physician

23 2024 In Memoriam SOCIETY

Dallas, TX 75260 and additional post offices.

December 2024 • DALLAS MEDICAL JOURNAL | 1

2024: A Year in Review Deborah Fuller, MD AS WE CLOSE OUT THE YEAR, WE’RE GRATEFUL FOR THE JOY, CHALLENGES, AND GROWTH THAT 2024 HAS BROUGHT TO DALLAS COUNTY MEDICAL SOCIETY. Serving as president of our Medical Society for 2024 has been the pinnacle of my professional career in organized medicine. We at DCMS are thankful for the trust and support you have given us throughout the year.

Dallas County Medical Society was founded in1876, making it one of the oldest county medical societies in Texas. With over 9,000 physician members and medical students, we are now the second-largest medical society in Texas and in the US. We serve to fulfill our mission statement: To promote the highest standards of ethical and medical practice, to advocate for physicians, and to enhance the quality of healthcare in Dallas County.

DCMS has had a highly active year with many fun and educational programs involving physicians, medical students, and their families.

2024 DCMS Activities • Installation Dinner and Awards Ceremony: January 2024 • Active Shooter Response Training and Panel Discussion (part 1 of a 3-part series): February 2024; 80 participants • DCMS Afternoon with the Mavericks: February 2024; 195 participants • DCMS Women in Medicine Afternoon Tea: April 2024; 34 participants • DCMS Risk Assessment and Verbal De-escalation Training: April 2024; 261 participants • Wellness and Lifestyle Medicine Symposium: May 2024 • DCMS Member Roundup at the Dallas Zoo: May 2024; 308 participants • Insperity HR and Gardenuity; Present Your Own Herb Garden: June 2024; 12 participants • DCMS Day with the Texas Rangers: June 2024; 156 participants • DCMS Workplace Violence Series: Risk Management: June 2024; 62 participants • Shakespeare in the Park: Twelfth Night: July 2024; 52 participants • 2024 DCMS Physician and Student Mixer: August 2024; 247 participants • DCMS Young Physicians and Medical Students Night at the State Fair of Texas: October 2024; 14 participants • Autumn at the Arboretum: October 2024; 125 participants • Women in Medicine: The Art of Beauty: November 2024; 44 participants • DCMS Holiday Social: The Nutcracker at the Texas Ballet; 65 participants and counting • TMA Top Ten: What Physicians Need to Know: December 2024; participants to be determined • DCMS Headquarters Open House: December 2024; participants to be determined

PRESIDENT’S PAGE

DCMS Staff

DCMS Board of Directors for 2024

Jon Roth MS, CAE: Executive Vice President/CEO Gaby Uquillas : Chief Financial Officer Ruby Blum: Vice President, Policy and Legislative Affairs Alyce Eyer: Program and Administrative Manager Nishi Badhwar: Member Engagement Manager Lauren Williams: Assistant Vice President, Publications and Digital Communications/Editor, Dallas Medical Journal Sarah Donahue: Vice President, Events and Fundraising Deanna Wooten: Senior Vice President, Membership/Operations and Information Technology

Donna Casey MD: Immediate Past President Shaina Drummond MD: President-Elect Gates Colbert MD: Secretary/Treasurer Neerja Bhardwaj MD: Member Sheila Chhutani MD: Member Philip Huang MD: Member Anil Tibrewal MD: Member Rajeev Jain MD: Member Raghu Krishnamurthy MD: Member Aekta Malhotra MD: Member Marcial Oquendo-rincon MD: Member Joy Chen MD: Chair, Board of Censors

No organization is complete without excellent staff at the helm and behind the scenes helping to keep DCMS running smoothly. Please know, each one of you, from myself and all our DCMS membership, that we wouldn’t be a leading, well-respected medical society without each of you supporting and caring for the physicians and the patients of Dallas County.

Thanks to all physicians, medical students, and families who took part in all these educational and fun-filled activities!

I also want to thank all those who took the time from their busy work schedules to serve on our DCMS Board of Directors for 2024:

As 2024 draws to a close, I am profoundly thankful for the privilege of serving as president of Dallas County Medical Society. It has been an incredible honor to work alongside such dedicated and compassionate physicians and staff who strive daily to improve the lives of our patients and the health of our community. Together, we have faced challenges, celebrated successes, and reaffirmed our commitment to the highest standards of medical care and advocacy. We look forward to our Open House in our new DCMS headquarters and sharing it with each of our DCMS members. Thank you all for entrusting me with this opportunity. It has been a year I will always treasure.

Wishing you warmth and joy and a hopeful start to the New Year! DMJ

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December 2024 • DALLAS MEDICAL JOURNAL | 3

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EV P/C EO L E T T E R

Fasten Your Seatbelts for a Wild Legislative Ride Jon R. Roth, MS, CAE AS WE CATCH OUR BREATH FROM THE INTENSE AND DRAMA-FILLED 2024 ELECTION SEASON, it’s time to gear up for the real work ahead. The Texas Legislature’s 89th Regular Session is set to run from January 14, 2025, to June 2, 2025. This 140-day session will be packed with discussions and decisions on legislation that will shape the future of our state. And who knows, we might even see special sessions called to tackle lingering policy issues.

The 2024 state election cycle for Texas House and Senate members was a spectacle of intraparty politics like never before. Republicans managed to pick up three seats—two in the House and one in the Senate. But the real story was the unprecedented number of incumbents ousted by new candidates within their own party during the primaries. A total of 14 incumbent Republicans lost their seats to new Republican challengers, largely due to backlash over votes on school vouchers and the impeachment attempt of the attorney general.

So, what does this mean for the physician community? The answer is both opportunities and challeng-

es. With 14 new legislators, nine of whom have never held elected office before, there’s a significant learning curve ahead. The Dallas County Medical Society (DCMS), Texas Medical Association (TMA), and our physicians will need to invest considerable time and effort in educating these newcomers on the critical issues facing medicine. We must ensure they understand the complexities and potential pitfalls of seemingly good ideas that could have adverse effects on healthcare.

Advocacy groups that have previously been stymied by the medical community on issues like scope of practice, tort reform, and prior authorization are likely to see these new legislators as fertile ground for advancing their agendas. Without the necessary background and education, these legislators might not ask the tough questions needed to protect the interests of Texans and Texas physicians.

However, this influx of new faces also presents a unique opportunity. By proactively educating these legislators, we can build relationships that may help advance our priorities. While freshman legislators may not have the clout to carry major policy bills, they can still be influential allies as legislation moves through committees and chambers.

A significant part of this educational process begins at home. Physicians should meet with their elected officials and offer their expertise before the session starts. As the saying goes, all politics is local.

DCMS can assist with these meetings and provide necessary talking points and background materials.

Another crucial way to engage is through the TMA First Tuesday legislative visits at the Capitol in Austin. These visits are vital for legislators to hear directly from their physician, medical student, and alliance constituents about how proposed legislation could impact medical practice in Texas.

Mark your calendars for the 2025 First Tuesdays at the Capitol on February 4, March 4, April 1, and May 6.

If you’re new to advocacy, don’t worry—DCMS is here to support you. We will schedule visits, assign physicians to small groups, and work with TMA to provide all the briefing materials. For more information on First Tuesdays, visit TexMed.org.

Let’s make sure we’re prepared for this wild legislative ride and ready to advocate for the future of medicine in Texas.

Jon R. Roth, MS, CAE DCMS EVP/CEO December 2024 • DALLAS MEDICAL JOURNAL | 5

OUR SERVICES ADMINISTRATIVE/HEALTH LAW RAC AUDIT DEFENSE CYBER LIABILITY MEDICAL MALPRACTICE DEFENSE PEER REVIEW EVIDENTIARY HEARING INTELLECTUAL PROPERTY RIGHTS REGULATORY COMPLIANCE CONTRACTS

FAMILY LAW ANTI-KICKBACK/QUI TAM DEFENSE FRAUD DEFENSE COMMERCIAL LITIGATION EMPLOYMENT MATTERS ASSET PROTECTION/ESTATE PLANNING GOVERNMENTAL ENTITIES PRODUCT LIABILITY

"WE'RE FROM THE GOVERNMENT AND WE'RE HERE TO HELP" "Those are the nine most terrifying words in the English language" President Ronald Reagan once quipped.

But when auditors or regulators threaten you, it's no laughing matter. You need aggressive intervention by a team of battletested specialists* to rebut the government's legions of lawyers, coders, auditors and forensic experts.

When facing "help" from the government, put Shaw corner.

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With He

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Wair in your

(Phone) 214-217-8357 (Fax) 214-217-828)

Shaw & Associates is a proud member of

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*Not certified by the Texas Board of Legal Speciali ation

6 | DALLAS MEDICAL JOURNAL • December 2024

Diane Shaw and the attorneys of Shaw & Associates are seasoned allies for physicians and medical practices facing legal and compliance issues.

