Last data update: Apr 29, 2024. (Total: 46658 publications since 2009)
Records 1-23 (of 23 Records) |
Query Trace: Hughes MM[original query] |
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Health conditions, education services, and transition planning for adolescents with autism
Hughes MM , Pas ET , Durkin MS , DaWalt LS , Bilder DA , Bakian AV , Amoakohene E , Shaw KA , Patrick ME , Salinas A , DiRienzo M , Lopez M , Williams S , McArthur D , Hudson A , Ladd-Acosta CM , Schwenk YD , Baroud TM , Robinson Williams A , Washington A , Maenner MJ . Pediatrics 2024 OBJECTIVE: Our objectives with this study were to describe the frequency of selected cooccurring health conditions and individualized education program (IEP) services and post-high school transition planning for adolescents with autism spectrum disorder and identify disparities by sex, intellectual ability, race or ethnicity, and geographic area. METHODS: The study sample included 1787 adolescents born in 2004 who were identified as having autism through a health and education record review through age 16 years in 2020. These adolescents were part of a longitudinal population-based surveillance birth cohort from the Autism and Developmental Disabilities Monitoring Network from 2004 to 2020 in 5 US catchment areas. RESULTS: Attention deficit hyperactivity disorder (47%) and anxiety (39%) were the most common cooccurring health conditions. Anxiety was less commonly identified for those with intellectual disability than those without. It was also less commonly identified among Black adolescents compared with White or Hispanic adolescents. There was wide variation across Autism and Developmental Disabilities Monitoring Network sites in the provision of school-based IEP services. Students with intellectual disability were less likely to receive school-based mental health services and more likely to have a goal for postsecondary independent living skills compared with those without intellectual disability. A total of 37% of students did not participate in standardized testing. CONCLUSIONS: We identified disparities in the identification of cooccurring conditions and school-based IEP services, practices, and transition planning. Working with pediatric health and education providers, families, and adolescents with autism will be important to identify contributing factors and to focus efforts to reduce disparities in the supports and services adolescents with autism have access to and receive. |
Response to Letter to the Editor: "'Profound Autism' Label Does Not Predict Strengths or Help Plan Supports"
Hughes MM , Maenner MJ . Public Health Rep 2023 138 (6) 851-852 We appreciate the letter by Kripke-Ludwig1 and the opportunity to further clarify our article’s2 intent on the newly proposed classification of “profound autism.” The Lancet Commission, which describes itself as being composed of “clinicians and other health-care providers, researchers, advocates, self-advocates, and parents,” developed the definition of profound autism to indicate a group likely needing services and support throughout their life span.3 As Kripke-Ludwig states, those who meet the criteria for profound autism may benefit from services and support, such as augmentative and alternative communication tools and therapy to overcome sensory and movement disabilities, to help them meet their full potential. Many questions have been raised about the term profound autism, and our study addressed some of these questions by contributing population-based data.2 | The validity of the definition of profound autism is not well established. However, these same critiques by Kripke-Ludwig could be (and have been) applied to autism as a whole.4 The wide variability in symptoms, lack of common etiology, and differences in needs among people with autism were motivating factors in developing a specific subgroup. To determine whether this term is useful or meaningful, many studies will be needed. Our study applied the definition of profound autism to population-level data. Using these data, we were able to describe the characteristics of this population, understand changes in prevalence over time, and determine differences by sex, race and ethnicity, and geography.2 This research was a start to evaluating this term and understanding how common it is for people with autism to meet the criteria and whether the term disproportionately includes individuals with certain characteristics. Kripke-Ludwig cited the data from our article—that most individuals met the criteria for profound autism by meeting only 1 of the criteria—to make an argument about the heterogeneity of the characteristics of individuals in this group. This use of our data illustrates the purpose of our research: to contribute data to advance our understanding and discussion of this group. With additional data and discourse, the definition of profound autism may be refined or modified, much like the criteria for autism have evolved over time. |
Individualized education programs and transition planning for adolescents with autism
Hughes MM , Kirby AV , Davis J , Bilder DA , Patrick M , Lopez M , DaWalt LS , Pas ET , Bakian AV , Shaw KA , DiRienzo M , Hudson A , Schwenk YD , Baroud TM , Washington A , Maenner MJ . Pediatrics 2023 152 (1) OBJECTIVES: The study objectives were to examine the contents of individualized education programs (IEPs) of adolescents with autism spectrum disorder (ASD), including postsecondary transition goals, services, and changes in special education classification over time. METHODS: This study involved a longitudinal population-based surveillance cohort from the Autism Developmental Disabilities Monitoring Network from 2002 to 2018 in 3 catchment areas in the United States. The sample included 322 adolescents who were born in 2002, identified with ASD, and had an IEP available for review at ages 15-16 years. RESULTS: We found that 297 (92%) adolescents with ASD had an IEP including a transition plan. Those without intellectual disability (ID) were more likely to have postsecondary education and employment goals and have those goals be to pursue higher education or competitive employment compared with those with ID. Forty-one percent of adolescents with ASD had a postsecondary living arrangement goal. Although 28% of adolescents with ASD received school-based mental health services, none of these adolescents were Black; additionally, 15% of those with ID received mental health services compared with 34% without ID. The percentage of adolescents with ASD served under an autism classification increased from 44% at age 8 years to 62% by age 16. CONCLUSIONS: We identified gaps and disparities in school-based postsecondary transition planning. Working with education partners, families, and adolescents will be important to identify what challenges contribute to these findings and what supports are needed to improve the equity and quality of the transition planning process for adolescents with ASD so they are prepared for adulthood. |
Social vulnerability and prevalence of autism, Metropolitan Atlanta Developmental Disabilities Surveillance Program (MADDSP)
Patrick ME , Hughes MM , Ali A , Shaw KA , Maenner MJ . Ann Epidemiol 2023 83 47-53 e1 PURPOSE: The Metropolitan Atlanta Developmental Disabilities Surveillance Program (MADDSP) tracks autism spectrum disorder (ASD) in selected counties within Georgia as part of the Autism and Developmental Disabilities Monitoring Network. ADDM Network analyses have historically found higher prevalence of ASD in areas of higher socioeconomic status. METHODS: We linked 2018 data from CDC's Social Vulnerability Index (SVI) to two MADDSP counties by census tract, grouped census tracts into tertiles representing low, medium, and high social vulnerability, and calculated ASD prevalence for each tertile, overall and by each of four SVI themes. RESULTS: We found that overall prevalence was higher in areas of low compared to high vulnerability for the socioeconomic status and transportation themes, and in areas of medium compared to high vulnerability for all themes. This pattern was consistent among males but varied for females and by race/ethnicity. CONCLUSION: Linking ASD prevalence to SVI metrics can improve understanding of inequities among children with ASD in racial and ethnic minority groups or those living in low resource settings. These methods can be applied to other ADDM Network surveillance sites and public health surveillance programs. |
