1
|
Fan J, Song Y, Cong S, Millman AJ, Wang N, Greene C, Zhang R, Zhou S, Fang L. Assessing interventions to encourage primary care health workers to recommend influenza vaccination and the impact on vaccination uptake for persons with Non-Communicable diseases in China. Vaccine 2024; 42:879-890. [PMID: 38233289 DOI: 10.1016/j.vaccine.2024.01.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 12/14/2023] [Accepted: 01/02/2024] [Indexed: 01/19/2024]
Abstract
BACKGROUND Influenza vaccination coverage is low among persons with non-communicable diseases (NCDs) in China. Chinese health workers (HWs) do not routinely recommend influenza vaccination despite evidence that recommendations increase vaccine uptake. This study aims to assess whether interventions increased primary care HWs' recommendation for influenza vaccination and measure their impact on influenza vaccine uptake in persons with NCDs. METHODS We conducted a cluster randomized controlled study in public primary healthcare clinics in Hubei from November 2018 through April 2019. In the intervention clinics, primary care HWs received training on the benefits of influenza vaccination and were asked to recommend influenza vaccine in routine primary healthcare for persons with NCDs. In the control clinics, primary care HWs did not receive training and provided standard services. We conducted questionnaire surveys before and after the intervention to collect information about recommendations made and receipt of influenza vaccines. RESULTS A total of 896 primary care HWs and 4552 persons with NCDs were included. After intervention, a higher percentage of HWs recommended influenza vaccines in intervention clinics compared to control clinics. Vaccinated primary care HWs were more likely to recommend vaccination. Persons with NCDs reported higher influenza vaccination coverage in intervention than control clinics, and primary care HWs' recommendation increased vaccination uptake among persons with NCDs. CONCLUSIONS Vaccinated primary care HWs were more likely to recommend influenza vaccination than unvaccinated HWs. Promoting primary care HWs' vaccination and encouraging them to recommend influenza vaccination during routine primary healthcare could increase influenza vaccine receipt among persons with NCDs. Registration number ChiCTR2200067140.
Collapse
Affiliation(s)
- Jing Fan
- National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Ying Song
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Shu Cong
- National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | | | - Ning Wang
- National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Carolyn Greene
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Ran Zhang
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Suizan Zhou
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Liwen Fang
- National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China.
| |
Collapse
|
2
|
Chen L, Levine MZ, Zhou S, Bai T, Pang Y, Bao L, Tan Y, Cui P, Zhang R, Millman AJ, Greene CM, Zhang Z, Wang Y, Zhang J. Mild and asymptomatic influenza B virus infection among unvaccinated pregnant persons: Implication for effectiveness of non-pharmaceutical intervention and vaccination to prevent influenza. Vaccine 2023; 41:694-701. [PMID: 36526503 DOI: 10.1016/j.vaccine.2022.11.055] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 10/13/2022] [Accepted: 11/21/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND We estimated symptomatic and asymptomatic influenza infection frequency in community-dwelling unvaccinated pregnant persons to inform risk communication. METHODS We collected residue sera from multiple antenatal-care blood draws during October 2016-April 2017. We determined influenza infection as seroconversion with ≥ 4-fold rise in antibody titers between any two serum samples by improved hemagglutinin-inhibition assay including ether-treated B antigens. The serology data were linked to the results of nuclei acid testing (rRT-PCR) based on acute respiratory illness (ARI) surveillance. RESULTS Among all participants, 43 %(602/1384) demonstrated serology and/or rRT-PCR evidenced infection, and 44 %(265/602) of all infections were asymptomatic. ARI-associated rRT-PCR testing identified only 10 %(61/602) of total infections. Only 1 %(5/420) of the B Victoria cases reported ARI and had a rRT-PCR positive result, compared with 33 %(54/165) of the H3N2 cases. Among influenza ARI cases with multiple serum samples, 19 %(11/58) had seroconversion to a different subtype prior to the illness. CONCLUSIONS The incidence of influenza B infection in unvaccinated pregnant persons is under-estimated substantially. Non-pharmaceutical intervention may have suboptimal effectiveness in preventing influenza B transmission due to the less clinical manifestation compared to influenza A. The findings support maternal influenza vaccination to protect pregnant persons and reduce consequent household transmission.
Collapse
Affiliation(s)
- Liling Chen
- Suzhou Center for Disease Control and Prevention, Suzhou, Jiangsu Province, PR China
| | - Min Z Levine
- U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Suizan Zhou
- U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Tian Bai
- Chinese National Influenza Center, National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, PR China
| | - Yuanyuan Pang
- Suzhou Center for Disease Control and Prevention, Suzhou, Jiangsu Province, PR China
| | - Lin Bao
- Suzhou Center for Disease Control and Prevention, Suzhou, Jiangsu Province, PR China
| | - Yayun Tan
- Suzhou Center for Disease Control and Prevention, Suzhou, Jiangsu Province, PR China
| | - Pengwei Cui
- Suzhou Center for Disease Control and Prevention, Suzhou, Jiangsu Province, PR China
| | - Ran Zhang
- U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Carolyn M Greene
- U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Zhongwei Zhang
- Suzhou Municipal Hospital, Suzhou, Jiangsu Province, PR China
| | - Yan Wang
- Wuzhong Maternal and Child Health Care Institute, Suzhou, Jiangsu Province, PR China
| | - Jun Zhang
- Suzhou Center for Disease Control and Prevention, Suzhou, Jiangsu Province, PR China.
| |
Collapse
|
3
|
Tilmon S, Aronsohn A, Boodram B, Canary L, Goel S, Hamlish T, Kemble S, Lauderdale DS, Layden J, Lee K, Millman AJ, Nelson N, Ritger K, Rodriguez I, Shurupova N, Wolf J, Johnson D. HepCCATT: a multilevel intervention for hepatitis C among vulnerable populations in Chicago. J Public Health (Oxf) 2022; 44:891-899. [PMID: 34156077 PMCID: PMC8692481 DOI: 10.1093/pubmed/fdab190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 05/07/2021] [Accepted: 05/20/2021] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Hepatitis C infection could be eliminated. Underdiagnosis and lack of treatment are the barriers to cure, especially for vulnerable populations (i.e. unable to pay for health care). METHODS A multilevel intervention from September 2014 to September 2019 focused on the providers and organizations in 'the safety net' (providing health care to populations unable to pay), including: (i) public education, (ii) training for primary care providers (PCPs) and case managers, (iii) case management for high-risk populations, (iv) policy advice and (v) a registry (Registry) for 13 health centers contributing data. The project tracked the number of PCPs trained and, among Registry sites, the number of people screened, engaged in care (i.e. clinical follow-up after diagnosis), treated and/or cured. RESULTS In Chicago, 215 prescribing PCPs and 56 other health professionals, 86% of whom work in the safety net, were trained to manage hepatitis C. Among Registry sites, there was a 137% increase in antibody screening and a 32% increase in current hepatitis C diagnoses. Engagement in care rose by 18%. CONCLUSIONS Hepatitis C Community Alliance to Test and Treat (HepCCATT) successfully targeted safety net providers and organizations with a comprehensive care approach. While there were challenges, HepCCATT observed increased hepatitis C screening, diagnosis and engagement in care in the Chicago community.
Collapse
Affiliation(s)
- Sandra Tilmon
- Academic Pediatrics, University of Chicago Medicine, Chicago, IL 60637, USA
| | - A Aronsohn
- Gastroenterology, University of Chicago Medicine, Chicago, IL 60637, USA
| | - B Boodram
- Department of Public Health, University of Illinois at Chicago, Chicago, IL 60607, USA
| | - L Canary
- CDC: Division of Viral Hepatitis, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, CDC, Atlanta, GA 30329, USA
| | - S Goel
- Division of General Internal Medicine and Geriatrics, Northwestern University (Medicine), Chicago, IL 60611 USA
| | - T Hamlish
- Cancer Center, University of Illinois at Chicago, Chicago, IL 60612 USA
| | - S Kemble
- Hawaii Department of Health, Honolulu, HI 96813, USA
| | - D S Lauderdale
- Public Health Sciences, University of Chicago Medicine, Chicago, IL 60637
| | - J Layden
- Illinois Department of Public Health, West Chicago, IL 60185, USA
| | - K Lee
- Academic Pediatrics, University of Chicago Medicine, Chicago, IL 60637, USA
| | - A J Millman
- CDC: Division of Viral Hepatitis, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, CDC, Atlanta, GA 30329, USA
| | - N Nelson
- CDC: Division of Viral Hepatitis, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, CDC, Atlanta, GA 30329, USA
| | - K Ritger
- Chicago Department of Public Health, Chicago, IL 60604, USA
| | - I Rodriguez
- Academic Pediatrics, University of Chicago Medicine, Chicago, IL 60637, USA
| | - N Shurupova
- Medical Research Analytics and Informatics Alliance (MRAIA), Chicago, IL 60606, USA
| | - J Wolf
- Caring Ambassadors Program, Oregon City, OR 97045, USA
| | - D Johnson
- Academic Pediatrics, University of Chicago Medicine, Chicago, IL 60637, USA
| |
Collapse
|
4
|
Millman AJ, Denson DJ, Allen ML, Malone JA, Daskalakis DC, Durrence D, Rustin RC, Toomey KE. A Health Equity Approach for Implementation of JYNNEOS Vaccination at Large, Community-Based LGBTQIA+ Events - Georgia, August 27-September 5, 2022. MMWR Morb Mortal Wkly Rep 2022; 71:1382-1883. [PMID: 36301799 PMCID: PMC9620574 DOI: 10.15585/mmwr.mm7143e4] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Gay, bisexual, and other men who have sex with men (MSM) have been disproportionately affected during the 2022 U.S. monkeypox outbreak, with Black or African American (Black) MSM being the most affected demographic group (1). As of September 28, 2022, Georgia had reported 1,784 monkeypox cases; 98% of which occurred in males and 77% among Black persons (2). As of September 13, 2022, 60% of reported cases were among persons with HIV infection, and 50% of persons with monkeypox had a sexually transmitted infection within the past year (3). Because of racial disparities in the incidence of monkeypox cases and a large proportion of cases among MSM in Georgia, early vaccination beginning in July focused on improving equitable access by establishing new and leveraging existing partnerships with community-based organizations that serve affected populations, including persons with HIV infection. Despite these efforts, disparities persisted because of high demand and limited vaccine supply. The Georgia Department of Public Health (DPH) requested CDC support for a vaccine pilot and received an additional allocation of 5,500 doses of JYNNEOS vaccine for administration at events leading up to and throughout a Black gay Pride festival in Atlanta, a multiday event held Labor Day weekend (September 2-5, 2022). The event celebrates lesbian, gay, bisexual, transgender, queer or questioning, intersex, asexual, and other (LGBTQIA+) communities of color and hosts more than 125,000 attendees each year. Before the festival (as of August 24), 17,546 persons had been vaccinated in Georgia, of whom 96% were male, 34% aged 25-36 years, 44% Black, and 8% Hispanic or Latino (Hispanic) (4).
Collapse
|
5
|
Chen L, Zhou S, Bao L, Millman AJ, Zhang Z, Wang Y, Tan Y, Song Y, Cui P, Pang Y, Liu C, Qin J, Zhang P, Thompson MG, Iuliano AD, Zhang R, Greene CM, Zhang J. Incidence rates of influenza illness during pregnancy in Suzhou, China, 2015-2018. Influenza Other Respir Viruses 2021; 16:14-23. [PMID: 34323381 PMCID: PMC8692813 DOI: 10.1111/irv.12888] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 06/09/2021] [Accepted: 06/24/2021] [Indexed: 11/28/2022] Open
Abstract
Background Data on influenza incidence during pregnancy in China are limited. Methods From October 2015 to September 2018, we conducted active surveillance for acute respiratory illness (ARI) among women during pregnancy. Nurses conducted twice weekly phone and text message follow‐up upon enrollment until delivery to identify new episodes of ARI. Nasal and throat swabs were collected ≤10 days from illness onset to detect influenza. Results In total, we enrolled 18 724 pregnant women median aged 28 years old, 37% in first trimester, 48% in second trimester, and 15% in third trimester, with seven self‐reported influenza vaccination during pregnancy. In the 18‐week epidemic period during October 2015 to September 2016, influenza incidence was 0.7/100 person‐months (95% CI: 0.5–0.9). In the cumulative 29‐week‐long epidemic during October 2016 to September 2017, influenza incidence was 1.0/100 person‐months (95% CI: 0.8–1.2). In the 11‐week epidemic period during October 2017 to September 2018, influenza incidence was 2.1/100 person‐months (95% CI: 1.9–2.4). Influenza incidence was similar by trimester. More than half of the total influenza illnesses had no elevated temperature and cough. Most influenza‐associated ARIs were mild, and <5.1% required hospitalization. Conclusions Influenza illness in all trimesters of pregnancy was common. These data may help inform decisions regarding the use of influenza vaccine to prevent influenza during pregnancy.
