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Kostoff RN, Briggs MB, Kanduc D, Shores DR, Kovatsi L, Vardavas AI, Porter AL. Common contributing factors to COVID-19 and inflammatory bowel disease. Toxicol Rep 2021; 8:1616-1637. [PMID: 34485092 PMCID: PMC8406546 DOI: 10.1016/j.toxrep.2021.08.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 08/17/2021] [Accepted: 08/28/2021] [Indexed: 12/11/2022] Open
Abstract
The devastating complications of coronavirus disease 2019 (COVID-19) result from an individual's dysfunctional immune response following the initial severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Multiple toxic stressors and behaviors contribute to underlying immune system dysfunction. SARS-CoV-2 exploits the dysfunctional immune system to trigger a chain of events ultimately leading to COVID-19. We have previously identified many contributing factors (CFs) (representing toxic exposure, lifestyle factors and psychosocial stressors) common to myriad chronic diseases. We hypothesized significant overlap between CFs associated with COVID-19 and inflammatory bowel disease (IBD), because of the strong role immune dysfunction plays in each disease. A streamlined dot-product approach was used to identify potential CFs to COVID-19 and IBD. Of the fifty CFs to COVID-19 that were validated for demonstration purposes, approximately half had direct impact on COVID-19 (the CF and COVID-19 were mentioned in the same record; i.e., CF---→COVID-19), and the other half had indirect impact. The nascent character of the COVID-19 core literature (∼ one year old) did not allow sufficient time for the direct impacts of many CFs on COVID-19 to be identified. Therefore, an immune system dysfunction (ID) literature directly related to the COVID-19 core literature was used to augment the COVID-19 core literature and provide the remaining CFs that impacted COVID-19 indirectly (i.e., CF---→immune system dysfunction---→COVID-19). Approximately 13000 potential CFs for myriad diseases (obtained from government and university toxic substance lists) served as the starting point for the dot-product identification process. These phrases were intersected (dot-product) with phrases extracted from a PubMed-derived IBD core literature, a nascent COVID-19 core literature, and the COVID-19-related immune system dysfunction (ID) core literature to identify common ID/COVID-19 and IBD CFs. Approximately 3000 potential CFs common to both ID and IBD, almost 2300 potential CFs common to ID and COVID-19, and over 1900 potential CFs common to IBD and COVID-19 were identified. As proof of concept, we validated fifty of these ∼3000 overlapping ID/IBD candidate CFs with biologic plausibility. We further validated 24 of the fifty as common CFs in the IBD and nascent COVID-19 core literatures. This significant finding demonstrated that the CFs indirectly related to COVID-19 -- identified with use of the immune system dysfunction literature -- are strong candidates to emerge eventually as CFs directly related to COVID-19. As discussed in the main text, many more CFs common to all these core literatures could be identified and validated. ID and IBD share many common risk/contributing factors, including behaviors and toxic exposures that impair immune function. A key component to immune system health is removal of those factors that contribute to immune system dysfunction in the first place. This requires a paradigm shift from traditional Western medicine, which often focuses on treatment, rather than prevention.
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Affiliation(s)
- Ronald Neil Kostoff
- School of Public Policy, Georgia Institute of Technology, Gainesville, VA, 20155, United States
| | | | - Darja Kanduc
- Dept. of Biosciences, Biotechnologies, and Biopharmaceutics, University of Bari, Via Orabona 4, Bari, 70125, Italy
| | - Darla Roye Shores
- Department of Pediatrics, Division of Gastroenterology, The Johns Hopkins University School of Medicine, Baltimore, MD, 21287, United States
| | - Leda Kovatsi
- Laboratory of Forensic Medicine and Toxicology, School of Medicine, Aristotle University of Thessaloniki, 54124, Greece
| | - Alexander I. Vardavas
- Laboratory of Toxicology & Forensic Sciences, Faculty of Medicine, University of Crete, Greece
| | - Alan L. Porter
- R&D, Search Technology, Inc., Peachtree Corners, GA, 30092, United States
- School of Public Policy, Georgia Institute of Technology, Atlanta, GA, 30332, United States
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Mesa-Vieira C, Botero-Rodríguez F, Padilla-Muñoz A, Franco OH, Gómez-Restrepo C. Reprint of: The Dark Side of the Moon: Global challenges in the distribution of vaccines and implementation of vaccination plans against COVID-19. Maturitas 2021; 150:61-63. [PMID: 34274076 PMCID: PMC8279820 DOI: 10.1016/j.maturitas.2021.05.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 05/14/2021] [Accepted: 05/18/2021] [Indexed: 12/29/2022]
Affiliation(s)
- Cristina Mesa-Vieira
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland.