The prevalence and characteristics of children with profound autism, 15 sites, United States, 2000-2016
Hughes MM , Shaw KA , DiRienzo M , Durkin MS , Esler A , Hall-Lande J , Wiggins L , Zahorodny W , Singer A , Maenner MJ . Public Health Rep 2023 138 (6) 333549231163551 OBJECTIVES: Autism spectrum disorder (autism) is a heterogeneous condition that poses challenges in describing the needs of individuals with autism and making prognoses about future outcomes. We applied a newly proposed definition of profound autism to surveillance data to estimate the percentage of children with autism who have profound autism and describe their sociodemographic and clinical characteristics. METHODS: We analyzed population-based surveillance data from the Autism and Developmental Disabilities Monitoring Network for 20 135 children aged 8 years with autism during 2000-2016. Children were classified as having profound autism if they were nonverbal, were minimally verbal, or had an intelligence quotient <50. RESULTS: The percentage of 8-year-old children with profound autism among those with autism was 26.7%. Compared with children with non-profound autism, children with profound autism were more likely to be female, from racial and ethnic minority groups, of low socioeconomic status, born preterm or with low birth weight; have self-injurious behaviors; have seizure disorders; and have lower adaptive scores. In 2016, the prevalence of profound autism was 4.6 per 1000 8-year-olds. The prevalence ratio (PR) of profound autism was higher among non-Hispanic Asian/Native Hawaiian/Other Pacific Islander (PR = 1.55; 95 CI, 1.38-1.73), non-Hispanic Black (PR = 1.76; 95% CI, 1.67-1.86), and Hispanic (PR = 1.50; 95% CI, 0.88-1.26) children than among non-Hispanic White children. CONCLUSIONS: As the population of children with autism continues to change, describing and quantifying the population with profound autism is important for planning. Policies and programs could consider the needs of people with profound autism across the life span to ensure their needs are met. |
Prevalence and characteristics of autism spectrum disorder among children aged 8 years - autism and developmental disabilities monitoring network, 11 sites, United States, 2020
Maenner MJ , Warren Z , Williams AR , Amoakohene E , Bakian AV , Bilder DA , Durkin MS , Fitzgerald RT , Furnier SM , Hughes MM , Ladd-Acosta CM , McArthur D , Pas ET , Salinas A , Vehorn A , Williams S , Esler A , Grzybowski A , Hall-Lande J , Nguyen RHN , Pierce K , Zahorodny W , Hudson A , Hallas L , Mancilla KC , Patrick M , Shenouda J , Sidwell K , DiRienzo M , Gutierrez J , Spivey MH , Lopez M , Pettygrove S , Schwenk YD , Washington A , Shaw KA . MMWR Surveill Summ 2023 72 (2) 1-14 PROBLEM/CONDITION: Autism spectrum disorder (ASD). PERIOD COVERED: 2020. DESCRIPTION OF SYSTEM: The Autism and Developmental Disabilities Monitoring (ADDM) Network is an active surveillance program that provides estimates of the prevalence of ASD among children aged 8 years. In 2020, there were 11 ADDM Network sites across the United States (Arizona, Arkansas, California, Georgia, Maryland, Minnesota, Missouri, New Jersey, Tennessee, Utah, and Wisconsin). To ascertain ASD among children aged 8 years, ADDM Network staff review and abstract developmental evaluations and records from community medical and educational service providers. A child met the case definition if their record documented 1) an ASD diagnostic statement in an evaluation, 2) a classification of ASD in special education, or 3) an ASD International Classification of Diseases (ICD) code. RESULTS: For 2020, across all 11 ADDM sites, ASD prevalence per 1,000 children aged 8 years ranged from 23.1 in Maryland to 44.9 in California. The overall ASD prevalence was 27.6 per 1,000 (one in 36) children aged 8 years and was 3.8 times as prevalent among boys as among girls (43.0 versus 11.4). Overall, ASD prevalence was lower among non-Hispanic White children (24.3) and children of two or more races (22.9) than among non-Hispanic Black or African American (Black), Hispanic, and non-Hispanic Asian or Pacific Islander (A/PI) children (29.3, 31.6, and 33.4 respectively). ASD prevalence among non-Hispanic American Indian or Alaska Native (AI/AN) children (26.5) was similar to that of other racial and ethnic groups. ASD prevalence was associated with lower household income at three sites, with no association at the other sites.Across sites, the ASD prevalence per 1,000 children aged 8 years based exclusively on documented ASD diagnostic statements was 20.6 (range = 17.1 in Wisconsin to 35.4 in California). Of the 6,245 children who met the ASD case definition, 74.7% had a documented diagnostic statement of ASD, 65.2% had a documented ASD special education classification, 71.6% had a documented ASD ICD code, and 37.4% had all three types of ASD indicators. The median age of earliest known ASD diagnosis was 49 months and ranged from 36 months in California to 59 months in Minnesota.Among the 4,165 (66.7%) children with ASD with information on cognitive ability, 37.9% were classified as having an intellectual disability. Intellectual disability was present among 50.8% of Black, 41.5% of A/PI, 37.8% of two or more races, 34.9% of Hispanic, 34.8% of AI/AN, and 31.8% of White children with ASD. Overall, children with intellectual disability had earlier median ages of ASD diagnosis (43 months) than those without intellectual disability (53 months). INTERPRETATION: For 2020, one in 36 children aged 8 years (approximately 4% of boys and 1% of girls) was estimated to have ASD. These estimates are higher than previous ADDM Network estimates during 2000-2018. For the first time among children aged 8 years, the prevalence of ASD was lower among White children than among other racial and ethnic groups, reversing the direction of racial and ethnic differences in ASD prevalence observed in the past. Black children with ASD were still more likely than White children with ASD to have a co-occurring intellectual disability. PUBLIC HEALTH ACTION: The continued increase among children identified with ASD, particularly among non-White children and girls, highlights the need for enhanced infrastructure to provide equitable diagnostic, treatment, and support services for all children with ASD. Similar to previous reporting periods, findings varied considerably across network sites, indicating the need for additional research to understand the nature of such differences and potentially apply successful identification strategies across states. |
Early identification of autism spectrum disorder among children aged 4 years - Autism and Developmental Disabilities Monitoring Network, 11 Sites, United States, 2020
