Last data update: Jan 27, 2025. (Total: 48650 publications since 2009)
Records 1-30 (of 42 Records) |
Query Trace: Millman AJ[original query] |
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The burden of all-cause mortality following influenza-associated hospitalizations, FluSurv-NET, 2010-2019
O'Halloran AC , Millman AJ , Holstein R , Olsen SJ , Cummings C , Chai SJ , Kirley PD , Alden NB , Yousey-Hindes K , Meek J , Openo KP , Fawcett E , Ryan PA , Leegwater L , Henderson J , McMahon M , Lynfield R , Angeles KM , Bleecker M , McGuire S , Spina NL , Tesini BL , Gaitan MA , Lung K , Shiltz E , Thomas A , Talbott HK , Schaffner W , Hill M , Reed C , Garg S . Clin Infect Dis 2024 BACKGROUND: While the estimated number of U.S. influenza-associated deaths is reported annually, detailed data on the epidemiology of influenza-associated deaths, including the burden of in-hospital versus post-hospital discharge deaths are limited. METHODS: Using data from the 2010-11 through 2018-19 seasons from the Influenza Hospitalization Surveillance Network, we linked cases to death certificates to identify patients who died from any cause during their influenza hospital stay or within 30 days post discharge. We described demographic and clinical characteristics of patients who died in hospital versus post discharge and characterized locations and causes of death (COD). RESULTS: Among 121,390 cases hospitalized with laboratory-confirmed influenza over 9 seasons, 5.5% died; 76% of deaths were in patients ≥65 years, 71% were non-Hispanic White, and 34% had ≥4 underlying medical conditions. Among all patients with an influenza-associated hospitalization who died, 48% of deaths occurred after hospital discharge; the median days from discharge to death was 9 days (IQR 3-19 days). Post-discharge deaths more often occurred in older patients and among those with underlying medical conditions. Only 37% of patients who died had "influenza" as a COD on their death certificate. Influenza was more frequently listed as a COD among persons who died in-hospital compared with cardiovascular disease among those who died after discharge. CONCLUSIONS: All-cause mortality burden is substantial among patients hospitalized with influenza, with almost 50% of deaths occurring within 30 days after hospital discharge. Surveillance systems should consider capture of post-discharge outcomes to better characterize the impact of influenza on all-cause mortality. |
Assessing interventions to encourage primary care health workers to recommend influenza vaccination and the impact on vaccination uptake for persons with Non-Communicable diseases in China
Fan J , Song Y , Cong S , Millman AJ , Wang N , Greene C , Zhang R , Zhou S , Fang L . Vaccine 2024 BACKGROUND: Influenza vaccination coverage is low among persons with non-communicable diseases (NCDs) in China. Chinese health workers (HWs) do not routinely recommend influenza vaccination despite evidence that recommendations increase vaccine uptake. This study aims to assess whether interventions increased primary care HWs' recommendation for influenza vaccination and measure their impact on influenza vaccine uptake in persons with NCDs. METHODS: We conducted a cluster randomized controlled study in public primary healthcare clinics in Hubei from November 2018 through April 2019. In the intervention clinics, primary care HWs received training on the benefits of influenza vaccination and were asked to recommend influenza vaccine in routine primary healthcare for persons with NCDs. In the control clinics, primary care HWs did not receive training and provided standard services. We conducted questionnaire surveys before and after the intervention to collect information about recommendations made and receipt of influenza vaccines. RESULTS: A total of 896 primary care HWs and 4552 persons with NCDs were included. After intervention, a higher percentage of HWs recommended influenza vaccines in intervention clinics compared to control clinics. Vaccinated primary care HWs were more likely to recommend vaccination. Persons with NCDs reported higher influenza vaccination coverage in intervention than control clinics, and primary care HWs' recommendation increased vaccination uptake among persons with NCDs. CONCLUSIONS: Vaccinated primary care HWs were more likely to recommend influenza vaccination than unvaccinated HWs. Promoting primary care HWs' vaccination and encouraging them to recommend influenza vaccination during routine primary healthcare could increase influenza vaccine receipt among persons with NCDs. Registration number ChiCTR2200067140. |
Use of Public Data to Describe COVID-19 Contact Tracing in China during January 20–February 29, 2020 (preprint)