| | - Felipe Botero-Rodríguez
- Departamento de Epidemiología Clínica y Bioestadística, Pontificia Universidad Javeriana, Bogotá, Colombia
| | | | - Oscar H Franco
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
| | - Carlos Gómez-Restrepo
- Departamento de Epidemiología Clínica y Bioestadística, Pontificia Universidad Javeriana, Bogotá, Colombia; Departamento de Psiquiatría y Salud Mental, Pontificia Universidad Javeriana, Bogotá, Colombia; Hospital Universitario San Ignacio, Bogotá, Colombia
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Mesa-Vieira C, Botero-Rodríguez F, Padilla-Muñoz A, Franco OH, Gómez-Restrepo C. The Dark Side of the Moon: Global challenges in the distribution of vaccines and implementation of vaccination plans against COVID-19. Maturitas 2021; 149:37-39. [PMID: 34083091 PMCID: PMC8152201 DOI: 10.1016/j.maturitas.2021.05.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 05/14/2021] [Accepted: 05/18/2021] [Indexed: 02/06/2023]
Affiliation(s)
- Cristina Mesa-Vieira
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland.
| | - Felipe Botero-Rodríguez
- Departamento de Epidemiología Clínica y Bioestadística, Pontificia Universidad Javeriana, Bogotá, Colombia
| | | | - Oscar H Franco
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
| | - Carlos Gómez-Restrepo
- Departamento de Epidemiología Clínica y Bioestadística, Pontificia Universidad Javeriana, Bogotá, Colombia; Departamento de Psiquiatría y Salud Mental, Pontificia Universidad Javeriana, Bogotá, Colombia; Hospital Universitario San Ignacio, Bogotá, Colombia
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Raj N, Fernandes S, Charyulu NR, Dubey A, G S R, Hebbar S. Postmarket surveillance: a review on key aspects and measures on the effective functioning in the context of the United Kingdom and Canada. Ther Adv Drug Saf 2019; 10:2042098619865413. [PMID: 31384423 PMCID: PMC6661791 DOI: 10.1177/2042098619865413] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Accepted: 07/02/2019] [Indexed: 12/03/2022] Open
Abstract
Regulatory approvals for the marketing of medicinal products authorize medical
practitioners to prescribe drugs to a group of patients that are defined within
the license of the medicinal product. However, such prescriptions are carried
out in a controlled manner. Prior to being approved, the medicinal product will
have been evaluated in a population pool containing fewer than 5,000 patients
and in a predesigned environment where several factors may be lacking, such as
the absence of women of childbearing potential, geriatric patients and
paediatric patients. Therefore, it is not surprising that several major adverse
drug reactions are detected only when the product has been prescribed to the
general population. National and international regulatory bodies have devised
systems for monitoring medicinal products after marketing, commonly known as
postmarketing surveillance systems. Postmarketing surveillance refers to the
process of monitoring the safety of drugs once they reach the market, after the
successful completion of clinical trials. The primary purpose for conducting
postmarketing surveillance is to identify previously unrecognized adverse
effects as well as positive effects. The Yellow Card scheme, practiced in the
United Kingdom and the Canada Vigilance Program adopted in the Canadian
jurisdiction, are two of the most successful postmarketing surveillance systems
implemented across the world. Therefore, this article intends to discuss
postmarketing surveillance and its role in the context of the United Kingdom and
Canadian jurisdictions with a view on presenting key aspects and measures that
are employed for operating an efficient postmarketing surveillance system in
regulated markets.