Collapse
Affiliation(s)
- Liling Chen
- Suzhou Center for Disease Control and Prevention, Suzhou, China
| | - Suizan Zhou
- U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Lin Bao
- Suzhou Center for Disease Control and Prevention, Suzhou, China
| | | | | | - Yan Wang
- Wuzhong Maternal and Child Health Care Institute, Suzhou, China
| | - Yayun Tan
- Suzhou Center for Disease Control and Prevention, Suzhou, China
| | - Ying Song
- U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Pengwei Cui
- Suzhou Center for Disease Control and Prevention, Suzhou, China
| | - Yuanyuan Pang
- Suzhou Center for Disease Control and Prevention, Suzhou, China
| | - Cheng Liu
- Suzhou Center for Disease Control and Prevention, Suzhou, China
| | - Jiangchun Qin
- Suzhou Center for Disease Control and Prevention, Suzhou, China
| | - Ping Zhang
- Suzhou Center for Disease Control and Prevention, Suzhou, China
| | - Mark G Thompson
- U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Ran Zhang
- U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Carolyn M Greene
- U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Jun Zhang
- Suzhou Center for Disease Control and Prevention, Suzhou, China
| |
Collapse
|
6
|
Scott J, Fagalde M, Baer A, Glick S, Barash E, Armstrong H, Kowdley KV, Golden MR, Millman AJ, Nelson NP, Canary L, Messerschmidt M, Patel P, Ninburg M, Duchin J. A Population-Based Intervention to Improve Care Cascades of Patients With Hepatitis C Virus Infection. Hepatol Commun 2021; 5:387-399. [PMID: 33681674 PMCID: PMC7917269 DOI: 10.1002/hep4.1627] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 09/14/2020] [Accepted: 09/23/2020] [Indexed: 12/24/2022] Open
Abstract
Hepatitis C virus (HCV) infection is common in the United States and leads to significant morbidity, mortality, and economic costs. Simplified screening recommendations and highly effective direct-acting antivirals for HCV present an opportunity to eliminate HCV. The objective of this study was to increase testing, linkage to care, treatment, and cure of HCV. This was an observational, prospective, population-based intervention program carried out between September 2014 and September 2018 and performed in three community health centers, three large multiclinic health care systems, and an HCV patient education and advocacy group in King County, WA. There were 232,214 patients included based on criteria of documented HCV-related diagnosis code, positive HCV laboratory test or prescription of HCV medication, and seen at least once at a participating clinical site in the prior year. Electronic health record (EHR) prompts and reports were created. Case management linked patients to care. Primary care providers received training through classroom didactics, an online curriculum, specialty clinic shadowing, and a telemedicine program. The proportion of baby boomer patients with documentation of HCV testing increased from 18% to 54% during the project period. Of 77,577 baby boomer patients screened at 87 partner clinics, 2,401 (3%) were newly identified HCV antibody positive. The number of patients staged for treatment increased by 391%, and those treated increased by 1,263%. Among the 79% of patients tested after treatment, 95% achieved sustained virologic response. Conclusion: A combination of EHR-based health care system interventions, active linkage to care, and clinician training contributed to a tripling in the number of patients screened and a more than 10-fold increase of those treated. The interventions are scalable and foundational to the goal of HCV elimination.
Collapse
Affiliation(s)
- John Scott
- Division of Allergy and Infectious DiseasesUniversity of WashingtonSeattleWAUSA
| | | | - Atar Baer
- Public Health – Seattle King CountySeattleWAUSA
| | - Sara Glick
- Division of Allergy and Infectious DiseasesUniversity of WashingtonSeattleWAUSA
- Public Health – Seattle King CountySeattleWAUSA
| | | | | | | | - Matthew R. Golden
- Division of Allergy and Infectious DiseasesUniversity of WashingtonSeattleWAUSA
- Public Health – Seattle King CountySeattleWAUSA
| | - Alexander J. Millman
- Division of Viral HepatitisNational Center for HIV/AIDS, Viral Hepatitis, STD, and TB PreventionCenters for Disease Control and PreventionAtlantaGAUSA
| | - Noele P. Nelson
- Division of Viral HepatitisNational Center for HIV/AIDS, Viral Hepatitis, STD, and TB PreventionCenters for Disease Control and PreventionAtlantaGAUSA
| | - Lauren Canary
- Division of Viral HepatitisNational Center for HIV/AIDS, Viral Hepatitis, STD, and TB PreventionCenters for Disease Control and PreventionAtlantaGAUSA
| | | | | | | | - Jeff Duchin
- Division of Allergy and Infectious DiseasesUniversity of WashingtonSeattleWAUSA
- Public Health – Seattle King CountySeattleWAUSA
| |
Collapse
|
7
|
Wang Y, Chen L, Cheng F, Biggerstaff M, Situ S, Zhou S, Gao J, Liu C, Zhang J, Millman AJ, Zhang T, Tian J, Zhao G. Economic burden of influenza illness among children under 5 years in Suzhou, China: Report from the cost surveys during 2011/12 to 2016/17 influenza seasons. Vaccine 2021; 39:1303-1309. [PMID: 33494968 DOI: 10.1016/j.vaccine.2020.12.075] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Revised: 12/02/2020] [Accepted: 12/28/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND Data are limited on the economic burden of seasonal influenza in China. We estimated the cost due to influenza illness among children < 5-year-old in Suzhou, China. METHODS This study adopted a societal perspective to estimate direct medical cost, direct non-medical cost, and indirect cost related to lost productivity. Data to calculate costs and rates of three influenza illness outcomes (non-medically attended, outpatient and hospitalization) were collected from prospective community-based cohort studies and hospital-based enhanced laboratory-confirmed influenza surveillance in Suzhou during the 2011/12 to 2016/17 influenza seasons. We used mean cost-per-episode, annual incidence rates of episodes of each outcome, and annual population size to estimate the total annual economic burden of influenza illnesses among children < 5-year-old for Suzhou. All costs were reported in 2017 U.S. dollars. RESULTS The mean cost-per-episode (standard deviation) was $9.92 (13.26) for non-medically attended influenza, $161.05 (176.98) for influenza outpatient illnesses, and $1425.95 (603.59) for influenza hospitalizations. By applying the annual incidence rates to the population size, we estimated an annual total of 4,919 episodes of non-medically attended influenza, 21,994 influenza outpatient, and 2,633 influenza hospitalization. Total annual economic burden of influenza to society among children < 5-year-old in Suzhou was $7.37 (95% confidence interval, 6.9-7.8) million, with estimated costs for non-medically attended influenza of $49,000 (46,000-52,000), influenza outpatients $3.5 (3.3-3.8) million, and influenza hospitalizations $3.8 (3.6-3.9) million. Among outpatients, the indirect cost was 36.3% ($1.3 million) of total economic burden, accounting for 21,994 days of lost productivity annually. Among inpatients, the indirect cost was 22.1% ($829,000), accounting for 18,431 days of lost productivity annually. CONCLUSIONS Our findings show that influenza in children < 5-year-oldcauses substantial societal economic burden in Suzhou, China. Assessing the potential economic benefit of increasing influenza vaccination coverage in this population is warranted.
Collapse
Affiliation(s)
- Yin Wang
- Department of Epidemiology, School of Public Health, Fudan University, Key Laboratory of Public Health Safety, Ministry of Education, Shanghai, China; Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
| | - Liling Chen
- Suzhou Center for Disease Prevention and Control, Suzhou, China
| | - Fangfang Cheng
- Children's Hospital of Soochow University, Suzhou, China
| | - Matthew Biggerstaff
- Centers for Disease Control and Prevention, Influenza Division, Atlanta, GA, USA
| | - Sujian Situ
- Centers for Disease Control and Prevention, Center of Global Health, Atlanta, GA, USA
| | - Suizan Zhou
- Centers for Disease Control and Prevention, Influenza Division, Atlanta, GA, USA
| | - Junmei Gao
- Department of Epidemiology, School of Public Health, Fudan University, Key Laboratory of Public Health Safety, Ministry of Education, Shanghai, China
| | - Changpeng Liu
- Department of Epidemiology, School of Public Health, Fudan University, Key Laboratory of Public Health Safety, Ministry of Education, Shanghai, China
| | - Jun Zhang
- Suzhou Center for Disease Prevention and Control, Suzhou, China
| | - Alexander J Millman
- Centers for Disease Control and Prevention, Influenza Division, Atlanta, GA, USA
| | - Tao Zhang
- Department of Epidemiology, School of Public Health, Fudan University, Key Laboratory of Public Health Safety, Ministry of Education, Shanghai, China
| | - Jianmei Tian
- Children's Hospital of Soochow University, Suzhou, China.
| | - Genming Zhao
- Department of Epidemiology, School of Public Health, Fudan University, Key Laboratory of Public Health Safety, Ministry of Education, Shanghai, China; Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China.
| |
Collapse
|
8
|
Zheng H, Millman AJ, Rainey JJ, Wang F, Zhang R, Chen H, Yin Z, Wang H, Zhang G. Correction to: Using a hepatitis B surveillance system evaluation in Fujian, Hainan, and Gansu provinces to improve data quality and assess program effectiveness, China, 2015. BMC Infect Dis 2020; 20:962. [PMID: 33349240 PMCID: PMC7751113 DOI: 10.1186/s12879-020-05708-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
An amendment to this paper has been published and can be accessed via the original article.
Collapse
Affiliation(s)
- Hui Zheng
- National Immunization Program, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Alexander J Millman
- Division of Viral Hepatitis, United States Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Jeanette J Rainey
- Division of Global Health Protection, United States, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Fuzhen Wang
- National Immunization Program, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Rui Zhang
- Emerging Infections Program, Chinese Center of Disease Control and Prevention, Beijing, China
| | - Hong Chen
- Emerging Infections Program, Chinese Center of Disease Control and Prevention, Beijing, China
| | - Zundong Yin
- National Immunization Program, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Huaqing Wang
- National Immunization Program, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Guomin Zhang
- National Immunization Program, Chinese Center for Disease Control and Prevention, Beijing, China.
| |
Collapse
|
9
|
Irvin R, Ntiri-Reid B, Kleinman M, Agee T, Hitt J, Anaedozie O, Arowolo T, Cassidy-Stewart H, Bush C, Wilson LE, Millman AJ, Nelson NP, Canary L, Brinkley S, Moon J, Falade-Nwulia O, Sulkowski MS, Thomas DL, Melia MT. Sharing the cure: Building primary care and public health infrastructure to improve the hepatitis C care continuum in Maryland. J Viral Hepat 2020; 27:1388-1395. [PMID: 32671942 PMCID: PMC7721959 DOI: 10.1111/jvh.13360] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 06/23/2020] [Accepted: 07/01/2020] [Indexed: 12/14/2022]
Abstract
In 2014, trained healthcare provider capacity was insufficient to deliver care to an estimated 70 000 persons in Maryland with chronic hepatitis C virus (HCV) infection. The goal of Maryland Community Based Programs to Test and Cure Hepatitis C, a public health implementation project, was to improve HCV treatment access by expanding the workforce. Sharing the Cure (STC) was a package of services deployed 10/1/14-9/30/18 that included enhanced information technology and public health infrastructure, primary care provider training and practice transformation. Nine primary care sites enrolled. HCV clinical outcomes were documented among individuals who presented for care at sites and met criteria for HCV testing including risk factor or birth cohort (born between 1945 and 1965) based testing. Fifty-three providers completed the STC training. STC providers identified 3237 HCV antibody-positive patients of which 2624 (81%) were RNA+. Of those HCV RNA+, 1739 (66%) were staged, 932 (36%) were prescribed treatment, 838 (32%) started treatment, 721 (27%) completed treatment and 543 (21%) achieved cure. Among 1739 patients staged, 693 (40%) patients had a liver fibrosis assessment score < F2, rendering them ineligible for treatment under Maryland Medicaid guidelines. HCV RNA testing among HCV antibody-positive people increased from 40% (baseline) to 95% among STC providers. Of 554 patients with virologic data reported, 543 (98%) achieved cure. Primary care practices can effectively serve as HCV treatment centers to expand treatment access. However, criteria by insurance providers in Maryland were a major barrier to treatment.