Shaw KA , Bilder DA , McArthur D , Williams AR , Amoakohene E , Bakian AV , Durkin MS , Fitzgerald RT , Furnier SM , Hughes MM , Pas ET , Salinas A , Warren Z , Williams S , Esler A , Grzybowski A , Ladd-Acosta CM , Patrick M , Zahorodny W , Green KK , Hall-Lande J , Lopez M , Mancilla KC , Nguyen RHN , Pierce K , Schwenk YD , Shenouda J , Sidwell K , Vehorn A , DiRienzo M , Gutierrez J , Hallas L , Hudson A , Spivey MH , Pettygrove S , Washington A , Maenner MJ . MMWR Surveill Summ 2023 72 (1) 1-15 PROBLEM/CONDITION: Autism spectrum disorder (ASD). PERIOD COVERED: 2020. DESCRIPTION OF SYSTEM: The Autism and Developmental Disabilities Monitoring Network is an active surveillance program that estimates prevalence and characteristics of ASD and monitors timing of ASD identification among children aged 4 and 8 years. In 2020, a total of 11 sites (located in Arizona, Arkansas, California, Georgia, Maryland, Minnesota, Missouri, New Jersey, Tennessee, Utah, and Wisconsin) conducted surveillance of ASD among children aged 4 and 8 years and suspected ASD among children aged 4 years. Surveillance included children who lived in the surveillance area at any time during 2020. Children were classified as having ASD if they ever received 1) an ASD diagnostic statement in an evaluation, 2) a special education classification of autism (eligibility), or 3) an ASD International Classification of Diseases (ICD) code (revisions 9 or 10). Children aged 4 years were classified as having suspected ASD if they did not meet the case definition for ASD but had a documented qualified professional's statement indicating a suspicion of ASD. This report focuses on children aged 4 years in 2020 compared with children aged 8 years in 2020. RESULTS: For 2020, ASD prevalence among children aged 4 years varied across sites, from 12.7 per 1,000 children in Utah to 46.4 in California. The overall prevalence was 21.5 and was higher among boys than girls at every site. Compared with non-Hispanic White children, ASD prevalence was 1.8 times as high among Hispanic, 1.6 times as high among non-Hispanic Black, 1.4 times as high among Asian or Pacific Islander, and 1.2 times as high among multiracial children. Among the 58.3% of children aged 4 years with ASD and information on intellectual ability, 48.5% had an IQ score of ≤70 on their most recent IQ test or an examiner's statement of intellectual disability. Among children with a documented developmental evaluation, 78.0% were evaluated by age 36 months. Children aged 4 years had a higher cumulative incidence of ASD diagnosis or eligibility by age 48 months compared with children aged 8 years at all sites; risk ratios ranged from 1.3 in New Jersey and Utah to 2.0 in Tennessee. In the 6 months before the March 2020 COVID-19 pandemic declaration by the World Health Organization, there were 1,593 more evaluations and 1.89 more ASD identifications per 1,000 children aged 4 years than children aged 8 years received 4 years earlier. After the COVID-19 pandemic declaration, this pattern reversed: in the 6 months after pandemic onset, there were 217 fewer evaluations and 0.26 fewer identifications per 1,000 children aged 4 years than children aged 8 years received 4 years earlier. Patterns of evaluation and identification varied among sites, but there was not recovery to pre-COVID-19 pandemic levels by the end of 2020 at most sites or overall. For 2020, prevalence of suspected ASD ranged from 0.5 (California) to 10.4 (Arkansas) per 1,000 children aged 4 years, with an increase from 2018 at five sites (Arizona, Arkansas, Maryland, New Jersey, and Utah). Demographic and cognitive characteristics of children aged 4 years with suspected ASD were similar to children aged 4 years with ASD. INTERPRETATION: A wide range of prevalence of ASD by age 4 years was observed, suggesting differences in early ASD identification practices among communities. At all sites, cumulative incidence of ASD by age 48 months among children aged 4 years was higher compared with children aged 8 years in 2020, indicating improvements in early identification of ASD. Higher numbers of evaluations and rates of identification were evident among children aged 4 years until the COVID-19 pandemic onset in 2020. Sustained lower levels of ASD evaluations and identification seen at a majority of sites after the pandemic onset could indicate disruptions in typical practices in evaluations and identification for health service providers and schools through the end of 2020. Sites with more recovery could indicate successful strategies to mitigate service interruption, such as pivoting to telehealth approaches for evaluation. PUBLIC HEALTH ACTION: From 2016 through February of 2020, ASD evaluation and identification among the cohort of children aged 4 years was outpacing ASD evaluation and identification 4 years earlier (from 2012 until March 2016) among the cohort of children aged 8 years in 2020 . From 2016 to March 2020, ASD evaluation and identification among the cohort of children aged 4 years was outpacing that among children aged 8 years in 2020 from 2012 until March 2016. The disruptions in evaluation that coincided with the start of the COVID-19 pandemic and the increase in prevalence of suspected ASD in 2020 could have led to delays in ASD identification and interventions. Communities could evaluate the impact of these disruptions as children in affected cohorts age and consider strategies to mitigate service disruptions caused by future public health emergencies. |
Adolescents with autism spectrum disorder: Diagnostic patterns, co-occurring conditions, and transition planning
Hughes MM , Shaw KA , Patrick ME , DiRienzo M , Bakian AV , Bilder DA , Durkin MS , Hudson A , Spivey MH , DaWalt LS , Salinas A , Schwenk YD , Lopez M , Baroud TM , Maenner MJ . J Adolesc Health 2023 73 (2) 271-278 PURPOSE: The objectives of this study were to describe child characteristics associated with later autism spectrum disorder (ASD) identification and the health status and educational transition plans of adolescents with ASD. METHODS: Longitudinal population-based surveillance cohort from the Autism Developmental Disabilities Monitoring Network during 2002-2018 in five catchment areas in the United States. Participants included 3,148 children born in 2002 whose records were first reviewed for ASD surveillance in 2010. RESULTS: Of the 1,846 children identified in the community as an ASD case, 11.6% were first identified after age 8 years. Children who were more likely to have ASD identified at older ages were Hispanic; were born with low birth weight; were verbal; had high intelligence quotient or adaptive scores; or had certain co-occurring neuropsychological conditions by age 8 years. By age 16 years, neuropsychological conditions were common with more than half of the adolescents with ASD having a diagnosis of attention-deficit/hyperactivity disorder or anxiety. Intellectual disability (ID) status was unchanged for the majority (>80%) of children from ages 8-16 years. A transition plan was completed for over 94% of adolescents, but disparities were observed in planning by ID status. DISCUSSION: A high percentage of adolescents with ASD have co-occurring neuropsychological conditions, markedly higher than at age 8. While most adolescents had transition planning, this occurred less often for those with ID. Ensuring access to services for all people with ASD during adolescence and transition to adulthood may help to promote overall health and quality of life. |
Statewide county-level autism spectrum disorder prevalence estimates - seven U.S. states, 2018
Shaw KA , Williams S , Hughes MM , Warren Z , Bakian AV , Durkin MS , Esler A , Hall-Lande J , Salinas A , Vehorn A , Andrews JG , Baroud T , Bilder DA , Dimian A , Galindo M , Hudson A , Hallas L , Lopez M , Pokoski O , Pettygrove S , Rossow K , Shenouda J , Schwenk YD , Zahorodny W , Washington A , Maenner MJ . Ann Epidemiol 2023 79 39-43 PURPOSE: Autism spectrum disorder (ASD) prevalence information is necessary for identifying community needs such as addressing disparities in identification and services. METHODS: Seven Autism and Developmental Disabilities Monitoring (ADDM) Network sites participated in a pilot project to link statewide health and education data to generate county-level prevalence estimates for a broader age range for their states for the first time. RESULTS: Statewide prevalence of ASD for ages 3-21 years in 2018 ranged from 1.5% in Tennessee and Wisconsin to 2.3% in Arizona. The median county-level prevalence of ASD was 1.4% of residents ages 3-21 years. More boys than girls had ASD at all sites, and prevalence was lower among non-Hispanic Black (Black), Hispanic, Asian/Pacific Islander (A/PI), and American Indian/Alaska Native (AI/AN) residents compared to non-Hispanic White (White) residents at most sites. ASD prevalence estimates for children aged 8 years were similar to 2018 ADDM Network estimates that used record review to provide more in-depth information, but showed greater variation for children aged 4 years. CONCLUSION: Linkage of statewide data sets provides less detailed but actionable local information when more resource-intensive methods are not possible. |
Use of the Janssen (Johnson & Johnson) COVID-19 Vaccine: Updated Interim Recommendations from the Advisory Committee on Immunization Practices - United States, December 2021.
