Last data update: May 06, 2024. (Total: 46732 publications since 2009)
Records 1-15 (of 15 Records) |
Query Trace: Greenbaum A[original query] |
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Reply to 'Reconciling disparate estimates of viral genetic diversity during human influenza infections'.
Poon LLM , Song T , Wentworth DE , Holmes EC , Greenbaum BD , Peiris JSM , Cowling BJ , Ghedin E . Nat Genet 2019 51 (9) 1301-1303 In their Correspondence, Xue and Bloom1 identify an important discrepancy in the sequence data that we provided in our 2016 paper2 on the transmission of influenza virus in Hong Kong during the first wave of the H1N1 pandemic in 2009. The goal of the study was to provide a quantitative approach to characterizing the within-host genetic diversity of influenza virus and how this genomic information might be used in tracking transmission. We have determined that the potential source of this discrepancy was due to the technical limitations of the methods used at the time, which inadvertently led to the reporting of substantially higher levels of within-host diversity than were likely to be present. |
Influenza virus infection causes global RNAPII termination defects.
Zhao N , Sebastiano V , Moshkina N , Mena N , Hultquist J , Jimenez-Morales D , Ma Y , Rialdi A , Albrecht R , Fenouil R , Sanchez-Aparicio MT , Ayllon J , Ravisankar S , Haddad B , Ho JSY , Low D , Jin J , Yurchenko V , Prinjha RK , Tarakhovsky A , Squatrito M , Pinto D , Allette K , Byun M , Smith ML , Sebra R , Guccione E , Tumpey T , Krogan N , Greenbaum B , van Bakel H , Garcia-Sastre A , Marazzi I . Nat Struct Mol Biol 2018 25 (9) 885-893 Viral infection perturbs host cells and can be used to uncover regulatory mechanisms controlling cellular responses and susceptibility to infections. Using cell biological, biochemical, and genetic tools, we reveal that influenza A virus (IAV) infection induces global transcriptional defects at the 3' ends of active host genes and RNA polymerase II (RNAPII) run-through into extragenic regions. Deregulated RNAPII leads to expression of aberrant RNAs (3' extensions and host-gene fusions) that ultimately cause global transcriptional downregulation of physiological transcripts, an effect influencing antiviral response and virulence. This phenomenon occurs with multiple strains of IAV, is dependent on influenza NS1 protein, and can be modulated by SUMOylation of an intrinsically disordered region (IDR) of NS1 expressed by the 1918 pandemic IAV strain. Our data identify a strategy used by IAV to suppress host gene expression and indicate that polymorphisms in IDRs of viral proteins can affect the outcome of an infection. |
Development of a respiratory severity score for hospitalized adults in a high HIV-prevalence setting-South Africa, 2010-2011
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 . BMC Pulm Med 2017 17 (1) 28 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. |
Do Thai physicians recommend seasonal influenza vaccines to pregnant women? A cross-sectional survey of physicians' perspectives and practices in Thailand
Praphasiri P , Ditsungneon D , Greenbaum A , Dawood FS , Yoocharoen P , Stone DM , Olsen SJ , Lindblade KA , Muangchana C . PLoS One 2017 12 (1) e0169221 BACKGROUND: Physicians play a major role in influencing acceptance and uptake of vaccines. However, little is known about physicians' perspectives on influenza vaccination of pregnant women in Thailand, for whom vaccine coverage is estimated at <1%. METHOD: In 2013, a self-administered questionnaire on physicians' perceptions, attitudes and practices related to influenza vaccination for pregnant women was distributed to 1,134 hospitals with an antenatal care clinic (ANC) in Thailand. At each hospital, one physician working at the ANC completed the survey. Predictors of routine recommendation of influenza vaccine were analyzed utilizing log-binomial regression. RESULTS: A total of 580 (51%) complete responses were received from physicians practicing at ANCs. A favorable attitude towards vaccination was expressed by 436 (75%) physicians, however only 142 (25%) reported routinely recommending influenza vaccine to pregnant women in their current practice. Physicians were more likely to recommend influenza vaccine routinely when they had more than three years of practice (prevalence ratio [PR] 1.9, 95% CI 1.2-2.3), had treated pregnant women for influenza (PR 1.8, 95% CI 1.3-2.7), perceived the influenza vaccine to be effective (moderate level: PR 1.6, 95% CI 1.1-2.4; high level: PR 1.9, 95% CI 1.3-2.9) and were aware of the Ministry of Public Health's (MOPH) recommendation of influenza vaccination in pregnancy (PR 1.3, 95% CI 1.1-1.7). Vaccine not being available, perception that policy was ambiguous and lack of awareness of MOPH recommendations were the most commonly cited barriers to routine recommendation of influenza vaccine. CONCLUSION: Despite a national policy to vaccinate pregnant women for influenza, only 25% of Thai physicians working in ANCs routinely recommend vaccination. Strategies are needed to increase vaccine availability and free vaccine services, address clinician concerns over vaccine effectiveness and expand healthcare provider awareness of MOPH recommendations. |
Multistate US outbreak of rapidly growing mycobacterial infections associated with medical tourism to the Dominican Republic, 2013-2014(1)
Schnabel D , Esposito DH , Gaines J , Ridpath A , Barry MA , Feldman KA , Mullins J , Burns R , Ahmad N , Nyangoma EN , Nguyen DB , Perz JF , Moulton-Meissner HA , Jensen BJ , Lin Y , Posivak-Khouly L , Jani N , Morgan OW , Brunette GW , Pritchard PS , Greenbaum AH , Rhee SM , Blythe D , Sotir M . Emerg Infect Dis 2016 22 (8) 1340-7 During 2013, the Maryland Department of Health and Mental Hygiene in Baltimore, MD, USA, received report of 2 Maryland residents whose surgical sites were infected with rapidly growing mycobacteria after cosmetic procedures at a clinic (clinic A) in the Dominican Republic. A multistate investigation was initiated; a probable case was defined as a surgical site infection unresponsive to therapy in a patient who had undergone cosmetic surgery in the Dominican Republic. We identified 21 case-patients in 6 states who had surgery in 1 of 5 Dominican Republic clinics; 13 (62%) had surgery at clinic A. Isolates from 12 (92%) of those patients were culture-positive for Mycobacterium abscessus complex. Of 9 clinic A case-patients with available data, all required therapeutic surgical intervention, 8 (92%) were hospitalized, and 7 (78%) required ≥3 months of antibacterial drug therapy. Healthcare providers should consider infection with rapidly growing mycobacteria in patients who have surgical site infections unresponsive to standard treatment. |
Knowledge, attitudes and beliefs related to seasonal influenza vaccine among pregnant women in Thailand
Ditsungnoen D , Greenbaum A , Prapasiri P , Dawood FS , Thompson MG , Yoocharoen P , Lindblade KA , Olsen SJ , Muangchana C . Vaccine 2016 34 (18) 2141-6 BACKGROUND: In 2009, Thailand recommended pregnant women be prioritized for influenza vaccination. Vaccine uptake among Thai pregnant women is lower than other high-risk groups. METHODS: During December 2012-April 2013, we conducted a cross-sectional survey of a convenience sample of Thai pregnant women aged ≥15 years attending antenatal clinics at public hospitals in 8 of 77 provinces. A self-administered questionnaire covered knowledge, attitudes, and beliefs related to influenza vaccination using the Health Belief Model. We examined factors associated with willingness to be vaccinated using log-binomial regression models. RESULTS: The survey was completed by 1031 (96%) of 1072 pregnant women approached. A total of 627 (61%) women had heard about influenza vaccine and were included in the analysis, of whom 262 (42%) were willing to be vaccinated, 155 (25%) had received a healthcare provider recommendation for influenza vaccination and 25 (4%) had received the influenza vaccine during the current pregnancy. In unadjusted models, high levels of perceptions of susceptibility (prevalence ratio [PR] 1.5, 