LEGAL CORNER OUR SERVICES ADMINISTRATIVE/HEALTH LAW RAC AUDIT DEFENSE CYBER LIABILITY MEDICAL MALPRACTICE DEFENSE PEER REVIEW EVIDENTIARY HEARING INTELLECTUAL PROPERTY RIGHTS REGULATORY COMPLIANCE CONTRACTS

IF YOU ARE A PHYSICIAN OR SIMPLY WORK IN AN ADMINISTRATIVE CAPACITY AT A MEDICAL FACILITY, it would be useful to review the AMA’s recent article

“Myth or fact? Only those providing care can enter billing codes.” If you can stomach the “Joy of Medicine™” HR speak, it provides a good overview of who should be entering billing codes. In it, you’ll find, “An AMA review of current guidelines shows that physicians and other qualified health care professionals must ensure that the correct diagnosis and CPT codes, as well as modifiers, if applicable, are used. However, other authorized, appropriate individuals are allowed to physically enter or change the code. If the person Experienced "WE'RE FROM THE GOVERNMENT entering or changing the code is not the physician, they should consult with AND WE'RE HERE TO HELP" lping With He "Those are the nine most terrifying words in the English the physician to ensure that any update that is made properly reflects the language" President Ronald Reagan once quipped. ls na io ss service provided.” fe by Shaw & Wiar, Attorneys at Law Pro Medical But when auditors or regulators threaten you, it's no laughing Remember, though, that if you’re the physician, if someone bills incormatter. You need aggressive intervention by a team of battletested specialists* to rebut the government's legions of lawyers, rectly, it is your responsibility. Make sure that whomever you have billing coders, auditors and forensic experts. knows exactly what services you provided, which CPT codes to use, and is regularly checking When facing "help" from the government, put Shaw Wair in your corner. for updated CPT codes and changes from insurers.

(Phone) 214-217-8357 (Fax) 214-217-828) All Local and National Coverage Determinations and insurers’ educational materials (Email) info@dkshaw.com Shaw & Associates is a Sponsored by proud member of Visit us online www.dkshaw.com including the outrageously cumbersome CMS manual are replete with documentation Diane Shaw and the attorneys of Shaw & Associates are requirements necessary to comply with basic insurer “reviews” or “audits.” It’s important to seasoned allies for physicians and medical practices facing *Not certified by the Texas keepissues. up with as much education as you can to ensure documentary compliance with your legal and compliance Board of Legal Speciali ation area of specialty or most used CPT codes.

If you’d like to learn more, you can review the AMA’s series on “Debunking Regulatory REFERENCES Myths” for CME credits, or you can read the AMA STEPS Forward® “Reducing Regulatory Bur1. https://www.ama-assn.org/practice-management/sustainability/ myth-or-fact-only-those-providing-care-can-enter-billing-codes den Playbook,”1 which would be just for education, as you’d receive no CME credit. DMJ

New AMA Series on Proper Coding and Billing FAMILY LAW ANTI-KICKBACK/QUI TAM DEFENSE FRAUD DEFENSE COMMERCIAL LITIGATION EMPLOYMENT MATTERS ASSET PROTECTION/ESTATE PLANNING GOVERNMENTAL ENTITIES PRODUCT LIABILITY

December 2024 • DALLAS MEDICAL JOURNAL | 7

HOUSE CALL The Value of Being a Member of the Dallas County Medical Society

THE DALLAS COUNTY MEDICAL SOCIETY (DCMS) REPRESENTS NEARLY 150 YEARS OF EXCELLENCE, advocacy, and community in the medical profession.

As one of the nation’s largest and most active county medical societies, DCMS is not just an organization— it’s a vibrant hub where physicians connect, grow, and lead. Joining DCMS unlocks opportunities that extend beyond professional development to include personal growth and a sense of belonging.

Building Connections and Networks At the heart of DCMS is a commitment to fostering

8 | DALLAS MEDICAL JOURNAL • December 2024

relationships. With the DCMS Directory, which is going digital in 2025, members can easily connect with peers for referrals and collaboration. The Physician Finder and DCMS Career Center offer resources like job boards, career coaching, and recruitment tools, making career advancement seamless. Networking doesn’t stop there; members enjoy access to a variety of DCMS events that blend family fun, entertainment, and professional engagement.

Enhancing Your Practice DCMS is an ally in helping members manage the complexities of running a medical practice. The TMA Knowledge Center, valued at over $1,000 per user, offers free access to research, journals, and databases.

Members also benefit from the Physician Payment Resource Center, a valuable service for resolving payer and reimbursement issues. The Practice Help Program connects members with experts in coding and reimbursement, ensuring the business side of medicine doesn’t hinder patient care.

Unparalleled Resources Practicing medicine involves both caring for patients and running a successful business. Many factors contribute to your business, and DCMS is your best resource for that information. Legislative actions, private payor trends, compliance issues, reimbursement discrepancies, and the economic climate in the North Texas healthcare arena all influence the success of

HOUSE CALL

your business. The Dallas County Medical Society tracks each of these factors and will keep you informed and up to date through this Business of Medicine section.

The Dallas County Medical Society is pleased to offer the DCMS Partners Program – a resource to assist member physicians in running their practices. The DCMS Partners Program consists of medicine-related businesses that serve Dallas-area physicians. These businesses include, but are not limited to, real estate professionals, practice management services, banking institutions, and legal entities.

Professional Growth Through Education and Advocacy Members gain access to over 140 CME programs, including TMB-mandated courses, completely free through the TMA Insurance Trust. Beyond education, DCMS ensures physicians’ voices are heard. Advocacy programs like First Tuesdays at the Capitol bring members face-to-face with legislators, strengthening the profession’s influence on public policy. Whether it’s connecting with local officials or supporting medicinefriendly candidates through the DCMS PAC and TEXPAC, members shape the future of healthcare.

Count on the Dallas Medical Society and the Texas Medical Association to advocate for physicians as legislation and administrative actions that impact physicians are deliberated. There is strength in numbers when it comes to advocacy, and when you are a member of organized medicine in Texas, you will never go it alone. The show of a collective effort of DCMS physicians is extremely important. Members provide a powerful common voice protecting patients, physicians, and their relationship, while serving as thought leaders and conveners to model positive change.

DCMS physicians are involved in influencing legislation as it pertains to the quality of care delivered to patients.

The Texas Legislature meets every odd-numbered year for 140 consecutive days and will convene again January 14, 2025. Legislators need to hear from you – their physician, medical student, and alliance constituents – during the session to understand how proposed legislation can potentially impact the practice of medicine in Texas. Mark your calendar for 2025 First Tuesdays at the Capitol: February 4, March 4 (TMA Alliance and Young Physician Month), April 1 (TMA Medical Student and Resident Month), and May 6.

Prioritizing Wellness and Leadership

and prioritizes physician well-being. Programs like the Emotional PPE Project and Wellness First provide confidential mental health resources, while the DCMS Physician Recovery Committee offers structured support for substance use or behavioral health challenges. For those looking to lead, the TMA Leadership College and the UT Dallas Physician Leadership Certificate Program can equip members with tools to navigate and influence the ever-evolving healthcare landscape.

Staying Informed With a robust communications platform, DCMS keeps its members updated on crucial topics. Members receive the monthly Dallas Medical Journal, science-based articles for ongoing learning, digital communications like the DMJ Weekly Newsletter and TMA’s Texas Medicine Today, offering timely updates on healthcare issues statewide, plus many ways to connect on social media.

Serving the Community DCMS isn’t just about serving members—it’s also about giving back.

From the Dallas County Medical Reserve Corps to disaster volunteer programs, DCMS creates avenues for physicians to make meaningful impacts locally and beyond.

The Dallas County Medical Society coordinates with the Dallas County Health and Human Services Department and other local response organizations during public health emergencies to meet the volunteer needs for medical support. Physicians who volunteer must be members in good standing with Dallas County Medical Society and maintain a current license to practice medicine from the Texas Medical Board.

Physicians who have volunteered in the past have been given assignments such as seeing patients who evacuated from Hurricanes Katrina, Rita, Gustav, and Ike, and providing vaccinations during the initial roll out of the COVID-19 vaccines. For medical sheltering operations, the need for pediatrics, emergency medicine, primary care, and infectious disease physicians is the highest.

Additionally, with the move of the Dallas County Medical Society headquarters into the heart of Uptown Dallas, we are excited to begin the process of creating programs where school children can interact with DCMS physician volunteers to discover the possibilities of medicine as a professional opportunity. Our vision is to provide interactive exhibits to spur young children’s interest in medicine as a profession, create physician-led interactive STEAM programs, foster partnerships with schools and other learning centers, all while cultivating the next generation of Dallas physicians.

