Last data update: Nov 04, 2024. (Total: 48056 publications since 2009)
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Antiviral agents for the treatment and chemoprophylaxis of influenza --- recommendations of the Advisory Committee on Immunization Practices (ACIP)
Fiore AE , Fry A , Shay D , Gubareva L , Bresee JS , Uyeki TM . MMWR Recomm Rep 2011 60 (1) 1-24 This report updates previous recommendations by CDC's Advisory Committee on Immunization Practices (ACIP) regarding the use of antiviral agents for the prevention and treatment of influenza (CDC. Prevention and control of influenza: recommendations of the Advisory Committee on Immunization Practices [ACIP]. MMWR 2008;57[No. RR-7]).This report contains information on treatment and chemoprophylaxis of influenza virus infection and provides a summary of the effectiveness and safety of antiviral treatment medications. Highlights include recommendations for use of 1) early antiviral treatment of suspected or confirmed influenza among persons with severe influenza (e.g., those who have severe, complicated, or progressive illness or who require hospitalization); 2) early antiviral treatment of suspected or confirmed influenza among persons at higher risk for influenza complications; and 3) either oseltamivir or zanamivir for persons with influenza caused by 2009 H1N1 virus, influenza A (H3N2) virus, or influenza B virus or when the influenza virus type or influenza A virus subtype is unknown; 4) antiviral medications among children aged <1 year; 5) local influenza testing and influenza surveillance data, when available, to help guide treatment decisions; and 6) consideration of antiviral treatment for outpatients with confirmed or suspected influenza who do not have known risk factors for severe illness, if treatment can be initiated within 48 hours of illness onset. Additional information is available from CDC's influenza website at http://www.cdc.gov/flu, including any updates or supplements to these recommendations that might be required during the 2010-11 influenza season. Health-care providers should be alert to announcements of recommendation updates and should check the CDC influenza website periodically for additional information. Recommendations related to the use of vaccines for the prevention of influenza during the 2010-11 influenza season have been published previously (CDC. Prevention and control of influenza with vaccines: recommendations of the Advisory Committee on Immunization Practices [ACIP], 2010. MMWR 2010;59[No. RR-8]). |
Prevention and control of influenza with vaccines: recommendations of the Advisory Committee on Immunization Practices (ACIP), 2010
Fiore AE , Uyeki TM , Broder K , Finelli L , Euler GL , Singleton JA , Iskander JK , Wortley PM , Shay DK , Bresee JS , Cox NJ . MMWR Recomm Rep 2010 59 1-62 This report updates the 2009 recommendations by CDC's Advisory Committee on Immunization Practices (ACIP) regarding the use of influenza vaccine for the prevention and control of influenza (CDC. Prevention and control of influenza: recommendations of the Advisory Committee on Immunization Practices [ACIP]. MMWR 2009;58[No. RR-8] and CDC. Use of influenza A (H1N1) 2009 monovalent vaccine---recommendations of the Advisory Committee on Immunization Practices [ACIP], 2009. MMWR 2009;58:[No. RR-10]). The 2010 influenza recommendations include new and updated information. Highlights of the 2010 recommendations include 1) a recommendation that annual vaccination be administered to all persons aged >or=6 months for the 2010-11 influenza season; 2) a recommendation that children aged 6 months--8 years whose vaccination status is unknown or who have never received seasonal influenza vaccine before (or who received seasonal vaccine for the first time in 2009-10 but received only 1 dose in their first year of vaccination) as well as children who did not receive at least 1 dose of an influenza A (H1N1) 2009 monovalent vaccine regardless of previous influenza vaccine history should receive 2 doses of a 2010-11 seasonal influenza vaccine (minimum interval: 4 weeks) during the 2010--11 season; 3) a recommendation that vaccines containing the 2010-11 trivalent vaccine virus strains A/California/7/2009 (H1N1)-like (the same strain as was used for 2009 H1N1 monovalent vaccines), A/Perth/16/2009 (H3N2)-like, and B/Brisbane/60/2008-like antigens be used; 4) information about Fluzone High-Dose, a newly approved vaccine for persons aged >or=65 years; and 5) information about other standard-dose newly approved influenza vaccines and previously approved vaccines with expanded age indications. Vaccination efforts should begin as soon as the 2010-11 seasonal influenza vaccine is available and continue through the influenza season. These recommendations also include a summary of safety data for U.S.-licensed influenza vaccines. These recommendations and other information are available at CDC's influenza website (http://www.cdc.gov/flu); any updates or supplements that might be required during the 2010-11 influenza season also will be available at this website. Recommendations for influenza diagnosis and antiviral use will be published before the start of the 2010-11 influenza season. Vaccination and health-care providers should be alert to announcements of recommendation updates and should check the CDC influenza website periodically for additional information. |
Prevention and control of seasonal influenza with vaccines: recommendations of the Advisory Committee on Immunization Practices (ACIP), 2009