Collapse
Affiliation(s)
- Risha Irvin
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Boatemaa Ntiri-Reid
- Infectious Disease Prevention and Health Services Bureau, Maryland Department of Health, Baltimore, MD, United States
| | - Mary Kleinman
- Infectious Disease Prevention and Health Services Bureau, Maryland Department of Health, Baltimore, MD, United States
| | - Tracy Agee
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Jeffrey Hitt
- Infectious Disease Prevention and Health Services Bureau, Maryland Department of Health, Baltimore, MD, United States
| | - Onyeka Anaedozie
- Infectious Disease Prevention and Health Services Bureau, Maryland Department of Health, Baltimore, MD, United States
| | - Tolu Arowolo
- Infectious Disease Prevention and Health Services Bureau, Maryland Department of Health, Baltimore, MD, United States
| | - Hope Cassidy-Stewart
- Infectious Disease Prevention and Health Services Bureau, Maryland Department of Health, Baltimore, MD, United States
| | - CaSaundra Bush
- Infectious Disease Prevention and Health Services Bureau, Maryland Department of Health, Baltimore, MD, United States
| | - Lucy E. Wilson
- Infectious Disease Prevention and Health Services Bureau, Maryland Department of Health, Baltimore, MD, United States
| | - Alexander J. Millman
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Noele P. Nelson
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Lauren Canary
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Sherilyn Brinkley
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Juhi Moon
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Oluwaseun Falade-Nwulia
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Mark S. Sulkowski
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - David L. Thomas
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Michael T. Melia
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| |
Collapse
|
10
|
Zhang W, Gao J, Chen L, Tian J, Biggerstaff M, Zhou S, Situ S, Wang Y, Zhang J, Millman AJ, Greene CM, Zhang T, Zhao G. Estimated influenza illnesses and hospitalizations averted by influenza vaccination among children aged 6-59 months in Suzhou, China, 2011/12 to 2015/16 influenza seasons. Vaccine 2020; 38:8200-8205. [PMID: 33176936 DOI: 10.1016/j.vaccine.2020.10.069] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 10/17/2020] [Accepted: 10/21/2020] [Indexed: 01/14/2023]
Abstract
BACKGROUND There are few estimates of vaccination-averted influenza-associated illnesses in China. METHODS We used a mathematical model and Monte Carlo algorithm to estimate numbers and 95% confidence intervals (CI) of influenza-associated outcomes (hospitalization, illness, and medically-attended (MA) illness) averted by vaccination among children aged 6-59 months in Suzhou from October 2011-September 2016. Influenza illnesses included non-hospitalized MA influenza illnesses and non-MA influenza illnesses. The numbers of influenza-associated outcomes averted by vaccination were the difference between the expected burden if there were no vaccination given and the observed burden with vaccination. The model incorporated the disease burden estimated based on surveillance data from Suzhou University Affiliated Children's Hospital (SCH) and data from health utilization surveys conducted in the catchment area of SCH, age-specific estimates of influenza vaccination coverage in Suzhou from the Expanded Program on Immunization database, and influenza vaccine effectiveness estimates from previous publications. Averted influenza estimations were presented as absolute numbers and in terms of the prevented fraction (PF). A hypothetical scenario with 50% coverage (but identical vaccine effectiveness) over the study period was also modeled. RESULTS In ~250,000 children, influenza vaccination prevented an estimated 731 (CI: 549-960) influenza hospitalizations (PF: 6.2% of expected, CI: 5.8-6.6%) and 10,024 (7593-12,937) influenza illnesses (PF: 6.5%, 6.4-6.7%), of which 8342 (6338-10,768) were MA (PF: 6.6%, 6.4-6.7%) from 2011 to 2016. The PFs declined each year along with decreasing influenza vaccination coverage. If 50% of the study population had been vaccinated over time, the estimated numbers of averted cases during the study period would have been 4059 (3120-5762) influenza hospitalizations (PF: 27.2%, 26.4-27.9%) and 56,215 (42,925-78,849) influenza illnesses (PF: 28.5%, 28.3-28.7%), of which 46,596 (35,662-65,234) would be MA (PF: 28.5%, 28.3-28.7%). CONCLUSION Influenza vaccination is estimated to have averted influenza-associated illness outcomes even with low coverage in children aged 6-59 months in Suzhou. Increasing influenza vaccination coverage in this population could further reduce illnesses and hospitalizations.
Collapse
Affiliation(s)
- Wanqing Zhang
- Department of Epidemiology, School of Public Health, Fudan University, Key Laboratory of Public Health Safety, Ministry of Education, Shanghai, China
| | - Junmei Gao
- Department of Epidemiology, School of Public Health, Fudan University, Key Laboratory of Public Health Safety, Ministry of Education, Shanghai, China
| | - Liling Chen
- Suzhou Center for Disease Control and Prevention, Suzhou, China
| | - Jianmei Tian
- Suzhou University Affiliated Children's Hospital, Suzhou, China
| | - Matthew Biggerstaff
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Suizan Zhou
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Sujian Situ
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Yin Wang
- Department of Epidemiology, School of Public Health, Fudan University, Key Laboratory of Public Health Safety, Ministry of Education, Shanghai, China
| | - Jun Zhang
- Suzhou Center for Disease Control and Prevention, Suzhou, China
| | - Alexander J Millman
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Carolyn M Greene
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Tao Zhang
- Department of Epidemiology, School of Public Health, Fudan University, Key Laboratory of Public Health Safety, Ministry of Education, Shanghai, China.
| | - Genming Zhao
- Department of Epidemiology, School of Public Health, Fudan University, Key Laboratory of Public Health Safety, Ministry of Education, Shanghai, China.
| |
Collapse
|
11
|
Shadaker S, Nasrullah M, Gamkrelidze A, Ray J, Gvinjilia L, Kuchuloria T, Butsashvili M, Getia V, Metreveli D, Tsereteli M, Tsertsvadze T, Link-Gelles R, Millman AJ, Turdziladze A, Averhoff F. Screening and linkage to care for hepatitis C among inpatients in Georgia's national hospital screening program. Prev Med 2020; 138:106153. [PMID: 32473265 PMCID: PMC7440391 DOI: 10.1016/j.ypmed.2020.106153] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 03/04/2020] [Accepted: 05/22/2020] [Indexed: 02/01/2023]
Abstract
The country of Georgia initiated an ambitious national hepatitis C elimination program. To facilitate elimination, a national hospital hepatitis C screening program was launched in November 2016, offering all inpatients screening for HCV infection. This analysis assesses the effectiveness of the first year of the screening program to identify HCV-infected persons and link them to care. Data from Georgia's electronic Health Management Information System and ELIMINATION-C treatment database were analyzed for patients aged ≥18 years hospitalized from November 1, 2016 to October 31, 2017. We described patient characteristics and screening results and compared linked-to-care patients to those not linked to care, defined as having a test for viremia following an HCV antibody (anti-HCV) positive hospital screening. Of 291,975 adult inpatients, 252,848 (86.6%) were screened. Of them, 4.9% tested positive, with a high of 17.4% among males aged 40-49. Overall, 19.8% of anti-HCV+ patients were linked to care, which differed by sex (20.6% for males vs. 18.4% for females; p = .019), age (23.9% for age 50-59 years vs. 10.7% for age ≥ 70 years; p < .0001), and length of hospitalization (21.8% among patients hospitalized for 1 day vs. 16.1% for those hospitalized 11+ days; p = .023). Redundant screening is a challenge; 15.6% of patients were screened multiple times and 27.6% of anti-HCV+ patients had a prior viremia test. This evaluation demonstrates that hospital-based screening programs can identify large numbers of anti-HCV+ persons, supporting hepatitis C elimination. However, low linkage-to-care rates underscore the need for screening programs to be coupled with effective linkage strategies.
Collapse
Affiliation(s)
- Shaun Shadaker
- Centers for Disease Control and Prevention, Division of Viral Hepatitis, National Center for HIV, Hepatitis, STD&TB Prevention, Atlanta, USA.
| | - Muazzam Nasrullah
- Centers for Disease Control and Prevention, Division of Viral Hepatitis, National Center for HIV, Hepatitis, STD&TB Prevention, Atlanta, USA
| | | | - Jessica Ray
- Seattle Children's Hospital, Seattle, Washington, USA
| | | | | | | | - Vladimer Getia
- National Center for Disease Control and Public Health, Tbilisi, Georgia
| | | | - Maia Tsereteli
- National Center for Disease Control and Public Health, Tbilisi, Georgia
| | - Tengiz Tsertsvadze
- Infectious Diseases, AIDS and Clinical Immunology Research Center, Tbilisi, Georgia
| | - Ruth Link-Gelles
- Centers for Disease Control and Prevention, Division of Viral Hepatitis, National Center for HIV, Hepatitis, STD&TB Prevention, Atlanta, USA
| | - Alexander J Millman
- Centers for Disease Control and Prevention, Division of Viral Hepatitis, National Center for HIV, Hepatitis, STD&TB Prevention, Atlanta, USA
| | | | - Francisco Averhoff
- Centers for Disease Control and Prevention, Division of Viral Hepatitis, National Center for HIV, Hepatitis, STD&TB Prevention, Atlanta, USA
| |
Collapse
|
12
|
Zheng H, Millman AJ, Rainey JJ, Wang F, Zhang R, Chen H, Yin Z, Wang H, Zhang G. Using a hepatitis B surveillance system evaluation in Fujian, Hainan, and Gansu provinces to improve data quality and assess program effectiveness, China, 2015. BMC Infect Dis 2020; 20:547. [PMID: 32711465 PMCID: PMC7382805 DOI: 10.1186/s12879-020-05265-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 07/16/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Monitoring hepatitis B surveillance data is important for evaluating progress towards global hepatitis B elimination goals. Accurate classification of acute and chronic hepatitis infections is essential for assessing program effectiveness. METHODS We evaluated hepatitis B case-reporting at six hospitals in Fujian, Hainan and Gansu provinces in 2015 to assess the accuracy of case classification. We linked National Notifiable Disease Reporting System (NNDRS) HBV case-reports with hospital information systems and extracted information on age, gender, admission ward and viral hepatitis diagnosis from medical records. To assess accuracy, we compared NNDRS reported case-classifications with the national HBV case definitions. Multivariable logistic regression was used to identify factors associated with misclassification. RESULTS Of the 1420 HBV cases reported to NNDRS, 23 (6.5%) of the 352 acute reports and 648 (60.7%) of the 1068 chronic reports were correctly classified. Of the remaining, 318 (22.4%) were misclassified and 431 (30.4%) could not be classified due to the lack of supporting information. Based on the multivariable analysis, HBV cases reported from Hainan (aOR = 1.8; 95% CI: 1.3-2.4) and Gansu (aOR = 12.7; 95% CI: 7.7-20.1) along with reports from grade 2 hospitals (aOR = 1.6; 95% CI:1.2-2.2) and those from non-HBV related departments (aOR = 5.3; 95% CI: 4.1-7.0) were independently associated with being 'misclassified' in NNDRS. CONCLUSIONS We identified discrepancies in the accuracy of HBV case-reporting in the project hospitals. Onsite training on the use of anti-HBc IgM testing as well as on HBV case definitions and reporting procedures are needed to accurately assess program effectiveness and ensure case-patients are referred to appropriate treatment and care. Routine surveillance evaluations such as this can be useful for improving data quality and monitoring program effectiveness.
Collapse
Affiliation(s)
- Hui Zheng
- National Immunization Program, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Alexander J. Millman
- Division of Viral Hepatitis, United States Centers for Disease Control and Prevention, Atlanta, GA USA
| | - Jeanette J. Rainey
- Division of Global Health Protection, United States, Centers for Disease Control and Prevention, Atlanta, GA USA
| | - Fuzhen Wang
- National Immunization Program, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Rui Zhang
- Emerging Infections Program, Chinese Center of Disease Control and Prevention, Beijing, China
| | - Hong Chen
- Emerging Infections Program, Chinese Center of Disease Control and Prevention, Beijing, China
| | - Zundong Yin
- National Immunization Program, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Huaqing Wang
- National Immunization Program, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Guomin Zhang
- National Immunization Program, Chinese Center for Disease Control and Prevention, Beijing, China
| |
Collapse
|
13
|
Millman AJ, Luo Q, Nelson NP, Vellozzi C, Weiser J. Missed opportunities for prevention and treatment of hepatitis C among persons with HIV/HCV coinfection. AIDS Care 2020; 32:921-929. [PMID: 31547683 PMCID: PMC7085966 DOI: 10.1080/09540121.2019.1668533] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Accepted: 09/11/2019] [Indexed: 12/17/2022]
Abstract
Hepatitis C (HCV) and HIV have common modes of transmission but information about HCV transmission risk, prevention, and treatment among persons with coinfection is lacking. The Medical Monitoring Project produces nationally representative estimates describing adults with diagnosed HIV in the United States. Using medical record data recorded during 6/2013-5/2017, we identified persons with detectable HCV RNA documented during the past 24 months. Among persons with coinfection, we described HCV transmission risk factors and receipt of HCV prevention services during the past 12 months and prescription of HCV treatment during the past 24 months. Overall, 4.9% had documented active HCV coinfection, among whom 30.2% were men who have sex with men (MSM), 6.7% reported injection drug use, and 62.1% were prescribed HCV treatment. Among MSM, 45.5% reported condomless anal sex and 42.3% received free condoms. Among persons who used drugs, 30.8% received drug or alcohol counseling, and among persons who injected drugs, 79.2% received sterile syringes. Among persons with HIV/HCV coinfection, recent drug injection was uncommon and most received sterile syringes. However, 1 in 3 were MSM, of whom half reported recent HCV sexual transmission risk behaviors. More than one-third of those with coinfection were not prescribed curative HCV treatment.
Collapse
Affiliation(s)
- Alexander J Millman
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Noele P Nelson
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Claudia Vellozzi
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - John Weiser
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| |
Collapse
|
14
|
Baer A, Fagalde MS, Drake CD, Sohlberg EH, Barash E, Glick S, Millman AJ, Duchin JS. Design of an Enhanced Public Health Surveillance System for Hepatitis C Virus Elimination in King County, Washington. Public Health Rep 2020; 135:33-39. [PMID: 31835010 DOI: 10.1177/0033354919889981] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/09/2022] Open
Abstract
INTRODUCTION With the goal of eliminating hepatitis C virus (HCV) as a public health problem in Washington State, Public Health-Seattle & King County (PHSKC) designed a Hepatitis C Virus Test and Cure (HCV-TAC) data system to integrate surveillance, clinical, and laboratory data into a comprehensive database. The intent of the system was to promote identification, treatment, and cure of HCV-infected persons (ie, HCV care cascade) using a population health approach. MATERIALS AND METHODS The data system automatically integrated case reports received via telephone and fax from health care providers and laboratories, hepatitis test results reported via electronic laboratory reporting, and data on laboratory and clinic visits reported by 6 regional health care systems. PHSKC examined patient-level laboratory test results and established HCV case classification using Council of State and Territorial Epidemiologists criteria, classifying patients as confirmed if they had detectable HCV RNA. RESULTS The data enabled PHSKC to report the number of patients at various stages along the HCV care cascade. Of 7747 HCV RNA-positive patients seen by a partner site, 5377 (69%) were assessed for severity of liver fibrosis, 3932 (51%) were treated, and 2592 (33%) were cured. PRACTICE IMPLICATIONS Data supported local public heath surveillance and HCV program activities. The data system could serve as a foundation for monitoring future HCV prevention and control programs.