Membership in the Dallas County Medical Society is more than a professional commitment; it’s an investment in your career, your community, and your future. With unparalleled resources, a thriving network, and opportunities for leadership and service, DCMS provides an environment where physicians are valued and supported through every phase of their career. Whether you’re seeking professional growth, advocacy support, or a chance to make a difference, DCMS welcomes you to join a legacy of excellence. DMJ

DCMS recognizes the demanding nature of medicine

December 2024 • DALLAS MEDICAL JOURNAL | 9

Vaccine and Toxin Injuries to Look for as a Physician

by Shaw & Wiar, Attorneys at Law IN AN ARTICLE BY THE NEW YORK TIMES ENTITLED “Thousands Believe Covid Vaccines Harmed Them. Is Anyone Listening?”2 Apoorva Mandavilli shares the stories of several people claiming to have been injured by the COVID-19 vaccine.

Mandavilli writes about Michelle Zimmerman, 37, a PhD in neuroscience, who claims that after her COVID-19 vaccination, she became extremely sensitive to light and had difficulty remembering simple facts, and now “over three years later, she lives with her parents and has been diagnosed with brain damage, unable to work, drive, or stand for long periods of time.”

Mandavilli also includes the story of Shaun Barcavage, a nurse practitioner in New York City who worked on clinical trials for HIV and COVID-19, who said ever since his first COVID-19 shot, standing up caused his heart to race, a symptom that suggests postural orthostatic tachycardia. He said he also experienced stinging pain in his eyes, mouth, and genitals, which has gone away, as well as tinnitus, which Gregory Poland, the editor-in-chief of the journal Vaccine, claims he, too, developed, as did Buddy Creech, who led multiple COVID-19 vaccine trials at Vanderbilt University.

Mandavilli notes that the COVID-19 vaccine has caused facial paralysis called Bell’s palsy,3 might have caused shingles, and that “CDC has linked mRNA vaccines made by PfizerBioNTech and Moderna to heart inflammation, or myocarditis, especially in boys and young men. CDC has also warned of anaphylaxis, which could occur after any vaccination. Meanwhile, the European Medicines Agency (EMA) has linked both the Pfizer and Moderna vaccines to facial paralysis, tingling sensations, and numbness. EMA also considers tinnitus a side

10 | DALLAS MEDICAL JOURNAL • December 2024

effect of the J&J vaccine, though American health agencies don’t.” Officially, the CDC recognizes Guillain-Barré syndrome, which is a known side effect of other vaccines, and a blood-clotting disorder, both from the J&J vaccine.

In the last few years, a large contingent, or even a majority, of Americans have become more open about vaccine and toxin injuries, which were previously taboo topics of discussion. Some would be surprised to learn that these issues have actually been litigated for decades. Many would also be surprised to discover that well-known carcinogens like asbestos have not been banned in the United States.

According to a ProPublica publication, “unlike dozens of other countries that banned the potent carcinogen outright, the United States never did. To this day, the U.S. allows hundreds of tons of asbestos to flow in each year from Brazil, primarily for the benefit of two major chemical companies, OxyChem and Olin Corp.” These companies use it to make chlorine.4 Everyone is now aware that asbestos causes mesothelioma or asbestosis, yet many in the medical industry forget, or often refuse, to consider that a toxin or vaccine might be causing their patients’ health issues. The effects of ignoring asbestos concerns are catastrophic for patients but lucrative for both doctors and lawyers. In fact, while asbestos is not outright banned in the US, there are entire law firms that only take asbestos-related injury cases.

H E A LT H A L L I E S

In an article entitled “Why the U.S. Is Losing the Fight to Ban Toxic Chemicals,” the authors lay out the legal hurdles faced in the US when trying to ban a toxic substance.5 They tell the story of a young girl named Emma Grace who developed cancer as a result of a chemical called TCE: “[T]he EPA never banned [TCE] in workplaces and industrial factories… In 2014, Kari Rhinehart, a nurse from Franklin, Indiana, was at work when she got a call about her daughter, Emma Grace Findley. Doctors had found signs of swelling during the 13-yearold’s annual eye exam and said she needed further testing…a week before Christmas, Emma Grace died at home in her mother’s arms.” The article continues, saying a local news station “discovered that many children in the community were developing abnormal cancers, [and] Rhinehart learned that sites near her home were polluted with TCE.” Incidents like this and many others—often welldocumented or litigated, and many anecdotal—remind doctors and lawyers alike to be open as to the cause of a problem. Indeed, besides official reports of COVID-19 vaccine injuries,6 there were, and remain, many unofficial reports of health issues that could be related to the vaccine; however, data from DHHS, the FDA, and CDC remains sorely lacking.7 There is also a concern of incorrect data due to conflicted interests, such as a quite favorable study from The Lancet funded by the FDA.8 As noted, it is difficult to legally ban toxins or examine vaccines in large part because of the relationships that exist between lawmakers, regulators, and the businesses that use toxins or manufacture vaccines.

The letter of the law has hamstrung these pursuits for decades, but fortunately, significant progress has been made.

The Toxic Substances Control Act of 1976 allowed the EPA to ban toxic substances but only in the way that was “least burdensome” to the companies that used these chemicals. As anticipated, the law didn’t have any power. Indeed, when the EPA tried to ban asbestos in 1991, the courts ruled against it using the “least burdensome” test, and Congress didn’t eliminate the test until 2016.

Similarly, the National Childhood Vaccine Injury Act of 1986 was passed by Congress “in response to mounting pressure from vaccine makers who claimed they could not afford to continue compensating for the excessive amount of injuries and deaths caused

by their products. The law granted pharmaceutical companies complete immunity from liability for any vaccine recommended on the CDC’s childhood schedule. Pharma ramped up development once there was no longer a threat of being sued for adverse outcomes, and a vaccine gold rush ensued, with revenues skyrocketing from $750 million in 1986 to $89 billion in 2021.”9 Many will again be surprised that while the US government makes it almost impossible to sue vaccine manufacturers, it doesn’t deny the reality of vaccine injury, but provides two programs, the National Vaccine Injury Compensation Program for all vaccines besides the COVID-19 vaccine and the Countermeasures Injury Compensation Program for the COVID-19 vaccine in order to compensate those who have been injured by vaccines.10, 11 Sadly also, many toxins are made to look fun specifically for children, but according to the Cleveland Clinic, “[c]urrently, the U.S. doesn’t ban any artificial food dyes.” It then writes that Red 40, a ubiquitous food dye used in many treats for its red color, may cause: “Hyperactivity, including ADHD, Behavioral changes like irritability and depression, Allergic reaction, Hives and asthma, Sneezing, Watery eyes, Skin irritation, Migraines.

Red dye 40 contains benzene, a known cancer-causing substance.”12 All in all, there is a lot of legal work that needs to be done to correct the toxic stream of chemicals known to cause serious health issues, but progress has been made. By good lawyers partnering with good doctors, many toxic substances that the vast majority of people can agree should be banned will be.

As for doctors and health systems, it is a good idea to consider that your patients could be suffering from a vaccine or toxin injury, both for the patients’ sake and to avoid litigation.

Keep an open mind about what might be causing your patients’ health issues. These topics are no longer taboo; rather, they are now topics openly taken seriously by lawyers and doctors alike. DMJ

REFERENCES

2. https://www.nytimes.com/2024/05/03/health/covid-vaccines-side-effects.html 3. https://jamanetwork.com/journals/jamaotolaryngology/fullarticle/2804297 4. https://www.propublica.org/article/asbestos-poisoning-chemical-plant-niagara-falls 5. https://www.propublica.org/article/toxic-chemicals-epa-regulation-failures#:~:text=The%20 Toxic%20Substances%20Control%20Act,lawmakers%20and%20the%20chemical%20industry.