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Affiliation(s)
- Nikhil Raj
- Department of Pharmaceutical Regulatory Affairs, N.G.S.M. Institute of Pharmaceutical Sciences, Nitte (Deemed to be University), Deralakatte, Mangaluru, Karnataka, India
| | - Swapnil Fernandes
- Department of Pharmaceutical Regulatory Affairs, N.G.S.M. Institute of Pharmaceutical Sciences, Nitte (Deemed to be University), Deralakatte, Mangaluru, Karnataka, India
| | - Narayana R Charyulu
- Department of Pharmaceutical Regulatory Affairs, N.G.S.M. Institute of Pharmaceutical Sciences, Nitte (Deemed to be University), Deralakatte, Mangaluru, Karnataka, India
| | - Akhilesh Dubey
- Department of Pharmaceutical Regulatory Affairs, N.G.S.M. Institute of Pharmaceutical Sciences, Nitte (Deemed to be University), Deralakatte, Mangaluru, Karnataka, India
| | - Ravi G S
- Department of Pharmaceutical Regulatory Affairs, N.G.S.M. Institute of Pharmaceutical Sciences, Nitte (Deemed to be University), Deralakatte, Mangaluru 575018, Karnataka, India
| | - Srinivas Hebbar
- Department of Pharmaceutical Regulatory Affairs, N.G.S.M. Institute of Pharmaceutical Sciences, Nitte (Deemed to be University), Deralakatte, Mangaluru, Karnataka, India
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McKenzie C, Tan J, Macia L, Mackay CR. The nutrition-gut microbiome-physiology axis and allergic diseases. Immunol Rev 2018; 278:277-295. [PMID: 28658542 DOI: 10.1111/imr.12556] [Citation(s) in RCA: 210] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Indexed: 02/06/2023]
Abstract
Dietary and bacterial metabolites influence immune responses. This raises the question whether the increased incidence of allergies, asthma, some autoimmune diseases, cardiovascular disease, and others might relate to intake of unhealthy foods, and the decreased intake of dietary fiber. In recent years, new knowledge on the molecular mechanisms underpinning a 'diet-gut microbiota-physiology axis' has emerged to substantiate this idea. Fiber is fermented to short chain fatty acids (SCFAs), particularly acetate, butyrate, and propionate. These metabolites bind 'metabolite-sensing' G-protein-coupled receptors such as GPR43, GPR41, and GPR109A. These receptors play fundamental roles in the promotion of gut homeostasis and the regulation of inflammatory responses. For instance, these receptors and their metabolites influence Treg biology, epithelial integrity, gut homeostasis, DC biology, and IgA antibody responses. The SCFAs also influence gene transcription in many cells and tissues, through their inhibition of histone deacetylase expression or function. Contained in this mix is the gut microbiome, as commensal bacteria in the gut have the necessary enzymes to digest dietary fiber to SCFAs, and dysbiosis in the gut may affect the production of SCFAs and their distribution to tissues throughout the body. SCFAs can epigenetically modify DNA, and so may be one mechanism to account for diseases with a 'developmental origin', whereby in utero or post-natal exposure to environmental factors (such as nutrition of the mother) may account for disease later in life. If the nutrition-gut microbiome-physiology axis does underpin at least some of the Western lifestyle influence on asthma and allergies, then there is tremendous scope to correct this with healthy foodstuffs, probiotics, and prebiotics.
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Affiliation(s)
- Craig McKenzie
- Infection and Immunity Program, Department of Biochemistry, Biomedicine Discovery Institute, Monash University, Clayton, Vic., Australia
| | - Jian Tan
- Infection and Immunity Program, Department of Biochemistry, Biomedicine Discovery Institute, Monash University, Clayton, Vic., Australia
| | - Laurence Macia
- Nutritional Immunometabolism Node Laboratory, Charles Perkins Centre, University of Sydney, Sydney, NSW, Australia.,School of Medical Sciences, University of Sydney, Sydney, NSW, Australia
| | - Charles R Mackay
- Infection and Immunity Program, Department of Biochemistry, Biomedicine Discovery Institute, Monash University, Clayton, Vic., Australia
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Tan J, McKenzie C, Vuillermin PJ, Goverse G, Vinuesa CG, Mebius RE, Macia L, Mackay CR. Dietary Fiber and Bacterial SCFA Enhance Oral Tolerance and Protect against Food Allergy through Diverse Cellular Pathways. Cell Rep 2017; 15:2809-24. [PMID: 27332875 DOI: 10.1016/j.celrep.2016.05.047] [Citation(s) in RCA: 463] [Impact Index Per Article: 57.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Revised: 03/02/2016] [Accepted: 05/10/2016] [Indexed: 02/07/2023] Open
Abstract
The incidence of food allergies in western countries has increased dramatically in recent decades. Tolerance to food antigens relies on mucosal CD103(+) dendritic cells (DCs), which promote differentiation of regulatory T (Treg) cells. We show that high-fiber feeding in mice improved oral tolerance and protected from food allergy. High-fiber feeding reshaped gut microbial ecology and increased the release of short-chain fatty acids (SCFAs), particularly acetate and butyrate. High-fiber feeding enhanced oral tolerance and protected against food allergy by enhancing retinal dehydrogenase activity in CD103(+) DC. This protection depended on vitamin A in the diet. This feeding regimen also boosted IgA production and enhanced T follicular helper and mucosal germinal center responses. Mice lacking GPR43 or GPR109A, receptors for SCFAs, showed exacerbated food allergy and fewer CD103(+) DCs. Dietary elements, including fiber and vitamin A, therefore regulate numerous protective pathways in the gastrointestinal tract, necessary for immune non-responsiveness to food antigens.