95% CI 1.2-2.0), high levels of belief in the benefits of vaccination (PR 2.3, 95% CI 1.7-3.1), moderate (PR 1.7, 95% CI 1.2-2.3) and high (PR 3.4, 95% CI 2.6-4.5) levels of encouragement by others to be vaccinated (i.e., cues to action) were positively associated with willingness to be vaccinated. Moderate (PR 0.5, 95% CI 0.4-0.7) and high levels of (PR 0.5, 95% CI 0.4-0.8) perceived barriers were negatively associated with willingness to be vaccinated. In the final adjusted model, only moderate (PR 1.5, 95% CI 1.1-2.0) and high levels of cues to action (PR 2.7, 95% CI 2.0-3.6) were statistically associated with willingness to be vaccinated. CONCLUSION: Cues to action were associated with willingness to be vaccinated and can be used to inform communication strategies during the vaccine campaign to increase influenza vaccination among Thai pregnant women. |
Investigation of an outbreak of variant influenza A (H3N2) virus associated with an agricultural fair - Ohio, August 2012
Greenbaum A , Quinn C , Bailer J , Su S , Havers F , Durand LO , Jiang V , Page S , Budd J , Shaw M , Biggerstaff M , de Fijter S , Smith K , Reed C , Epperson S , Brammer L , Feltz D , Sohner K , Ford J , Jain S , Gargiullo P , Weiss E , Burg P , DiOrio M , Fowler B , Finelli L , Jhung MA . J Infect Dis 2015 212 (10) 1592-9 BACKGROUND: In 2012, one third of cases in a multi-state outbreak of variant influenza A(H3N2) virus [(H3N2)v] occurred in Ohio. We conducted an investigation of (H3N2)v cases associated with agricultural Fair A in Ohio. METHODS: We surveyed Fair A swine exhibitors and their household members. Confirmed cases had influenza-like illness (ILI) and a positive laboratory test for (H3N2)v virus and probable cases had ILI. We calculated attack rates. We determined risk factors for infection using multivariable log-binomial regression. RESULTS: We identified a total of 20 confirmed and 94 probable cases associated with Fair A. Among 114 cases, the median age was 10 years, there were no hospitalizations or deaths, and 85% had swine exposure. In the exhibitor household cohort of 359 persons (83 households), we identified 6 confirmed (2%) and 40 probable (11%) cases. Age <10 years was a significant risk factor (p<0.01) for illness. One instance of likely human-to-human transmission was identified. CONCLUSIONS: In this (H3N2)v outbreak, no evidence of sustained human-to-human (H3N2)v transmission was found. Our risk factor analysis contributed to the development of recommendations that those at increased risk of influenza complications, including children aged <5 years, avoid swine barns at fairs during the 2012 fair season. |
Hospitalizations for severe lower respiratory tract infections
Greenbaum AH , Chen J , Reed C , Beavers S , Callahan D , Christensen D , Finelli L , Fry AM . Pediatrics 2014 134 (3) 546-54 BACKGROUND: Hospitalization for lower respiratory tract infections (LRTIs) among children have been well characterized. We characterized hospitalizations for severe LRTI among children. METHODS: We analyzed claims data from commercial and Medicaid insurance enrollees (MarketScan) ages 0 to 18 years from 2007 to 2011. LRTI hospitalizations were identified by the first 2 listed International Classification of Diseases, Ninth Revision discharge codes; those with ICU admission and/or receiving mechanical ventilation were defined as severe LRTI. Underlying conditions were determined from out- and inpatient discharge codes in the preceding year. We report insurance specific and combined rates that used both commercial and Medicaid rates and adjusted for age and insurance status. RESULTS: During 2007-2011, we identified 16 797 and 12 053 severe LRTI hospitalizations among commercial and Medicaid enrollees, respectively. The rates of severe LRTI hospitalizations per 100 000 person-years were highest in children aged <1 year (commercial: 244; Medicaid: 372, respectively), and decreased with age. Among commercial enrollees, ≥1 condition increased the risk for severe LRTI (1 condition: adjusted relative risk, 2.68; 95% confidence interval, 2.58-2.78; 3 conditions: adjusted relative risk, 4.85; 95% confidence interval, 4.65-5.07) compared with children with no medical conditions. Using commercial/Medicaid combined rates, an estimated 31 289 hospitalizations for severe LRTI occurred each year in children in the United States. CONCLUSIONS: Among children, the burden of hospitalization for severe LRTI is greatest among children aged <1 year. Children with underlying medical conditions are at greatest risk for severe LRTI hospitalization. |