6. https://www.bhf.org.uk/informationsupport/heart-matters-magazine/news/coronavirus-andyour-health/coronavirus-vaccine-your-questions-answered/myocarditis-and-covid-19-vaccines-should-you-be-worried 7. https://nypost.com/2024/11/21/us-news/wisconsin-sen-ron-johnson-threatens-legal-action-toget-covid-19-vaccine-data/ 8. https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(24)00388-2/fulltext 9. https://childrenshealthdefense.org/vaccine-curriculum/ 10. https://www.hrsa.gov/vaccine-compensation 11. https://childrenshealthdefense.org/defender/covid-vaccine-injury-largest-payout-claimspending-cicp/ 12. https://health.clevelandclinic.org/red-dye-40

December 2024 • DALLAS MEDICAL JOURNAL | 11

RESEARCH

Burden of Respiratory Syncytial Virus Associated Hospitalizations in US Adults, October 2016 to September 2023

by Fiona P. Havers, MD, MHS; Michael Whitaker, MPH; Michael Melgar, MD; Huong Pham, MPH; Shua J. Chai, MD, MPH; Elizabeth Austin, MPH; James Meek, MPH; Kyle P. Openo, DrPH; Patricia A. Ryan, MS; Chloe Brown, MPH; Kathryn Como-Sabetti, MPH; Daniel M. Sosin, MD, MPH; Grant Barney, MPH; Brenda L. Tesini, MD; Melissa Sutton, MD, MPH; H. Keipp Talbot, MD, MPH; Ryan Chatelain, MPH; Pam Daily Kirley, MPH; Isaac Armistead, MD, MPH; Kimberly Yousey-Hindes, MPH; Maya L. Monroe, MPH; Val Tellez Nunez, MPH; Ruth Lynfield, MD; Chelsea L. Esquibel, MSc; Kerianne Engesser, MPH; Kevin Popham, MPH; Arilene Novak, MPH; William Schaffner, MD; Tiffanie M. Markus, PhD; Ashley Swain, BS; Monica E. Patton, MD; Lindsay Kim, MD, MPH

Abstract

Surveillance Network (RSV-NET), a population-based surveil-

IMPORTANCE Respiratory syncytial virus (RSV) infec-

lance platform that captures RSV-associated hospitalizations

tion can cause severe illness in adults. However, there

in 58 counties in 12 states, covering approximately 8% of the

is considerable uncertainty in the burden of RSV-as-

US population. The study period spanned 7 surveillance sea-

sociated hospitalizations among adults prior to RSV

sons from 2016-2017 through 2022- 2023. Included cases from

vaccine introduction.

RSV-NET were nonpregnant hospitalized adults aged 18 years

OBJECTIVE To describe the demographic charac-

or older residing in the surveillance catchment area and with a

teristics of adults hospitalized with laboratory- con-

positive RSV test result.

firmed RSV and to estimate annual rates and numbers

EXPOSURE Laboratory-confirmed RSV-associated hospitaliza-

of RSV-associated hospitalizations, intensive care unit

tion, defined as a positive RSV test result within 14 days before or

(ICU) admissions, and in-hospital deaths.

during hospitalization.

DESIGN, SETTING, AND PARTICIPANTS This cross-sec-

MAIN OUTCOMES AND MEASURES Hospitalization rates per

tional study used data from the RSV Hospitalization

100,000 adult population, stratified by age group. After adjust-

December 2024 • DALLAS MEDICAL JOURNAL | 13

ing for test sensitivity and undertesting for RSV in adults hospi-

34,900 (95% CI, 25,500- 55,600) for the same seasons.

talized with acute respiratory illnesses, rates were extrapolated

Estimated annual in-hospital deaths ranged from

to the US population to estimate annual numbers of RSV-asso-

4,680 (95% CI, 3,570-6,820) in 2018 to 2019 to 8,620

ciated hospitalizations. Clinical outcome data were used to es-

(95% CI, 6,220-14,090) in 2017 to 2018. Adults 75 years or

timate RSV-associated ICU admissions and in-hospital deaths.

older accounted for 45.6% (range, 43.1%-48.8%) of all

RESULTS From the 2016 to 2017 through the 2022 to 2023 RSV

RSV-associated hospitalizations, 38.6% (range, 36.7%-

seasons, there were 16 575 RSV-associated hospitalizations in

41.0%) of all ICU admissions, and 58.7% (range, 51.9%-

adults (median [IQR] age, 70 [58-81] years; 9641 females [58.2%]).

67.1%) of all in-hospital deaths.

Excluding the 2020 to 2021 and the 2021 to 2022 seasons, when

CONCLUSIONS AND RELEVANCE In this cross-sec-

the COVID-19 pandemic affected RSV circulation, hospitaliza-

tional study of adults hospitalized with RSV before the

tion rates ranged from 48.9 (95% CI, 33.4-91.5) per 10,000 adults

2023 introduction of RSV vaccines, RSV was associated

in 2016 to 2017 to 76.2 (95% CI, 55.2-122.7) per 100,000 adults in

with substantial burden of hospitalizations, ICU admis-

2017 to 2018. Rates were lowest among adults aged 18 to 49

sions, and in-hospital deaths in adults, with the highest

years (8.6 [95% CI, 5.7-16.8] per 100,000 adults in 2016-2017 to

rates occurring in adults 75 years or older. Increasing

13.1 [95% CI, 11.0-16.1] per 100,000 adults in 2022-2023) and high-

RSV vaccination of older adults has the potential to

est among adults 75 years or older (244.7 [95% CI, 207.9-297.3]

reduce associated hospitalizations and severe clinical

per 100,000 adults in 2022-2023 to 411.4 [95% CI, 292.1-695.4] per

outcomes.

100,000 adults in 2017-2018). Annual hospitalization estimates ranged from 123 000 (95% CI, 84,000-230,000) in 2016 to 2017 to

Introduction

193 000 (95% CI, 140,000-311,000) in 2017 to 2018. Annual ICU ad-

Respiratory syncytial virus (RSV) plays an important

mission estimates ranged from 24,400 (95% CI, 16,700-44,800) to

role in mortality and morbidity in US adults 60 years or older, although there is considerable uncertainty about the overall burden of RSV-

Proportion of Adults With Respiratory Syncytial Virus ICU

associated hospitalizations in this population.1-6 As of May 2024, the US Food and Drug In-hospital death

25

Administration had approved 3 vaccines for prevention of RSV lower respiratory tract disease in adults.7-9 In June 2023, the Centers for Disease Control and Prevention (CDC) recommended a single dose of RSV vaccine in

20

adults aged 60 years or older using shared

Hospitalized patients, %

clinical decision-making10; the recommendations were updated in June 2024 to rec-

15

ommend a single dose of RSV vaccine for all adults aged 75 years or older and for those

10

aged 60 to 74 years who are at increased risk for severe RSV disease.11 To assess vaccine impact, it is essential to clearly define

5

the prevaccine burden of RSV disease in this population.

Clinicians often do not test for RSV in hos-

0 18-49 Y

50-64 Y

65-74 Y

≥75 Y

Overall

Age group

Associated Intensive Care Unit (ICU) Stay and In-Hospital Death by Age Group for the 2016 to 2017 Through 2022 to 2023 Seasons Season is defined as October to April for 2016 to 2017 through 2019 to 2020 and as October to September for 2020 to 2021 through 2022 to 2023.

14 | DALLAS MEDICAL JOURNAL • December 2024

pitalized adults with respiratory illness12 because an RSV diagnosis does not generally change disease management and because of limited awareness of RSV as an important pathogen affecting adults. Evidence also

RESEARCH

suggests that standard RSV detection assays in hos-

tino ethnicity; hospital admission date; positive RSV test result;

pitalized adults might have lower sensitivity than pre-

and clinical outcomes (ICU admission status and in-hospital

viously believed.13-16 Furthermore, potential changes

deaths) were collected on all patients, allowing calculation of

in respiratory virus testing, including during the CO-

population-based incidence. To characterize the demographic

VID-19 pandemic, increase uncertainty in estimates

characteristics of adults hospitalized with RSV, race and eth-

of RSV hospitalizations in older adults.

This analysis

nicity (Hispanic or Latino and non-Hispanic American Indian

used 2016 to 2023 data from the population-based

or Alaska Native, Asian or Pacific Islander, Black, White, or other

RSV Hospitalization Surveillance Network (RSV-NET) to

[including multiracial and unknown]) were abstracted from the

describe the demographic characteristics of adults 18

medical record.

1-6

years or older hospitalized with laboratory-confirmed

From 2016 to 2019, prospective surveillance was conducted

RSV and to estimate rates and numbers of RSV-asso-

annually during the typical RSV season, defined as October to

ciated hospitalizations, intensive care unit (ICU) ad-

April. Beginning in October 2020, surveillance was conducted

missions, and in-hospital deaths.

year- round, and the RSV season was defined as October to September. Incidence was calculated using National Center for

Methods

Health Statistics vintage 2020 bridged-race postcensal popu-

The Respiratory Virus Hospitalization Surveillance Net-

lation estimates (2019 to September 2020 and before October

work (RESP-NET) conducts population-based surveil-

2020) or US Census Bureau vintage unbridged-race postcensal

lance for US hospitalizations associated with labora-

population estimates (October 2020 to September 2023) for

tory-confirmed RSV (recorded in RSV-NET), COVID-19

surveillance-area counties or county equivalents.18

(recorded in COVID-19 Hospitalization Surveillance

Adults hospitalized with RSV were captured in RSV-NET only

Network [COVID-NET]), and influenza (recorded in In-

if they were tested for RSV and if the test accurately detected

fluenza Hospitalization Surveillance Network [FluSurv-

RSV. Because RSV testing is often not performed in hospital-

NET]). During the 2022 to 2023 surveillance season,

ized adults and RSV diagnostic testing practices have changed

RSV-NET captured laboratory-confirmed RSV-associ-

over time, rates of RSV-associated hospitalizations in RSV-NET

ated hospitalizations in 58 counties in 12 states (Cali-

were adjusted for underdetection of RSV infection due to test-

fornia, Colorado, Connecticut, Georgia, Maryland,

ing practices and test sensitivity using a multiplier approach, as

Michigan, Minnesota, New Mexico, New York, Oregon,

previously described for

Tennessee, and Utah) covering approximately 27 mil-

FluSurv-NET.19-21 Briefly, each RSV-NET site identified all adults

lion persons (approximately 8% of the US population),

hospitalized with acute respiratory illness (ARI), using Interna-

17

although the catchment area changed over time.

