Last data update: Sep 23, 2024. (Total: 47723 publications since 2009)
Records 1-5 (of 5 Records) |
Query Trace: Faulkner AE [original query] |
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Pertussis Infections among pregnant women in the United States, 2012-2017
Skoff TH , Faulkner AE , Liang JL , Barnes M , Kudish K , Thomas E , Kenyon C , Hoffman M , Pradhan E , Liko J , Hariri S . Clin Infect Dis 2020 73 (11) e3836-e3841 BACKGROUND: Little is known about pertussis among pregnant women, a population at increased risk for severe morbidity from respiratory infections such as influenza. We used CDC's Enhanced Pertussis Surveillance (EPS) system to describe pertussis epidemiology among pregnant and non-pregnant women of childbearing age. METHODS: Pertussis cases in women aged 18-44 years with cough onset between 1/1/2012-12/31/2017 were identified in 7 EPS states. Surveillance data were collected through patient and provider interview and immunization registries. Bridged-race, intercensal population data and live birth estimates were used as denominators. RESULTS: 1,582 pertussis cases were identified among women aged 18-44 years; 5.1% (76/1499) of patients with known pregnancy status were pregnant at cough onset. Of pregnant patients with complete information, 81.7% (49/60) reported onset during the second or third trimester. The median age of pregnant and non-pregnant patients was 29.0 and 33.0 years, respectively. Most pregnant and non-pregnant patients were white (78.3% vs. 86.4%, p=0.09) and non-Hispanic (72.6% vs. 77.3%, p=0.35). Average annual pertussis incidence was 5.7/100,000 among pregnant and 7.3/100,000 among non-pregnant women. Compared to non-pregnant patients, more pregnant patients reported whoop (41.9% vs. 31.3%), post-tussive vomiting (58.1% vs. 47.9%) and apnea (37.3% vs. 29.0%); however, differences were not statistically significant (p>0.05 for all). A similar proportion of pregnant and non-pregnant patients reported ever having received Tdap (31.6% vs. 32.7%, p=0.84). CONCLUSIONS: Our analysis suggests that pertussis incidence and clinical characteristics of disease are similar among pregnant and non-pregnant women. Continued monitoring is important to further define pertussis epidemiology in pregnant women. |
Tetanus, diphtheria and acellular pertussis (Tdap) vaccine for prevention of pertussis among adults aged 19 years and older in the United States: A cost-effectiveness analysis
Cho BH , Acosta AM , Leidner AJ , Faulkner AE , Zhou FJ . Prev Med 2020 134 106066 Currently, the Advisory Committee on Immunization Practices recommends one-time tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccination for all adults 19 years and older. This study is designed to evaluate the cost-effectiveness of Tdap vaccination for Tdap-eligible adults aged 19 through 85 in the United States. A cost-effectiveness model was developed to compute costs and health outcomes associated with pertussis among 100,000 Tdap-eligible persons of each age cohort. From the societal perspective, the cost per quality-adjusted life-year (QALY) saved was evaluated under the vaccination scenarios. Sensitivity analyses were also conducted to evaluate the impacts of changes in key variables. All costs were adjusted to 2018 US$ with an annual discount rate of 3% applied to costs and outcomes. The incremental cost-effectiveness ratios (ICERs) for vaccinating US adults aged 19 to 85 with Tdap ranged from $248,000/QALY to $900,000/QALY. The lowest cost per QALY was found to be $248,000 for the age 65 cohort, followed by $332,000 for the cohort of age 19, and followed by $477,000 for the age 50 cohort. Sensitivity analysis showed the most dramatic changes in ICER occurred when changing the underreporting factor, vaccine effectiveness and vaccination costs. While Tdap vaccination may not be as cost effective as predicted earlier, it remains the best available preventive measure against pertussis. Further investigation of the true burden of pertussis disease among adults and the effectiveness of Tdap vaccination in this population is needed to better estimate the impact of Tdap vaccination. |
Trends in pertussis diagnostic testing in the United States, 1990-2012
Faulkner AE , Skoff TH , Tondella ML , Cohn A , Clark TA , Martin SW . Pediatr Infect Dis J 2015 35 (1) 39-44 BACKGROUND: Reports of pertussis have been increasing in the U.S. since the 1990s and pertussis diagnostics have evolved during that time. Here we describe temporal changes in pertussis diagnostic practices in the U.S. during 1990-2012 and discuss potential implications. METHODS: Pertussis cases reported through the National Notifiable Diseases Surveillance System (NNDSS) during 1990- 2012 were included in this analysis. Laboratory results were stratified by test type, case classification, age group, and case-patient state of residence. RESULTS: 291,290 cases were included with 64% (n=186,766) reporting at least one pertussis laboratory result. Culture and DFA were the primary results reported during the early 1990s; however, PCR surpassed all other test types during the late 1990s and 2000s. By 2012 more than 91% of cases with known results were tested using PCR, either alone or in combination with another test type. Before 2005, Massachusetts reported 71% of serology results, but an increasing number of states reported serologic results during 2005-2012. When stratified by age group, overall testing trends persist. As of 2012, culture confirmation is used infrequently across all ages, while use of serology increases with age and is most prevalent among adults aged ≥ 20 years. CONCLUSIONS: PCR has become the primary diagnostic method, and serologic assays now are used in a majority of states. Epidemiologic trends must be considered in the context of changing diagnostic tests, and modifications to surveillance case definitions should be considered to better reflect current testing practices. |
An evaluation of the level of agreement in Bordetella species identification in three United States laboratories during a period of increased pertussis.