Outbreak of variant influenza A(H3N2) virus in the United States
Jhung MA , Epperson S , Biggerstaff M , Allen D , Balish A , Barnes N , Beaudoin A , Berman L , Bidol S , Blanton L , Blythe D , Brammer L , D'Mello T , Danila R , Davis W , de Fijter S , Diorio M , Durand LO , Emery S , Fowler B , Garten R , Grant Y , Greenbaum A , Gubareva L , Havers F , Haupt T , House J , Ibrahim S , Jiang V , Jain S , Jernigan D , Kazmierczak J , Klimov A , Lindstrom S , Longenberger A , Lucas P , Lynfield R , McMorrow M , Moll M , Morin C , Ostroff S , Page SL , Park SY , Peters S , Quinn C , Reed C , Richards S , Scheftel J , Simwale O , Shu B , Soyemi K , Stauffer J , Steffens C , Su S , Torso L , Uyeki TM , Vetter S , Villanueva J , Wong KK , Shaw M , Bresee JS , Cox N , Finelli L . Clin Infect Dis 2013 57 (12) 1703-12 BACKGROUND: Variant influenza virus infections are rare but may have pandemic potential if person-to-person transmission is efficient. We describe the epidemiology of a multistate outbreak of an influenza A(H3N2) variant virus (H3N2v) first identified in 2011. METHODS: We identified laboratory-confirmed cases of H3N2v and used a standard case report form to characterize illness and exposures. We considered illness to result from person-to-person H3N2v transmission if swine contact was not identified within 4 days prior to illness onset. RESULTS: From 9 July to 7 September 2012, we identified 306 cases of H3N2v in 10 states. The median age of all patients was 7 years. Commonly reported signs and symptoms included fever (98%), cough (85%), and fatigue (83%). Sixteen patients (5.2%) were hospitalized, and 1 fatal case was identified. The majority of those infected reported agricultural fair attendance (93%) and/or contact with swine (95%) prior to illness. We identified 15 cases of possible person-to-person transmission of H3N2v. Viruses recovered from patients were 93%-100% identical and similar to viruses recovered from previous cases of H3N2v. All H3N2v viruses examined were susceptible to oseltamivir and zanamivir and resistant to adamantane antiviral medications. CONCLUSIONS: In a large outbreak of variant influenza, the majority of infected persons reported exposures, suggesting that swine contact at an agricultural fair was a risk for H3N2v infection. We identified limited person-to-person H3N2v virus transmission, but found no evidence of efficient or sustained person-to-person transmission. Fair managers and attendees should be aware of the risk of swine-to-human transmission of influenza viruses in these settings. |
Heavy alcohol use as a risk factor for severe outcomes among adults hospitalized with laboratory-confirmed influenza, 2005-2012
Greenbaum A , Chaves SS , Perez A , Aragon D , Bandyopadhyay A , Bennett N , Fowler B , Hancock E , Lynfield R , McDonald-Hamm C , Reingold A , Ryan P , Schaffner W , Sharangpani R , Spencer M , Thomas A , Yousey-Hindes K , Zansky S , Finelli L . Infection 2013 42 (1) 165-70 We examined heavy alcohol use as a risk factor for severe influenza (intensive care admission or death) among hospitalized adults. In <65- and ≥65-year-olds, heavy alcohol use increased disease severity [relative risk (RR) 1.34; 95 % confidence interval (CI): 1.04-1.74, and RR 2.47; 95 % CI: 1.69-3.60, respectively]. Influenza vaccination and early, empiric antiviral treatment should be emphasized in this population. |
Prevalence, characteristics and clinical diagnosis of maturity onset diabetes of the young due to mutations in HNF1A, HNF4A, and glucokinase: results from the SEARCH for Diabetes in Youth.