Dirlikov E , Zhou S , Han L , Li Z , Hao L , Millman AJ , Marston B . medRxiv 2020 2020.12.04.20243972 Objective Although contact tracing is generally not used to control influenza pandemics, China and several countries in the Western Pacific Region employed contact tracing as part of COVID-19 response activities. To improve understanding on the use of contact tracing for COVID-19 emergency public health response activities, we describe reported COVID-19 contacts traced and quarantined in China and a proxy for number of reported contacts traced per reported case.Methods We abstracted publicly available online aggregate data reported from China’s National Health Commission and provincial health commissions’ COVID-19 daily situational reports for January 20–February 29, 2020. The number of new contacts traced by report date was computed as the difference between total contacts traced on consecutive reports. A proxy for the number of contacts traced per case was computed as the number of new contacts traced divided by the number of new cases.Results During January 20–February 29, 2020, China reported 80,968 new COVID-19 cases (Hubei Province = 67,608 [83%]), and 659,899 contacts traced (Hubei Province = 265,617 [40%]). Non-Hubei provinces reported more contacts traced per case than Hubei Province; this difference increased over time.Discussion Along with other NPI used in China, contact tracing likely contributed to reducing SARS-CoV-2 transmission by quarantining a large number of potentially infected contacts. Despite reporting only 15% of total cases, non-Hubei provinces had 1.5 times more reported contacts traced compared to Hubei Province. Contract tracing may have been more complete in areas and periods with lower case counts.Competing Interest StatementThe authors have declared no competing interest.Funding StatementData collection and analysis were conducted as part of COVID-19 emergency response. No external funds were used.Author DeclarationsI confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.YesThe details of the IRB/oversight body that provided approval or exemption for the research described are given below:This activity was reviewed by CDC and was determined to be non-research, public health emergency response, consistent with applicable U.S. federal law and CDC policy.All necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived.YesI understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).YesI have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable.YesData were compiled from Provincial-Level Health Commission Websites Containing Publicly Available Reported Data on COVID-19 National Health Commission http://weekly.chinacdc.cn/news/TrackingtheEpidemic.htm Anhui http://wjw.ah.gov.cn/ Beijing http://wjw.beijing.gov.cn/xwzx_20031/xwfb/ Chongqing http://wsjkw.cq.gov.cn/ Fujian http://wjw.fujian.gov.cn/ Gansu http://wsjk.gansu.gov.cn/ Guangdong http://wsjkw.gd.gov.cn/zwyw_yqxx/index.html Guangxi http://wsjkw.gxzf.gov.cn/gzdt/bt/ Guizhou http://www.gzhfpc.gov.cn/ Hainan http://wst.hainan.gov.cn/swjw/index.html Hebei http://wsjkw.hebei.gov.cn/ Heilongjiang http://wsjkw.hlj.gov.cn/ Henan http://www.hnwsjsw.gov.cn/ Hubei http://wjw.hubei.gov.cn/fbjd/dtyw/ Hunan http://wjw.hunan.gov.cn/ Inner Mongolia http://wjw.nmg.gov.cn/ Jiangsu http://wjw.jiangsu.gov.cn/ Jiangxi http://hc.jiangxi.gov.cn/ Jilin http://wsjkw.jl.gov.cn/ Liaoning http://wsjk.ln.gov.cn/ Ningxia http://wsjkw.nx.gov.cn/ Qinghai https://wsjkw.qinghai.gov.cn/ Shaanxi http://sx jw.shaanxi.gov.cn/ Shandong http://wsjkw.shandong.gov.cn Shanghai http://wsjkw.sh.gov.cn/xwfb/index.html Shanxi http://wjw.shanxi.gov.cn/ Sichuan http://wsjkw.sc.gov.cn/scwsjkw/szyw/tygl.shtml Tianjin http://wsjs.tj.gov.cn/ Tibet http://wjw.xizang.gov.cn Xinjiang http://xjhfpc.gov.cn Yunnan http://ynswsjkw.yn.gov.cn/wjwWebsite/web/index Zhejiang http://www.zjwjw.gov.cn/col/col1202101/index.html |
Enhanced environmental surveillance for avian influenza A/H5, H7 and H9 viruses in Guangxi, China, 2017–2019
Chen T , Tan Y , Song Y , Wei G , Li Z , Wang X , Yang J , Millman AJ , Chen M , Liu D , Huang T , Jiao M , He W , Zhao X , Greene CM , Kile JC , Zhou S , Zhang R , Zeng X , Guo Q , Wang D . Biosaf Health 2023 5 (1) 30-36 We conducted environmental surveillance to detect avian influenza viruses circulating at live poultry markets (LPMs) and poultry farms in Guangxi Autonomous Region, China, where near the China-Vietnam border. From November through April 2017–2018 and 2018–2019, we collected environmental samples from 14 LPMs, 4 poultry farm, and 5 households with backyard poultry in two counties of Guangxi and tested for avian influenza A, H5, H7, and H9 by real-time reverse transcription-polymerase chain reaction (rRT-PCR). In addition, we conducted four cross-sectional questionnaire surveys among stall owners on biosecurity practices in LPMs of two study sites. Among 16,713 environmental specimens collected and tested, the median weekly positive rate for avian influenza A was 53.6% (range = 33.5% − 66.0%), including 25.2% for H9, 4.9% for H5, and 21.2% for other avian influenza viruses A subtypes, whereas a total of two H7 positive samples were detected. Among the 189 LPM stalls investigated, most stall owners (73.0%) sold chickens and ducks. Therefore, continued surveillance of the avian influenza virus is necessary for detecting and responding to emerging trends in avian influenza virus epidemiology. © 2023 |