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Affiliation(s)
- Jian Tan
- Infection and Immunity Program, Monash Biomedicine Discovery Institute and Department of Biochemistry and Molecular Biology, Monash University, Clayton, VIC 3800, Australia
| | - Craig McKenzie
- Infection and Immunity Program, Monash Biomedicine Discovery Institute and Department of Biochemistry and Molecular Biology, Monash University, Clayton, VIC 3800, Australia
| | | | - Gera Goverse
- Department of Molecular Cell Biology and Immunology, VU University Medical Center, 1081 HZ Amsterdam, the Netherlands
| | - Carola G Vinuesa
- Department of Pathogens and Immunity, John Curtin School of Medical Research, Australian National University, Building 131, Garran Road, Canberra, ACT 0200, Australia
| | - Reina E Mebius
- Department of Molecular Cell Biology and Immunology, VU University Medical Center, 1081 HZ Amsterdam, the Netherlands
| | - Laurence Macia
- Infection and Immunity Program, Monash Biomedicine Discovery Institute and Department of Biochemistry and Molecular Biology, Monash University, Clayton, VIC 3800, Australia; Charles Perkins Centre, The University of Sydney, Sydney, NSW 2006, Australia; Department of Physiology, Faculty of Medicine, The University of Sydney, Sydney, NSW 2006, Australia.
| | - Charles R Mackay
- Infection and Immunity Program, Monash Biomedicine Discovery Institute and Department of Biochemistry and Molecular Biology, Monash University, Clayton, VIC 3800, Australia; Charles Perkins Centre, The University of Sydney, Sydney, NSW 2006, Australia; Department of Physiology, Faculty of Medicine, The University of Sydney, Sydney, NSW 2006, Australia.
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Hawken S, Potter BK, Little J, Benchimol EI, Mahmud S, Ducharme R, Wilson K. The use of relative incidence ratios in self-controlled case series studies: an overview. BMC Med Res Methodol 2016; 16:126. [PMID: 27664070 PMCID: PMC5035460 DOI: 10.1186/s12874-016-0225-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Accepted: 09/14/2016] [Indexed: 11/21/2022] Open
Abstract
Background The self-controlled case series (SCCS) is a useful design for investigating associations between outcomes and transient exposures. The SCCS design controls for all fixed covariates, but effect modification can still occur. This can be evaluated by including interaction terms in the model which, when exponentiated, can be interpreted as a relative incidence ratio (RIR): the change in relative incidence (RI) for a unit change in an effect modifier. Methods We conducted a scoping review to investigate the use of RIRs in published primary SCCS studies, and conducted a case-study in one of our own primary SCCS studies to illustrate the use of RIRs within an SCCS analysis to investigate subgroup effects in the context of comparing whole cell (wcp) and acellular (acp) pertussis vaccines. Using this case study, we also illustrated the potential utility of RIRs in addressing the healthy vaccinee effect (HVE) in vaccine safety surveillance studies. Results Our scoping review identified 122 primary studies reporting an SCCS analysis. Of these, 24 described the use of interaction terms to test for effect modification. 21 of 24 studies reported stratum specific RIs, 22 of 24 reported the p-value for interaction, and less than half (10 of 24) reported the estimate of the interaction term/RIR, the stratum specific RIs and interaction p-values. Our case-study demonstrated that there was a nearly two-fold greater RI of ER visits and admissions following wcp vaccination relative to acp vaccination (RIR = 1.82, 95 % CI 1.64–2.01), where RI estimates in each subgroup were clearly impacted by a strong healthy vaccinee effect. Conclusions We demonstrated in our scoping review that calculating RIRs is not a widely utilized strategy. We showed that calculating RIRs across time periods is useful for the detection of relative changes in adverse event rates that might otherwise be missed due to the HVE. Many published studies of vaccine-associated adverse events could have missed/underestimated important safety signals masked by the HVE. With further development, our application of RIRs could be an important tool to address the HVE, particularly in the context of self-controlled study designs.