Oliver SE , Wallace M , See I , Mbaeyi S , Godfrey M , Hadler SC , Jatlaoui TC , Twentyman E , Hughes MM , Rao AK , Fiore A , Su JR , Broder KR , Shimabukuro T , Lale A , Shay DK , Markowitz LE , Wharton M , Bell BP , Brooks O , McNally V , Lee GM , Talbot HK , Daley MF . MMWR Morb Mortal Wkly Rep 2022 71 (3) 90-95 On February 27, 2021, the Food and Drug Administration (FDA) issued an Emergency Use Authorization (EUA) for the adenovirus-vectored COVID-19 vaccine (Janssen Biotech, Inc., a Janssen Pharmaceutical company, Johnson & Johnson), and on February 28, 2021, the Advisory Committee on Immunization Practices (ACIP) issued an interim recommendation for its use as a single-dose primary vaccination in persons aged ≥18 years (1,2). On April 13, 2021, CDC and FDA recommended a pause in the use of Janssen COVID-19 vaccine after reports of thrombosis with thrombocytopenia syndrome (TTS), a rare condition characterized by low platelets and thrombosis, including at unusual sites such as the cerebral venous sinus (cerebral venous sinus thrombosis [CVST]), after receipt of the vaccine.* ACIP rapidly convened two emergency meetings to review reported cases of TTS, and 10 days after the pause commenced, ACIP reaffirmed its interim recommendation for use of the Janssen COVID-19 vaccine in persons aged ≥18 years, but included a warning regarding rare clotting events after vaccination, primarily among women aged 18-49 years (3). In July, after review of an updated benefit-risk assessment accounting for risks of Guillain-Barré syndrome (GBS) and TTS, ACIP concluded that benefits of vaccination with Janssen COVID-19 vaccine outweighed risks. Through ongoing safety surveillance and review of reports from the Vaccine Adverse Event Reporting System (VAERS), additional cases of TTS after receipt of Janssen COVID-19 vaccine, including deaths, were identified. On December 16, 2021, ACIP held an emergency meeting to review updated data on TTS and an updated benefit-risk assessment. At that meeting, ACIP made a recommendation for preferential use of mRNA COVID-19 vaccines over the Janssen COVID-19 vaccine, including both primary and booster doses administered to prevent COVID-19, for all persons aged ≥18 years. The Janssen COVID-19 vaccine may be considered in some situations, including for persons with a contraindication to receipt of mRNA COVID-19 vaccines. |
Sensory features in autism: Findings from a large population-based surveillance system
Kirby AV , Bilder DA , Wiggins LD , Hughes MM , Davis J , Hall-Lande JA , Lee LC , McMahon WM , Bakian AV . Autism Res 2022 15 (4) 751-760 Sensory features (i.e., atypical responses to sensory stimuli) are included in the current diagnostic criteria for autism spectrum disorder. Yet, large population-based studies have not examined these features. This study aimed to determine the prevalence of sensory features among autistic children, and examine associations between sensory features, demographics, and co-occurring problems in other areas. Analysis for this study included a sample comprised of 25,627 four- or eight-year-old autistic children identified through the multistate Autism and Developmental Disabilities Monitoring Network (2006-2014). We calculated the prevalence of sensory features and applied multilevel logistic regression modeling. The majority (74%; 95% confidence interval: 73.5%-74.5%) of the children studied had documented sensory features. In a multivariable model, children who were male and those whose mothers had more years of education had higher odds of documented sensory features. Children from several racial and ethnic minority groups had lower odds of documented sensory features than White, non-Hispanic children. Cognitive problems were not significantly related to sensory features. Problems related to adaptive behavior, emotional states, aggression, attention, fear, motor development, eating, and sleeping were associated with higher odds of having documented sensory features. Results from a large, population-based sample indicate a high prevalence of sensory features in autistic children, as well as relationships between sensory features and co-occurring problems. This study also pointed to potential disparities in the identification of sensory features, which should be examined in future research. Disparities should also be considered clinically to avoid reduced access to supports for sensory features and related functional problems. LAY SUMMARY: In a large, population-based sample of 25,627 autistic children, 74% had documented differences in how they respond to sensation. We also identified significant associations of sensory features with adaptive behavior and problems in other domains. Sensory features were less common among girls, children of color, and children of mothers with fewer years of education, suggesting potential disparities in identification. |
Prevalence and Characteristics of Autism Spectrum Disorder Among Children Aged 8 Years - Autism and Developmental Disabilities Monitoring Network, 11 Sites, United States, 2018
Maenner MJ , Shaw KA , Bakian AV , Bilder DA , Durkin MS , Esler A , Furnier SM , Hallas L , Hall-Lande J , Hudson A , Hughes MM , Patrick M , Pierce K , Poynter JN , Salinas A , Shenouda J , Vehorn A , Warren Z , Constantino JN , DiRienzo M , Fitzgerald RT , Grzybowski A , Spivey MH , Pettygrove S , Zahorodny W , Ali A , Andrews JG , Baroud T , Gutierrez J , Hewitt A , Lee LC , Lopez M , Mancilla KC , McArthur D , Schwenk YD , Washington A , Williams S , Cogswell ME . MMWR Surveill Summ 2021 70 (11) 1-16 PROBLEM/CONDITION: Autism spectrum disorder (ASD). PERIOD COVERED: 2018. DESCRIPTION OF SYSTEM: The Autism and Developmental Disabilities Monitoring (ADDM) Network conducts active surveillance of ASD. This report focuses on the prevalence and characteristics of ASD among children aged 8 years in 2018 whose parents or guardians lived in 11 ADDM Network sites in the United States (Arizona, Arkansas, California, Georgia, Maryland, Minnesota, Missouri, New Jersey, Tennessee, Utah, and Wisconsin). To ascertain ASD among children aged 8 years, ADDM Network staff review and abstract developmental evaluations and records from community medical and educational service providers. In 2018, children met the case definition if their records documented 1) an ASD diagnostic statement in an evaluation (diagnosis), 2) a special education classification of ASD (eligibility), or 3) an ASD International Classification of Diseases (ICD) code. RESULTS: For 2018, across all 11 ADDM sites, ASD prevalence per 1,000 children aged 8 years ranged from 16.5 in Missouri to 38.9 in California. The overall ASD prevalence was 23.0 per 1,000 (one in 44) children aged 8 years, and ASD was 4.2 times as prevalent among boys as among girls. Overall ASD prevalence was similar across racial and ethnic groups, except American Indian/Alaska Native children had higher ASD prevalence than non-Hispanic