Enhanced environmental surveillance for avian influenza A/H5, H7 and H9 viruses in Guangxi, China, 20172019
Chen T , Tan Y , Song Y , Wei G , Li Z , Wang X , Yang J , Millman AJ , Chen M , Liu D , Huang T , Jiao M , He W , Zhao X , Greene CM , Kile JC , Zhou S , Zhang R , Zeng X , Guo Q , Wang D . Biosaf Health 2023 We conducted environmental surveillance to detect avian influenza viruses circulating at live poultry markets (LPMs) and poultry farms in Guangxi Autonomous Region, China, where near the China-Vietnam border. From November through April 20172018 and 20182019, we collected environmental samples from 14 LPMs, 4 poultry farm, and 5 households with backyard poultry in two counties of Guangxi and tested for avian influenza A, H5, H7, and H9 by real-time reverse transcription-polymerase chain reaction (rRT-PCR). In addition, we conducted four cross-sectional questionnaire surveys among stall owners on biosecurity practices in LPMs of two study sites. Among 16,713 environmental specimens collected and tested, the median weekly positive rate for avian influenza A was 53.6% (range = 33.5% 66.0%), including 25.2% for H9, 4.9% for H5, and 21.2% for other avian influenza viruses A subtypes, whereas a total of two H7 positive samples were detected. Among the 189 LPM stalls investigated, most stall owners (73.0%) sold chickens and ducks. Therefore, continued surveillance of the avian influenza virus is necessary for detecting and responding to emerging trends in avian influenza virus epidemiology. 2023 |
Mild and asymptomatic influenza B virus infection among unvaccinated pregnant persons: Implication for effectiveness of non-pharmaceutical intervention and vaccination to prevent influenza
Chen L , Levine MZ , Zhou S , Bai T , Pang Y , Bao L , Tan Y , Cui P , Zhang R , Millman AJ , Greene CM , Zhang Z , Wang Y , Zhang J . Vaccine 2023 41 (3) 694-701 BACKGROUND: We estimated symptomatic and asymptomatic influenza infection frequency in community-dwelling unvaccinated pregnant persons to inform risk communication. METHODS: We collected residue sera from multiple antenatal-care blood draws during October 2016-April 2017. We determined influenza infection as seroconversion with ≥ 4-fold rise in antibody titers between any two serum samples by improved hemagglutinin-inhibition assay including ether-treated B antigens. The serology data were linked to the results of nuclei acid testing (rRT-PCR) based on acute respiratory illness (ARI) surveillance. RESULTS: Among all participants, 43 %(602/1384) demonstrated serology and/or rRT-PCR evidenced infection, and 44 %(265/602) of all infections were asymptomatic. ARI-associated rRT-PCR testing identified only 10 %(61/602) of total infections. Only 1 %(5/420) of the B Victoria cases reported ARI and had a rRT-PCR positive result, compared with 33 %(54/165) of the H3N2 cases. Among influenza ARI cases with multiple serum samples, 19 %(11/58) had seroconversion to a different subtype prior to the illness. CONCLUSIONS: The incidence of influenza B infection in unvaccinated pregnant persons is under-estimated substantially. Non-pharmaceutical intervention may have suboptimal effectiveness in preventing influenza B transmission due to the less clinical manifestation compared to influenza A. The findings support maternal influenza vaccination to protect pregnant persons and reduce consequent household transmission. |
A health equity approach for implementation of JYNNEOS vaccination at large, community-based LGBTQIA+ events - Georgia, August 27-September 5, 2022