tional Statistical Classification of Diseases and Related Health

This study was reviewed by the Centers for Disease

Problems, Tenth Revision (ICD-10) diagnosis codes, in select

Control and Prevention (CDC), deemed not research,

hospitals and ascertained the proportion of patients tested for

and conducted consistent with applicable federal law

RSV and the type of RSV detection test used among a strati-

and CDC policy (45 CFR part 46.102(l)(2), 21 CFR part

fied random sample. Adjustment multipliers, the inverse of the

56; 42 USC §241(d); 5 USC §552a; 44 USC §3501 et seq).

frequency multiplied by the mean sensitivity of the assays, were

We followed the Strengthening the Reporting of Ob-

estimated for each season using testing data from hospitaliza-

servational Studies in Epidemiology (STROBE) report-

tions in each age group.22 Unadjusted rates were estimated by

ing guideline.

dividing the number of laboratory-confirmed hospitalizations

Included RSV-NET cases were nonpregnant hos-

detected within the RSV-NET catchment area by the catchment

pitalized adults aged 18 years or older residing in the

area population estimate. Adjusted rates were estimated by

surveillance catchment area with a positive molecular

multiplying the unadjusted rates by the adjustment multipliers

or rapid antigen RSV test result during hospitalization

and then presented with 95% CIs to account for uncertainty in

or within 14 days before admission. Laboratory testing

adjustment multipliers. Rates of RSV-associated ICU admissions

was ordered at the discretion of clinicians or through

and in-hospital deaths were estimated by multiplying age-spe-

hospital screening procedures. Demographic infor-

cific hospitalization rates by the proportion of patients in each

mation, including age, sex, race, and Hispanic or La-

age group who were admitted to the ICU (ICU to hospitalization

December 2024 • DALLAS MEDICAL JOURNAL | 15

ratio) or who died in the hospital.19 Overall numbers of RSV-asso-

and ethnicity. Hospitalization rates peaked each Jan-

ciated hospitalizations, ICU admissions, and in-hospital deaths

uary during 2016 to 2017 through 2019 to 2020, showed

in the US were estimated by multiplying adjusted age-specific

reduced and atypical circulation in 2020 to 2021 and

rates of hospitalization, ICU admission, and in-hospital death

2021 to 2022, and showed increased circulation and

by estimated US populations for each age group.18 Starting with

an earlier peak in 2022 to 2023. Across all RSV seasons,

the 2020 to 2021 surveillance season, the COVID-19 pandemic

19.1% of patients (2,844 of 14,896) were admitted to the

affected both RSV circulation and respiratory virus testing prac-

ICU, including 21.0% (425 of 2027) of those aged 18 to

tices, affecting RSV-associated hospitalization timing and rates.

49 years; 4.3% (706 of 16,506) died in the hospital, with

Demographic characteristics, clinical outcomes, and burden

in-hospital deaths highest among those 75 years or

estimates of hospitalizations, ICU admissions, and in-hospital

older (5.8% [378 of 6546]).

deaths for all seasons; 2020 to 2021 and 2021 to 2022 seasons

Generally, the proportions of adults hospitalized

were excluded from these ranges given atypical RSV circulation.

with ARI who were tested for RSV increased over time

Adjustment multipliers for burden estimates accounted for

and were similar across age groups. Across all seasons,

test sensitivity. Recent studies, including a systematic review and

43.5% of hospitalized adults with an ARI were tested

meta-analysis, indicated that adding specimen types, such as

for RSV (range, 30.0%-60.7%). In 2016 to 2017, 30.4% of

paired serological testing or sputum to nasopharyngeal or na-

those aged 18 to 49 years, 33.1% of those aged 50 to

sal swab reverse transcriptase– polymerase chain reaction (RT-

64 years, 31.5% of those aged 65 to 74 years, and 27.7%

PCR) testing, increased RSV detection by 50% to 66%, demon-

of those 75 years or older were tested. In 2022 to 2023,

strating that molecular assays with reportedly high sensitivity

testing increased to 56.1%, 61.2%, 62.3%, and 61.6% in

might underdetect RSV in adults.13-15 To account for presumed

the same age groups, respectively,. Unadjusted over-

lower sensitivity of PCR testing as performed previously in similar

all rates of laboratory- confirmed hospitalizations

16

analyses, we multiplied rate estimates by 1.5, which assumed a

within the RSV-NET catchment area ranged from 8.8

PCR testing sensitivity of 66%. We performed a sensitivity analy-

per 100,000 adults in 2016 to 2017 to 21.2 per 100,000

sis using more conservative estimates that did not include the 1.5

adults in 2022 to 2023. Using adjustment multipliers to

multiplier and that presumed a baseline sensitivity of 92%16 for

account for the proportion tested and test sensitivity

molecular assays (PCR) and 29% for antigen assays.

(range of 3.2-5.4, by season and age group), seasonal

2

23

Statistical Analysis

hospitalization rates for adults 18 years or older ranged from 48.9 (95% CI, 33.4-91.5) per 100,000 adults in 2016

Rates were presented per 100 000 adults aged 18 years or older;

to 2017 to 76.2 (95% CI, 55.2-122.7) per 10,000 adults in

differences in age group–specific rates were compared using χ2

2017 to 2018. Results from the sensitivity analysis where

tests. A 2-tailed P < .05 was considered to be statistically signifi-

a higher RT-PCR sensitivity (92%) was assumed (ie,

cant. Data analyses were conducted using SAS, version 9.4 (SAS

without the 1.5 × adjustment multiplier).

Institute Inc).

Results

Hospitalization rates increased with increasing age.

Adjusted rates were lowest in those aged 18 to 49 years, varying from 8.6 (95% CI, 5.7-16.8) per 100,000 adults in

From the 2016 to 2017 through 2022 to 2023 RSV seasons, 16,575

2016 to 2017 to 13.1 (95% CI, 11.0-16.1) per 100,000 adults

laboratory-confirmed RSV-associated hospitalizations in adults

in 2022 to 2023. Adjusted rates were highest among

aged 18 years or older were identified; 98.7% of tests used to de-

those aged 75 years or older, varying from 244.7 (95%

tect RSV were RT-PCR. Among hospitalized patients, 9,641 were

CI, 207.9-297.3) per 100,000 adults in 2022 to 2023 to

females (58.2%) and 6,934 were males (41.8%), with a median

411.4 (95% CI, 292.1-695.4) per 100,000 adults in 2017 to

(IQR) age of 70 (58-81) years; specifically, 62.6% were 65 years

2018.

or older and 39.7% were 75 years or older. A total of 1,429 patients

Extrapolating adjusted rates to the US adult popu-

(8.6%) were Hispanic or Latino, and non-Hispanic patients in-

lation, estimated numbers of annual RSV-associat-

cluded 87 American Indian or Alaska Native (0.5%), 985 Asian

ed hospitalizations in adults aged 18 years or older

or Pacific Islander (5.9%), 3,234 Black (19.5%), and 10,187 White

ranged from 123 000 (95% CI, 84,000-230,000) in 2016

(61.5%) individuals, with 653 (3.9%) having other or unknown race

to 2017 to 193 000 (95% CI, 140,000-311,000) in 2017 to

16 | DALLAS MEDICAL JOURNAL • December 2024

RESEARCH

2018, while annual ICU admission estimates ranged from 24,400 (95% CI, 16,700-44,800) to 34,900 (95% CI, 25,500-55,600) for the same seasons. Estimated annual in-hospital deaths ranged from 4,680 (95% CI, 3,570-6,820) in 2018 to 2019 to 8620 (95% CI, 6,220-

Demographic Characteristics and Clinical Outcomes of Adults Hospitalized With Laboratory-Confirmed Respiratory Syncytial Virus Infection 2016 to 2017 Through 2022 to 2023

14,090) in 2017 to 2018. Averaging across seasons, most

Characteristic

adult disease burden occurred in adults aged 65 years

RSV Season

No. (%) (N=16,575)a

a,b

or older, including 68.2% (range, 65.9%-70.4%) of all

2016-2017

1,248 (7.5)

hospitalizations, 63.1% (range, 62.5%-64.2%) of ICU

2017-2018

2,457 (14.8)

admissions, and 81.1% (range, 76.9%-83.0%) of in-hos-

2018-2019

2,516 (15.2)

pital deaths. Estimated numbers of hospitalizations

2019-2020

3,165 (19.1)

in adults 65 years or older ranged from 85,000 (95%

2020-2021

557 (3.4)

CI, 57 000-163 000) in 2016 to 2017 to 136 000 (95%

2021-2022

2,441 (14.7)

CI, 97 000-228 000) in 2017 to 2018. Averaging across

2022-2023

4,191 (25.3)

seasons, adults aged 75 years or older accounted

Demographics a

for 45.6% (range, 43.1%-48.8%) of all hospitalizations,

Age group, y

38.6% (range, 36.7%-41.0%) of all ICU admissions, and

18-49

2,230 (13.5)

58.7% (range, 51.9%-67.1%) of all in-hospital deaths.