White (White) children (29.0 versus 21.2 per 1,000 children aged 8 years). At multiple sites, Hispanic children had lower ASD prevalence than White children (Arizona, Arkansas, Georgia, and Utah), and non-Hispanic Black (Black) children (Georgia and Minnesota). The associations between ASD prevalence and neighborhood-level median household income varied by site. Among the 5,058 children who met the ASD case definition, 75.8% had a diagnostic statement of ASD in an evaluation, 18.8% had an ASD special education classification or eligibility and no ASD diagnostic statement, and 5.4% had an ASD ICD code only. ASD prevalence per 1,000 children aged 8 years that was based exclusively on documented ASD diagnostic statements was 17.4 overall (range: 11.2 in Maryland to 29.9 in California). The median age of earliest known ASD diagnosis ranged from 36 months in California to 63 months in Minnesota. Among the 3,007 children with ASD and data on cognitive ability, 35.2% were classified as having an intelligence quotient (IQ) score ≤70. The percentages of children with ASD with IQ scores ≤70 were 49.8%, 33.1%, and 29.7% among Black, Hispanic, and White children, respectively. Overall, children with ASD and IQ scores ≤70 had earlier median ages of ASD diagnosis than children with ASD and IQ scores >70 (44 versus 53 months). INTERPRETATION: In 2018, one in 44 children aged 8 years was estimated to have ASD, and prevalence and median age of identification varied widely across sites. Whereas overall ASD prevalence was similar by race and ethnicity, at certain sites Hispanic children were less likely to be identified as having ASD than White or Black children. The higher proportion of Black children compared with White and Hispanic children classified as having intellectual disability was consistent with previous findings. PUBLIC HEALTH ACTION: The variability in ASD prevalence and community ASD identification practices among children with different racial, ethnic, and geographical characteristics highlights the importance of research into the causes of that variability and strategies to provide equitable access to developmental evaluations and services. These findings also underscore the need for enhanced infrastructure for diagnostic, treatment, and support services to meet the needs of all children. |
Early Identification of Autism Spectrum Disorder Among Children Aged 4 Years - Autism and Developmental Disabilities Monitoring Network, 11 Sites, United States, 2018
Shaw KA , Maenner MJ , Hughes MM , Patrick M , DiRienzo M , Ali A , Washington A , Williams S , Cogswell ME . MMWR Surveill Summ 2021 70 (10) 1-14 PROBLEM/CONDITION: Autism spectrum disorder (ASD). PERIOD COVERED: 2018. DESCRIPTION OF SYSTEM: The Autism and Developmental Disabilities Monitoring Network is an active surveillance program that estimates ASD prevalence and monitors timing of ASD identification among children aged 4 and 8 years. This report focuses on children aged 4 years in 2018, who were born in 2014 and had a parent or guardian who lived in the surveillance area in one of 11 sites (Arizona, Arkansas, California, Georgia, Maryland, Minnesota, Missouri, New Jersey, Tennessee, Utah, and Wisconsin) at any time during 2018. Children were classified as having ASD if they ever received 1) an ASD diagnostic statement (diagnosis) in an evaluation, 2) a special education classification of ASD (eligibility), or 3) an ASD International Classification of Diseases (ICD) code. Suspected ASD also was tracked among children aged 4 years. Children who did not meet the case definition for ASD were classified as having suspected ASD if their records contained a qualified professional's statement indicating a suspicion of ASD. RESULTS: For 2018, the overall ASD prevalence was 17.0 per 1,000 (one in 59) children aged 4 years. Prevalence varied from 9.1 per 1,000 in Utah to 41.6 per 1,000 in California. At every site, prevalence was higher among boys than girls, with an overall male-to-female prevalence ratio of 3.4. Prevalence of ASD among children aged 4 years was lower among non-Hispanic White (White) children (12.9 per 1,000) than among non-Hispanic Black (Black) children (16.6 per 1,000), Hispanic children (21.1 per 1,000), and Asian/Pacific Islander (A/PI) children (22.7 per 1,000). Among children aged 4 years with ASD and information on intellectual ability, 52% met the surveillance case definition of co-occurring intellectual disability (intelligence quotient ≤70 or an examiner's statement of intellectual disability documented in an evaluation). Of children aged 4 years with ASD, 72% had a first evaluation at age ≤36 months. Stratified by census-tract-level median household income (MHI) tertile, a lower percentage of children with ASD and intellectual disability was evaluated by age 36 months in the low MHI tertile (72%) than in the high MHI tertile (84%). Cumulative incidence of ASD diagnosis or eligibility received by age 48 months was 1.5 times as high among children aged 4 years (13.6 per 1,000 children born in 2014) as among those aged 8 years (8.9 per 1,000 children born in 2010). Across MHI tertiles, higher cumulative incidence of ASD diagnosis or eligibility received by age 48 months was associated with lower MHI. Suspected ASD prevalence was 2.6 per 1,000 children aged 4 years, meaning for every six children with ASD, one child had suspected ASD. The combined prevalence of ASD and suspected ASD (19.7 per 1,000 children aged 4 years) was lower than ASD prevalence among children aged 8 years (23.0 per 1,000 children aged 8 years). INTERPRETATION: Groups with historically lower prevalence of ASD (non-White and lower MHI) had higher prevalence and cumulative incidence of ASD among children aged 4 years in 2018, suggesting progress in identification among these groups. However, a lower percentage of children with ASD and intellectual disability in the low MHI tertile were evaluated by age 36 months than in the high MHI group, indicating disparity in timely evaluation. Children aged 4 years had a higher cumulative incidence of diagnosis or eligibility by age 48 months compared with children aged 8 years, indicating improvement in early identification of ASD. The overall prevalence for children aged 4 years was less than children aged 8 years, even when prevalence of children suspected of having ASD by age 4 years is included. This finding suggests that many children identified after age 4 years do not have suspected ASD documented by age 48 months. PUBLIC HEALTH ACTION: Children born in 2014 were more likely to be identified with ASD by age 48 months than children born in 2010, indicating increased early identification. However, ASD identification among children aged 4 years varied by site, suggesting opportunities to examine developmental screening and diagnostic practices that promote earlier identification. Children aged 4 years also were more likely to have co-occurring intellectual disability than children aged 8 years, suggesting that improvement in the early identification and evaluation of developmental concerns outside of cognitive impairments is still needed. Improving early identification of ASD could lead to earlier receipt of evidence-based interventions and potentially improve developmental outcomes. |