Collapse
Affiliation(s)
- Atar Baer
- Public Health-Seattle & King County, Seattle, WA, USA
| | | | | | | | | | - Sara Glick
- Division of Allergy and Infectious Diseases, School of Medicine, University of Washington, Seattle, WA, USA
| | - Alexander J Millman
- Division of Viral Hepatitis, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Jeffrey S Duchin
- Public Health-Seattle & King County, Seattle, WA, USA.,Division of Allergy and Infectious Diseases, School of Medicine, University of Washington, Seattle, WA, USA.,School of Public Health, University of Washington, Seattle, WA, USA
| |
Collapse
|
15
|
Zhou S, Greene CM, Song Y, Zhang R, Rodewald LE, Feng L, Millman AJ. Review of the status and challenges associated with increasing influenza vaccination coverage among pregnant women in China. Hum Vaccin Immunother 2020; 16:602-611. [PMID: 31589548 DOI: 10.1080/21645515.2019.1664230] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
Influenza vaccination coverage in pregnant women in China remains low. In this review, we first provide an overview of the evidence for the use of influenza vaccination during pregnancy. Second, we discuss influenza vaccination policy and barriers to increased seasonal influenza vaccination coverage in pregnant women in China. Third, we provide case studies of successes and challenges of programs for increasing seasonal influenza vaccination in pregnant women from other parts of Asia with lessons learned for China. Finally, we assess opportunities and challenges for increasing influenza vaccination coverage among pregnant women in China.
Collapse
Affiliation(s)
- Suizan Zhou
- Influenza Division, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Carolyn M Greene
- Influenza Division, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Ying Song
- Influenza Division, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Ran Zhang
- Influenza Division, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Lance E Rodewald
- National Immunization Programme, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Luzhao Feng
- Key Laboratory of Surveillance and Early-warning on Infectious Disease, Division of Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Alexander J Millman
- Influenza Division, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
| |
Collapse
|
16
|
Miller LS, Millman AJ, Lom J, Osinubi A, Ahmed F, Dupont S, Rein D, Vellozzi C, Harris AM. Defining the hepatitis C cure cascade in an Urban health system using the electronic health record. J Viral Hepat 2020; 27:13-19. [PMID: 31505088 DOI: 10.1111/jvh.13199] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 06/10/2019] [Accepted: 08/26/2019] [Indexed: 12/28/2022]
Abstract
Hepatitis C virus (HCV) infection is a public health threat. The electronic health record (EHR) can be used to monitor patients along the HCV cure cascade and highlight opportunities for interventions to improve cascade outcomes. We developed an HCV patient registry using data from Grady Health System's (GHS) EHR and performed a cross-sectional analysis of 72 745 GHS patients who received anti-HCV testing from 2004 to 2016. We created a testing cascade: (1) anti-HCV reactive, (2) HCV RNA tested and (3) HCV RNA detectable; and a cure cascade: (1) HCV RNA detectable, (2) engaged in care, (3) treatment prescribed, (4) sustained virologic response (SVR) tested and (5) SVR documented. A total of 9893 (14%) had reactive anti-HCV tests of 72 745 patients tested, 5109 (52%) of these had HCV RNA tested, and 4224 (43%) were HCV RNA detectable. A total of 2738 (65%) of 4224 with detectable RNA were engaged in care, 909 (22%) were prescribed antiviral therapy, and 354 (8%) achieved SVR. Factors associated with HCV treatment included cirrhosis, tobacco use, depression, diabetes, obesity, alcohol use, male gender, black race and Medicare insurance. Uninsured patients were significantly less likely to be prescribed HCV treatment. In conclusion, using EHR data, we identified high anti-HCV prevalence and noted gaps in HCV RNA testing, linkage to care and treatment. The EHR can be used to evaluate the effectiveness of targeted interventions to overcome these gaps.
Collapse
Affiliation(s)
| | - Alexander J Millman
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Jennifer Lom
- Emory University School of Medicine, Atlanta, GA, USA
| | - Ademola Osinubi
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Farah Ahmed
- NORC at the University of Chicago, Atlanta, GA, USA
| | - Sarah Dupont
- Emory University School of Medicine, Atlanta, GA, USA
| | - David Rein
- NORC at the University of Chicago, Atlanta, GA, USA
| | - Claudia Vellozzi
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Aaron M Harris
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, GA, USA
| |
Collapse
|
17
|
Boodram B, Kaufmann M, Aronsohn A, Hamlish T, Peregrine Antalis E, Kim K, Wolf J, Rodriguez I, Millman AJ, Johnson D. Case Management and Capacity Building to Enhance Hepatitis C Treatment Uptake at Community Health Centers in a Large Urban Setting. Fam Community Health 2020; 43:150-160. [PMID: 32079971 DOI: 10.1097/fch.0000000000000253] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
An estimated 4.1 million people in the United States are infected with hepatitis C virus (HCV). In 2014, the Hepatitis C Community Alliance to Test and Treat (HepCCATT) collaborative was formed to address hepatitis C in Chicago. From 2014 to 2017, the HepCCATT Case Management Program case managed 181 HCV-infected people and performed on-site capacity building at a 6-site community health center (CHC) that produced codified protocols, which were translated into a telehealth program to build capacity within CHCs to deliver hepatitis C care. HepCCATT's innovative approach to addressing multilevel barriers is a potential model for increasing access to hepatitis C care and treatment.
Collapse
Affiliation(s)
- Basmattee Boodram
- School of Public Health (Dr Boodram and Ms Kaufmann) and Cancer Center (Dr Hamlish), University of Illinois at Chicago; Department of Internal Medicine, University of Michigan, Ann Arbor and Sarcoma Alliance for Research Through Collaboration, Ann Arbor, Michigan (Dr Peregrine Antalis); University of Chicago Medicine, Chicago, Illinois (Drs Aronsohn and Johnson and Ms Rodriguez); Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania (Ms Kim); Caring Ambassadors Program, Inc, Chicago, Illinois (Ms Wolf); and Centers for Disease Control and Prevention, Atlanta, Georgia (Dr Millman)
| | | | | | | | | | | | | | | | | | | |
Collapse
|
18
|
Song Y, Millman AJ. Overview and Lessons Learned for Increasing Influenza Vaccination Coverage Among Healthcare Workers in the United States. China CDC Wkly 2020; 2:862-866. [PMID: 34733572 PMCID: PMC8543717 DOI: 10.46234/ccdcw2020.229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 10/27/2020] [Indexed: 11/14/2022] Open
Affiliation(s)
- Ying Song
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Alexander J. Millman
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, USA
- Alexander J Millman,
| |
Collapse
|
19
|
Xiang N, Song Y, Wang Y, Wu J, Millman AJ, Greene CM, Ding Z, Sun J, Yang W, Guo G, Wang R, Guo P, Ren Z, Gong L, Xu P, Zhou S, Lin D, Ni D, Feng Z, Li Q. Lessons from an active surveillance pilot to assess the pneumonia of unknown etiology surveillance system in China, 2016: the need to increase clinician participation in the detection and reporting of emerging respiratory infectious diseases. BMC Infect Dis 2019; 19:770. [PMID: 31481020 PMCID: PMC6724368 DOI: 10.1186/s12879-019-4345-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Accepted: 07/31/2019] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND We sought to assess reporting in China's Pneumonia of Unknown Etiology (PUE) passive surveillance system for emerging respiratory infections and to identify ways to improve the PUE surveillance system's detection of respiratory infections of public health significance. METHODS From February 29-May 29, 2016, we actively identified and enrolled patients in two hospitals with acute respiratory infections (ARI) that met all PUE case criteria. We reviewed medical records for documented exposure history associated with respiratory infectious diseases, collected throat samples that were tested for seasonal and avian influenza, and interviewed clinicians regarding reasons for reporting or not reporting PUE cases. We described and analyzed the proportion of PUE cases reported and clinician awareness of and practices related to the PUE system. RESULTS Of 2619 ARI admissions in two hospitals, 335(13%) met the PUE case definition; none were reported. Of 311 specimens tested, 18(6%) were seasonal influenza virus-positive; none were avian influenza-positive. < 10% PUE case medical records documented whether or not there were exposures to animals or others with respiratory illness. Most commonly cited reasons for not reporting cases were no awareness of the PUE system (76%) and not understanding the case definition (53%). CONCLUSIONS Most clinicians have limited awareness of and are not reporting to the PUE system. Exposures related to respiratory infections are rarely documented in medical records. Increasing clinicians' awareness of the PUE system and including relevant exposure items in standard medical records may increase reporting.
Collapse
Affiliation(s)
- Nijuan Xiang
- Chinese Center for Disease Control and Prevention, No. 155 Changbai Road, Changping District, Beijing, 102206 China
| | - Ying Song
- US Centers for Disease Control and Prevention, Atlanta, GA USA
| | - Yu Wang
- Beijing Municipal Center for Disease Prevention and Control, Beijing, China
- Beijing Research Center for Preventive Medicine, Beijing, China
| | - Jiabing Wu
- Anhui Provincial Center for Disease Control and Prevention, Hefei, Anhui China
| | | | | | - Zhentao Ding
- Fuyang Prefecture Center for Disease Control and Prevention, Fuyang, Anhui China
| | - Jie Sun
- Lu’an Prefecture Center for Disease Control and Prevention, Lu’an, Anhui China
| | - Wei Yang
- Lu’an Prefecture Center for Disease Control and Prevention, Lu’an, Anhui China
| | - Guoxia Guo
- Fuyang Prefecture Center for Disease Control and Prevention, Fuyang, Anhui China
| | - Ruirui Wang
- The Second People’s Hospital of Fuyang City, Fuyang, Anhui China
| | - Ping Guo
- Lu’an People’s Hospital, Lu’an, Anhui China
| | - Zhixing Ren
- Changchun Prefecture Center for Disease Control and Prevention, Changchun, Jilin China
| | - Lei Gong
- Anhui Provincial Center for Disease Control and Prevention, Hefei, Anhui China
| | - Pengpeng Xu
- Lu’an Prefecture Center for Disease Control and Prevention, Lu’an, Anhui China
| | - Suizan Zhou
- US Centers for Disease Control and Prevention, Atlanta, GA USA
| | - Dan Lin
- Fujian Provincial Center for Disease Control and Prevention, Fuzhou, Fujian China
| | - Daxin Ni
- Chinese Center for Disease Control and Prevention, No. 155 Changbai Road, Changping District, Beijing, 102206 China
| | - Zijian Feng
- Chinese Center for Disease Control and Prevention, No. 155 Changbai Road, Changping District, Beijing, 102206 China
| | - Qun Li
- Chinese Center for Disease Control and Prevention, No. 155 Changbai Road, Changping District, Beijing, 102206 China
| |
Collapse
|
20
|
Momin B, Mera J, Essex W, Gahn D, Burkhart M, Nielsen D, Mezzo J, Millman AJ. Implementation of Liver Cancer Education Among Health Care Providers and Community Coalitions in the Cherokee Nation. Prev Chronic Dis 2019; 16:E112. [PMID: 31441770 PMCID: PMC6716386 DOI: 10.5888/pcd16.180671] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
The Cherokee Nation Comprehensive Cancer Control Program collaborated with the Cherokee Nation Hepatitis C Virus (HCV) Elimination Program within Cherokee Nation’s Health Services to plan and implement activities to increase knowledge and awareness of liver cancer prevention among health care providers and the Cherokee Nation community. From August 2017 to April 2018, the 2 programs implemented liver cancer prevention interventions that focused on education of health care providers and community members. We used descriptive statistics to analyze data collected from a brief, retrospective pre–post survey for each intervention. We assessed overall awareness and knowledge of liver cancer and ability and intention to address it on a scale of 1 to 5. Project Extension for Community Healthcare Outcomes didactic sessions resulted in a 1.1-point improvement, provider education workshops resulted in a 1.4-point improvement, and presentations at community coalition meetings resulted in a 1.7-point improvement. Our study shows that HCV interventions can be used by public health and medical professionals interested in controlling HCV and related diseases such as liver cancer.