50-64

3,965 (23.9)

≥ 65

10,380 (62.6)

65-74

3,807 (23.0)

≥ 75

6,573 (39.7)

Discussion Analysis of data on 16,575 laboratory-confirmed RSVassociated hospitalizations in US adults across mul-

Sex

tiple seasons obtained from RSV-NET, a large, pop-

Male

ulation-based, geographically diverse surveillance

Female

platform, showed estimated RSV-associated hospi-

6,934 (41.8) 9,641 (58.2)

Race and ethnicity

c

talization rates of 48.9 to 76.2 per 100,000 adults per

Hispanic or Latino

1,429 (8.6)

season. These rates suggest a high burden of severe

Non-Hispanic American Indian or Alaska Native

87 (0.5)

RSV disease, with an estimated 123,000 to 193,000

Non-Hispanic Asian or Pacific Islander

985 (5.9)

hospitalizations, 24,400 to 34,900 ICU admissions, and

Non-Hispanic Black

3,234 (19.5)

4,680 to 8,620 in-hospital deaths occurring annually

Non-Hispanic White

10,187 (61.5)

among US adults, although there was a considerable

Other or unknown d

amount of uncertainty surrounding these estimates.

Clinical outcomes by age group, y

Almost half of all hospitalizations and most deaths

ICU admission

653 (3.9) e

2,844 / 14,896 (19.1)

occurred in adults aged 75 years or older. RSV-associ-

18-49

425 / 2,207 (21.0)

ated hospitalizations resulted in considerable morbid-

50-64

795 / 3,625 (21.9)

ity and mortality; nearly 20% of hospitalized patients

65-74

696 / 3,418 (20.2)

were admitted to the ICU, and approximately 1 in 25

≥ 75

928 / 5,806 (16.0)

died in the hospital.

These findings validated RSV as a substantial contributor to respiratory illness and hospitalization among adults, especially older adults, with up to 136,000 estimated annual hospitalizations among those 65 years or older. The burden of RSV-associated hospitalizations in older adults was comparable to the burden of influenza-associated hospitalizations during milder influenza seasons; notwithstanding re-

In-hospital death

706 / 16,506 (4.3)

18-49

42 / 2,223 (1.9)

50-64

124 / 3,948 (3.1)

65-74

162 / 3,789 (4.3)

≥ 75

378 / 6,546 (5.8)

Abbreviations: ICU, intensive care unit; RSV, respiratory syncytial virus. a For seasons and demographic characteristics, the denominator was 16 575. b Season was defined as October to April for 2016 to 2017 through 2019 to 2020 and as October to September for 2020 to 2021 through 2022 to 2023. c Race and ethnicity were abstracted from medical records. d Other included multiracial. Persons of Hispanic or Latino origin might be of any race but were categorized as Hispanic; all racial groups were categorized as non-Hispanic. All other races included non-Hispanic multiracial persons. If ethnicity was unknown, non-Hispanic ethnicity was assumed. e For clinical outcomes, the denominators were 14 896 for ICU admission and 16 506 for in-hospital death

December 2024 • DALLAS MEDICAL JOURNAL | 17

ductions in influenza disease achieved through vaccination,

NET data reflect considerable uncertainty in estimat-

20

87,000 to 523,000 hospitalizations in adults 65 years or older

ing the true burden of RSV-associated hospitalizations

were estimated to occur annually based on data from FluSurv-

in the US. This uncertainty is exacerbated by the sub-

NET, an RESP-NET network with methods and catchment area

optimal sensitivity of available RSV detection tests and

nearly identical to those of RSV-NET. Similarly, RSV disease sever-

lack of testing for RSV in adults hospitalized with respi-

ity among hospitalized adults appeared to be comparable to

ratory illnesses, as demonstrated by less than half of

or possibly more than the severity of influenza and SARS-CoV-2

adults hospitalized with ARI in participating RSV-NET

in hospitalized adults.5,24-27 In the present analysis, 19.1% of adults

hospitals being tested for RSV. Despite the uncertainty

hospitalized with RSV were admitted to the ICU and 4.3% died

in these estimates, RSV-NET–based hospitalization

in the hospital, comparable to study of an RESP-NET analysis of

rate and burden estimates are comparable to other

adults hospitalized in 2021 to 2022 that found among those with

burden estimates, including an industry-sponsored

laboratory-confirmed SARS-CoV-2, 15.5% were admitted to the

meta-analysis and systematic review estimating that

ICU and 4.6% died; for influenza, those proportions were 13.3%

RSV was associated with 108,834 hospitalizations and

and 4.6%, respectively. These proportions of patients with RSV

7,763 deaths in 2019 in adults 60 years or older.31 An-

who were admitted to the ICU and died in the hospital were

other industry-sponsored systematic review and me-

comparable to those in other studies of RSV,4,26,28-30 including the

ta-analysis, which similarly adjusted for underdetec-

7.1% in-hospital case-fatality proportion estimated for adults

tion of RSV by nasopharyngeal or nasal RT-PCR alone

aged 60 years or older in a systematic review and meta-analysis

(eg, applied the RSV detection multiplier of 1.5) and

of data from high-income countries.31 Even among patients

used pooled estimates of hospitalization rates from

aged 18 to 49 years who were hospitalized with RSV, clinical out-

prospective1,4-6,34 and modeling studies,35-38 estimated

comes were severe; in the present study, 21.0% were admitted to

that 17 700, 42 060, and 159 247 RSV-associated hos-

the ICU, likely reflecting the high proportion of younger adult pa-

pitalizations occurred annually in adults aged 18 to 49

tients hospitalized with RSV who were immunocompromised or

years, 50 to 64 years, and 65 years or older, respective-

had underlying medical conditions that made them vulnerable

ly,2 which were higher than RSV-NET–based estimates

to severe disease.32 In-hospital deaths occurred in over 4.0% of

but were within estimated CIs for most seasons. Five

adults aged 18 years or older in our analysis, which was likely an

prospective studies were the source of the estimates,

underestimation of RSV mortality given that a substantial pro-

although several studies were limited to a single sea-

portion of deaths may occur after hospital discharge.29,33

son4 or a restricted geographic area,1,4-6,34 which might

25

The wide CIs for estimated hospitalization rates based on RSV-

have affected rate estimates. Unlike these studies, RSV-NET uses population-based surveillance in multiple sites in geographically diverse areas.

Although RSV is now a vaccine-preventable disease,39 its role in acute respiratory disease continues to be underrecognized by clinicians specializing in adult care.40 In the present analysis, less than half of the patients hospitalized with ARI were tested for RSV, consistent with other literature,12 although the proportion of patients who were tested for RSV increased from 2016 to 2017 through 2022 to 2023 in all age groups. The availability of vaccines and the increased use of multiplex respiratory virus testing might increase clinicians’ and patients’ aware-

18 | DALLAS MEDICAL JOURNAL • December 2024

RESEARCH

ness of RSV as a cause of illness in adults. This analysis

in adults. Second, although adjustments for underdetection of

also highlighted the potential public health impact of

RSV were made related to testing practices and test sensitivity,

RSV vaccination among older adults. RSV particularly

assumptions underlying adjustment multipliers may not be cor-

affects adults aged 75 years or older, a finding consis-

rect. These assumptions included that poor test sensitivity was

tently reported by studies estimating RSV-associated

random and that patients hospitalized with ARI who were not

hospitalization disease burden.

RSV vaccination is

tested for RSV were as likely to have RSV as patients who were

effective in preventing hospitalization in adults aged

tested; if untested patients were less likely to have RSV infection,

60 years or older41 and is recommended in the US for

then these methods may overestimate the burden of disease.

adults aged 75 years or older and those aged 60 to 74

In contrast, these adjustments did not account for hospital-

years who are at an increased risk for severe RSV dis-

ization of adults with nonrespiratory complications of RSV (eg,

ease.11 Early vaccination coverage estimates indicated

heart failure exacerbation)48 who were not tested for RSV and

that in the US, less than 20% of adults aged 60 years

who may not have an assigned ICD-10 diagnosis code for ARI,

or older and less than 10% of nursing home residents

potentially leading to an underestimation of RSV-attributable

had received RSV vaccination by December 2023.

hospitalizations.