Millman AJ , Denson DJ , Allen ML , Malone JA , Daskalakis DC , Durrence D , Rustin RC , Toomey KE . MMWR Morb Mortal Wkly Rep 2022 71 (43) 1382-1883 Gay, bisexual, and other men who have sex with men (MSM) have been disproportionately affected during the 2022 U.S. monkeypox outbreak, with Black or African American (Black) MSM being the most affected demographic group (1). As of September 28, 2022, Georgia had reported 1,784 monkeypox cases; 98% of which occurred in males and 77% among Black persons (2). As of September 13, 2022, 60% of reported cases were among persons with HIV infection, and 50% of persons with monkeypox had a sexually transmitted infection within the past year (3). Because of racial disparities in the incidence of monkeypox cases and a large proportion of cases among MSM in Georgia, early vaccination beginning in July focused on improving equitable access by establishing new and leveraging existing partnerships with community-based organizations that serve affected populations, including persons with HIV infection. Despite these efforts, disparities persisted because of high demand and limited vaccine supply. The Georgia Department of Public Health (DPH) requested CDC support for a vaccine pilot and received an additional allocation of 5,500 doses of JYNNEOS vaccine for administration at events leading up to and throughout a Black gay Pride festival in Atlanta, a multiday event held Labor Day weekend (September 2-5, 2022). The event celebrates lesbian, gay, bisexual, transgender, queer or questioning, intersex, asexual, and other (LGBTQIA+) communities of color and hosts more than 125,000 attendees each year. Before the festival (as of August 24), 17,546 persons had been vaccinated in Georgia, of whom 96% were male, 34% aged 25-36 years, 44% Black, and 8% Hispanic or Latino (Hispanic) (4). |
Use of public data to describe COVID-19 contact tracing in Hubei Province and non-Hubei provinces in China between 20 January and 29 February 2020.
Dirlikov E , Zhou S , Han L , Li Z , Hao L , Millman AJ , Marston B . Western Pac Surveill Response J 2021 12 (3) 82-87 OBJECTIVE: Contact tracing has been used in China and several other countries in the WHO Western Pacific Region as part of the COVID-19 response. We describe COVID-19 cases and the number of contacts traced and quarantined per case as part of COVID-19 emergency public health response activities in China. METHODS: We abstracted publicly available, online aggregated data published in daily COVID-19 situational reports by China's National Health Commission and provincial health commissions between 20 January and 29 February 2020. The number of new contacts traced by report date was computed as the difference between total contacts traced in consecutive reports. A proxy for the number of contacts traced per case was computed as the number of new contacts traced divided by the number of new cases. RESULTS: During the study period, China reported 80 968 new COVID-19 cases and 659 899 contacts. In Hubei Province, there were 67 608 cases and 264 878 contacts, representing 83% and 40% of the total, respectively. Non-Hubei provinces reported tracing 1.5 times more contacts than Hubei Province; the weekly number of contacts traced per case was also higher in non-Hubei provinces than in Hubei Province and increased from 17.2 in epidemiological week 4 to 115.7 in epidemiological week 9. DISCUSSION: More contacts per case were reported from areas and periods with lower COVID-19 case counts. With other non-pharmaceutical interventions used in China, contact tracing and quarantining large numbers of potentially infected contacts probably contributed to reducing SARS-CoV-2 transmission. |
Incidence rates of influenza illness during pregnancy in Suzhou, China, 2015-2018
Chen L , Zhou S , Bao L , Millman AJ , Zhang Z , Wang Y , Tan Y , Song Y , Cui P , Pang Y , Liu C , Qin J , Zhang P , Thompson MG , Iuliano AD , Zhang R , Greene CM , Zhang J . Influenza Other Respir Viruses 2021 16 (1) 14-23 BACKGROUND: Data on influenza incidence during pregnancy in China are limited. METHODS: From October 2015 to September 2018, we conducted active surveillance for acute respiratory illness (ARI) among women during pregnancy. Nurses conducted twice weekly phone and text message follow-up upon enrollment until delivery to identify new episodes of ARI. Nasal and throat swabs were collected ≤10 days from illness onset to detect influenza. RESULTS: In total, we enrolled 18 724 pregnant women median aged 28 years old, 37% in first trimester, 48% in second trimester, and 15% in third trimester, with seven self-reported influenza vaccination during pregnancy. In the 18-week epidemic period during October 2015 to September 2016, influenza incidence was 0.7/100 person-months (95% CI: 0.5-0.9). In the cumulative 29-week-long epidemic during October 2016 to September 2017, influenza incidence was 1.0/100 person-months (95% CI: 0.8-1.2). In the 11-week epidemic period during October 2017 to September 2018, influenza incidence was 2.1/100 person-months (95% CI: 1.9-2.4). Influenza incidence was similar by trimester. More than half of the total influenza illnesses had no elevated temperature and cough. Most influenza-associated ARIs were mild, and <5.1% required hospitalization. CONCLUSIONS: Influenza illness in all trimesters of pregnancy was common. These data may help inform decisions regarding the use of influenza vaccine to prevent influenza during pregnancy. |