Collapse
Affiliation(s)
- Behnoosh Momin
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, 4770 Buford Hwy, MS F-76, Atlanta, GA 30341.
| | - Jorge Mera
- Cherokee Nation Health Services, Tahlequah, Oklahoma
| | - Whitney Essex
- Cherokee Nation Health Services, Tahlequah, Oklahoma
| | - David Gahn
- Cherokee Nation Comprehensive Cancer Control Program, Tahlequah, Oklahoma
| | - Margie Burkhart
- Cherokee Nation Comprehensive Cancer Control Program, Tahlequah, Oklahoma
| | | | | | - Alexander J Millman
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, Georgia
| |
Collapse
|
21
|
Osinubi A, Harris AM, Vellozzi C, Lom J, Miller L, Millman AJ. Evaluation of the Performance of Algorithms That Use Serial Hepatitis C RNA Tests to Predict Treatment Initiation and Sustained Virological Response Among Patients Infected With Hepatitis C Virus. Am J Epidemiol 2019; 188:555-561. [PMID: 30535062 DOI: 10.1093/aje/kwy270] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 06/12/2018] [Accepted: 12/06/2018] [Indexed: 12/11/2022] Open
Abstract
The structure of electronic medical record data prevents easy population-level monitoring of hepatitis C virus (HCV) treatment uptake and cure. Using an HCV registry from a public hospital system in Atlanta, Georgia, we developed multiple algorithms that use serial HCV RNA test results as proxy measures for initiation of direct-acting antiviral (DAA) treatment and sustained virological response (SVR). We calculated sensitivity and positive predictive values (PPVs) by comparing the algorithms with the DAA initiation and SVR results from the registry. From December 2013 to August 2016, 1,807 persons actively infected with HCV were identified in the registry. Of those, 698 initiated DAA treatment on the basis of medical record abstraction; of 442 patients with treatment start and/or end dates, 314 had documented SVR. Treatment algorithm 2 (a detectable HCV RNA result followed by 2 sequential HCV RNA test results) and treatment algorithm 5 (a detectable HCV RNA result followed by 2 sequential HCV RNA test results >6 weeks apart) had the highest sensitivity (87% and 85%, respectively) and PPV (80% and 82%, respectively) combinations. Four SVR algorithms relied on fulfilling treatment algorithm definitions and having an undetectable HCV RNA test result ≥12 weeks after the last HCV RNA result; sensitivity for all 4 algorithms was 79%, and PPV was 92%-93%. Algorithms using serial quantitative HCV RNA results can serve as proxy measures for evaluating population-level DAA treatment and SVR outcomes.
Collapse
Affiliation(s)
- Ademola Osinubi
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Aaron M Harris
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Claudia Vellozzi
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jennifer Lom
- Division of General Internal Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Lesley Miller
- Division of General Internal Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Alexander J Millman
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, Georgia
| |
Collapse
|
22
|
Zhang R, Dong X, Wang D, Feng L, Zhou L, Ren R, Greene C, Song Y, J. Millman A, Azziz-Baumgartner E, Feng Z. One Hundred Years of Influenza Since the 1918 Pandemic — Is China Prepared Today? China CDC Wkly 2019. [DOI: 10.46234/ccdcw2019.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
23
|
Momin B, Millman AJ, Nielsen DB, Revels M, Steele CB. Promising practices for the prevention of liver cancer: a review of the literature and cancer plan activities in the National Comprehensive Cancer Control Program. Cancer Causes Control 2018; 29:1265-1275. [PMID: 30506129 DOI: 10.1007/s10552-018-1094-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Accepted: 11/02/2018] [Indexed: 01/23/2023]
Abstract
INTRODUCTION Hepatitis B virus (HBV) and hepatitis C virus (HCV) infections are risk factors for hepatocellular carcinoma, a type of primary liver cancer, and are most prevalent in people born 1945-1965. Relatively little information is available for liver cancer prevention, compared to other cancers. In this review, we provide a summary of current promising public health practices for liver cancer prevention from the literature, as well as liver cancer-related initiatives in the National Comprehensive Cancer Control Program (NCCCP). METHODS Two types of source materials were analyzed for this review: published literature (2005-present), and current cancer plans from the NCCCP (2005-2022). A search strategy was developed to include a review of several scientific databases. Of the 73 articles identified as potentially eligible, 20 articles were eligible for inclusion in the review. Eligible articles were abstracted using a data abstraction tool. Three independent keyword searches on 65 NCCCP plans were conducted. Keyword searches within each of the plans to identify activities related to liver cancer were conducted. Relevant information was abstracted from the plans and saved in a data table. RESULTS Of the 20 eligible articles, 15 articles provided information on interventions related to liver cancer and hepatitis B or hepatitis C prevention. All 15 of the intervention articles were related to hepatitis; 13 were hepatitis B-focused, two were hepatitis C-focused, and 14 focused on Asian/Pacific Islander American populations. The independent keyword search of NCCCP plans produced 46 results for liver, 27 results for hepatitis, and 52 results for alcohol. Two plans included activities related to liver cancer. Twenty-four plans included activities related to hepatitis. DISCUSSION A majority of the intervention articles published focused on HBV infection in Asian/Pacific Islander American populations, and a small percentage of NCCCP plans included liver-related content. The findings from this review will inform the development of an Action Plan on liver cancer prevention for the NCCCP, which will assist programs with the adoption and uptake of promising practices for the prevention of liver cancer.
Collapse
Affiliation(s)
- Behnoosh Momin
- Division of Cancer Prevention and Control, U.S. Centers for Disease Control and Prevention, 4770 Buford Highway, MS F-76, Atlanta, GA, 30341, USA.
| | - Alexander J Millman
- Division of Viral Hepatitis, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | | | - C Brooke Steele
- Division of Cancer Prevention and Control, U.S. Centers for Disease Control and Prevention, 4770 Buford Highway, MS F-76, Atlanta, GA, 30341, USA
| |
Collapse
|
24
|
Irvin R, Ward K, Agee T, Nelson NP, Vellozzi C, Thomas DL, Millman AJ. Comparison of hepatitis C virus testing recommendations in high-income countries. World J Hepatol 2018; 10:743-751. [PMID: 30386467 PMCID: PMC6206144 DOI: 10.4254/wjh.v10.i10.743] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Revised: 07/02/2018] [Accepted: 07/10/2018] [Indexed: 02/06/2023] Open
Abstract
AIM To investigate hepatitis C virus (HCV) testing recommendations from the United States and other high-income countries.
METHODS A comprehensive search for current HCV testing recommendations from the top quartile of United Nations Human Development Index (HDI) countries (very high HDI) was performed using Google and reviewed from May 1 - October 30, 2014 and re-reviewed April 1 - October 2, 2017.
RESULTS Of the 51 countries identified, 16 had HCV testing recommendations from a government body or recommendations issued collaboratively between a government and a medical organization. Of these 16 countries, 15 had HCV testing recommendations that were primarily risk-based and highlight behaviors, exposures, and conditions that are associated with HCV transmission in that region. In addition to risk-based testing, the HCV Guidance Panel (United States) incorporates recommendations for a one-time test for individuals born during 1945-1965 (the birth cohort) without prior ascertainment of risk into their guidance. In addition to the United States, six other countries either have an age-based testing recommendation or recommend one-time testing for all adults independent of risk factors typical of the region.
CONCLUSION This review affirmed the similarities of the HCV Guidance Panel’s guidance with those of recommendations from very high HDI countries.
Collapse
Affiliation(s)
- Risha Irvin
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD 21205, United States
| | - Kathleen Ward
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD 21205, United States
| | - Tracy Agee
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD 21205, United States
| | - Noele P Nelson
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, GA 30329, United States
| | - Claudia Vellozzi
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, GA 30329, United States
| | - David L Thomas
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD 21205, United States
| | - Alexander J Millman
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, GA 30329, United States
| |
Collapse
|
25
|
Rolfes MA, Millman AJ, Talley P, Elbadawi LI, Kramer NA, Barnes JR, Blanton L, Davis JP, Cole S, Dreisig JJ, Garten R, Haupt T, Jackson MA, Kocharian A, Leifer D, Lynfield R, Martin K, McHugh L, Robinson S, Turabelidze G, Webber LA, Pearce Weinberg M, Wentworth DE, Finelli L, Jhung MA. Influenza-Associated Parotitis During the 2014-2015 Influenza Season in the United States. Clin Infect Dis 2018; 67:485-492. [PMID: 29617957 PMCID: PMC6295667 DOI: 10.1093/cid/ciy136] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Accepted: 02/13/2018] [Indexed: 02/06/2023] Open
Abstract
Background During the 2014-2015 influenza season in the United States, 256 cases of influenza-associated parotitis were reported from 27 states. We conducted a case-control study and laboratory investigation to further describe this rare clinical manifestation of influenza. Methods During February 2015-April 2015, we interviewed 50 cases (with parotitis) and 124 ill controls (without parotitis) with laboratory-confirmed influenza; participants resided in 11 states and were matched by age, state, hospital admission status, and specimen collection date. Influenza viruses were characterized using real-time polymerase chain reaction and next-generation sequencing. We compared cases and controls using conditional logistic regression. Specimens from additional reported cases were also analyzed. Results Cases, 73% of whom were aged <20 years, experienced painful (86%), unilateral (68%) parotitis a median of 4 (range, 0-16) days after onset of systemic or respiratory symptoms. Cases were more likely than controls to be male (76% vs 51%; P = .005). We detected influenza A(H3N2) viruses, genetic group 3C.2a, in 100% (32/32) of case and 92% (105/108) of control specimens sequenced (P = .22). Influenza B and A(H3N2) 3C.3 and 3C.3b genetic group virus infections were detected in specimens from additional cases. Conclusions Influenza-associated parotitis, as reported here and in prior sporadic case reports, seems to occur primarily with influenza A(H3N2) virus infection. Because of the different clinical and infection control considerations for mumps and influenza virus infections, we recommend clinicians consider influenza in the differential diagnoses among patients with acute parotitis during the influenza season.
Collapse
Affiliation(s)
- Melissa A Rolfes
- Epidemic Intelligence Service, Atlanta, Georgia
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Alexander J Millman
- Epidemic Intelligence Service, Atlanta, Georgia
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Pamela Talley
- Epidemic Intelligence Service, Atlanta, Georgia
- Minnesota Department of Health, St. Paul, Madison
| | - Lina I Elbadawi
- Epidemic Intelligence Service, Atlanta, Georgia
- Bureau of Communicable Disease, Wisconsin Division of Public Health, Madison
| | - Natalie A Kramer
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - John R Barnes
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Lenee Blanton
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jeffrey P Davis
- Bureau of Communicable Disease, Wisconsin Division of Public Health, Madison
| | - Stefanie Cole
- Michigan Department of Health and Human Services, Lansing
| | - John J Dreisig
- New Hampshire Division of Public Health Services, Concord
| | - Rebecca Garten
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Thomas Haupt
- Bureau of Communicable Disease, Wisconsin Division of Public Health, Madison
| | | | - Anna Kocharian
- Bureau of Communicable Disease, Wisconsin Division of Public Health, Madison
| | - Daniel Leifer
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Karen Martin
- Minnesota Department of Health, St. Paul, Madison
| | - Lisa McHugh
- Communicable Disease Service, New Jersey Department of Health, Trenton
| | - Sara Robinson
- Maine Center for Disease Control and Prevention, Maine Department of Health and Human Services, Augusta
| | | | - Lori A Webber
- Maine Center for Disease Control and Prevention, Maine Department of Health and Human Services, Augusta
| | - Meghan Pearce Weinberg
- Epidemic Intelligence Service, Atlanta, Georgia
- Michigan Department of Health and Human Services, Lansing
| | - David E Wentworth
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Lyn Finelli
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Michael A Jhung
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia
| |
Collapse
|
26
|
Elbadawi LI, Talley P, Rolfes MA, Millman AJ, Reisdorf E, Kramer NA, Barnes JR, Blanton L, Christensen J, Cole S, Danz T, Dreisig JJ, Garten R, Haupt T, Isaac BM, Jackson MA, Kocharian A, Leifer D, Martin K, McHugh L, McNall RJ, Palm J, Radford KW, Robinson S, Rosen JB, Sakthivel SK, Shult P, Strain AK, Turabelidze G, Webber LA, Weinberg MP, Wentworth DE, Whitaker BL, Finelli L, Jhung MA, Lynfield R, Davis JP. Non-mumps Viral Parotitis During the 2014-2015 Influenza Season in the United States. Clin Infect Dis 2018; 67:493-501. [PMID: 29617951 PMCID: PMC6240917 DOI: 10.1093/cid/ciy137] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Accepted: 02/13/2018] [Indexed: 12/17/2022] Open
Abstract
Background During the 2014-2015 US influenza season, 320 cases of non-mumps parotitis (NMP) among residents of 21 states were reported to the Centers for Disease Control and Prevention (CDC). We conducted an epidemiologic and laboratory investigation to determine viral etiologies and clinical features of NMP during this unusually large occurrence. Methods NMP was defined as acute parotitis or other salivary gland swelling of >2 days duration in a person with a mumps- negative laboratory result. Using a standardized questionnaire, we collected demographic and clinical information. Buccal samples were tested at the CDC for selected viruses, including mumps, influenza, human parainfluenza viruses (HPIVs) 1-4, adenoviruses, cytomegalovirus, Epstein-Barr virus (EBV), herpes simplex viruses (HSVs) 1 and 2, and human herpes viruses (HHVs) 6A and 6B. Results Among the 320 patients, 65% were male, median age was 14.5 years (range, 0-90), and 67% reported unilateral parotitis. Commonly reported symptoms included sore throat (55%) and fever (48%). Viruses were detected in 210 (71%) of 294 NMP patients with adequate samples for testing, ≥2 viruses were detected in 37 samples, and 248 total virus detections were made among all samples. These included 156 influenza A(H3N2), 42 HHV6B, 32 EBV, 8 HPIV2, 2 HPIV3, 3 adenovirus, 4 HSV-1, and 1 HSV-2. Influenza A(H3N2), HHV6B, and EBV were the most frequently codetected viruses. Conclusions Our findings suggest that, in addition to mumps, clinicians should consider respiratory viral (influenza) and herpes viral etiologies for parotitis, particularly among patients without epidemiologic links to mumps cases or outbreaks.