Fiore AE , Shay DK , Broder K , Iskander JK , Uyeki TM , Mootrey G , Bresee JS , Cox NJ . MMWR Recomm Rep 2009 58 1-52 This report updates the 2008 recommendations by CDC's Advisory Committee on Immunization Practices (ACIP) regarding the use of influenza vaccine for the prevention and control of seasonal influenza (CDC. Prevention and control of influenza: recommendations of the Advisory Committee on Immunization Practices [ACIP]. MMWR 2008;57[No. RR-7]). Information on vaccination issues related to the recently identified novel influenza A H1N1 virus will be published later in 2009. The 2009 seasonal influenza recommendations include new and updated information. Highlights of the 2009 recommendations include 1) a recommendation that annual vaccination be administered to all children aged 6 months-18 years for the 2009-10 influenza season; 2) a recommendation that vaccines containing the 2009-10 trivalent vaccine virus strains A/Brisbane/59/2007 (H1N1)-like, A/Brisbane/10/2007 (H3N2)-like, and B/Brisbane/60/2008-like antigens be used; and 3) a notice that recommendations for influenza diagnosis and antiviral use will be published before the start of the 2009-10 influenza season. Vaccination efforts should begin as soon as vaccine is available and continue through the influenza season. Approximately 83% of the United States population is specifically recommended for annual vaccination against seasonal influenza; however, <40% of the U.S. population received the 2008-09 influenza vaccine. These recommendations also include a summary of safety data for U.S. licensed influenza vaccines. These recommendations and other information are available at CDC's influenza website (http://www.cdc.gov/flu); any updates or supplements that might be required during the 2009-10 influenza season also can be found at this website. Vaccination and health-care providers should be alert to announcements of recommendation updates and should check the CDC influenza website periodically for additional information. |
Epidemiology of sepsis in US children and young adults
Magill SS , Sapiano MRP , Gokhale R , Nadle J , Johnston H , Brousseau G , Maloney M , Ray SM , Wilson LE , Perlmutter R , Lynfield R , DeSilva M , Sievers M , Irizarry L , Dumyati G , Pierce R , Zhang A , Kainer M , Fiore AE , Dantes R , Epstein L . Open Forum Infect Dis 2023 10 (5) ofad218 BACKGROUND: Most multicenter studies of US pediatric sepsis epidemiology use administrative data or focus on pediatric intensive care units. We conducted a detailed medical record review to describe sepsis epidemiology in children and young adults. METHODS: In a convenience sample of hospitals in 10 states, patients aged 30 days-21 years, discharged during 1 October 2014-30 September 2015, with explicit diagnosis codes for severe sepsis or septic shock, were included. Medical records were reviewed for patients with documentation of sepsis, septic shock, or similar terms. We analyzed overall and age group-specific patient characteristics. RESULTS: Of 736 patients in 26 hospitals, 442 (60.1%) had underlying conditions. Most patients (613 [83.3%]) had community-onset sepsis, although most community-onset sepsis was healthcare associated (344 [56.1%]). Two hundred forty-one patients (32.7%) had outpatient visits 1-7 days before sepsis hospitalization, of whom 125 (51.9%) received antimicrobials ≤30 days before sepsis hospitalization. Age group-related differences included common underlying conditions (<5 years: prematurity vs 5-12 years: chronic pulmonary disease vs 13-21 years: chronic immunocompromise); medical device presence ≤30 days before sepsis hospitalization (1-4 years: 46.9% vs 30 days-11 months: 23.3%); percentage with hospital-onset sepsis (<5 years: 19.6% vs ≥5 years: 12.0%); and percentage with sepsis-associated pathogens (30 days-11 months: 65.6% vs 13-21 years: 49.3%). CONCLUSIONS: Our data suggest potential opportunities to raise sepsis awareness among outpatient providers to facilitate prevention, early recognition, and intervention in some patients. Consideration of age-specific differences may be important as approaches are developed to improve sepsis prevention, risk prediction, recognition, and management. |
Epidemiology, outcomes, and trends of patients with sepsis and opioid-related hospitalizations in U.S. hospitals
Alrawashdeh M , Klompas M , Kimmel S , Larochelle MR , Gokhale RH , Dantes RB , Hoots B , Hatfield KM , Reddy SC , Fiore AE , Septimus EJ , Kadri SS , Poland R , Sands K , Rhee C . Crit Care Med 2021 49 (12) 2102-2111 OBJECTIVES: Widespread use and misuse of prescription and illicit opioids have exposed millions to health risks including serious infectious complications. Little is known, however, about the association between opioid use and sepsis. DESIGN: Retrospective cohort study. SETTING: About 373 U.S. hospitals. PATIENTS: Adults hospitalized between January 2009 and September 2015. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Sepsis was identified by clinical indicators of concurrent infection and organ dysfunction. Opioid-related hospitalizations were identified by the International Classification of Diseases, 9th Revision, Clinical Modification codes and/or inpatient orders for buprenorphine. Clinical characteristics and outcomes were compared by sepsis and opioid-related hospitalization status. The association between opioid-related hospitalization and all-cause, in-hospital mortality in patients with sepsis was assessed using mixed-effects logistic models to adjust for baseline characteristics and severity of illness. The cohort included 6,715,286 hospitalizations; 375,479 (5.6%) had sepsis, 130,399 (1.9%) had opioid-related hospitalizations, and 8,764 (0.1%) had both. Compared with sepsis patients without opioid-related hospitalizations (n = 366,715), sepsis patients with opioid-related hospitalizations (n = 8,764) were younger (mean 52.3 vs 66.9 yr) and healthier (mean Elixhauser score 5.4 vs 10.5), had more bloodstream infections from Gram-positive and fungal pathogens (68.9% vs 47.0% and 10.6% vs 6.4%, respectively), and had lower in-hospital mortality rates (10.6% vs 16.2%; adjusted odds ratio, 0.73; 95% CI, 0.60-0.79; p < 0.001 for all comparisons). Of 1,803 patients with opioid-related hospitalizations who died in-hospital, 928 (51.5%) had sepsis. Opioid-related hospitalizations accounted for 1.5% of all sepsis-associated deaths, including 5.7% of sepsis deaths among patients less than 50 years old. From 2009 to 2015, the proportion of sepsis hospitalizations that were opioid-related increased by 77% (95% CI, 40.7-123.5%). CONCLUSIONS: Sepsis is an important cause of morbidity and mortality in patients with opioid-related hospitalizations, and opioid-related hospitalizations contribute disproportionately to sepsis-associated deaths among younger patients. In addition to ongoing efforts to combat the opioid crisis, public health agencies should focus on raising awareness about sepsis among patients who use opioids and their providers. |
Evidence, Experience, Expertise, and the U.S. COVID-19 Public Health Response.