Burgos-Rivera B , Lee AD , Bowden KE , Faulkner AE , Seaton BL , Lembke BD , Cartwright CP , Martin SW , Tondella ML . J Clin Microbiol 2015 53 (6) 1842-7 While PCR is the most common method used for detecting Bordetella pertussis in the US, most laboratories use insertion sequence 481 (IS481), which is not specific for B. pertussis; therefore, the relative contribution of other Bordetella species is not understood. The objectives of this study were to evaluate the proportion of other Bordetella spp. misidentified as B. pertussis during a period of increased pertussis incidence, determine the level of agreement in Bordetella species detection between US commercial laboratories and CDC, and assess the relative diagnostic sensitivity of CDC's PCR assay when using a different PCR master mix. Specimens collected between May 2012-2013 were tested at two US commercial laboratories for B. pertussis and B. parapertussis detection. Every fifth specimen positive for IS481 and/or IS1001 with Ct values ≤35 was sent to CDC for PCR testing that identifies Bordetella species. Specimens with CDC PCR indeterminate or negative results were tested using an alternate PCR master mix. Of 755 specimens, there was agreement in species identification for 83.4% (n=630). Of those with different identifications (n=125), 79.2% (n=99) were identified as indeterminate B. pertussis at CDC. Overall, 0.66% (n=5) of the specimens were identified as B. holmesii or B. bronchiseptica at CDC. Of 115 specimens with indeterminate or negative results, 46.1% (n=53) were B. pertussis positive when tested by an alternate master mix, suggesting possible increase in assay sensitivity. This study demonstrates good agreement between the two US commercial laboratories and CDC and little misidentification of Bordetella species during the 2012 US epidemic. |
Pertussis Pseudo-outbreak linked to specimens contaminated by Bordetella pertussis DNA From clinic surfaces.
Mandal S , Tatti KM , Woods-Stout D , Cassiday PK , Faulkner AE , Griffith MM , Jackson ML , Pawloski LC , Wagner B , Barnes M , Cohn AC , Gershman KA , Messonnier NE , Clark TA , Tondella ML , Martin SW . Pediatrics 2012 129 (2) e424-30 BACKGROUND AND OBJECTIVES: We investigated a pertussis outbreak characterized by atypical cases, confirmed by polymerase chain reaction (PCR) alone at a single laboratory, which persisted despite high vaccine coverage and routine control measures. We aimed to determine whether Bordetella pertussis was the causative agent and advise on control interventions. METHODS: We conducted case ascertainment, confirmatory testing for pertussis and other pathogens, and an assessment for possible sources of specimen contamination, including a survey of clinic practices, sampling clinics for B pertussis DNA, and review of laboratory quality indicators. RESULTS: Between November 28, 2008, and September 4, 2009, 125 cases were reported, of which 92 (74%) were PCR positive. Cases occurring after April 2009 (n = 79; 63%) had fewer classic pertussis symptoms (63% vs 98%; P < .01), smaller amounts of B pertussis DNA (mean PCR cycle threshold value: 40.9 vs 33.1; P < .01), and a greater proportion of PCR-positive results (34% vs 6%; P < .01). Cultures and serology for B pertussis were negative. Other common respiratory pathogens were detected. We identified factors that likely resulted in specimen contamination at the point of collection: environmentally present B pertussis DNA in clinics from vaccine, clinic standard specimen collection practices, use of liquid transport medium, and lack of clinically relevant PCR cutoffs. CONCLUSIONS: A summer pertussis pseudo-outbreak, multifactorial in cause, likely occurred. Recommendations beyond standard practice were made to providers on specimen collection and environmental cleaning, and to laboratories on standardizing PCR protocols and reporting results, to minimize false-positive results from contaminated clinical specimens. |
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