Progress and Disparities in Early Identification of Autism Spectrum Disorder: Autism and Developmental Disabilities Monitoring Network, 2002-2016
Shaw KA , McArthur D , Hughes MM , Bakian AV , Lee LC , Pettygrove S , Maenner MJ . J Am Acad Child Adolesc Psychiatry 2021 61 (7) 905-914 OBJECTIVE: Early identification can improve outcomes for children with autism spectrum disorder (ASD). We sought to assess changes in early ASD identification over time and by co-occurring intellectual disability (ID) and race/ethnicity. METHOD: Using data for 2002 through 2016 from a biennial population-based ASD surveillance program among 8-year-old children in the United States, we defined identification as a child's earliest recorded ASD diagnosis or special education eligibility. Unidentified children had characteristics meeting the ASD surveillance case definition but no recorded identification by age 8 years. We calculated median age at identification among identified children, median age at identification including unidentified children, and cumulative incidence of identification by age 48 months. RESULTS: ASD identification by age 48 months was four times (95% CI: 3.6-4.3) as likely in 2016 as 2002, with the largest increases among children without ID. Median age at ASD identification among identified children decreased 3 months during this time. Children of every race/ethnicity were more likely to be identified over time. There were racial disparities stratified by ID: in 2016, Black and Hispanic children without ID were less likely to be identified with ASD than White children (both groups risk ratio: 0.7; 95% CI: 0.5-0.8), but Black children were 1.5 times (95% CI:1.3-1.9) as likely as White children to be identified with ASD and ID. CONCLUSION: Substantial progress has been made to identify more children with ASD early, despite minimal decrease in median age at diagnosis. Considerable disparities remain in early ASD identification by race/ethnicity and co-occurring intellectual disability. |
County-Level COVID-19 Vaccination Coverage and Social Vulnerability - United States, December 14, 2020-March 1, 2021.
Hughes MM , Wang A , Grossman MK , Pun E , Whiteman A , Deng L , Hallisey E , Sharpe JD , Ussery EN , Stokley S , Musial T , Weller DL , Murthy BP , Reynolds L , Gibbs-Scharf L , Harris L , Ritchey MD , Toblin RL . MMWR Morb Mortal Wkly Rep 2021 70 (12) 431-436 The U.S. COVID-19 vaccination program began in December 2020, and ensuring equitable COVID-19 vaccine access remains a national priority.* COVID-19 has disproportionately affected racial/ethnic minority groups and those who are economically and socially disadvantaged (1,2). Thus, achieving not just vaccine equality (i.e., similar allocation of vaccine supply proportional to its population across jurisdictions) but equity (i.e., preferential access and administra-tion to those who have been most affected by COVID-19 disease) is an important goal. The CDC social vulnerability index (SVI) uses 15 indicators grouped into four themes that comprise an overall SVI measure, resulting in 20 metrics, each of which has national and state-specific county rankings. The 20 metric-specific rankings were each divided into lowest to highest tertiles to categorize counties as low, moderate, or high social vulnerability counties. These tertiles were combined with vaccine administration data for 49,264,338 U.S. residents in 49 states and the District of Columbia (DC) who received at least one COVID-19 vaccine dose during December 14, 2020-March 1, 2021. Nationally, for the overall SVI measure, vaccination coverage was higher (15.8%) in low social vulnerability counties than in high social vulnerability counties (13.9%), with the largest coverage disparity in the socioeconomic status theme (2.5 percentage points higher coverage in low than in high vulnerability counties). Wide state variations in equity across SVI metrics were found. Whereas in the majority of states, vaccination coverage was higher in low vulnerability counties, some states had equitable coverage at the county level. CDC, state, and local jurisdictions should continue to monitor vaccination coverage by SVI metrics to focus public health interventions to achieve equitable coverage with COVID-19 vaccine. |
Demographic Characteristics of Persons Vaccinated During the First Month of the COVID-19 Vaccination Program - United States, December 14, 2020-January 14, 2021.
Painter EM , Ussery EN , Patel A , Hughes MM , Zell ER , Moulia DL , Scharf LG , Lynch M , Ritchey MD , Toblin RL , Murthy BP , Harris LQ , Wasley A , Rose DA , Cohn A , Messonnier NE . MMWR Morb Mortal Wkly Rep 2021 70 (5) 174-177 In December 2020, two COVID-19 vaccines (Pfizer-BioNTech and Moderna) were authorized for emergency use in the United States for the prevention of coronavirus disease 2019 (COVID-19).* Because of limited initial vaccine supply, the Advisory Committee on Immunization Practices (ACIP) prioritized vaccination of health care personnel(†) and residents and staff members of long-term care facilities (LTCF) during the first phase of the U.S. COVID-19 vaccination program (1). Both vaccines require 2 doses to complete the series. Data on vaccines administered during December 14, 2020-January 14, 2021, and reported to CDC by January 26, 2021, were analyzed to describe demographic characteristics, including sex, age, and race/ethnicity, of persons who received ≥1 dose of COVID-19 vaccine (i.e., initiated vaccination). During this period, 12,928,749 persons in the United States in 64 jurisdictions and five federal entities(§) initiated COVID-19 vaccination. Data on sex were reported for 97.0%, age for 99.9%, and race/ethnicity for 51.9% of vaccine recipients. Among persons who received the first vaccine dose and had reported demographic data, 63.0% were women, 55.0% were aged ≥50 years, and 60.4% were non-Hispanic White (White). More complete reporting of race and ethnicity data at the provider and jurisdictional levels is critical to ensure rapid detection of and response to potential disparities in COVID-19 vaccination. As the U.S. COVID-19 vaccination program expands, public health officials should ensure that vaccine is administered efficiently and equitably within each successive vaccination priority category, especially among those at highest risk for infection and severe adverse health outcomes, many of whom are non-Hispanic Black (Black), non-Hispanic American Indian/Alaska Native (AI/AN), and Hispanic persons (2,3). |
Update: Characteristics of Health Care Personnel with COVID-19 - United States, February 12-July 16, 2020.