Goswami ND , Fiore AE , Walke HT . Clin Infect Dis 2021 73 S1-S4 The U.S. Centers for Disease Control and Prevention (CDC), state, tribal, and local health departments assess available and promising interventions and individual and population health outcomes when crafting public health recommendations. This supplement provides a snapshot of some of the science, experience, and expertise supporting the COVID-19 response. |
Bacterial infections associated with substance use disorders, large cohort of United States hospitals, 2012-2017
McCarthy NL , Baggs J , See I , Reddy SC , Jernigan JA , Gokhale RH , Fiore AE . Clin Infect Dis 2020 71 (7) e37-e44 BACKGROUND: Rises in incidence of bacterial infections such as endocarditis have been reported in conjunction with the opioid crisis, but recent trends for infective endocarditis (IE) and other serious infections among persons with substance use disorders (SUD) are unknown. METHODS: Using the Premier Healthcare Database, we identified hospitalizations among adults >/=18 years from 2012-2017 with primary discharge diagnoses of bacterial infections and secondary SUD diagnoses using ICD-9 and ICD-10 codes. We calculated annual rates of infections with SUD diagnoses and evaluated temporal trends. Blood and cardiac tissue specimens were identified from IE hospitalizations to describe microbiology distribution and temporal trends among hospitalizations with and without SUD. RESULTS: Among 72,481 weighted IE admissions recorded, SUD diagnoses increased from 19.9% in 2012 to 39.4% in 2017 (p<.0001). In adults, the rate of hospitalizations with SUD increased from 1.1 to 2.1 per 100,000 persons for IE, 1.4 to 2.4 per 100,000 persons for osteomyelitis, 0.5 to 0.9 per 100,000 persons for central nervous system abscesses, and 24.4 to 32.9 per 100,000 persons for skin and soft tissue infections. For those 18-44 years, IE-SUD hospitalizations more than doubled from 1.6 in 2012 to 3.6 in 2017 per 100,000 persons. Among all IE-SUD hospitalizations, 50.3% had a Staphylococcus aureus infection, compared to 19.4% of IE hospitalizations without SUD. CONCLUSIONS: Rates of hospitalizations for serious infections among persons with SUD are increasing, driven primarily by younger age groups. The differences in the microbiology of IE hospitalizations suggest SUD is changing the epidemiology of these infections. |
A national approach to pediatric sepsis surveillance
Hsu HE , Abanyie F , Agus MSD , Balamuth F , Brady PW , Brilli RJ , Carcillo JA , Dantes R , Epstein L , Fiore AE , Gerber JS , Gokhale RH , Joyner BL Jr , Kissoon N , Klompas M , Lee GM , Macias CG , Puopolo KM , Sulton CD , Weiss SL , Rhee C . Pediatrics 2019 144 (6) Pediatric sepsis is a major public health concern, and robust surveillance tools are needed to characterize its incidence, outcomes, and trends. The increasing use of electronic health records (EHRs) in the United States creates an opportunity to conduct reliable, pragmatic, and generalizable population-level surveillance using routinely collected clinical data rather than administrative claims or resource-intensive chart review. In 2015, the US Centers for Disease Control and Prevention recruited sepsis investigators and representatives of key professional societies to develop an approach to adult sepsis surveillance using clinical data recorded in EHRs. This led to the creation of the adult sepsis event definition, which was used to estimate the national burden of sepsis in adults and has been adapted into a tool kit to facilitate widespread implementation by hospitals. In July 2018, the Centers for Disease Control and Prevention convened a new multidisciplinary pediatric working group to tailor an EHR-based national sepsis surveillance approach to infants and children. Here, we describe the challenges specific to pediatric sepsis surveillance, including evolving clinical definitions of sepsis, accommodation of age-dependent physiologic differences, identifying appropriate EHR markers of infection and organ dysfunction among infants and children, and the need to account for children with medical complexity and the growing regionalization of pediatric care. We propose a preliminary pediatric sepsis event surveillance definition and outline next steps for refining and validating these criteria so that they may be used to estimate the national burden of pediatric sepsis and support site-specific surveillance to complement ongoing initiatives to improve sepsis prevention, recognition, and treatment. |
Variation in identifying sepsis and organ dysfunction using administrative versus electronic clinical data and impact on hospital outcome comparisons
Rhee C , Jentzsch MS , Kadri SS , Seymour CW , Angus DC , Murphy DJ , Martin GS , Dantes RB , Epstein L , Fiore AE , Jernigan JA , Danner RL , Warren DK , Septimus EJ , Hickok J , Poland RE , Jin R , Fram D , Schaaf R , Wang R , Klompas M . Crit Care Med 2018 47 (4) 493-500 OBJECTIVES: Administrative claims data are commonly used for sepsis surveillance, research, and quality improvement. However, variations in diagnosis, documentation, and coding practices for sepsis and organ dysfunction may confound efforts to estimate sepsis rates, compare outcomes, and perform risk adjustment. We evaluated hospital variation in the sensitivity of claims data relative to clinical data from electronic health records and its impact on outcome comparisons. DESIGN, SETTING, AND PATIENTS: Retrospective cohort study of 4.3 million adult encounters at 193 U.S. hospitals in 2013-2014. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Sepsis was defined using electronic health record-derived clinical indicators of presumed infection (blood culture draws and antibiotic administrations) and concurrent organ dysfunction (vasopressors, mechanical ventilation, doubling in creatinine, doubling in bilirubin to >/= 2.0 mg/dL, decrease in platelets to < 100 cells/microL, or lactate >/= 2.0 mmol/L). We compared claims for sepsis prevalence and mortality rates between both methods. All estimates were reliability adjusted to account for random variation using hierarchical logistic regression modeling. The sensitivity of hospitals' claims data was low and variable: median 30% (range, 5-54%) for sepsis, 66% (range, 26-84%) for acute kidney injury, 39% (range, 16-60%) for thrombocytopenia, 36% (range, 29-44%) for hepatic injury, and 66% (range, 29-84%) for shock. Correlation between claims and clinical data was moderate for sepsis prevalence (Pearson coefficient, 0.64) and mortality (0.61). Among hospitals in the lowest sepsis mortality quartile by claims, 46% shifted to higher mortality quartiles using clinical data. Using implicit sepsis criteria based on infection and organ dysfunction codes also yielded major differences versus clinical data. CONCLUSIONS: Variation in the accuracy of claims data for identifying sepsis and organ dysfunction limits their use for comparing hospitals' sepsis rates and outcomes. Using objective clinical data may facilitate more meaningful hospital comparisons. |
Assessing variability in hospital-level mortality among U.S. Medicare beneficiaries with hospitalizations for severe sepsis and septic shock