HepCCATT: a multilevel intervention for hepatitis C among vulnerable populations in Chicago
Tilmon S , Aronsohn A , Boodram B , Canary L , Goel S , Hamlish T , Kemble S , Lauderdale DS , Layden J , Lee K , Millman AJ , Nelson N , Ritger K , Rodriguez I , Shurupova N , Wolf J , Johnson D . J Public Health (Oxf) 2021 44 (4) 891-899 BACKGROUND: Hepatitis C infection could be eliminated. Underdiagnosis and lack of treatment are the barriers to cure, especially for vulnerable populations (i.e. unable to pay for health care). METHODS: A multilevel intervention from September 2014 to September 2019 focused on the providers and organizations in 'the safety net' (providing health care to populations unable to pay), including: (i) public education, (ii) training for primary care providers (PCPs) and case managers, (iii) case management for high-risk populations, (iv) policy advice and (v) a registry (Registry) for 13 health centers contributing data. The project tracked the number of PCPs trained and, among Registry sites, the number of people screened, engaged in care (i.e. clinical follow-up after diagnosis), treated and/or cured. RESULTS: In Chicago, 215 prescribing PCPs and 56 other health professionals, 86% of whom work in the safety net, were trained to manage hepatitis C. Among Registry sites, there was a 137% increase in antibody screening and a 32% increase in current hepatitis C diagnoses. Engagement in care rose by 18%. CONCLUSIONS: Hepatitis C Community Alliance to Test and Treat (HepCCATT) successfully targeted safety net providers and organizations with a comprehensive care approach. While there were challenges, HepCCATT observed increased hepatitis C screening, diagnosis and engagement in care in the Chicago community. |
Economic burden of influenza illness among children under 5years in Suzhou, China: Report from the cost surveys during 2011/12 to 2016/17 influenza seasons
Biggerstaff M , Situ S , Zhou S , Millman AJ . Vaccine 2021 39 (8) 1303-1309 BACKGROUND: Data are limited on the economic burden of seasonal influenza in China. We estimated the cost due to influenza illness among children < 5-year-old in Suzhou, China. METHODS: This study adopted a societal perspective to estimate direct medical cost, direct non-medical cost, and indirect cost related to lost productivity. Data to calculate costs and rates of three influenza illness outcomes (non-medically attended, outpatient and hospitalization) were collected from prospective community-based cohort studies and hospital-based enhanced laboratory-confirmed influenza surveillance in Suzhou during the 2011/12 to 2016/17 influenza seasons. We used mean cost-per-episode, annual incidence rates of episodes of each outcome, and annual population size to estimate the total annual economic burden of influenza illnesses among children < 5-year-old for Suzhou. All costs were reported in 2017 U.S. dollars. RESULTS: The mean cost-per-episode (standard deviation) was $9.92 (13.26) for non-medically attended influenza, $161.05 (176.98) for influenza outpatient illnesses, and $1425.95 (603.59) for influenza hospitalizations. By applying the annual incidence rates to the population size, we estimated an annual total of 4,919 episodes of non-medically attended influenza, 21,994 influenza outpatient, and 2,633 influenza hospitalization. Total annual economic burden of influenza to society among children < 5-year-old in Suzhou was $7.37 (95% confidence interval, 6.9-7.8) million, with estimated costs for non-medically attended influenza of $49,000 (46,000-52,000), influenza outpatients $3.5 (3.3-3.8) million, and influenza hospitalizations $3.8 (3.6-3.9) million. Among outpatients, the indirect cost was 36.3% ($1.3 million) of total economic burden, accounting for 21,994 days of lost productivity annually. Among inpatients, the indirect cost was 22.1% ($829,000), accounting for 18,431 days of lost productivity annually. CONCLUSIONS: Our findings show that influenza in children < 5-year-oldcauses substantial societal economic burden in Suzhou, China. Assessing the potential economic benefit of increasing influenza vaccination coverage in this population is warranted. |
Overview and Lessons Learned for Increasing Influenza Vaccination Coverage Among Healthcare Workers in the United States