Pihoker C , Gilliam LK , Ellard S , Dabelea D , Davis C , Dolan LM , Greenbaum CJ , Imperatore G , Lawrence JM , Marcovina SM , Mayer-Davis E , Rodriguez BL , Steck AK , Williams DE , Hattersley AT . J Clin Endocrinol Metab 2013 98 (10) 4055-62 AIMS: Our study aims were to determine the frequency of MODY mutations (HNF1A, HNF4A, glucokinase) in a diverse population of youth with diabetes and to assess how well clinical features identify youth with maturity-onset diabetes of the young (MODY). METHODS: The SEARCH for Diabetes in Youth study is a US multicenter, population-based study of youth with diabetes diagnosed at age younger than 20 years. We sequenced genomic DNA for mutations in the HNF1A, HNF4A, and glucokinase genes in 586 participants enrolled in SEARCH between 2001 and 2006. Selection criteria included diabetes autoantibody negativity and fasting C-peptide levels of 0.8 ng/mL or greater. RESULTS: We identified a mutation in one of three MODY genes in 47 participants, or 8.0% of the tested sample, for a prevalence of at least 1.2% in the pediatric diabetes population. Of these, only 3 had a clinical diagnosis of MODY, and the majority was treated with insulin. Compared with the MODY-negative group, MODY-positive participants had lower FCP levels (2.2 +/- 1.4 vs 3.2 +/- 2.1 ng/mL, P < .01) and fewer type 2 diabetes-like metabolic features. Parental history of diabetes did not significantly differ between the 2 groups. CONCLUSIONS/INTERPRETATION: In this systematic study of MODY in a large pediatric US diabetes cohort, unselected by referral pattern or family history, MODY was usually misdiagnosed and incorrectly treated with insulin. Although many type 2 diabetes-like metabolic features were less common in the mutation-positive group, no single characteristic identified all patients with mutations. Clinicians should be alert to the possibility of MODY diagnosis, particularly in antibody-negative youth with diabetes. |
Outbreak of influenza A (H3N2) variant virus infection among attendees of an agricultural fair, Pennsylvania, USA, 2011
Wong KK , Greenbaum A , Moll ME , Lando J , Moore EL , Ganatra R , Biggerstaff M , Lam E , Smith EE , Storms AD , Miller JR , Dato V , Nalluswami K , Nambiar A , Silvestri SA , Lute JR , Ostroff S , Hancock K , Branch A , Trock SC , Klimov A , Shu B , Brammer L , Epperson S , Finelli L , Jhung MA . Emerg Infect Dis 2012 18 (12) 1937-44 During August 2011, influenza A (H3N2) variant [A(H3N2)v] virus infection developed in a child who attended an agricultural fair in Pennsylvania, USA; the virus resulted from reassortment of a swine influenza virus with influenza A(H1N1)pdm09. We interviewed fair attendees and conducted a retrospective cohort study among members of an agricultural club who attended the fair. Probable and confirmed cases of A(H3N2)v virus infection were defined by serology and genomic sequencing results, respectively. We identified 82 suspected, 4 probable, and 3 confirmed case-patients who attended the fair. Among 127 cohort study members, the risk for suspected case status increased as swine exposure increased from none (4%; referent) to visiting swine exhibits (8%; relative risk 2.1; 95% CI 0.2-53.4) to touching swine (16%; relative risk 4.4; 95% CI 0.8-116.3). Fairs may be venues for zoonotic transmission of viruses with epidemic potential; thus, health officials should investigate respiratory illness outbreaks associated with agricultural events. |
Long-term follow-up and survival of antiretroviral-naive patients with cryptococcal meningitis in the pre-antiretroviral therapy era, Gauteng Province, South Africa
Park BJ , Shetty S , Ahlquist A , Greenbaum A , Miller JL , Motsi A , McCarthy K , Govender N . Int J STD AIDS 2011 22 (4) 199-203 Cryptococcal meningitis (CM) is a major cause of death among HIV-infected persons in sub-Saharan Africa. We conducted a study to describe the long-term outcomes during the pre-antiretroviral post-ART therapy period. Enrolled cases were those detected through population-based surveillance in Gauteng Province, South Africa, and diagnosed during March-November 2002 and July-September 2003 from eight large hospitals representing academic, provincial and rural settings. Of 1089 case-patients diagnosed with CM, 721 (70%) survived to discharge. Among the 256 with follow-up information, 154 (60%) were established to have died, 44% of whom died as outpatients. Overall, the 14- and 90-day survival post-diagnosis was 68% and 41%, respectively. On Cox proportional hazards multivariable analysis, severe disease was associated with shorter survival time; having received any antifungal treatment for the cryptococcal episode was associated with increased survival time at follow-up. Although most patients in this cohort survived the initial hospitalization, only 41% were still alive three months after diagnosis, with nearly half of deaths occurring outside a hospital. These data are an important baseline from which to measure effectiveness of public health management of CM in South Africa. |