Hatfield KM , Dantes RB , Baggs J , Sapiano MRP , Fiore AE , Jernigan JA , Epstein L . Crit Care Med 2018 46 (11) 1753-1760 OBJECTIVES: To assess the variability in short-term sepsis mortality by hospital among Centers for Medicare and Medicaid Services beneficiaries in the United States during 2013-2014. DESIGN: A retrospective cohort design. SETTING: Hospitalizations from 3,068 acute care hospitals that participated in the Centers for Medicare and Medicaid Services inpatient prospective payment system in 2013 and 2014. PATIENTS: Medicare fee-for-service beneficiaries greater than or equal to 65 years old who had an inpatient hospitalization coded with present at admission severe sepsis or septic shock. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Individual level mortality was assessed as death at or within 7 days of hospital discharge and aggregated to calculate hospital-level mortality rates. We used a logistic hierarchal linear model to calculate mortality risk-adjusted for patient characteristics. We quantified variability among hospitals using the median odds ratio and calculated risk-standardized mortality rates for each hospital. The overall crude mortality rate was 34.7%. We found significant variability in mortality by hospital (p < 0.001). The middle 50% of hospitals had similar risk-standardized mortality rates (32.7-36.9%), whereas the decile of hospitals with the highest risk-standardized mortality rates had a median mortality rate of 40.7%, compared with a median of 29.2% for hospitals in the decile with the lowest risk-standardized mortality rates. The median odds ratio (1.29) was lower than the adjusted odds ratios for several measures of patient comorbidities and severity of illness, including present at admission organ dysfunction, no identified source of infection, and age. CONCLUSIONS: In a large study of present at admission sepsis among Medicare beneficiaries, we showed that mortality was most strongly associated with underlying comorbidities and measures of illness on arrival. However, after adjusting for patient characteristics, mortality also modestly depended on where a patient with sepsis received care, suggesting that efforts to improve sepsis outcomes in lower performing hospitals could impact sepsis survival. |
Incidence and trends of sepsis in US hospitals using clinical vs claims data, 2009-2014
Rhee C , Dantes R , Epstein L , Murphy DJ , Seymour CW , Iwashyna TJ , Kadri SS , Angus DC , Danner RL , Fiore AE , Jernigan JA , Martin GS , Septimus E , Warren DK , Karcz A , Chan C , Menchaca JT , Wang R , Gruber S , Klompas M . JAMA 2017 318 (13) 1241-1249 Importance: Estimates from claims-based analyses suggest that the incidence of sepsis is increasing and mortality rates from sepsis are decreasing. However, estimates from claims data may lack clinical fidelity and can be affected by changing diagnosis and coding practices over time. Objective: To estimate the US national incidence of sepsis and trends using detailed clinical data from the electronic health record (EHR) systems of diverse hospitals. Design, Setting, and Population: Retrospective cohort study of adult patients admitted to 409 academic, community, and federal hospitals from 2009-2014. Exposures: Sepsis was identified using clinical indicators of presumed infection and concurrent acute organ dysfunction, adapting Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3) criteria for objective and consistent EHR-based surveillance. Main Outcomes and Measures: Sepsis incidence, outcomes, and trends from 2009-2014 were calculated using regression models and compared with claims-based estimates using International Classification of Diseases, Ninth Revision, Clinical Modification codes for severe sepsis or septic shock. Case-finding criteria were validated against Sepsis-3 criteria using medical record reviews. Results: A total of 173690 sepsis cases (mean age, 66.5 [SD, 15.5] y; 77660 [42.4%] women) were identified using clinical criteria among 2901019 adults admitted to study hospitals in 2014 (6.0% incidence). Of these, 26061 (15.0%) died in the hospital and 10731 (6.2%) were discharged to hospice. From 2009-2014, sepsis incidence using clinical criteria was stable (+0.6% relative change/y [95% CI, -2.3% to 3.5%], P = .67) whereas incidence per claims increased (+10.3%/y [95% CI, 7.2% to 13.3%], P < .001). In-hospital mortality using clinical criteria declined (-3.3%/y [95% CI, -5.6% to -1.0%], P = .004), but there was no significant change in the combined outcome of death or discharge to hospice (-1.3%/y [95% CI, -3.2% to 0.6%], P = .19). In contrast, mortality using claims declined significantly (-7.0%/y [95% CI, -8.8% to -5.2%], P < .001), as did death or discharge to hospice (-4.5%/y [95% CI, -6.1% to -2.8%], P < .001). Clinical criteria were more sensitive in identifying sepsis than claims (69.7% [95% CI, 52.9% to 92.0%] vs 32.3% [95% CI, 24.4% to 43.0%], P < .001), with comparable positive predictive value (70.4% [95% CI, 64.0% to 76.8%] vs 75.2% [95% CI, 69.8% to 80.6%], P = .23). Conclusions and Relevance: In clinical data from 409 hospitals, sepsis was present in 6% of adult hospitalizations, and in contrast to claims-based analyses, neither the incidence of sepsis nor the combined outcome of death or discharge to hospice changed significantly between 2009-2014. The findings also suggest that EHR-based clinical data provide more objective estimates than claims-based data for sepsis surveillance. |
The potential for interventions in a long-term acute care hospital to reduce transmission of carbapenem-resistant Enterobacteriaceae in affiliated healthcare facilities
Toth DJA , Khader K , Slayton RB , Kallen AJ , Gundlapalli AV , O'Hagan JJ , Fiore AE , Rubin MA , Jernigan JA , Samore MH . Clin Infect Dis 2017 65 (4) 581-587 Background.: Carbapenem-resistant Enterobacteriaceae (CRE) are high-priority bacterial pathogens targeted for efforts to decrease transmissions and infections in healthcare facilities. Some regions have experienced CRE outbreaks that were likely amplified by frequent transmission in long-term acute care hospitals (LTACHs). Planning and funding intervention efforts focused on LTACHs is one proposed strategy to contain outbreaks; however, the potential regional benefits of such efforts are unclear. Methods.: We designed an agent-based simulation model of patients in a regional network of 10 healthcare facilities including 1 LTACH, 3 short-stay acute care hospitals (ACHs) and 6 nursing homes (NHs). The model was calibrated to achieve realistic patient flow and CRE transmission and detection rates. We then simulated the initiation of an entirely LTACH-focused intervention in a previously CRE-free region, including active surveillance for CRE carriers and enhanced isolation of identified carriers. Results.: When initiating the intervention at the 1st clinical CRE detection in the LTACH, cumulative CRE transmissions over 5 years across all 10 facilities were reduced by 79-93% compared to no-intervention simulations. This result was robust to changing assumptions for transmission within non-LTACH facilities and flow of patients from the LTACH. Delaying the intervention until the 20th CRE detection resulted in substantial delays in achieving optimal regional prevalence, while still reducing transmissions by 60-79% over 5 years. Conclusions.: Focusing intervention efforts on LTACHs is potentially a highly efficient strategy for reducing CRE transmissions across an entire region, particularly when implemented as early as possible in an emerging outbreak. |
2013 multistate outbreaks of Cyclospora cayetanensis infections associated with fresh produce: focus on the Texas investigations