Hughes MM , Groenewold MR , Lessem SE , Xu K , Ussery EN , Wiegand RE , Qin X , Do T , Thomas D , Tsai S , Davidson A , Latash J , Eckel S , Collins J , Ojo M , McHugh L , Li W , Chen J , Chan J , Wortham JM , Reagan-Steiner S , Lee JT , Reddy SC , Kuhar DT , Burrer SL , Stuckey MJ . MMWR Morb Mortal Wkly Rep 2020 69 (38) 1364-1368 As of September 21, 2020, the coronavirus disease 2019 (COVID-19) pandemic had resulted in 6,786,352 cases and 199,024 deaths in the United States.* Health care personnel (HCP) are essential workers at risk for exposure to patients or infectious materials (1). The impact of COVID-19 on U.S. HCP was first described using national case surveillance data in April 2020 (2). Since then, the number of reported HCP with COVID-19 has increased tenfold. This update describes demographic characteristics, underlying medical conditions, hospitalizations, and intensive care unit (ICU) admissions, stratified by vital status, among 100,570 HCP with COVID-19 reported to CDC during February 12-July 16, 2020. HCP occupation type and job setting are newly reported. HCP status was available for 571,708 (22%) of 2,633,585 cases reported to CDC. Most HCP with COVID-19 were female (79%), aged 16-44 years (57%), not hospitalized (92%), and lacked all 10 underlying medical conditions specified on the case report form(†) (56%). Of HCP with COVID-19, 641 died. Compared with nonfatal COVID-19 HCP cases, a higher percentage of fatal cases occurred in males (38% versus 22%), persons aged ≥65 years (44% versus 4%), non-Hispanic Asians (Asians) (20% versus 9%), non-Hispanic Blacks (Blacks) (32% versus 25%), and persons with any of the 10 underlying medical conditions specified on the case report form (92% versus 41%). From a subset of jurisdictions reporting occupation type or job setting for HCP with COVID-19, nurses were the most frequently identified single occupation type (30%), and nursing and residential care facilities were the most common job setting (67%). Ensuring access to personal protective equipment (PPE) and training, and practices such as universal use of face masks at work, wearing masks in the community, and observing social distancing remain critical strategies to protect HCP and those they serve. |
Support for transition from adolescent to adult health care among adolescents with and without mental, behavioral, and developmental disorders - United States, 2016-2017
Leeb RT , Danielson ML , Bitsko RH , Cree RA , Godfred-Cato S , Hughes MM , Powell P , Firchow B , Hart LC , Lebrun-Harris LA . MMWR Morb Mortal Wkly Rep 2020 69 (34) 1156-1160 Clinical guidelines recommend that primary care providers (PCPs) provide guidance and support to ensure a planned transition from pediatric to adult health care for adolescents, beginning at age 12 years (1). However, most adolescents do not receive the recommended health care transition planning (2). This is particularly concerning for adolescents with diagnosed mental, behavioral, and developmental disorders (MBDDs) (3), who account for approximately 20% of U.S. adolescents (4). Childhood MBDDs are linked to increased long-term morbidity and mortality; timely health care transition planning might mitigate adverse outcomes (5,6). CDC analyzed pooled, parent-reported data from the 2016 and 2017 National Survey of Children's Health (NSCH), comparing adolescents, aged 12-17 years, with and without MBDDs on a composite measure and specific indicators of recommended health care transition planning by PCPs. Overall, approximately 15% of adolescents received recommended health care transition planning: 15.8% (95% confidence interval [CI] = 14.1%-17.5%) of adolescents with MBDDs, compared with 14.2% (95% CI = 13.2%-15.3%) of adolescents without MBDDs. Relative to peers without MBDDs and after adjusting for age, adolescents with anxiety were 36% more likely to receive recommended health care transition planning, and those with depression were 69% more likely; adolescents with autism spectrum disorder (ASD) were 35% less likely to receive such transition planning, and those with developmental delay* were 25% less likely. Fewer than 20% of adolescents with MBDDs receiving current treatment met the transition measure. These findings suggest that a minority of adolescents with MBDDs receive recommended transition planning, indicating a potential missed public health opportunity to prevent morbidity and mortality in a population at high risk for health care disengagement (1). Improving access to comprehensive and coordinated programs and services,(†) as well as increasing provider training concerning adolescents' unique mental and physical health care needs (7), could help increase the number of adolescents benefiting from successful health care transitions (4). |
Estimating the incidence of influenza at the state level - Utah, 2016-17 and 2017-18 influenza seasons
Hughes MM , Carmack AE , McCaffrey K , Spencer M , Reed GM , Hill M , Dunn A , Risk I , Garg S , Reed C , Biggerstaff M , Mayer J , Gesteland P , Korgenski K , Dascomb K , Pavia A , Rolfes MA . MMWR Morb Mortal Wkly Rep 2019 68 (50) 1158-1161 The 2017-18 U.S. influenza season was notable for its high severity, with approximately 45 million illnesses and 810,000 influenza-associated hospitalizations throughout the United States (1). The purpose of the investigation reported here was to create a state-level estimate of the number of persons in Utah who became ill with influenza disease during this severe national seasonal influenza epidemic and to create a sustainable system for making timely updates in future influenza seasons. Knowing the extent of influenza-associated illness can help public health officials, policymakers, and clinicians tailor influenza messaging, planning, and responses for seasonal influenza epidemics or during pandemics. Using national methods and existing influenza surveillance and testing data, the influenza burden (number of influenza illnesses, medical visits for influenza, and influenza-associated hospitalizations) in Utah during the 2016-17 and 2017-18 influenza seasons was estimated. During the 2016-17 season, an estimated 265,000 symptomatic illnesses affecting 9% of Utah residents occurred, resulting in 125,000 medically attended illnesses and 2,700 hospitalizations. During the 2017-18 season, an estimated 338,000 symptomatic illnesses affecting 11% of Utah residents occurred, resulting in 160,000 medically attended illnesses and 3,900 hospitalizations. Other state or county health departments could adapt similar methods in their jurisdictions to estimate the burden of influenza locally and support prompt public health activities. |
Update: Characteristics of patients in a national outbreak of e-cigarette, or vaping, product use-associated lung injuries - United States, October 2019