Collapse
Affiliation(s)
- Lina I Elbadawi
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia
- Bureau of Communicable Diseases, Wisconsin Division of Public Health, Madison
| | - Pamela Talley
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia
- Minnesota Department of Health, St. Paul, Atlanta, Georgia
| | - Melissa A Rolfes
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Alexander J Millman
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Natalie A Kramer
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - John R Barnes
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Lenee Blanton
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Stefanie Cole
- Michigan Department of Health and Human Services, Lansing
| | - Tonya Danz
- Wisconsin State Laboratory of Hygiene, Madison
| | - John J Dreisig
- New Hampshire Division of Public Health Services, Concord
| | - Rebecca Garten
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Thomas Haupt
- Bureau of Communicable Diseases, Wisconsin Division of Public Health, Madison
| | - Beth M Isaac
- New York City Department of Health & Mental Hygiene Bureau of Immunization, Queens
- CSTE/CDC Applied Epidemiology Fellowship, Atlanta, Georgia
| | | | - Anna Kocharian
- Bureau of Communicable Diseases, Wisconsin Division of Public Health, Madison
| | - Daniel Leifer
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Karen Martin
- Minnesota Department of Health, St. Paul, Atlanta, Georgia
| | - Lisa McHugh
- Communicable Disease Service, New Jersey Department of Health, Trenton
| | - Rebecca J McNall
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jennifer Palm
- Minnesota Department of Health, St. Paul, Atlanta, Georgia
| | - Kay W Radford
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Sara Robinson
- Maine Center for Disease Control and Prevention, Maine Department of Health and Human Services, Augusta
| | - Jennifer B Rosen
- New York City Department of Health & Mental Hygiene Bureau of Immunization, Queens
| | | | - Peter Shult
- Wisconsin State Laboratory of Hygiene, Madison
| | - Anna K Strain
- Minnesota Department of Health, St. Paul, Atlanta, Georgia
| | | | - Lori A Webber
- Maine Center for Disease Control and Prevention, Maine Department of Health and Human Services, Augusta
| | - Meghan Pearce Weinberg
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia
- Michigan Department of Health and Human Services, Lansing
| | - David E Wentworth
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Brett L Whitaker
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Lyn Finelli
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Michael A Jhung
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Ruth Lynfield
- Minnesota Department of Health, St. Paul, Atlanta, Georgia
| | - Jeffrey P Davis
- Bureau of Communicable Diseases, Wisconsin Division of Public Health, Madison
| |
Collapse
|
27
|
Jentes ES, Millman AJ, Decenteceo M, Klevos A, Biggs HM, Esposito DH, McPherson H, Sullivan C, Voorhees D, Watkins J, Anzalone FL, Gaul L, Flores S, Brunette GW, Sotir MJ. Interagency and Commercial Collaboration During an Investigation of Chikungunya and Dengue Among Returning Travelers to the United States. Am J Trop Med Hyg 2017; 96:265-267. [PMID: 27601520 DOI: 10.4269/ajtmh.16-0298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Accepted: 08/09/2016] [Indexed: 11/07/2022] Open
Abstract
Public health investigations can require intensive collaboration between numerous governmental and nongovernmental organizations. We describe an investigation involving several governmental and nongovernmental partners that was successfully planned and performed in an organized, comprehensive, and timely manner with several governmental and nongovernmental partners.
Collapse
Affiliation(s)
- Emily S Jentes
- Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, Georgia.
| | - Alexander J Millman
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia.,Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Michelle Decenteceo
- Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Miami, Florida
| | - Andrew Klevos
- Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Miami, Florida
| | - Holly M Biggs
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia.,Division of Vector-borne Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Douglas H Esposito
- Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | | | | | - Jim Watkins
- Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Miami, Florida
| | | | - Linda Gaul
- Texas Department of State Health Services, Austin, Texas
| | - Sal Flores
- Customs and Border Protection, Miami, Florida
| | - Gary W Brunette
- Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Mark J Sotir
- Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, Georgia.
| |
Collapse
|
28
|
Millman AJ, Greenbaum A, Walaza S, Cohen AL, Groome MJ, Reed C, McMorrow M, Tempia S, Venter M, Treurnicht FK, Madhi SA, Cohen C, Variava E. Development of a respiratory severity score for hospitalized adults in a high HIV-prevalence setting-South Africa, 2010-2011. BMC Pulm Med 2017; 17:28. [PMID: 28148246 PMCID: PMC5288997 DOI: 10.1186/s12890-017-0368-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Accepted: 01/18/2017] [Indexed: 11/29/2022] Open
Abstract
Background Acute lower respiratory tract infections (LRTI) are a frequent cause of hospitalization and mortality in South Africa; however, existing respiratory severity scores may underestimate mortality risk in HIV-infected adults in resource limited settings. A simple predictive clinical score for low-resource settings could aid healthcare providers in the management of patients hospitalized with LRTI. Methods We analyzed 1,356 LRTI hospitalizations in adults aged ≥18 years enrolled in Severe Acute Respiratory Illness (SARI) surveillance in three South African hospitals from January 2010 to December 2011. Using demographic and clinical data at admission, we evaluated potential risk factors for in-hospital mortality. We evaluated three existing respiratory severity scores, CURB-65, CRB-65, and Classification Tree Analysis (CTA) Score assessing for discrimination and calibration. We then developed a new respiratory severity score using a multivariable logistic regression model for in-hospital mortality and assigned points to risk factors based on the coefficients in the multivariable model. Finally we evaluated the model statistically using bootstrap resampling techniques. Results Of the 1,356 patients hospitalized with LRTI, 101 (7.4%) died while hospitalized. The CURB-65, CRB-65, and CTA scores had poor calibration and demonstrated low discrimination with c-statistics of 0.594, 0.548, and 0.569 respectively. Significant risk factors for in-hospital mortality included age ≥ 45 years (A), confusion on admission (C), HIV-infection (H), and serum blood urea nitrogen >7 mmol/L (U), which were used to create the seven-point ACHU clinical predictor score. In-hospital mortality, stratified by ACHU score was: score ≤1, 2.4%, score 2, 6.4%, score 3, 11.9%, and score ≥ 4, 29.3%. Final models showed good discrimination (c-statistic 0.789) and calibration (chi-square 1.6, Hosmer-Lemeshow goodness-of-fit p-value = 0.904) and discriminated well in the bootstrap sample (average optimism of 0.003). Conclusions Existing clinical predictive scores underestimated mortality in a low resource setting with a high HIV burden. The ACHU score incorporates a simple set a risk factors that can accurately stratify patients ≥18 years of age with LRTI by in-hospital mortality risk. This score can quantify in-hospital mortality risk in an HIV-endemic, resource-limited setting with limited clinical information and if used to facilitate timely treatment may improve clinical outcomes. Electronic supplementary material The online version of this article (doi:10.1186/s12890-017-0368-8) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Alexander J Millman
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, 30329, USA. .,Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Adena Greenbaum
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, 30329, USA.,Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Sibongile Walaza
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa.,School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Adam L Cohen
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, 30329, USA.,Influenza Program, Centers for Disease Control and Prevention, Pretoria, South Africa
| | - Michelle J Groome
- Medical Research Council, Respiratory and Meningeal Pathogens Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Carrie Reed
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, 30329, USA
| | - Meredith McMorrow
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, 30329, USA
| | - Stefano Tempia
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, 30329, USA.,Influenza Program, Centers for Disease Control and Prevention, Pretoria, South Africa.,Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa
| | - Marietjie Venter
- Global Disease Detection Center, Division of Global Health Protection, Centers for Disease Control and Prevention, Pretoria, South Africa.,Zoonoses Research Program, Department of Medical Virology, University of Pretoria, Pretoria, South Africa
| | - Florette K Treurnicht
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa
| | - Shabir A Madhi
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa.,Medical Research Council, Respiratory and Meningeal Pathogens Research Unit, University of the Witwatersrand, Johannesburg, South Africa.,Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases, University of the Witwatersrand, Johannesburg, South Africa
| | - Cheryl Cohen
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa.,School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Ebrahim Variava
- Department of Medicine, Klerksdorp-Tshepong Hospital Complex, Klerksdorp, South Africa.,Department of Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,Perinatal HIV Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| |
Collapse
|
29
|
Millman AJ, Reynolds S, Duffy J, Chen J, Gargiullo P, Fry AM. Hospitalizations within 14days of vaccination among pediatric recipients of the live attenuated influenza vaccine, United States 2010-2012. Vaccine 2017; 35:529-535. [PMID: 28041779 PMCID: PMC5949885 DOI: 10.1016/j.vaccine.2016.12.033] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Revised: 07/21/2016] [Accepted: 12/16/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Live attenuated influenza vaccine (LAIV) is safe in healthy children ⩾2years. The original clinical trials excluded individuals with underlying conditions; however, post-marketing data suggest LAIV may be safe for these populations. METHODS We analyzed MarketScan Commercial Claims Databases from 2010 to 2012 to describe hospitalizations within 14days of vaccination among LAIV recipients. We evaluated LAIV recipients aged 2-18years and defined underlying conditions by presence of inpatient or outpatient ICD-9 code during the previous calendar year. We excluded asthma and immunocompromising conditions. We defined risk windows as 1-7days and 8-14days after vaccination; the control period was 12-4days prior to and 15-23days after vaccination. We conducted a self-controlled case series analysis using a conditional Poisson regression model to estimate incidence-rate ratios (IRR). RESULTS 1,216,123 children aged 2-18years received LAIV from 2010 to 2012. 634 children met our inclusion criteria and were hospitalized during the observation period (12days prior to vaccination to 23days after vaccination). Of those hospitalized, 72 (11.4%) had non-asthma, non-immunocompromising underlying conditions. Children with non-asthma, non-immunocompromising underlying conditions had an all-cause hospitalization IRR of 1.1 (95% CI 0.6-2.0, p=0.83) in the 1-7day risk period and 0.9 (95% CI 0.4-1.7, p=0.67) in the 8-14day risk period. Children with no underlying conditions had an all-cause hospitalization IRR of 0.9 (0.8-1.2, p=0.60) in the 1-7day risk period and 1.1 (95% CI 0.9-1.3, p=0.53) in the 8-14day risk period. There were no differences in all-cause hospitalization risk in individuals with non-asthma, non-immunocompromising underlying conditions compared to those without underlying conditions in the 1-7day (p=0.88) or 8-14day (p=0.24) risk period. CONCLUSIONS We found no evidence of differences in post-LAIV hospitalization risk among children with non-asthma, non-immunocompromising underlying conditions compared to healthy children.
Collapse
Affiliation(s)
- Alexander J Millman
- Influenza Division, Centers for Disease Control and Prevention, 1600 Clifton Road MS A-32, Atlanta, GA 30329, USA; Epidemic Intelligence Service assigned to Influenza Division, Centers for Disease Control and Prevention, 1600 Clifton Road MS A-32, Atlanta, GA 30329, USA.
| | - Sue Reynolds
- Influenza Division, Centers for Disease Control and Prevention, 1600 Clifton Road MS A-32, Atlanta, GA 30329, USA.
| | - Jonathan Duffy
- Immunization Safety Office, Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, 1600 Clifton Road MS D-26, Atlanta, GA 30329, USA.
| | - Jufu Chen
- Influenza Division, Centers for Disease Control and Prevention, 1600 Clifton Road MS A-32, Atlanta, GA 30329, USA.
| | - Paul Gargiullo
- Influenza Division, Centers for Disease Control and Prevention, 1600 Clifton Road MS A-32, Atlanta, GA 30329, USA.
| | - Alicia M Fry
- Influenza Division, Centers for Disease Control and Prevention, 1600 Clifton Road MS A-32, Atlanta, GA 30329, USA.
| |
Collapse
|
30
|
Millman AJ, Ntiri-Reid B, Irvin R, Kaufmann MH, Aronsohn A, Duchin JS, Scott JD, Vellozzi C. Barriers to Treatment Access for Chronic Hepatitis C Virus Infection: A Case Series. Top Antivir Med 2017; 25:110-113. [PMID: 28820726 PMCID: PMC5678961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Accepted: 12/01/2016] [Indexed: 06/07/2023]
Abstract
Restrictive policies on access to new, curative hepatitis C treatments represent a substantial barrier to treating patients infected with hepatitis C. This case series demonstrates challenges experienced by patients and practitioners in accessing these treatments and highlights several strategies for navigating the treatment preauthorization process.
Collapse
Affiliation(s)
| | | | - Risha Irvin
- The Johns Hopkins University, Baltimore, MD, USA
| | | | | | - Jeffrey S Duchin
- Communicable Disease Epidemiology and Immunization Section at Public Health-Seattle and King County, Seattle, WA, USA
| | | | | |
Collapse
|
31
|
Millman AJ, Finelli L, Bramley AM, Peacock G, Williams DJ, Arnold SR, Grijalva CG, Anderson EJ, McCullers JA, Ampofo K, Pavia AT, Edwards KM, Jain S. Community-Acquired Pneumonia Hospitalization among Children with Neurologic Disorders. J Pediatr 2016; 173:188-195.e4. [PMID: 27017483 PMCID: PMC4897771 DOI: 10.1016/j.jpeds.2016.02.049] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Revised: 01/28/2016] [Accepted: 02/18/2016] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To describe and compare the clinical characteristics, outcomes, and etiology of pneumonia among children hospitalized with community-acquired pneumonia (CAP) with neurologic disorders, non-neurologic underlying conditions, and no underlying conditions. STUDY DESIGN Children <18 years old hospitalized with clinical and radiographic CAP were enrolled at 3 US children's hospitals. Neurologic disorders included cerebral palsy, developmental delay, Down syndrome, epilepsy, non-Down syndrome chromosomal abnormalities, and spinal cord abnormalities. We compared the epidemiology, etiology, and clinical outcomes of CAP in children with neurologic disorders with those with non-neurologic underlying conditions, and those with no underlying conditions using bivariate, age-stratified, and multivariate logistic regression analyses. RESULTS From January 2010-June 2012, 2358 children with radiographically confirmed CAP were enrolled; 280 (11.9%) had a neurologic disorder (52.1% of these individuals also had non-neurologic underlying conditions), 934 (39.6%) had non-neurologic underlying conditions only, and 1144 (48.5%) had no underlying conditions. Children with neurologic disorders were older and more likely to require intensive care unit (ICU) admission than children with non-neurologic underlying conditions and children with no underlying conditions; similar proportions were mechanically ventilated. In age-stratified analysis, children with neurologic disorders were less likely to have a pathogen detected than children with non-neurologic underlying conditions. In multivariate analysis, having a neurologic disorder was associated with ICU admission for children ≥2 years of age. CONCLUSIONS Children with neurologic disorders hospitalized with CAP were less likely to have a pathogen detected and more likely to be admitted to the ICU than children without neurologic disorders.