Abanyie F , Harvey RR , Harris JR , Wiegand RE , Gaul L , Desvignes-Kendrick M , Irvin K , Williams I , Hall RL , Herwaldt B , Gray EB , Qvarnstrom Y , Wise ME , Cantu V , Cantey PT , Bosch S , da Silva AJ , Fields A , Bishop H , Wellman A , Beal J , Wilson N , Fiore AE , Tauxe R , Lance S , Slutsker L , Parise M . Epidemiol Infect 2015 143 (16) 1-8 The 2013 multistate outbreaks contributed to the largest annual number of reported US cases of cyclosporiasis since 1997. In this paper we focus on investigations in Texas. We defined an outbreak-associated case as laboratory-confirmed cyclosporiasis in a person with illness onset between 1 June and 31 August 2013, with no history of international travel in the previous 14 days. Epidemiological, environmental, and traceback investigations were conducted. Of the 631 cases reported in the multistate outbreaks, Texas reported the greatest number of cases, 270 (43%). More than 70 clusters were identified in Texas, four of which were further investigated. One restaurant-associated cluster of 25 case-patients was selected for a case-control study. Consumption of cilantro was most strongly associated with illness on meal date-matched analysis (matched odds ratio 19.8, 95% confidence interval 4.0-infinity). All case-patients in the other three clusters investigated also ate cilantro. Traceback investigations converged on three suppliers in Puebla, Mexico. Cilantro was the vehicle of infection in the four clusters investigated; the temporal association of these clusters with the large overall increase in cyclosporiasis cases in Texas suggests cilantro was the vehicle of infection for many other cases. However, the paucity of epidemiological and traceback information does not allow for a conclusive determination; moreover, molecular epidemiological tools for cyclosporiasis that could provide more definitive linkage between case clusters are needed. |
Toxocariasis: a review for pediatricians
Woodhall DM , Fiore AE . J Pediatric Infect Dis Soc 2014 3 (2) 154-159 Toxocariasis is a parasitic disease caused by roundworms of cats and dogs. The disease is endemic throughout the United States and causes significant morbidity in children, including damage to the lungs, liver, or central nervous system, especially the eyes. Two well established clinical syndromes of disease include visceral and ocular toxocariasis. Symptoms of visceral toxocariasis include abdominal pain, cough, or wheezing. Vision loss or strabismus are common symptoms of ocular toxocariasis. Serologic testing for presence of Toxocara antibody is available, although a positive test result does not necessarily correlate with active clinical infection. Albendazole or mebendazole is the recommended treatment for visceral toxocariasis. Treatment options for ocular toxocariasis include corticosteroids or ophthalmic surgery; anthelminthic medications also may be used. Risk for toxocariasis can be reduced by handwashing after soil contact, routine pets deworming, discouraging geophagia, and appropriate disposal of pet feces. |
Neglected parasitic infections in the United States: toxoplasmosis
Jones JL , Parise ME , Fiore AE . Am J Trop Med Hyg 2014 90 (5) 794-9 Toxoplasma gondii is a leading cause of severe foodborne illness in the United States. Population-based studies have found T. gondii infection to be more prevalent in racial/ethnic minority and socioeconomically disadvantaged groups. Soil contaminated with cat feces, undercooked meat, and congenital transmission are the principal sources of infection. Toxoplasmosis-associated illnesses include congenital neurologic and ocular disease; acquired illness in immunocompetent persons, most notably ocular disease; and encephalitis or disseminated disease in immunosuppressed persons. The association of T. gondii infection with risk for mental illness is intriguing and requires further research. Reduction of T. gondii in meat, improvements in hygiene and food preparation practices, and reduction of environmental contamination can prevent toxoplasmosis, but more research is needed on how to implement these measures. In addition, screening and treatment may help prevent toxoplasmosis or reduce the severity of disease in some settings. |
Effects of vaccine program against pandemic influenza A(H1N1) virus, United States, 2009-2010
Borse RH , Shrestha SS , Fiore AE , Atkins CY , Singleton JA , Furlow C , Meltzer MI . Emerg Infect Dis 2013 19 (3) 439-448 In April 2009, the United States began a response to the emergence of a pandemic influenza virus strain: A(H1N1)pdm09. Vaccination began in October 2009. By using US surveillance data (April 12, 2009-April 10, 2010) and vaccine coverage estimates (October 3, 2009-April 18, 2010), we estimated that the A(H1N1)pdm09 virus vaccination program prevented 700,000-1,500,000 clinical cases, 4,000-10,000 hospitalizations, and 200-500 deaths. We found that the national health effects were greatly influenced by the timing of vaccine administration and the effectiveness of the vaccine. We estimated that recommendations for priority vaccination of targeted priority groups were not inferior to other vaccination prioritization strategies. These results emphasize the need for relevant surveillance data to facilitate a rapid evaluation of vaccine recommendations and effects. |
Expanding the recommendations for annual influenza vaccination to school-age children in the United States
Fiore AE , Epperson S , Perrotta D , Bernstein H , Neuzil K . Pediatrics 2012 129 Suppl 2 S54-62 BACKGROUND: Despite long-standing recommendations to vaccinate children who have underlying chronic medical conditions or who are contacts of high-risk persons, vaccination coverage among school-age children remains low. Community studies have indicated that school-age children have the highest incidence of influenza and are an important source of amplifying and sustaining community transmission that affects all age groups. METHODS: A consultation to discuss the advantages and disadvantages of a universal recommendation for annual influenza vaccination of all children age ≥6 months was held in Atlanta, Georgia, in September 2007. Consultants provided summaries of current data on vaccine effectiveness, safety, supply, successful program implementation, and economics studies and discussed challenges associated with continuing a risk- and contact-based vaccination strategy compared with a universal vaccination recommendation. RESULTS: Consultants noted that school-age children had a substantial illness burden caused by influenza, that vaccine was safe and effective for children aged 6 months through 18 years, and that evidence suggested that vaccinating school-age children would provide benefits to both the vaccinated children and their unvaccinated household and community contacts. However, implementation of an annual recommendation for all school-age children would pose major challenges to parents, medical providers and health care systems. Alternative vaccination venues were needed, and of these school-located vaccination programs might offer the most promise as an alternative vaccination site for school-age children. CONCLUSIONS: Expansion of recommendations to include all school-age children will require additional development of an infrastructure to support implementation and methods to adequately evaluate impact. |
Evolution of the pediatric influenza vaccination program in the United States
