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Tippett A, Ess G, Hussaini L, Reese O, Salazar L, Kelly M, Taylor M, Ciric C, Keane A, Cheng A, Gibson T, Li W, Hsiao HM, Bristow L, Hellmeister K, Al-Husein Z, Hubler R, Begier E, Liu Q, Gessner B, Swerdlow DL, Kamidani S, Kao C, Yildirim I, Rouphael N, Rostad CA, Anderson EJ. Influenza Vaccine Effectiveness Pre-pandemic Among Adults Hospitalized With Congestive Heart Failure or Chronic Obstructive Pulmonary Disease and Older Adults. Clin Infect Dis 2024; 78:1065-1072. [PMID: 37946601 DOI: 10.1093/cid/ciad679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 10/30/2023] [Accepted: 11/06/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND Data are limited on influenza vaccine effectiveness (VE) in the prevention of influenza-related hospitalizations in older adults and those with underlying high-risk comorbidities. METHODS We conducted a prospective, test-negative, case-control study at 2 US hospitals from October 2018-March 2020 among adults aged ≥50 years hospitalized with acute respiratory illnesses (ARIs) and adults ≥18 years admitted with congestive heart failure (CHF) or chronic obstructive pulmonary disease (COPD) exacerbations. Adults were eligible if they resided in 1 of 8 counties in metropolitan Atlanta, Georgia. Nasopharyngeal and oropharyngeal swabs were tested using BioFire FilmArray (bioMérieux, Inc.) respiratory panel, and standard-of-care molecular results were included when available. Influenza vaccination history was determined from the Georgia vaccine registry and medical records. We used multivariable logistic regression to control for potential confounders and to determine 95% confidence intervals (CIs). RESULTS Among 3090 eligible adults, 1562 (50.6%) were enrolled. Of the 1515 with influenza vaccination history available, 701 (46.2%) had received vaccination during that season. Influenza was identified in 37 (5.3%) vaccinated versus 78 (9.6%) unvaccinated participants. After adjustment for age, race/ethnicity, immunosuppression, month, and season, pooled VE for any influenza-related hospitalization in the eligible study population was 63.1% (95% CI, 43.8-75.8%). Adjusted VE against influenza-related hospitalization for ARI in adults ≥50 years was 55.9% (29.9-72.3%) and adjusted VE against influenza-related CHF/COPD exacerbation in adults ≥18 years was 80.3% (36.3-93.9%). CONCLUSIONS Influenza vaccination was effective in preventing influenza-related hospitalizations in adults aged ≥50 years and those with CHF/COPD exacerbations during the 2018-2020 seasons.
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Affiliation(s)
- Ashley Tippett
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Gabby Ess
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Laila Hussaini
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Olivia Reese
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Luis Salazar
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Mary Kelly
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Meg Taylor
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Caroline Ciric
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Amy Keane
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Andrew Cheng
- Department of Medicine, Hope Clinic, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Theda Gibson
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Wensheng Li
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Hui-Mien Hsiao
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Laurel Bristow
- Department of Medicine, Hope Clinic, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Kieffer Hellmeister
- Department of Medicine, Hope Clinic, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Zayna Al-Husein
- Department of Medicine, Hope Clinic, Emory University School of Medicine, Atlanta, Georgia, USA
| | | | | | - Qing Liu
- Pfizer, Inc,New York, New York, USA
| | | | | | - Satoshi Kamidani
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
- Center for Childhood Infections and Vaccines, Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Carol Kao
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
- Center for Childhood Infections and Vaccines, Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Inci Yildirim
- Department of Pediatrics (Infectious Diseases), Yale-New Haven Hospital, New Haven, Connecticut, USA
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut, USA
- Yale School of Public Health, Yale Institute for Global Health, New Haven, Connecticut, USA
- Center for Infection and Immunity, Yale School of Medicine, New Haven, Connecticut, USA
| | - Nadine Rouphael
- Department of Medicine, Hope Clinic, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Christina A Rostad
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
- Center for Childhood Infections and Vaccines, Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Evan J Anderson
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
- Center for Childhood Infections and Vaccines, Children's Healthcare of Atlanta, Atlanta, Georgia, USA
- Department of Medicine, Hope Clinic, Emory University School of Medicine, Atlanta, Georgia, USA
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Niekler P, Goettler D, Liese JG, Streng A. Hospitalizations due to respiratory syncytial virus (RSV) infections in Germany: a nationwide clinical and direct cost data analysis (2010-2019). Infection 2023:10.1007/s15010-023-02122-8. [PMID: 37973718 DOI: 10.1007/s15010-023-02122-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 10/21/2023] [Indexed: 11/19/2023]