Collapse
Affiliation(s)
- Alexander J. Millman
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA,Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA,Reprint requests: Alexander J. Millman, MD, Influenza Division, Centers for Disease Control and Prevention, 1600 Clifton Rd, Mailstop G-37, Atlanta, GA 30329.
| | - Lyn Finelli
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA
| | - Anna M. Bramley
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA
| | - Georgina Peacock
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA
| | | | - Sandra R. Arnold
- Le Bonheur Children's Hospital, Memphis, TN,University of Tennessee Health Science Center, Memphis, TN
| | | | | | - Jonathan A. McCullers
- Le Bonheur Children's Hospital, Memphis, TN,University of Tennessee Health Science Center, Memphis, TN,St. Jude Children's Research Hospital, Memphis, TN
| | - Krow Ampofo
- University of Utah Health Sciences Center, Salt Lake City, UT
| | - Andrew T. Pavia
- University of Utah Health Sciences Center, Salt Lake City, UT
| | | | - Seema Jain
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA
| |
Collapse
|
32
|
Millman AJ, Reed C, Kirley PD, Aragon D, Meek J, Farley MM, Ryan P, Collins J, Lynfield R, Baumbach J, Zansky S, Bennett NM, Fowler B, Thomas A, Lindegren ML, Atkinson A, Finelli L, Chaves SS. Improving Accuracy of Influenza-Associated Hospitalization Rate Estimates. Emerg Infect Dis 2016; 21:1595-601. [PMID: 26292017 PMCID: PMC4550134 DOI: 10.3201/eid2109.141665] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Adjusting for diagnostic test sensitivity enables more accurate and timely comparisons over time. Diagnostic test sensitivity affects rate estimates for laboratory-confirmed influenza–associated hospitalizations. We used data from FluSurv-NET, a national population-based surveillance system for laboratory-confirmed influenza hospitalizations, to capture diagnostic test type by patient age and influenza season. We calculated observed rates by age group and adjusted rates by test sensitivity. Test sensitivity was lowest in adults >65 years of age. For all ages, reverse transcription PCR was the most sensitive test, and use increased from <10% during 2003–2008 to ≈70% during 2009–2013. Observed hospitalization rates per 100,000 persons varied by season: 7.3–50.5 for children <18 years of age, 3.0–30.3 for adults 18–64 years, and 13.6–181.8 for adults >65 years. After 2009, hospitalization rates adjusted by test sensitivity were ≈15% higher for children <18 years, ≈20% higher for adults 18–64 years, and ≈55% for adults >65 years of age. Test sensitivity adjustments improve the accuracy of hospitalization rate estimates.
Collapse
|
33
|
Millman AJ, Esposito DH, Biggs HM, Decenteceo M, Klevos A, Hunsperger E, Munoz-Jordan J, Kosoy OI, McPherson H, Sullivan C, Voorhees D, Baron D, Watkins J, Gaul L, Sotir MJ, Brunette G, Fischer M, Sharp TM, Jentes ES. Chikungunya and Dengue Virus Infections Among United States Community Service Volunteers Returning from the Dominican Republic, 2014. Am J Trop Med Hyg 2016; 94:1336-41. [PMID: 26976891 DOI: 10.4269/ajtmh.15-0815] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Accepted: 01/06/2016] [Indexed: 11/07/2022] Open
Abstract
Chikungunya spread throughout the Dominican Republic (DR) after the first identified laboratory-confirmed cases were reported in April 2014. In June 2014, a U.S.-based service organization operating in the DR reported chikungunya-like illnesses among several staff. We assessed the incidence of chikungunya virus (CHIKV) and dengue virus (DENV) infection and illnesses and evaluated adherence to mosquito avoidance measures among volunteers/staff deployed in the DR who returned to the United States during July-August 2014. Investigation participants completed a questionnaire that collected information on demographics, medical history, self-reported illnesses, and mosquito exposures and avoidance behaviors and provided serum for CHIKV and DENV diagnostic testing by reverse transcription polymerase chain reaction and IgM enzyme-linked immunosorbent assay. Of 102 participants, 42 (41%) had evidence of recent CHIKV infection and two (2%) had evidence of recent DENV infection. Of the 41 participants with evidence of recent CHIKV infection only, 39 (95%) reported fever, 37 (90%) reported rash, and 37 (90%) reported joint pain during their assignment. All attended the organization's health trainings, and 89 (87%) sought a pretravel health consultation. Most (∼95%) used insect repellent; however, only 30% applied it multiple times daily and < 5% stayed in housing with window/door screens. In sum, CHIKV infections were common among these volunteers during the 2014 chikungunya epidemic in the DR. Despite high levels of preparation, reported adherence to mosquito avoidance measures were inconsistent. Clinicians should discuss chikungunya with travelers visiting areas with ongoing CHIKV outbreaks and should consider chikungunya when diagnosing febrile illnesses in travelers returning from affected areas.
Collapse
Affiliation(s)
- Alexander J Millman
- Centers for Disease Control and Prevention, Atlanta, Georgia; Centers for Disease Control and Prevention, Miami, Florida; Centers for Disease Control and Prevention, San Juan, Puerto Rico; Centers for Disease Control and Prevention, Fort Collins, Colorado; Amigos de las Américas, Houston, Texas; Texas Department of State Health Services, Austin, Texas
| | - Douglas H Esposito
- Centers for Disease Control and Prevention, Atlanta, Georgia; Centers for Disease Control and Prevention, Miami, Florida; Centers for Disease Control and Prevention, San Juan, Puerto Rico; Centers for Disease Control and Prevention, Fort Collins, Colorado; Amigos de las Américas, Houston, Texas; Texas Department of State Health Services, Austin, Texas
| | - Holly M Biggs
- Centers for Disease Control and Prevention, Atlanta, Georgia; Centers for Disease Control and Prevention, Miami, Florida; Centers for Disease Control and Prevention, San Juan, Puerto Rico; Centers for Disease Control and Prevention, Fort Collins, Colorado; Amigos de las Américas, Houston, Texas; Texas Department of State Health Services, Austin, Texas
| | - Michelle Decenteceo
- Centers for Disease Control and Prevention, Atlanta, Georgia; Centers for Disease Control and Prevention, Miami, Florida; Centers for Disease Control and Prevention, San Juan, Puerto Rico; Centers for Disease Control and Prevention, Fort Collins, Colorado; Amigos de las Américas, Houston, Texas; Texas Department of State Health Services, Austin, Texas
| | - Andrew Klevos
- Centers for Disease Control and Prevention, Atlanta, Georgia; Centers for Disease Control and Prevention, Miami, Florida; Centers for Disease Control and Prevention, San Juan, Puerto Rico; Centers for Disease Control and Prevention, Fort Collins, Colorado; Amigos de las Américas, Houston, Texas; Texas Department of State Health Services, Austin, Texas
| | - Elizabeth Hunsperger
- Centers for Disease Control and Prevention, Atlanta, Georgia; Centers for Disease Control and Prevention, Miami, Florida; Centers for Disease Control and Prevention, San Juan, Puerto Rico; Centers for Disease Control and Prevention, Fort Collins, Colorado; Amigos de las Américas, Houston, Texas; Texas Department of State Health Services, Austin, Texas
| | - Jorge Munoz-Jordan
- Centers for Disease Control and Prevention, Atlanta, Georgia; Centers for Disease Control and Prevention, Miami, Florida; Centers for Disease Control and Prevention, San Juan, Puerto Rico; Centers for Disease Control and Prevention, Fort Collins, Colorado; Amigos de las Américas, Houston, Texas; Texas Department of State Health Services, Austin, Texas
| | - Olga I Kosoy
- Centers for Disease Control and Prevention, Atlanta, Georgia; Centers for Disease Control and Prevention, Miami, Florida; Centers for Disease Control and Prevention, San Juan, Puerto Rico; Centers for Disease Control and Prevention, Fort Collins, Colorado; Amigos de las Américas, Houston, Texas; Texas Department of State Health Services, Austin, Texas
| | - Heidi McPherson
- Centers for Disease Control and Prevention, Atlanta, Georgia; Centers for Disease Control and Prevention, Miami, Florida; Centers for Disease Control and Prevention, San Juan, Puerto Rico; Centers for Disease Control and Prevention, Fort Collins, Colorado; Amigos de las Américas, Houston, Texas; Texas Department of State Health Services, Austin, Texas
| | - Carmen Sullivan
- Centers for Disease Control and Prevention, Atlanta, Georgia; Centers for Disease Control and Prevention, Miami, Florida; Centers for Disease Control and Prevention, San Juan, Puerto Rico; Centers for Disease Control and Prevention, Fort Collins, Colorado; Amigos de las Américas, Houston, Texas; Texas Department of State Health Services, Austin, Texas
| | - Dayton Voorhees
- Centers for Disease Control and Prevention, Atlanta, Georgia; Centers for Disease Control and Prevention, Miami, Florida; Centers for Disease Control and Prevention, San Juan, Puerto Rico; Centers for Disease Control and Prevention, Fort Collins, Colorado; Amigos de las Américas, Houston, Texas; Texas Department of State Health Services, Austin, Texas
| | - David Baron
- Centers for Disease Control and Prevention, Atlanta, Georgia; Centers for Disease Control and Prevention, Miami, Florida; Centers for Disease Control and Prevention, San Juan, Puerto Rico; Centers for Disease Control and Prevention, Fort Collins, Colorado; Amigos de las Américas, Houston, Texas; Texas Department of State Health Services, Austin, Texas
| | - Jim Watkins
- Centers for Disease Control and Prevention, Atlanta, Georgia; Centers for Disease Control and Prevention, Miami, Florida; Centers for Disease Control and Prevention, San Juan, Puerto Rico; Centers for Disease Control and Prevention, Fort Collins, Colorado; Amigos de las Américas, Houston, Texas; Texas Department of State Health Services, Austin, Texas
| | - Linda Gaul
- Centers for Disease Control and Prevention, Atlanta, Georgia; Centers for Disease Control and Prevention, Miami, Florida; Centers for Disease Control and Prevention, San Juan, Puerto Rico; Centers for Disease Control and Prevention, Fort Collins, Colorado; Amigos de las Américas, Houston, Texas; Texas Department of State Health Services, Austin, Texas
| | - Mark J Sotir
- Centers for Disease Control and Prevention, Atlanta, Georgia; Centers for Disease Control and Prevention, Miami, Florida; Centers for Disease Control and Prevention, San Juan, Puerto Rico; Centers for Disease Control and Prevention, Fort Collins, Colorado; Amigos de las Américas, Houston, Texas; Texas Department of State Health Services, Austin, Texas
| | - Gary Brunette
- Centers for Disease Control and Prevention, Atlanta, Georgia; Centers for Disease Control and Prevention, Miami, Florida; Centers for Disease Control and Prevention, San Juan, Puerto Rico; Centers for Disease Control and Prevention, Fort Collins, Colorado; Amigos de las Américas, Houston, Texas; Texas Department of State Health Services, Austin, Texas
| | - Marc Fischer
- Centers for Disease Control and Prevention, Atlanta, Georgia; Centers for Disease Control and Prevention, Miami, Florida; Centers for Disease Control and Prevention, San Juan, Puerto Rico; Centers for Disease Control and Prevention, Fort Collins, Colorado; Amigos de las Américas, Houston, Texas; Texas Department of State Health Services, Austin, Texas
| | - Tyler M Sharp
- Centers for Disease Control and Prevention, Atlanta, Georgia; Centers for Disease Control and Prevention, Miami, Florida; Centers for Disease Control and Prevention, San Juan, Puerto Rico; Centers for Disease Control and Prevention, Fort Collins, Colorado; Amigos de las Américas, Houston, Texas; Texas Department of State Health Services, Austin, Texas
| | - Emily S Jentes
- Centers for Disease Control and Prevention, Atlanta, Georgia; Centers for Disease Control and Prevention, Miami, Florida; Centers for Disease Control and Prevention, San Juan, Puerto Rico; Centers for Disease Control and Prevention, Fort Collins, Colorado; Amigos de las Américas, Houston, Texas; Texas Department of State Health Services, Austin, Texas
| |
Collapse
|
34
|
Millman AJ, Chamany S, Guthartz S, Thihalolipavan S, Porter M, Schroeder A, Vora NM, Varma JK, Starr D. Active Monitoring of Travelers Arriving from Ebola-Affected Countries - New York City, October 2014-April 2015. MMWR Morb Mortal Wkly Rep 2016; 65:51-4. [PMID: 26820056 DOI: 10.15585/mmwr.mm6503a3] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
The Ebola virus disease (Ebola) outbreak in West Africa has claimed approximately 11,300 lives (1), and the magnitude and course of the epidemic prompted many nonaffected countries to prepare for Ebola cases imported from affected countries. In October 2014, CDC and the Department of Homeland Security (DHS) implemented enhanced entry risk assessment and management at five U.S. airports: John F. Kennedy (JFK) International Airport in New York City (NYC), O'Hare International Airport in Chicago, Newark Liberty International Airport in New Jersey, Hartsfield-Jackson International Airport in Atlanta, and Dulles International Airport in Virginia (2). Enhanced entry risk assessment began at JFK on October 11, 2014, and at the remaining airports on October 16 (3). On October 21, DHS exercised its authority to direct all travelers flying into the United States from an Ebola-affected country to arrive at one of the five participating airports. At the time, the Ebola-affected countries included Guinea, Liberia, Mali, and Sierra Leone. On October 27, CDC issued updated guidance for monitoring persons with potential Ebola virus exposure (4), including recommending daily monitoring of such persons to ascertain the presence of fever or symptoms for a period of 21 days (the maximum incubation period of Ebola virus) after the last potential exposure; this was termed "active monitoring." CDC also recommended "direct active monitoring" of persons with a higher risk for Ebola virus exposure, including health care workers who had provided direct patient care in Ebola-affected countries. Direct active monitoring required direct observation of the person being monitored by the local health authority at least once daily (5). This report describes the operational structure of the NYC Department of Health and Mental Hygiene's (DOHMH) active monitoring program during its first 6 months (October 2014-April 2015) of operation. Data collected on persons who required direct active monitoring are not included in this report.