Neuzil KM , Fiore AE , Schieber RA . Pediatrics 2012 129 Suppl 2 S51-3 For many years, the Advisory Committee on Immunization Practices (ACIP) for the Centers for Disease Control and Prevention (CDC) focused its vaccination policy on persons at higher risk for influenza complications (eg, older adults, children and adults with certain high-risk conditions, pregnant women) and their contacts (eg, household contacts, health care personnel). Unfortunately, although vaccination coverage rates varied, they remained low for most adult and pediatric high-risk groups, other than persons aged ≥65 years.1 In conjunction with the recognition that influenza vaccination recommendations for high-risk target populations were not being optimally implemented, the adverse effects of influenza illness on all children was increasingly recognized. This led to the expansion of vaccination recommendations for children, beginning in 2002, when influenza vaccination was “encouraged” for children aged 6 through 23 months, and in 2004, when a full recommendation was issued for this age group.2,3 That recommendation was based largely on studies documenting that these young children had influenza-related hospitalization rates that were comparable to hospitalization rates in older persons with underlying risk conditions who were targeted to receive influenza vaccine.4,–6 Full recommendation was added for other groups who are at risk, such as adults and children with neuromuscular and other conditions that can compromise respiratory function or the handling of respiratory secretions, as data became available.7 |
Antiviral treatment of influenza in children
Garg S , Fry AM , Patton M , Fiore AE , Finelli L . Pediatr Infect Dis J 2012 31 (2) e43-51 Influenza causes substantial morbidity in children in the United States each year. The 2009 influenza A (H1N1) pandemic disproportionately affected the pediatric population and resulted in a substantially increased number of hospitalizations and deaths among children. Early influenza antiviral treatment reduces the duration of illness, frequency of complications, antibiotic use, and health care utilization costs attributable to influenza. A comprehensive strategy to reduce influenza-associated hospitalizations and deaths among children should include empiric antiviral treatment for suspected or confirmed influenza of any severity in children who are hospitalized; who have severe, complicated, or progressive illness; or who are at high risk for influenza complications. Here, we summarize data on the burden of influenza among children in the United States, the indications for influenza antiviral treatment among children, the available evidence for influenza antiviral treatment, and antiviral treatment considerations, including resistance and adverse events. |
Community-based values for 2009 pandemic influenza A H1N1 illnesses and vaccination-related adverse events
Lavelle TA , Meltzer MI , Gebremariam A , Lamarand K , Fiore AE , Prosser LA . PLoS One 2011 6 (12) e27777 OBJECTIVE: To evaluate community-based values for avoiding pandemic influenza (A) H1N1 (pH1N1) illness and vaccination-related adverse events in adults and children. METHODS: Adult community members were randomly selected from a nationally representative research panel to complete an internet survey (response rate = 65%; n = 718). Respondents answered a series of time trade-off questions to value four hypothetical health state scenarios for varying ages (1, 8, 35, or 70 years): uncomplicated pH1N1 illness, pH1N1 illness-related hospitalization, severe allergic reaction to the pH1N1 vaccine, and Guillain-Barre syndrome. We calculated descriptive statistics for time trade-off amounts and derived quality adjusted life year losses for these events. Multivariate regression analyses evaluated the effect of scenario age, as well as respondent socio-demographic and health characteristics on time trade-off amounts. RESULTS: Respondents were willing to trade more time to avoid the more severe outcomes, hospitalization and Guillain-Barre syndrome. In our adjusted and unadjusted analyses, age of the patient in the scenario was significantly associated with time trade-off amounts (p-value<0.05), with respondents willing to trade more time to prevent outcomes in children versus adults. Persons who had received the pH1N1 vaccination were willing to trade significantly more time to avoid hospitalization, severe allergic reaction, and Guillain-Barre syndrome, controlling for other variables in adjusted analyses.(p-value<0.05) CONCLUSIONS: Community members placed the highest value on preventing outcomes in children, compared with adults, and the time trade-off values reported were consistent with the severity of the outcomes presented. Considering these public values along with other decision-making factors may help policy makers improve the allocation of pandemic vaccine resources. |
Completion of the 2-dose influenza vaccine series among children aged 6 to 59 months: Immunization Information System sentinel sites, 2007-2008 influenza season
Pabst LJ , Fiore AE , Cullen KA . Clin Pediatr (Phila) 2011 50 (11) 1068-70 Recommendations for routine vaccination of all children aged 6 to 23 months and 24 to 59 months with seasonal influenza vaccine were first published by the Advisory Committee for Immunization Practices (ACIP) in 2004 and 2006, respectively.1 Vaccine effectiveness and immunogenicity studies have shown that administration of only 1 influenza vaccine dose in the first year of vaccination conveys suboptimal protection.2-4 Prior to the 2007-2008 influenza season, children aged less than 9 years were recommended to receive 2 doses in their first year of vaccination.1 Two-dose vaccination recommendations were expanded for the 2007-2008 season to include children who received only 1 dose for the first time in the previous season.1 | Monitoring 2-dose compliance for influenza vaccination is important for evaluating vaccination efforts and developing innovative strategies to improve coverage. A limited number of studies have assessed 2-dose compliance in children. The Vaccine Safety Datalink Project, which includes data from 8 health maintenance organizations, reported that 2-dose compliance among children aged 6 to 23 months ranged from 29% to 54% during the 2001-2002, 2002-2003, and 2004-2005 seasons.5 Rates were lower among children aged 2 to 8 years (12%-24%). Data from the National Immunization Survey showed that only 11% of vaccine naïve children aged 6 to 23 months received both doses during the 2005-2006 influenza season.6 And, a recent study using private pediatric practice data from the 2007-2008 and 2008-2009 seasons found 2-dose compliance rates of 49.9% to 58.7% among 6- to 23-month-olds and 37.6% to 45.2% among 24- to 59-month-olds.7 | Because 2-dose compliance for immunization vaccination has not been assessed using population-based data since 2-dose vaccination recommendations changed for the 2007-2008 season, data from the Immunization Information System Sentinel Site Project were used to assess compliance among children aged 6 to 59 months during the 2007-2008 season and to determine if influenza vaccination history was associated with completion of 2 doses. |
Cost-effectiveness of 2009 pandemic influenza A(H1N1) vaccination in the United States