1,2,31

42-44

Reducing barriers to vaccination and increasing cli-

Third, this study did not evaluate reasons for admission, and

nician awareness of the disease burden associated

RSV may not be the primary reason for hospitalization. However,

with RSV are needed to increase use of RSV vaccines.

previous RSV-NET–based analyses have shown that most hos-

Additional population-based epidemiologic analyses

pitalized adults with an RSV diagnosis experience substantial

are planned to examine risk factors beyond patient

respiratory illness, suggesting that mild or asymptomatic RSV in-

age, such as underlying medical conditions, race and

fections make up only a small percentage of detected RSV-as-

ethnicity, rural residence, and social determinants of

sociated hospitalizations.48,49 Fourth, patients with more severe

health, that identify individuals at greatest risk for se-

illness might have been more likely to be tested for RSV, resulting

vere clinical outcomes.

in a potential overestimation of the proportion of patients with

The data we collected and analyzed also demon-

RSV-associated hospitalizations who were admitted to the

strated how the COVID-19 pandemic disrupted the

ICU or who died. Fifth, the demographic characteristics of peo-

consistent prepandemic seasonality of RSV-associat-

ple in the RSV-NET surveillance area were generally similar to

ed hospitalizations, with 2 years of atypical seasonal-

those of the US population. However, RSV-NET data might not

ity and lower circulation, followed by a surge of RSV-

be generalizable to the entire country, and the methods in this

associated hospitalizations in the fall of 2022 with an

study might not adequately account for the uncertainty in ex-

earlier peak than in prepandemic seasons. This disrup-

trapolating RSV-NET data nationally.

tion of RSV circulation has been well documented in other studies,45-47 likely because of nonpharmaceutical

Conclusions

interventions such as mask wearing, school closure,

This cross-sectional study of adults hospitalized with laborato-

and social distancing. These data, along with data

ry-confirmed RSV demonstrated that prior to the availability of

from FluSurv-NET and COVID-NET, demonstrate the

vaccines in 2023, RSV was associated with a substantial burden

importance of ongoing, robust, population-based

of disease in adults, particularly older adults. In the US, effec-

hospital surveillance to track major changes in the

tive RSV vaccines27 have become available and vaccination is

burden and epidemiologic pattern of seasonal respi-

now recommended for all adults aged 75 years or older and

ratory viruses.

for those aged 60 to 74 years who are at an increased risk for

Limitations

severe RSV disease. The study found that most hospitalizations occurred among older adults, with the highest hospitalization

There are multiple limitations to this analysis. First,

rates in those aged 75 years or older. Given the large numbers

decisions about RSV testing were made at the dis-

of potentially vaccine-preventable hospitalizations and deaths

cretion of the treating clinician. Estimates of RSV

associated with RSV, increasing vaccine coverage among adults

burden based only on laboratory-confirmed hospi-

at highest risk could reduce associated hospitalizations and se-

talizations underestimate the true burden of disease

vere clinical outcomes. DMJ

December 2024 • DALLAS MEDICAL JOURNAL | 19

RESEARCH

REFERENCES 1.

Branche AR, Saiman L, Walsh EE, et al. Incidence of respiratory syncytial virus infection among hospitalized adults, 2017-2020. Clin Infect Dis. 2022;74(6):1004-1011. doi:10.1093/ cid/ciab595 2. McLaughlin JM, Khan F, Begier E, Swerdlow DL, Jodar L, Falsey AR. Rates of medically attended RSV among US adults: a systematic review and meta-analysis. Open Forum Infect Dis. 2022;9(7):ofac300. doi:10.1093/ofid/ ofac300 3. Falsey AR. Respiratory syncytial virus infection in elderly and high-risk adults. Exp Lung Res. 2005;31(suppl 1):77. doi:10.1056/NEJMoa043951 4. Widmer K, Griffin MR, Zhu Y, Williams JV, Talbot HK. Respiratory syncytial virus- and human metapneumovirus- associated emergency department and hospital burden in adults. Influenza Other Respir Viruses. 2014;8(3): 5. 347-352. doi:10.1111/irv.12234 6. Widmer K, Zhu Y, Williams JV, Griffin MR, Edwards KM, Talbot HK. Rates of hospitalizations for respiratory syncytial virus, human metapneumovirus, and influenza virus in older adults. J Infect Dis. 2012;206(1):56-62. doi: 10.1093/infdis/jis309 7. Belongia EA, King JP, Kieke BA, et al. Clinical features, severity, and incidence of RSV illness during 12 consecutive seasons in a community cohort of adults >60 years old. Open Forum Infect Dis. 2018;5(12):ofy316. doi:10.1093/ofid/ofy316 8. Abrysvo. Package insert. US Food and Drug Administration. Accessed September 11, 2024. https://www.fda.gov/ media/168889/download?attachment 9. Arexvy. Package insert. US Food and Drug Administration. Accessed September 11, 2024. https://www.fda.gov/ media/167805/download?attachment 10. Mresvia. Package insert. US Food and Drug Administration. Accessed September 11, 2024. https://www.fda. gov/media/179005/download 11. Melgar M, Britton A, Roper LE, et al. Use of respiratory syncytial virus vaccines in older adults: recommendations of the Advisory Committee on Immunization Practices—United States, 2023. MMWR Morb Mortal Wkly Rep. 2023;72(29):793-801. doi:10.15585/mmwr. mm7229a4 12. Britton A, Roper LE, Kotton CN, et al. Use of respiratory syncytial virus vaccines in adults aged >60 years: updated recommendations of the Advisory Committee on Immunization Practices—United States, 2024. MMWR Morb Mortal Wkly Rep. 2024;73(32):696-702. doi:10.15585/mmwr.mm7332e1 13. Rozenbaum MH, Judy J, Tran D, Yacisin K, Kurosky SK, Begier E. Low levels of RSV testing among adults hospitalized for lower respiratory tract infection in the United States.

Infect Dis Ther. 2023;12(2):677-685. doi:10. 1007/s40121-023-00758-5 14. Zhang Y, Sakthivel SK, Bramley A, et al. Serology enhances molecular diagnosis of respiratory virus infections other than influenza in children and adults hospitalized with community-acquired pneumonia. J Clin Microbiol. 2016;55(1):79-89. doi:10.1128/ JCM.01701-16 15. Bouzid D, Hingrat QL, Salipante F, et al. Agreement of respiratory viruses’ detection between nasopharyngeal swab and bronchoalveolar lavage in adults admitted for pneumonia: a retrospective study. Clin Microbiol Infect. 2023;29(7):942.e1-942.e6. doi:10.1016/j. cmi.2022.12.024 16. Ramirez J, Carrico R, Wilde A, et al. Diagnosis of respiratory syncytial virus in adults substantially increases when adding sputum, saliva, and serology testing to nasopharyngeal swab RT-PCR. Infect Dis Ther. 2023;12(6): 1593-1603. doi:10.1007/s40121-023-00805-1 17. Onwuchekwa C, Moreo LM, Menon S, et al. Under-ascertainment of respiratory syncytial virus infection in adults due to diagnostic testing limitations: a systematic literature review and meta-analysis. J Infect Dis. 2023; 228(2):173-184. doi:10.1093/infdis/jiad012 18. RSV-NET. Centers for Disease Control and Prevention. Accessed September 6, 2024. https://www.cdc.gov/rsv/ php/surveillance/rsv-net.html 19. U.S. Census populations with bridged race categories. Centers for Disease Control and Prevention. Accessed August 4, 2021. https://www.cdc.gov/nchs/nvss/bridged_race.htm 20. Reed C, Chaves SS, Daily Kirley P, et al. Estimating influenza disease burden from population-based surveillance data in the United States. PLoS One. 2015;10(3):e0118369. doi:10.1371/journal.pone.0118369 21. Rolfes MA, Foppa IM, Garg S, et al. Annual estimates of the burden of seasonal influenza in the United States: a tool for strengthening influenza surveillance and preparedness.

Influenza Other Respir Viruses. 2018;12(1): 22. 132-137. doi:10.1111/irv.12486 23. Kamidani S, Garg S, Rolfes MA, et al. Epidemiology, clinical characteristics, and outcomes of influenza- associated hospitalizations in US children over 9 seasons following the 2009 H1N1 pandemic. Clin Infect Dis. 2022; 75(11):1930-1939. doi:10.1093/cid/ciac296 24. Millman AJ, Reed C, Kirley PD, et al. Improving accuracy of influenza-associated hospitalization rate estimates.