Cigarette smoking and second-hand smoking exposure in adolescents with chronic kidney disease: a study from the Midwest Pediatric Nephrology Consortium
Omoloja A , Chand D , Greenbaum L , Wilson A , Bastian V , Ferris M , Bernert J , Stolfi A , Patel H . Nephrol Dial Transplant 2011 26 (3) 908-13 BACKGROUND: Smoking and second-hand smoking [SHS] cause significant cardiovascular mortality and morbidity. In healthy individuals and adults with chronic kidney disease [CKD], cigarette smoking is associated with albuminuria, increased risk for CKD, increased graft loss and progression of renal insufficiency. In children, SHS has been associated with higher blood pressure variability, blood pressure load, elevated C-reactive protein and decreased cognitive function. Using a survey document and urine cotinine, we sought to investigate prevalence of cigarette use and SHS in adolescents with CKD. METHODS: A cross-sectional study was conducted in which adolescents aged 13 to 18 years with CKD were asked to complete a single anonymous self-administered survey. In addition, a single freshly voided urine sample for cotinine measurement was obtained from eligible subjects. RESULTS: Of 182 subjects, 60 (34%), 25 (14%) and 93 (52%) were transplant recipients, were dialysis dependent and had a glomerulopathy, respectively. Renal status was lacking in four. Twenty-four per cent (24%) had smoked at some point in their lives, and 13% had smoked within the last 30 days of taking the survey. Fifty-two per cent (52%) of all respondents reported living with an adult who smoked, and 54% reported having friends that smoked. Forty-seven per cent (47%) and 44% of those who had never smoked lived with an adult and had friends that smoked, respectively. There was a discrepancy rate of 7% between self-reported non-smokers and urine cotinine, suggesting smoking rates were higher. The highest cotinine/creatinine levels among the non-smokers were observed in those who lived with a smoker and had friends that smoked. CONCLUSION: Among adolescents with CKD, cigarette smoking and SHS exposure are prevalent and may be important variables to consider when evaluating renal and cardiovascular risk factors and outcomes in children with CKD. |
Financing vaccination of children and adolescents: National Vaccine Advisory Committee recommendations
Lindley MC , Birkhead GS , Almquist JR , Clover RD , Dekker C , Feinberg M , Fergie J , Gordon LK , Humiston SG , Jackson LA , Lovell Jr C , Mason JO , McCormick M , Nevin-Woods C , Parnell T , Pavia A , Riley LE , Abramson JS , Coleman MS , Edwards B , Freed GL , Gellin B , Greenbaum E , Haddix AC , Hinman AR , Johnson CB , Kelman J , Klein JO , Orenstein WA , Pauly M , Pisani AA , Rodewald LE , Rosenberg A , Salesa J , Shen AK , Wallace G , Wilson JJ , Wisniewski AC . Pediatrics 2009 124 S558-S562 Increases in the number and cost of vaccines routinely recommended for children and adolescents have raised concerns about the ability of the current systems for vaccine financing and delivery to ensure that all children and adolescents have access to all routinely recommended vaccinations without financial barriers. The National Vaccine Advisory Committee (NVAC) was chartered in 1988 to advise and to make recommendations to the director of the National Vaccine Program and the Assistant Secretary for Health at the US Department of Health and Human Services on matters related to the prevention of infectious diseases through vaccination. In October 2006, NVAC established a Vaccine Financing Working Group to explore approaches for child and adolescent vaccine financing. The Vaccine Financing Working Group was charged with establishing a process for obtaining stakeholder input regarding challenges to creating optimal approaches to vaccine financing in both the public and private sectors. The goal of this process was to develop recommendations to ensure that all children and adolescents have access to all routinely recommended vaccinations without financial barriers. | The NVAC considered several overarching principles in formulating its recommendations. First, vaccine-preventable diseases are not constrained by geographic boundaries, and policies on vaccine financing should be national in scope. Second, vaccine financing solutions should address near-term problems with vaccine financing and should anticipate continued changes in recommended child and adolescent immunization schedules and the health care delivery system. Third, because vaccine financing problems are multifactorial, their solutions also should be multifactorial and all stakeholders will need to participate in implementing the solutions. Finally, because it is difficult to achieve uniform national implementation of policies that require state-based legislative or budgetary action, legislative or policy actions at the federal level, when appropriate, are recommended for achieving vaccine financing goals. |
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