Prosser LA , Lavelle TA , Fiore AE , Bridges CB , Reed C , Jain S , Dunham KM , Meltzer MI . PLoS One 2011 6 (7) e22308 BACKGROUND: Pandemic influenza A(H1N1) (pH1N1) was first identified in North America in April 2009. Vaccination against pH1N1 commenced in the U.S. in October 2009 and continued through January 2010. The objective of this study was to evaluate the cost-effectiveness of pH1N1 vaccination. METHODOLOGY: A computer simulation model was developed to predict costs and health outcomes for a pH1N1 vaccination program using inactivated vaccine compared to no vaccination. Probabilities, costs and quality-of-life weights were derived from emerging primary data on pH1N1 infections in the US, published and unpublished data for seasonal and pH1N1 illnesses, supplemented by expert opinion. The modeled target population included hypothetical cohorts of persons aged 6 months and older stratified by age and risk. The analysis used a one-year time horizon for most endpoints but also includes longer-term costs and consequences of long-term sequelae deaths. A societal perspective was used. Indirect effects (i.e., herd effects) were not included in the primary analysis. The main endpoint was the incremental cost-effectiveness ratio in dollars per quality-adjusted life year (QALY) gained. Sensitivity analyses were conducted. RESULTS: For vaccination initiated prior to the outbreak, pH1N1 vaccination was cost-saving for persons 6 months to 64 years under many assumptions. For those without high risk conditions, incremental cost-effectiveness ratios ranged from $8,000-$52,000/QALY depending on age and risk status. Results were sensitive to the number of vaccine doses needed, costs of vaccination, illness rates, and timing of vaccine delivery. CONCLUSIONS: Vaccination for pH1N1 for children and working-age adults is cost-effective compared to other preventive health interventions under a wide range of scenarios. The economic evidence was consistent with target recommendations that were in place for pH1N1 vaccination. We also found that the delays in vaccine availability had a substantial impact on the cost-effectiveness of vaccination. |
Antiviral treatment of patients with oseltamivir-resistant and oseltamivir-susceptible seasonal influenza A (H1N1) infection during the 2007-2008 influenza season in the United States
Dharan NJ , Gubareva LV , Klimov AI , Fiore AE , Bresee JS , Fry AM . Clin Infect Dis 2010 50 (4) 621-2 During the 2007–2008 influenza season, we collected epidemiologic and clinical information from patients infected with seasonal influenza A (H1N1) viruses to describe the characteristics of oseltamivir-resistant infection and compare them with the characteristics of oseltamivir-susceptible infection [1]. Here we use the data collected to compare the clinical symptoms and outcomes of patients with oseltamivir-resistant and oseltamivir-susceptible A (H1N1) virus infections that were treated and not treated with antiviral agents. Specimens for laboratory testing were collected before antivirals were started. Few reports that correlate antiviral resistance, determined by in vitro assays [2], with clinical response have been published [3]. | We used generalized estimating equations controlling for state as a clustered variable and age group, and we used Wilcoxon rank-sum tests for continuous var-iables. Among 99 patients with oselta-mivir-resistant A (H1N1) infection, 47 (47%) were treated; 44 (94%) received oseltamivir alone and 3 (6%) received oseltamivir and rimantadine. Among 182 patients with oseltamivir-susceptible A (H1N1) infections, 64 (35%) were treated; 60 (94%) received oseltamivir, 2 (3%) received amantadine, 1 (2%) received rimantadine, and 1 (2%) received zanamivir. We excluded 37 case patients: 14 who were <1 year old, 2 who died before a decision on antiviral treatment could have been made, 3 who were treated with oseltamivir and an adamantane, and 19 for whom antiviral treatment could not be confirmed. |
2009 influenza A(H1N1) monovalent vaccines for children
Fiore AE , Neuzil KM . JAMA 2009 303 (1) 73-4 The 2009 influenza A(H1N1) virus was first identified 8 months ago,1 but the virus has already had a substantial effect on human health. Influenza activity in the United States has remained higher than normal since May, and measures of severe illness such as hospitalizations and deaths during the summer and fall have been equal to or higher than rates usually observed in a typical winter influenza season in all age groups except older adults.2 Even though influenza activity has decreased in recent weeks in some states, there remains the possibility of continued activity through the traditional winter influenza season and the prospect of normal winter circulation of seasonal influenza viruses. | The 2009 influenza A(H1N1) pandemic highlights the role of children in influenza epidemiology. Serological studies suggested that children had no measurable immunity against H1N1 prior to the outbreak.3 In addition, children have been a primary source of illness in community outbreaks of pandemic influenza, as indicated by the association between outbreaks in schools or summer camps and influenza activity in the community.4 Children also have developed severe influenza A(H1N1)–related complications more frequently than is usually seen for seasonal influenza and reports of pediatric deaths and hospitalizations continue to increase.2 As of December 5, 2009, 224 laboratory-confirmed deaths among children had been reported to the Centers for Disease Control and Prevention, far surpassing any recent influenza season,2 and the actual number of pediatric deaths due to the influenza A(H1N1) virus pandemic is likely to be considerably higher.5 Children have been among the primary groups targeted for the limited amount of vaccine available in most areas.6 |
Hospitalized patients with 2009 H1N1 influenza in the United States, April-June 2009
Jain S , Kamimoto L , Bramley AM , Schmitz AM , Benoit SR , Louie J , Sugerman DE , Druckenmiller JK , Ritger KA , Chugh R , Jasuja S , Deutscher M , Chen S , Walker JD , Duchin JS , Lett S , Soliva S , Wells EV , Swerdlow D , Uyeki TM , Fiore AE , Olsen SJ , Fry AM , Bridges CB , Finelli L , Pandemic Influenza A (H1N1) Virus Hospitalizations Investigation Team . N Engl J Med 2009 361 (20) 1935-44 BACKGROUND: During the spring of 2009, a pandemic influenza A (H1N1) virus emerged and spread globally. We describe the clinical characteristics of patients who were hospitalized with 2009 H1N1 influenza in the United States from April 2009 to mid-June 2009. METHODS: Using medical charts, we collected data on 272 patients who were hospitalized for at least 24 hours for influenza-like illness and who tested positive for the 2009 H1N1 virus with the use of a real-time reverse-transcriptase-polymerase-chain-reaction assay. RESULTS: Of the 272 patients we studied, 25% were admitted to an intensive care unit and 7% died. Forty-five percent of the patients were children under the age of 18 years, and 5% were 65 years of age or older. Seventy-three percent of the patients had at least one underlying medical condition; these conditions included asthma; diabetes; heart, lung, and neurologic diseases; and pregnancy. Of the 249 patients who underwent chest radiography on admission, 100 (40%) had findings consistent with pneumonia. Of the 268 patients for whom data were available regarding the use of antiviral drugs, such therapy was initiated in 200 patients (75%) at a median of 3 days after the onset of illness. Data suggest that the use of antiviral drugs was beneficial in hospitalized patients, especially when such therapy was initiated early. CONCLUSIONS: During the evaluation period, 2009 H1N1 influenza caused severe illness requiring hospitalization, including pneumonia and death. Nearly three quarters of the patients had one or more underlying medical conditions. Few severe illnesses were reported among persons 65 years of age or older. Patients seemed to benefit from antiviral therapy. |
A primer on strategies for prevention and control of seasonal and pandemic influenza