Abstract
PURPOSE Clinical and direct medical cost data on RSV-related hospitalizations are relevant for public health decision-making. We analyzed nationwide data on RSV-coded hospitalizations from Germany in different age and risk groups. METHODS Assessment of RSV-coded hospitalizations (ICD-10-GM RSV-code J12.1/J20.5/J21.0 as primary discharge diagnosis) from 01/2010 to 12/2019, using remote data retrieval from the Hospital Statistics Database of the German Federal Statistical Office. RESULTS Overall, 205,352 RSV-coded hospitalizations (198,139 children < 18 years, 1,313 adults, 5,900 seniors > 59 years) were reported (median age < 1 year, IQR 0; 1; 56% males, 32% with RSV pneumonia). Annual median RSV-coded hospitalization incidence was 24.8/100,000 persons (IQR 21.3; 27.5); children reported a median incidence of 145.8 (IQR 130.9; 168.3). Between 2010 and 2019, hospitalization incidence increased 1.7-fold/15.1-fold/103-fold in children/adults/seniors. Adults and seniors reported higher rates of underlying chronic conditions, complications, and intensive care treatment than children; of 612 in-hospital fatalities, 103/51/458 occurred in children/adults/seniors. Per-patient mean costs varied between 3286€ ± 4594 in 1-4-year-olds and 7215€ ± 13,564 among adults. Increased costs were associated with immune disorders (2.55-fold increase compared to those without), nervous system disorders (2.66-fold), sepsis (7.27-fold), ARDS (12.85-fold), intensive care (4.60-fold) and ECMO treatment (16.88-fold). CONCLUSION The economic burden of RSV-related hospitalizations in Germany is substantial, even when only considering cases with RSV-coded as the primary discharge diagnosis. Children represented the vast majority of RSV-coded hospitalizations. However, adults and seniors hospitalized for RSV were at a higher risk of severe complications, required more costly treatments, and had higher fatality rates; although their RSV-coded hospitalization incidence showed a clear upward trend since 2017, their true hospitalization incidence is still likely to be underestimated due to lack of routine RSV testing in these age groups. Hence, new treatments and vaccines for RSV ideally should also target adults and seniors in addition to children.
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Affiliation(s)
- Patricia Niekler
- Department of Pediatrics, University Hospital of Würzburg, Josef-Schneider-Str. 2, 97080, Würzburg, Germany
| | - David Goettler
- Department of Pediatrics, University Hospital of Würzburg, Josef-Schneider-Str. 2, 97080, Würzburg, Germany
| | - Johannes G Liese
- Department of Pediatrics, University Hospital of Würzburg, Josef-Schneider-Str. 2, 97080, Würzburg, Germany
| | - Andrea Streng
- Department of Pediatrics, University Hospital of Würzburg, Josef-Schneider-Str. 2, 97080, Würzburg, Germany.
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Hariharan D, Kumar VSS, Glaser EL, Crown WH, Wolf ZA, Fisher KA, Wood CT, Malcolm WF, Nelson CB, Shepard DS. Quality of life burden on United States infants and caregivers due to lower respiratory tract infection and adjusting for selective testing: Pilot prospective observational study. Health Sci Rep 2023; 6:e1338. [PMID: 37334041 PMCID: PMC10273330 DOI: 10.1002/hsr2.1338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 05/28/2023] [Accepted: 05/31/2023] [Indexed: 06/20/2023] Open
Abstract
Background and Aims Policymakers need data about the burden of respiratory syncytial virus (RSV) lower respiratory tract infections (LRTI) among infants. This study estimates quality of life (QoL) for otherwise healthy term US infants with RSV-LRTI and their caregivers, previously limited to premature and hospitalized infants, and corrects for selective testing. Methods The study enrolled infants <1 year with a clinically diagnosed LRTI encounter between January and May 2021. Using an established 0-100 scale, the 36 infants' and caregivers' QoL at enrollment and quality-adjusted life year losses per 1000 LRTI episodes (quality-adjusted life years [QALYs]/1000) were validated and analyzed. Regression analyses examined predictors of RSV-testing and RSV-positivity, creating modeled positives. Results Mean QoL at enrollment in outpatient (n = 11) LRTI-tested infants (66.4) was lower than that in not-tested LRTI infants (79.6, p = 0.096). For outpatient LRTI infants (n = 23), median QALYs/1000 losses were 9.8 and 0.25 for their caregivers. RSV-positive outpatient LRTI infants (n = 6) had significantly milder QALYs/1000 losses (7.0) than other LRTI-tested infants (n = 5)(21.8, p = 0.030). Visits earlier in the year were more likely to be RSV-positive than later visits (p = 0.023). Modeled RSV-positivity (51.9%) was lower than the observed rate (55.0%). Infants' and caregivers' QALYs/1000 loss were positively correlated (rho = 0.34, p = 0.046), indicating that infants perceived as sicker imposed greater burdens on caregivers. Conclusions The overall median QALYs/1000 losses for LRTI (9.0) and RSV-LRTI (5.6) in US infants are substantial, with additional losses for their caregivers (0.25 and 0.20, respectively). These losses extend equally to outpatient episodes. This study is the first reporting QALY losses for infants with LRTI born at term or presenting in nonhospitalized settings, and their caregivers.