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Affiliation(s)
- Steven Hawken
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, 725 Parkdale Ave, Ottawa, ON, K1Y 4E9, Canada. .,School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, 451 Smyth Road, Ottawa, ON, K1H 8 M5, Canada. .,Institute for Clinical Evaluative Sciences Ottawa, Box 684, 1053 Carling Ave., Admin Services Bldg. Rm 1009, Ottawa, ON, K1Y4E9, Canada.
| | - Beth K Potter
- School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, 451 Smyth Road, Ottawa, ON, K1H 8 M5, Canada.,Institute for Clinical Evaluative Sciences Ottawa, Box 684, 1053 Carling Ave., Admin Services Bldg. Rm 1009, Ottawa, ON, K1Y4E9, Canada
| | - Julian Little
- School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, 451 Smyth Road, Ottawa, ON, K1H 8 M5, Canada
| | - Eric I Benchimol
- School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, 451 Smyth Road, Ottawa, ON, K1H 8 M5, Canada.,Institute for Clinical Evaluative Sciences Ottawa, Box 684, 1053 Carling Ave., Admin Services Bldg. Rm 1009, Ottawa, ON, K1Y4E9, Canada.,Division of Gastroenterology, Hepatology and Nutrition, Children's Hospital of Eastern Ontario and Department of Pediatrics, University of Ottawa, 401 Smyth Road, Ottawa, ON, K1H 8L1, Canada
| | - Salah Mahmud
- Department of Medicine, 727 McDermot Ave., Winnipeg, MB, R3E 3P5, Canada
| | - Robin Ducharme
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, 725 Parkdale Ave, Ottawa, ON, K1Y 4E9, Canada.,Institute for Clinical Evaluative Sciences Ottawa, Box 684, 1053 Carling Ave., Admin Services Bldg. Rm 1009, Ottawa, ON, K1Y4E9, Canada
| | - Kumanan Wilson
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, 725 Parkdale Ave, Ottawa, ON, K1Y 4E9, Canada.,School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, 451 Smyth Road, Ottawa, ON, K1H 8 M5, Canada.,Institute for Clinical Evaluative Sciences Ottawa, Box 684, 1053 Carling Ave., Admin Services Bldg. Rm 1009, Ottawa, ON, K1Y4E9, Canada
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Sukumaran L, McCarthy NL, Li R, Weintraub ES, Jacobsen SJ, Hambidge SJ, Jackson LA, Naleway AL, Chan B, Tao B, Gee J. Demographic characteristics of members of the Vaccine Safety Datalink (VSD): A comparison with the United States population. Vaccine 2015; 33:4446-50. [PMID: 26209836 PMCID: PMC4547875 DOI: 10.1016/j.vaccine.2015.07.037] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Revised: 07/08/2015] [Accepted: 07/11/2015] [Indexed: 01/20/2023]
Abstract
BACKGROUND The Vaccine Safety Datalink (VSD) is a collaboration between CDC and nine integrated health care systems that serves as a cornerstone of US post-licensure vaccine safety monitoring. Given concerns that potential differences between the insured VSD population and the US population could limit the generalizability of VSD study findings, we performed a comparison of the demographic characteristics between the two populations. METHODS We collected data from medical records and administrative files at VSD sites in 2010 to compare sex, age, race, ethnicity, income, and educational attainment to the 2010 US Census population. We also compared data on the 2012 VSD Medicaid population to 2012 US Medicaid data. RESULTS The VSD population included over eight million individuals in 2010, which represented 2.6% of the total US population. All major demographic groups were represented in the VSD. We found no major differences in comparing sex, race, ethnicity, and educational attainment between the VSD and the US population. Middle income populations were comparable between the VSD and the US. While the percentage of lower income populations was less in the VSD compared to the US, the VSD had over two million individuals in this group. Additionally, there were over 600,000 Medicaid members in the VSD in 2012, which represented 1.1% of the US Medicaid population. CONCLUSIONS We found that the VSD population is representative of the general US population on several key demographic and socioeconomic variables. Despite a few specific groups being underrepresented in the VSD compared to the US, the absolute number of VSD members is large enough to ensure significant representation of these groups in vaccine safety studies that use VSD data.