Collapse
|
35
|
Millman AJ, Havers F, Iuliano AD, Davis CT, Sar B, Sovann L, Chin S, Corwin AL, Vongphrachanh P, Douangngeun B, Lindblade KA, Chittaganpitch M, Kaewthong V, Kile JC, Nguyen HT, Pham DV, Donis RO, Widdowson MA. Detecting Spread of Avian Influenza A(H7N9) Virus Beyond China. Emerg Infect Dis 2016; 21:741-9. [PMID: 25897654 PMCID: PMC4412232 DOI: 10.3201/eid2105.141756] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
This virus is unlikely to have spread substantially among humans in Vietnam, Thailand, Cambodia, and Laos. During February 2013–March 2015, a total of 602 human cases of low pathogenic avian influenza A(H7N9) were reported; no autochthonous cases were reported outside mainland China. In contrast, since highly pathogenic avian influenza A(H5N1) reemerged during 2003 in China, 784 human cases in 16 countries and poultry outbreaks in 53 countries have been reported. Whether the absence of reported A(H7N9) outside mainland China represents lack of spread or lack of detection remains unclear. We compared epidemiologic and virologic features of A(H5N1) and A(H7N9) and used human and animal influenza surveillance data collected during April 2013–May 2014 from 4 Southeast Asia countries to assess the likelihood that A(H7N9) would have gone undetected during 2014. Surveillance in Vietnam and Cambodia detected human A(H5N1) cases; no A(H7N9) cases were detected in humans or poultry in Southeast Asia. Although we cannot rule out the possible spread of A(H7N9), substantial spread causing severe disease in humans is unlikely.
Collapse
|
36
|
Rolfes MA, Millman AJ, Talley P, Elbadawi LI, Kramer N, Blanton L, Davis JP, Devita S, Dreisig J, Foust A, Golwalkar M, Haupt T, Kocharian A, Mchugh L, Martin K, Patel R, Pontones P, Quilliam D, Richards S, Robinson S, Webber L, Weinberg MP, Finelli L, Jhung MA. Influenza-Associated Parotitis-Novel Occurrence During the 2014–2015 United States Influenza Season. Open Forum Infect Dis 2015. [DOI: 10.1093/ofid/ofv133.417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
37
|
Millman AJ, Kornylo Duong K, Lafond K, Green NM, Lippold SA, Jhung MA. Influenza Outbreaks Among Passengers and Crew on Two Cruise Ships: A Recent Account of Preparedness and Response to an Ever-Present Challenge. J Travel Med 2015; 22:306-11. [PMID: 26031322 PMCID: PMC4869710 DOI: 10.1111/jtm.12215] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND During spring 2014, two large influenza outbreaks occurred among cruise ship passengers and crew on trans-hemispheric itineraries. METHODS Passenger and crew information for both ships was obtained from components of the ship medical records. Data included demographics, diagnosis of influenza-like illness (ILI) or acute respiratory illness (ARI), illness onset date, passenger cabin number, crew occupation, influenza vaccination history, and rapid influenza diagnostic test (RIDT) result, if performed. RESULTS In total, 3.7% of passengers and 3.1% of crew on Ship A had medically attended acute respiratory illness (MAARI). On Ship B, 6.2% of passengers and 4.7% of crew had MAARI. In both outbreaks, passengers reported illness prior to the ship's departure. Influenza activity was low in the places of origin of the majority of passengers and both ships' ports of call. The median age of affected passengers on both ships was 70 years. Diagnostic testing revealed three different co-circulating influenza viruses [influenza A(H1N1)pdm09, influenza A(H3N2), and influenza B] on Ship A and one circulating influenza virus (influenza B) on Ship B. Both ships voluntarily reported the outbreaks to the Centers for Disease Control and Prevention (CDC) and implemented outbreak response plans including isolation of sick individuals and antiviral treatment and prophylaxis. CONCLUSIONS Influenza activity can become widespread during cruise ship outbreaks and can occur outside of traditional influenza seasons. Comprehensive outbreak prevention and control plans, including prompt antiviral treatment and prophylaxis, may mitigate the impact of influenza outbreaks on cruise ships.
Collapse
Affiliation(s)
- Alexander J Millman
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Krista Kornylo Duong
- Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Kathryn Lafond
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Nicole M Green
- Los Angeles County Public Health Laboratory, Downey, CA, USA
| | - Susan A Lippold
- Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Michael A Jhung
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, USA
| |
Collapse
|
38
|
Chaisson LH, Roemer M, Cantu D, Haller B, Millman AJ, Cattamanchi A, Davis JL. Impact of GeneXpert MTB/RIF assay on triage of respiratory isolation rooms for inpatients with presumed tuberculosis: a hypothetical trial. Clin Infect Dis 2014; 59:1353-60. [PMID: 25091300 DOI: 10.1093/cid/ciu620] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Placing inpatients with presumed active pulmonary tuberculosis in respiratory isolation pending results of serial sputum acid-fast bacilli (AFB) smear microscopy is standard practice in high-income countries. However, this diagnostic strategy is slow and yields few tuberculosis diagnoses. We sought to determine if replacing microscopy with the GeneXpert MTB/RIF (Xpert) nucleic acid amplification assay could reduce testing time and usage of isolation rooms. METHODS We prospectively followed inpatients at San Francisco General Hospital undergoing tuberculosis evaluation. We performed smear microscopy and Xpert testing on concentrated sputum, and calculated diagnostic accuracy for both strategies in reference to serial sputum mycobacterial culture. We measured turnaround time for microscopy and estimated hypothetical turnaround times for Xpert on concentrated and unconcentrated sputum. We compared median and total isolation times for microscopy to those estimated for the 2 Xpert strategies. RESULTS Among 139 patients with 142 admissions, median age was 54 years (interquartile range [IQR], 43-60 years); 32 (23%) patients were female, and 42 (30%) were HIV seropositive. Serial sputum smear microscopy and a single concentrated sputum Xpert had identical sensitivity (89%; 95% confidence interval [CI], 52%-100%) and similar specificity (99% [95% CI, 96%-100%] vs 100% [95% CI, 97%-100%]). A single concentrated sputum Xpert could have saved a median of 35 hours (IQR, 24-36 hours) in unnecessary isolation compared with microscopy, and a single unconcentrated sputum Xpert, 45 hours (IQR, 35-46 hours). CONCLUSIONS Replacing serial sputum smear microscopy with a single sputum Xpert could eliminate most unnecessary isolation for inpatients with presumed tuberculosis, greatly benefiting patients and hospitals.
Collapse
Affiliation(s)
| | | | | | | | | | - Adithya Cattamanchi
- Division of Pulmonary and Critical Care Medicine Department of Medicine Curry International Tuberculosis Center, San Francisco General Hospital, University of California
| | - J Lucian Davis
- Division of Pulmonary and Critical Care Medicine Department of Medicine Curry International Tuberculosis Center, San Francisco General Hospital, University of California
| |
Collapse
|
39
|
Millman AJ, Finelli L, Bramley AM, Peacock G, Williams DJ, Arnold SR, Grijalva CG, Anderson EJ, Mccullers JA, Ampofo K, Pavia A, Edwards K, Jain S. 780Clinical Characteristics And Outcomes among Children with Neurological Disorders Hospitalized with Community-acquired Pneumonia (CAP) in the Etiology of Pneumonia in the Community (EPIC) Study. Open Forum Infect Dis 2014. [PMCID: PMC5782159 DOI: 10.1093/ofid/ofu052.488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
|
40
|
Millman AJ, Dowdy DW, Miller CR, Brownell R, Metcalfe JZ, Cattamanchi A, Davis JL. Rapid molecular testing for TB to guide respiratory isolation in the U.S.: a cost-benefit analysis. PLoS One 2013; 8:e79669. [PMID: 24278155 PMCID: PMC3835836 DOI: 10.1371/journal.pone.0079669] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2013] [Accepted: 09/23/2013] [Indexed: 11/30/2022] Open
Abstract
Background Respiratory isolation of inpatients during evaluation for TB is a slow and costly process in low-burden settings. Xpert MTB/RIF (Xpert) is a novel molecular test for tuberculosis (TB) that is faster and more sensitive but substantially more expensive than smear microscopy. No previous studies have examined the costs of molecular testing as a replacement for smear microscopy in this setting. Methods We conducted an incremental cost–benefit analysis comparing the use of a single negative Xpert versus two negative sputum smears to release consecutive adult inpatients with presumed TB from respiratory isolation at an urban public hospital in the United States. We estimated all health-system costs and patient outcomes related to Xpert implementation, diagnostic evaluation, isolation, hospitalization, and treatment. We performed sensitivity and probabilistic uncertainty analyses to determine at what threshold the Xpert strategy would become cost-saving. Results Among a hypothetical cohort of 234 individuals undergoing evaluation for presumed active TB annually, 6.4% had culture-positive TB. Compared to smear microscopy, Xpert reduced isolation bed utilization from an average of 2.7 to 1.4 days per patient, leading to a 48% reduction in total annual isolation bed usage from 632 to 328 bed-days. Xpert saved an average of $2,278 (95% uncertainty range $1582–4570) per admission, or $533,520 per year, compared with smear microscopy. Conclusions Molecular testing for TB could provide substantial savings to hospitals in high-income countries by reducing respiratory isolation usage and overall length of stay.
Collapse
Affiliation(s)
- Alexander J. Millman
- Department of Medicine, San Francisco General Hospital, University of California San Francisco, San Francisco, California, United States of America
- PRIME Residency Program, University of California San Francisco, San Francisco, California, United States of America
| | - David W. Dowdy
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Cecily R. Miller
- Department of Biostatistics and Epidemiology, University of California San Francisco, San Francisco, California, United States of America
| | - Robert Brownell
- Department of Medicine, San Francisco General Hospital, University of California San Francisco, San Francisco, California, United States of America
| | - John Z. Metcalfe
- Division of Pulmonary and Critical Care Medicine, San Francisco General Hospital, University of California San Francisco, San Francisco, California, United States of America
- Curry International Tuberculosis Center, San Francisco General Hospital, University of California San Francisco, San Francisco, California, United States of America
- Department of Medicine, San Francisco General Hospital, University of California San Francisco, San Francisco, California, United States of America
| | - Adithya Cattamanchi
- Division of Pulmonary and Critical Care Medicine, San Francisco General Hospital, University of California San Francisco, San Francisco, California, United States of America
- Curry International Tuberculosis Center, San Francisco General Hospital, University of California San Francisco, San Francisco, California, United States of America
- Department of Medicine, San Francisco General Hospital, University of California San Francisco, San Francisco, California, United States of America
| | - J. Lucian Davis
- Division of Pulmonary and Critical Care Medicine, San Francisco General Hospital, University of California San Francisco, San Francisco, California, United States of America
- Curry International Tuberculosis Center, San Francisco General Hospital, University of California San Francisco, San Francisco, California, United States of America
- Department of Medicine, San Francisco General Hospital, University of California San Francisco, San Francisco, California, United States of America
- * E-mail:
| |
Collapse
|
41
|
|
42
|
King DT, Millman AJ, Gurevitch AW, Hirose FM. Giant cell tumor of the tendon sheath involving skin. Arch Dermatol 1978; 114:944-6. [PMID: 208469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Giant cell tumor of the tendon sheath is the second most common tumor of the fingers and hands but is only rarely mentioned in the dermatologic literature. Although its pathogenesis has been debated, it is probably a type of fibrous histiocytoma. This tumor is almost always benign but may locally invade the overlying dermis and be confused with a malignant neoplasms. It often extends to the synovium of the adjacent joint space and necessitates total excision to prevent local recurrence. Therefore, excision should be undertaken by a physican who is surgically qualified for such procedure. We report a case that illustrates the clinical and pathologic aspects of this lesion.
Collapse
|