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Affiliation(s)
- Dhwani Hariharan
- Heller School for Social Policy and ManagementBrandeis UniversityWalthamMassachusettsUSA
| | - V. S. Senthil Kumar
- Heller School for Social Policy and ManagementBrandeis UniversityWalthamMassachusettsUSA
| | - Elizabeth L Glaser
- Heller School for Social Policy and ManagementBrandeis UniversityWalthamMassachusettsUSA
| | - William H. Crown
- Heller School for Social Policy and ManagementBrandeis UniversityWalthamMassachusettsUSA
| | | | | | - Charles T. Wood
- Duke University School of MedicineDuke UniversityDurhamNorth CarolinaUSA
| | - William F. Malcolm
- Duke University School of MedicineDuke UniversityDurhamNorth CarolinaUSA
| | | | - Donald S. Shepard
- Heller School for Social Policy and ManagementBrandeis UniversityWalthamMassachusettsUSA
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Bylsma LC, Suh M, Movva N, Fryzek JP, Nelson CB. Mortality Among US Infants and Children Under 5 Years of Age with Respiratory Syncytial Virus and Bronchiolitis: A Systematic Literature Review. J Infect Dis 2022; 226:S267-S281. [PMID: 35968871 PMCID: PMC9377034 DOI: 10.1093/infdis/jiac226] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background A systematic literature review was conducted to summarize the mortality (overall and by disease severity factors) of US infants and children aged <5 years with respiratory syncytial virus (RSV) or all-cause bronchiolitis (ACB). Methods Comprehensive, systematic literature searches were conducted; articles were screened using prespecified eligibility criteria. A standard risk of bias tool was used to evaluate studies. Mortality was extracted as the rate per 100 000 or the case fatality ratio (CFR; proportion of deaths among RSV/ACB cases). Results Among 42 included studies, 36 evaluated inpatient deaths; 10 used nationally representative populations updated through 2013, and only 2 included late-preterm/full-term otherwise healthy infants and children. The RSV/ACB definition varied across studies (multiple International Classification of Diseases [ICD] codes; laboratory confirmation); no study reported systematic testing for RSV. No studies reported RSV mortality rates, while 3 studies provided ACB mortality rates (0.57–9.4 per 100 000). CFRs ranged from 0% to 1.7% for RSV (n = 15) and from 0% to 0.17% for ACB (n = 6); higher CFRs were reported among premature, intensive care unit-admitted, and publicly insured infants and children. Conclusions RSV mortality reported among US infants and children is variable. Current, nationally representative estimates are needed for otherwise healthy, late-preterm to full-term infants and children.
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Affiliation(s)
- Lauren C Bylsma
- EpidStrategies, A Division of ToxStrategies, Inc, Rockville, Maryland, USA
| | - Mina Suh
- EpidStrategies, A Division of ToxStrategies, Inc, Rockville, Maryland, USA
| | - Naimisha Movva
- EpidStrategies, A Division of ToxStrategies, Inc, Rockville, Maryland, USA
| | - Jon P Fryzek
- EpidStrategies, A Division of ToxStrategies, Inc, Rockville, Maryland, USA
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Reichert H, Suh M, Jiang X, Movva N, Bylsma LC, Fryzek JP, Nelson CB. OUP accepted manuscript. J Infect Dis 2022; 226:S246-S254. [PMID: 35968877 PMCID: PMC9377030 DOI: 10.1093/infdis/jiac127] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 04/05/2022] [Indexed: 11/12/2022] Open
Abstract
Background Methods Results Conclusions
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Affiliation(s)
- Heidi Reichert
- Correspondence: Heidi Reichert, MA, EpidStrategies, A Division of ToxStrategies, Johns Hopkins Campus, 9601 Medical Center Drive, Rockville, MD 20850 ()
| | - Mina Suh
- EpidStrategies, A Division of ToxStrategies, Rockville, Maryland, USA
| | - Xiaohui Jiang
- EpidStrategies, A Division of ToxStrategies, Rockville, Maryland, USA
| | - Naimisha Movva
- EpidStrategies, A Division of ToxStrategies, Rockville, Maryland, USA
| | - Lauren C Bylsma
- EpidStrategies, A Division of ToxStrategies, Rockville, Maryland, USA
| | - Jon P Fryzek
- EpidStrategies, A Division of ToxStrategies, Rockville, Maryland, USA
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