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Affiliation(s)
- Lakshmi Sukumaran
- Immunization Safety Office, Centers for Disease Control and Prevention, Atlanta, Georgia; Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia.
| | - Natalie L McCarthy
- Immunization Safety Office, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Rongxia Li
- Immunization Safety Office, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Eric S Weintraub
- Immunization Safety Office, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Steven J Jacobsen
- Department of Research and Evaluation, Kaiser Permanente of Southern California, Pasadena, California, USA
| | - Simon J Hambidge
- Department of Ambulatory Care Services, Denver Health, Institute for Health Research, Kaiser Permanente Colorado, Department of Pediatrics, University of Colorado, Denver, Colorado, USA
| | - Lisa A Jackson
- Group Health Research Institute, Seattle, Washington, USA
| | - Allison L Naleway
- The Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon, USA
| | - Berwick Chan
- Kaiser Permanente Vaccine Study Center, Oakland, California, USA
| | - Biwen Tao
- Immunization Safety Office, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Julianne Gee
- Immunization Safety Office, Centers for Disease Control and Prevention, Atlanta, Georgia
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Hawken S, Potter BK, Benchimol EI, Little J, Ducharme R, Wilson K. Seasonal variation in rates of emergency room visits and acute admissions following recommended infant vaccinations in Ontario, Canada: A self-controlled case series analysis. Vaccine 2014; 32:7148-53. [DOI: 10.1016/j.vaccine.2014.09.059] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2014] [Revised: 09/19/2014] [Accepted: 09/29/2014] [Indexed: 11/25/2022]
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Hawken S, Kwong JC, Deeks SL, Crowcroft NS, Ducharme R, Manuel DG, Wilson K. Association between birth order and emergency room visits and acute hospital admissions following pediatric vaccination: a self-controlled study. PLoS One 2013; 8:e81070. [PMID: 24324662 PMCID: PMC3852020 DOI: 10.1371/journal.pone.0081070] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2013] [Accepted: 10/08/2013] [Indexed: 11/19/2022] Open
Abstract
Objective We investigated the association between a child's birth order and emergency room (ER) visits and hospital admissions following 2-,4-,6- and 12-month pediatric vaccinations. Methods We included all children born in Ontario between April 1st, 2006 and March 31st, 2009 who received a qualifying vaccination. We identified vaccinations, ER visits and admissions using health administrative data housed at the Institute for Clinical Evaluative Sciences. We used the self-controlled case series design to compare the relative incidence (RI) of events among 1st-born and later-born children using relative incidence ratios (RIR). Results For the 2-month vaccination, the RIR for 1st-borns versus later-born children was 1.37 (95% CI: 1.19–1.57), which translates to 112 additional events/100,000 vaccinated. For the 4-month vaccination, the RIR for 1st-borns vs. later-borns was 1.70 (95% CI: 1.45–1.99), representing 157 additional events/100,000 vaccinated. At 6 months, the RIR for 1st vs. later-borns was 1.27 (95% CI: 1.09–1.48), or 77 excess events/100,000 vaccinated. At the 12-month vaccination, the RIR was 1.11 (95% CI: 1.02–1.21), or 249 excess events/100,000 vaccinated. Conclusions Birth order is associated with increased incidence of ER visits and hospitalizations following vaccination in infancy. 1st-born children had significantly higher relative incidence of events compared to later-born children.
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Affiliation(s)
- Steven Hawken
- ICES uOttawa, Ottawa, Ontario, Canada
- Department of Clinical Epidemiology, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Jeffrey C. Kwong
- Public Health Ontario, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Shelley L. Deeks
- Public Health Ontario, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Natasha S. Crowcroft
- Public Health Ontario, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Robin Ducharme
- ICES uOttawa, Ottawa, Ontario, Canada
- Department of Clinical Epidemiology, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Douglas G. Manuel
- ICES uOttawa, Ottawa, Ontario, Canada
- Department of Clinical Epidemiology, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Kumanan Wilson
- ICES uOttawa, Ottawa, Ontario, Canada
- Department of Clinical Epidemiology, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
- * E-mail:
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