Moritz ED , Zapata LB , Lekiachvili A , Glidden E , Annor FB , Werner AK , Ussery EN , Hughes MM , Kimball A , DeSisto CL , Kenemer B , Shamout M , Garcia MC , Reagan-Steiner S , Petersen EE , Koumans EH , Ritchey MD , King BA , Jones CM , Briss PA , Delaney L , Patel A , Polen KD , Sives K , Meaney-Delman D , Chatham-Stephens K . MMWR Morb Mortal Wkly Rep 2019 68 (43) 985-989 CDC, the Food and Drug Administration, state and local health departments, and other public health and clinical stakeholders are investigating a national outbreak of electronic-cigarette (e-cigarette), or vaping, product use-associated lung injury (EVALI) (1). As of October 22, 2019, 49 states, the District of Columbia (DC), and the U.S. Virgin Islands have reported 1,604 cases of EVALI to CDC, including 34 (2.1%) EVALI-associated deaths in 24 states. Based on data collected as of October 15, 2019, this report updates data on patient characteristics and substances used in e-cigarette, or vaping, products (2) and describes characteristics of EVALI-associated deaths. The median age of EVALI patients who survived was 23 years, and the median age of EVALI patients who died was 45 years. Among 867 (54%) EVALI patients with available data on use of specific e-cigarette, or vaping, products in the 3 months preceding symptom onset, 86% reported any use of tetrahydrocannabinol (THC)-containing products, 64% reported any use of nicotine-containing products, and 52% reported use of both. Exclusive use of THC-containing products was reported by 34% of patients and exclusive use of nicotine-containing products by 11%, and for 2% of patients, no use of either THC- or nicotine-containing products was reported. Among 19 EVALI patients who died and for whom substance use data were available, 84% reported any use of THC-containing products, including 63% who reported exclusive use of THC-containing products; 37% reported any use of nicotine-containing products, including 16% who reported exclusive use of nicotine-containing products. To date, no single compound or ingredient used in e-cigarette, or vaping, products has emerged as the cause of EVALI, and there might be more than one cause. Because most patients reported using THC-containing products before symptom onset, CDC recommends that persons should not use e-cigarette, or vaping, products that contain THC. In addition, because the specific compound or ingredient causing lung injury is not yet known, and while the investigation continues, persons should consider refraining from the use of all e-cigarette, or vaping, products. |
Projected population benefit of increased effectiveness and coverage of influenza vaccination on influenza burden - United States
Hughes MM , Reed C , Flannery B , Garg S , Singleton JA , Fry AM , Rolfes MA . Clin Infect Dis 2019 70 (12) 2496-2502 BACKGROUND: Vaccination is the best way to prevent influenza; however, greater benefit could be achieved. To help guide research and policy agendas, we aimed to quantify the magnitude of influenza disease that would be prevented through targeted increases in vaccine effectiveness (VE) or coverage. METHODS: For three influenza seasons (2011-12, 2015-16, and 2017-18) we used a mathematical model to estimate the number of prevented influenza-associated illnesses, medically-attended illnesses, and hospitalizations across five age groups. Compared with estimates of prevented illness during each season, given observed VE and coverage, we explored the number of additional outcomes that would be prevented from a 5% absolute increase in VE or coverage or achieving 60% VE or 70% coverage. RESULTS: During the 2017-18 season, compared with the burden already prevented by influenza vaccination, a 5% absolute VE increase would prevent an additional 1,050,000 illnesses and 25,000 hospitalizations (76% among those aged >/=65 years) while achieving 60% VE would prevent an additional 190,000 hospitalizations. A 5% coverage increase would result in 785,000 fewer illnesses (56% among those aged 18-64 years) and 11,000 fewer hospitalizations; reaching 70% would prevent an additional 39,000 hospitalizations. CONCLUSIONS: Small, attainable improvements in effectiveness or coverage of influenza vaccine could lead to substantial additional reductions in influenza burden in the U.S. Improvements in VE would have the greatest impact in reducing hospitalizations in adults aged >/=65 years and coverage improvements would have the largest benefit in reducing illnesses in adults aged 18-49 years. |
Effect of acute respiratory illness on short-term frailty status of older adults in Nakhon Phanom, Thailand-June 2015 to June 2016: A prospective matched cohort study
Hughes MM , Praphasiri P , Dawood FS , Sornwong K , Ditsungnoen D , Mott JA , Prasert K . Influenza Other Respir Viruses 2019 13 (4) 391-397 BACKGROUND: Frailty is associated with increased risk of mortality and decline in functional status among older adults. Older adults are at increased risk of severe disease from acute respiratory illness (ARIs), but ARI effects on frailty status among older adults are not well understood. We evaluated how ARIs affect short-term frailty status among community-dwelling adults aged >/=65 years in Nakhon Phanom, Thailand. METHODS: During May 2015 to May 2017, older adults were contacted weekly to identify ARIs as part of a community-based longitudinal cohort study. Each participant's frailty status was assessed at baseline and every 6 months using the Vulnerable Elders Survey-13 (VES-13). We selected cohort participants with an ARI and compared them with a sample of participants without an ARI matched on age, sex, influenza vaccination status, and most recent VES-13 score. For these matched cohort members, an additional VES-13 was recorded at 3-4 weeks after the ARI episode date. RESULTS: Of 3220 cohort study participants, 114 participants with an ARI and 111 comparison participants without an ARI were selected for the matched cohort; three comparison participants were matched to two ARI cases. We found no statistically significant difference between ARI and non-ARI participants in modified VES-13 score 3-4 weeks post-episode (cases = 0.90, controls = 0.63, P = 0.07). Only two ARI episodes required hospitalization. CONCLUSIONS: Primarily mild ARIs did not affect short-term frailty status among community-dwelling older adults in Thailand. As few cases of severe ARI were detected, the contribution of severe ARI to changes in frailty requires further investigation. |
Notes from the field: Assessment of state-level influenza season severity - Minnesota and Utah, 2017-18 influenza season
Hughes MM , Doyle JD , McCaffrey K , McMahon M , Spencer M , Martin K , Reed GM , Carmack AE , Garg S , Rolfes M , Reed C , Biggerstaff M . MMWR Morb Mortal Wkly Rep 2019 68 (6) 165-166 The U.S. 2017–18 influenza season was a high-severity season, with the highest number of outpatient visits for influenza-like illness* (ILI) since the 2009–10 pandemic and the highest rate of influenza-associated hospitalizations since surveillance expanded to include adult hospitalizations during the 2005–06 season (1). The severe season was characterized by reports of strained emergency departments and hospitals and spot shortages of influenza antiviral medications (2). Influenza activity can vary widely across geographic regions (3), and local severity assessments might better guide public health actions and health care needs and support the development of tailored communication messages to prevent influenza morbidity and mortality. CDC assesses influenza season severity at the national level (4),† but the applicability of this approach at state or local levels has not been tested. |
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