25. Emerg Infect Dis. 2015;21(9):1595-1601. doi:10.3201/eid2109.141665 26. Chartrand C, Tremblay N, Renaud C, Papenburg J. Diagnostic accuracy of rapid antigen detection tests for respiratory syncytial virus infection: systematic review and metaanalysis. J Clin Microbiol. 2015;53(12):3738-3749. doi:10.1128/JCM.01816-15 27. Surie D, Yuengling KA, DeCuir J, et al; IVY Network. Disease severity of respiratory syncytial virus compared with COVID-19 and influenza among hospitalized adults aged >60 years—IVY Network, 20 U.S. states, February 2022-May 2023. MMWR Morb Mortal Wkly Rep. 2023;72(40):1083-1088. doi:10.15585/mmwr.mm7240a2 28. Kojima N, Taylor CA, Tenforde MW, et al. Clinical outcomes of US adults hospitalized for COVID-19 and influenza in the Respiratory Virus Hospitalization Surveillance Network, October 2021-September 2022. Open Forum Infect Dis. 2023;11(1):ofad702. doi:10.1093/ ofid/ofad702 29. Begley KM, Monto AS, Lamerato LE, et al. Prevalence and clinical outcomes of respiratory syncytial virus vs influenza in adults hospitalized with acute respiratory illness from a prospective multicenter study. Clin Infect Dis. 2023;76(11):1980-1988. doi:10.1093/cid/ciad031 30. Surie D, Yuengling KA, DeCuir J, et al; Investigating Respiratory Viruses in the Acutely Ill (IVY) Network. Severity of respiratory syncytial virus vs COVID-19 and influenza among hospitalized US adults. JAMA Netw Open. 2024;7(4):e244954. doi:10.1001/jamanetworkopen.2024.4954 31. Kujawski SA, Whitaker M, Ritchey MD, et al. Rates of respiratory syncytial virus (RSV)associated hospitalization among adults with congestive heart failure—United States, 2015-2017. PLoS One. 2022;17(3): e0264890. doi:10.1371/journal.pone.0264890

32. Tseng HF, Sy LS, Ackerson B, et al. Severe morbidity and short- and mid- to long-term mortality in older adults hospitalized with respiratory syncytial virus infection. J Infect Dis. 2020;222(8):1298-1310. doi:10.1093/infdis/ jiaa361 33. Pastula ST, Hackett J, Coalson J, et al. Hospitalizations for respiratory syncytial virus among adults in the United States, 1997-2012. Open Forum Infect Dis. 2017;4(1):ofw270. doi:10.1093/ofid/ofw270 34. Savic M, Penders Y, Shi T, Branche A, Pircon JY. Respiratory syncytial virus disease burden in adults aged 60 years and older in high-income countries: a systematic literature review and meta-analysis. Influenza Other Respir Viruses. 2022;17(1):e13031. doi:10.1111/ irv.13031 35. Nam HH, Ison MG. Respiratory syncytial virus infection in adults. BMJ. 2019;366:l5021. doi:10.1136/bmj.l5021 36. Branche AR, Saiman L, Walsh EE, et al. Change in functional status associated with respiratory syncytial virus infection in hospitalized older adults. Influenza Other Respir Viruses.

2022;16(6):1151-1160. doi:10.1111/irv.13043 37. McClure DL, Kieke BA, Sundaram ME, et al. Seasonal incidence of medically attended respiratory syncytial virus infection in a community cohort of adults >50 years old. PLoS One. 2014;9(7):e102586. doi:10.1371/journal. pone.0102586 38. Matias G, Taylor R, Haguinet F, Schuck-Paim C, Lustig R, Shinde V. Estimates of hospitalization attributable to influenza and RSV in the US during 1997-2009, by age and risk status. BMC Public Health. 2017;17(1):271. doi:10. 1186/s12889-017-4177-z 39. Goldstein E, Greene SK, Olson DR, Hanage WP, Lipsitch M. Estimating the hospitalization burden associated with influenza and respiratory syncytial virus in New York City, 20032011. Influenza Other Respir Viruses. 2015;9 (5):225-233. doi:10.1111/irv.12325 40. Mullooly JP, Bridges CB, Thompson WW, et al; Vaccine Safety Datalink Adult Working Group. Influenza- and RSV-associated hospitalizations among adults. Vaccine.

2007;25(5):846-855. doi:10.1016/j.vaccine.2006.09.041 41. Zhou H, Thompson WW, Viboud CG, et al. Hospitalizations associated with influenza and respiratory syncytial virus in the United States, 1993-2008. Clin Infect Dis. 2012;54(10):14271436. doi:10.1093/cid/cis211 42. Scruggs-Wodkowski EA, Malani PN, Linder KA. Therapies to decrease severe respiratory syncytial virus illness.

43. JAMA. 2024;331(24):2127-2128. doi:10.1001/jama.2024.7406 44. Hurley LP, Allison MA, Kim L, et al. Primary care physicians’ perspectives on respiratory syncytial virus (RSV) disease in adults and a potential RSV vaccine for adults. Vaccine.

2019;37(4):565-570. doi:10.1016/j.vaccine.2018. 12.031 45. Surie D, Self WH, Zhu Y, et al; Investigating Respiratory Viruses in the Acutely Ill (IVY) Network. RSV vaccine effectiveness against hospitalization among US adults 60 years and older. JAMA. 2024;332(13):1105-1107. doi:10. 1001/jama.2024.15775 46. Black CL, Kriss JL, Razzaghi H, et al. Influenza, updated COVID-19, and respiratory syncytial virus vaccination coverage among adults—United States, Fall 2023. MMWR Morb Mortal Wkly Rep. 2023;72(51):1377-1382. doi:10. 15585/mmwr.mm7251a4 47. Reses HE, Dubendris H, Haas L, et al. Coverage with influenza, respiratory syncytial virus, and updated 48. COVID-19 vaccines among nursing home residents—National Healthcare Safety Network, United States, December 2023. MMWR Morb Mortal Wkly Rep. 2023;72(51):1371-1376. doi:10.15585/mmwr.mm7251a3 49. Centers for Disease Control and Prevention. National Immunization Survey-Adult COVID Module (NIS-ACM). Accessed September 11, 2024. https://www.cdc.gov/rsvvaxview/ dashboard/adults-60-coverage-intent.html?CDC_ AAref_Val=https://www.cdc.gov/ vaccines/imz-managers/coverage/rsvvaxview/adults-60-coverage-intent.html 50. Falsey AR, Cameron A, Branche AR, Walsh EE. Perturbations in respiratory syncytial virus activity during the SARS-CoV-2 pandemic. J Infect Dis. 2022;227(1):83-86. doi:10.1093/ infdis/jiac434 51. Munkstrup C, Lomholt FK, Emborg HD, et al. Early and intense epidemic of respiratory syncytial virus (RSV) in Denmark, August to December 2022. Euro Surveill.

2023;28(1):2200937. doi:10.2807/1560-7917.ES.2023.28.1. 2200937 52. Mrcela D, Markic J, Zhao C, et al. Changes following the onset of the COVID-19 pandemic in the burden of hospitalization for respiratory syncytial virus acute lower respiratory infection in children under two years: 53. a retrospective study from Croatia. Viruses. 2022;14(12):2746. doi:10.3390/v14122746 54. Woodruff RC, Melgar M, Pham H, et al; Respiratory Syncytial Virus Hospitalization Surveillance Network (RSV- NET). Acute cardiac events in hospitalized older adults with respiratory syncytial virus infection. JAMA Intern Med. 2024;184(6):602-611. doi:10.1001/ jamainternmed.2024.0212 55. Havers FP, Whitaker M, Melgar M, et al; RSV-NET Surveillance Team. Characteristics and outcomes among adults aged >60 years hospitalized with laboratory-confirmed respiratory syncytial virus—RSV-NET, 12 states, July 2022-June 2023. MMWR Morb Mortal Wkly Rep. 2023;72(40):1075-1082. doi:10.15585/mmwr.mm7240a1

View the full text, supplements, and tables: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2826104?resultClick=3

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2024 In Memoriam Sarah Blumenschein, MD October 25, 2024 DCMS member for 45 years

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Health Insurance Open Enrollment

We Help Members Improve Their Health Insurance Coverage and Control Costs Here are some of the ways we help owners and independents get better coverage: Hundreds of medical groups and thousands of physicians, their dependents and employees across Texas have improved their health insurance coverage and controlled costs by working with TMA Insurance Trust. We helped them secure more comprehensive coverage or find a more budgetfriendly option. Many times, it’s both. How? We are group specialists and have uncovered special options available only during Open Enrollment that help owners and independents access group PPO insurance for their employees, or just for themselves - even when they do not have employees. And this is all backed by a higher level of service and care our dedicated members deserve.

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