Santibanez S , Fiore AE , Merlin TL , Redd S . Am J Public Health 2009 99 S216-24 The United States has made considerable progress in pandemic preparedness. Limited attention, however, has been given to the challenges faced by populations that will be at increased risk of the consequences of the pandemic, including challenges caused by societal, economic, and health-related factors. This supplement to the American Journal of Public Health focuses on the challenges faced by at-risk and vulnerable populations in preparing for and responding to an influenza pandemic. Here, we provide background information for subsequent articles throughout the supplement. We summarize (1) seasonal influenza epidemiology, transmission, clinical illness, diagnosis, vaccines, and antiviral medications; (2) H5N1 avian influenza; and (3) pandemic influenza vaccines, antiviral medications, and nonpharmaceutical interventions. |
Antibody levels and protection after hepatitis B vaccine: results of a 22-year follow-up study and response to a booster dose
McMahon BJ , Dentinger CM , Bruden D , Zanis C , Peters H , Hurlburt D , Bulkow L , Fiore AE , Bell BP , Hennessy TW . J Infect Dis 2009 200 (9) 1390-6 BACKGROUND: The duration of protection in children and adults (including health care workers) resulting from the hepatitis B vaccine primary series is unknown. METHODS: To determine the protection afforded by hepatitis B vaccine, Alaska Native persons who had received plasma-derived hepatitis B vaccine when they were >6 months of age were tested for antibody to hepatitis B surface antigen (anti-HBs) 22 years later. Those with levels <10 mIU/mL received 1 dose of recombinant hepatitis B vaccine and were evaluated on the basis of anti-HBs measurements at 10-14 days, 30-60 days, and 1 year. RESULTS: Of 493 participants, 60% (298) had an anti-HBs level 10 mIU/mL. A booster dose was administered to 164 persons, and 77% responded with an anti-HBs level 10 mIU/mL at 10-14 days, reaching 81% by 60 days. Response to a booster dose was positively correlated with younger age, peak anti-HBs response after primary vaccination, and the presence of detectable anti-HBs before boosting. Considering persons with an anti-HBs level 10 mIU/mL at 22 years and those who responded to the booster dose, protection was demonstrated in 87% of the participants. No new acute or chronic hepatitis B virus infections were identified. CONCLUSIONS: The protection afforded by primary immunization with plasma-derived hepatitis B vaccine during childhood and adulthood lasts at least 22 years. Booster doses are not needed. |
Seasonal influenza vaccines
Fiore AE , Bridges CB , Cox NJ . Curr Top Microbiol Immunol 2009 333 43-82 Influenza vaccines are the mainstay of efforts to reduce the substantial health burden from seasonal influenza. Inactivated influenza vaccines have been available since the 1940s and are administered via intramuscular injection. Inactivated vaccines can be given to anyone six months of age or older. Live attenuated, cold-adapted influenza vaccines (LAIV) were developed in the 1960s but were not licensed in the United States until 2003, and are administered via nasal spray. Both vaccines are trivalent preparations grown in eggs and do not contain adjuvants. LAIV is licensed for use in the United States for healthy nonpregnant persons 2-49 years of age.Influenza vaccination induces antibodies primarily against the major surface glycoproteins hemagglutinin (HA) and neuraminidase (NA); antibodies directed against the HA are most important for protection against illness. The immune response peaks at 2-4 weeks after one dose in primed individuals. In previously unvaccinated children <9 years of age, two doses of influenza vaccine are recommended, as some children in this age group have limited or no prior infections from circulating types and subtypes of seasonal influenza. These children require both an initial priming dose and a subsequent booster dose of vaccine to mount a protective antibody response.The most common adverse events associated with inactivated vaccines are sore arm and redness at the injection site; systemic symptoms such as fever or malaise are less commonly reported. Guillian-Barre Syndrome (GBS) was identified among approximately 1 per 100,000 recipients of the 1976 swine influenza vaccine. The risk of influenza vaccine-associated GBS from seasonal influenza vaccine is thought to be at most approximately 1-2 cases per 1 million vaccinees, based on a few studies that have found an association; other studies have found no association.The most common adverse events associated with LAIV are nasal congestion, headache, myalgias or fever. Studies of the safety of LAIV among young children suggest an increased risk of wheezing in some young children, and the vaccine is not recommended for children younger than 2 years old, ages 2-4 old with a history of recurrent wheezing or reactive airways disease, or older persons who have any medical condition that confers an increased risk of influenza-related complications.The effectiveness of influenza vaccines is related predominantly to the age and immune competence of the vaccinee and the antigenic relatedness of vaccine strains to circulating strains. Vaccine effectiveness in preventing laboratory-confirmed influenza illness when the vaccine strains are well matched to circulating strains is 70-90% in randomized, placebo-controlled trials conducted among children and young healthy adults, but is lower among elderly or immunocompromised persons. In years with a suboptimal match, vaccine benefit is likely to be lower, although the vaccine can still provide substantial benefit, especially against more severe outcomes. Live, attenuated influenza vaccines have been most extensively studied among children, and have been shown to be more effective than inactivated vaccines in several randomized controlled trials among young children.Influenza vaccination is recommended in the United States for all children six months or older, all adults 50 years or older, all persons with chronic medical conditions, and pregnant women, and contacts of these persons, including healthcare workers. The global disease burden of influenza is substantial, and the World Health Organization has indicated that member states should evaluate the cost-effectiveness of introducing influenza vaccination into national immunization programs. More research is needed to develop more effective seasonal influenza vaccines that provide long-lasting immunity and broad protection against strains that differ antigenically from vaccine viruses. |
Reduction in hepatitis B virus seroprevalence among U.S.-born children of foreign-born Asian parents-Benefit of universal infant hepatitis B vaccination
Shuler CM , Fiore AE , Neeman R , Bell BP , Kuhnert W , Watkins S , Kilgour K , Arnold KE . Vaccine 2009 27 (43) 5942-7 We demonstrate that after implementation of recommendations for universal infant hepatitis B vaccination, HBV infection prevalence among children of foreign-born Asian parents in Georgia declined dramatically; horizontal transmission of infection within households has occurred infrequently; and the vast majority of infants and children have received the recommended hepatitis B vaccinations. These results provide evidence of the success of the hepatitis B infant vaccination program and highlight its potential impact on reducing chronic HBV infection morbidity and mortality among U.S. populations at high risk. |
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