Song Y , Millman AJ . China CDC Wkly 2020 2 (44) 862-866 Vaccinating healthcare workers (HCWs) annually against influenza is a key strategy for protecting HCWs, preventing nosocomial outbreaks and mortality (particularly among high-risk patient populations), and reducing work absenteeism during the influenza season (1-4). Vaccinated HCWs have also been shown to be more likely to recommend influenza vaccination to their patients (5-7). | | US CDC’s official position has been recommending annual influenza vaccination to HCWs with direct patient contact since 1984 and for all HCWs since 1993 (8-10). In 2006, the CDC’s recommendation for influenza vaccination defined HCW to include physicians, nurses, nursing assistants, therapists, technicians, emergency medical service personnel, dental personnel, pharmacists, laboratory personnel, autopsy personnel, students and trainees, contractual staff not employed by the health-care facility, and persons (e.g., clerical, dietary, housekeeping, maintenance, and volunteers) not directly involved in patient care but potentially exposed to infectious agents (1). Since then, influenza vaccination coverage among HCWs in the United States increased from 10.0% in the 1987–1989 influenza season to 81.1% in the 2018–2019 influenza season, largely as a result of state and local government, professional society, and healthcare institutional policy and programmatic efforts to increase vaccination in this population (11-19). Although influenza vaccination coverage among HCWs has improved substantially, differing implementation strategies have been needed to increase influenza vaccination in this population. This paper aims to describe the evolution of influenza vaccination policies for HCWs in the United States and to discuss lessons learned for increasing influenza coverage. |
A population-based intervention to improve care cascades of patients with hepatitis C virus infection
Scott J , Fagalde M , Baer A , Glick S , Barash E , Armstrong H , Kowdley KV , Golden MR , Millman AJ , Nelson NP , Canary L , Messerschmidt M , Patel P , Ninburg M , Duchin J . Hepatol Commun 2020 5 (3) 387-399 Hepatitis C virus (HCV) infection is common in the United States and leads to significant morbidity, mortality, and economic costs. Simplified screening recommendations and highly effective direct-acting antivirals for HCV present an opportunity to eliminate HCV. The objective of this study was to increase testing, linkage to care, treatment, and cure of HCV. This was an observational, prospective, population-based intervention program carried out between September 2014 and September 2018 and performed in three community health centers, three large multiclinic health care systems, and an HCV patient education and advocacy group in King County, WA. There were 232,214 patients included based on criteria of documented HCV-related diagnosis code, positive HCV laboratory test or prescription of HCV medication, and seen at least once at a participating clinical site in the prior year. Electronic health record (EHR) prompts and reports were created. Case management linked patients to care. Primary care providers received training through classroom didactics, an online curriculum, specialty clinic shadowing, and a telemedicine program. The proportion of baby boomer patients with documentation of HCV testing increased from 18% to 54% during the project period. Of 77,577 baby boomer patients screened at 87 partner clinics, 2,401 (3%) were newly identified HCV antibody positive. The number of patients staged for treatment increased by 391%, and those treated increased by 1,263%. Among the 79% of patients tested after treatment, 95% achieved sustained virologic response. Conclusion(s): A combination of EHR-based health care system interventions, active linkage to care, and clinician training contributed to a tripling in the number of patients screened and a more than 10-fold increase of those treated. The interventions are scalable and foundational to the goal of HCV elimination. |
Estimated influenza illnesses and hospitalizations averted by influenza vaccination among children aged 6-59months in Suzhou, China, 2011/12 to 2015/16 influenza seasons
Zhang W , Gao J , Chen L , Tian J , Biggerstaff M , Zhou S , Situ S , Wang Y , Zhang J , Millman AJ , Greene CM , Zhang T , Zhao G . Vaccine 2020 38 (51) 8200-8205 ![]() BACKGROUND: There are few estimates of vaccination-averted influenza-associated illnesses in China. METHODS: We used a mathematical model and Monte Carlo algorithm to estimate numbers and 95% confidence intervals (CI) of influenza-associated outcomes (hospitalization, illness, and medically-attended (MA) illness) averted by vaccination among children aged 6-59 months in Suzhou from October 2011-September 2016. Influenza illnesses included non-hospitalized MA influenza illnesses and non-MA influenza illnesses. The numbers of influenza-associated outcomes averted by vaccination were the difference between the expected burden if there were no vaccination given and the observed burden with vaccination. The model incorporated the disease burden estimated based on surveillance data from Suzhou University Affiliated Children's Hospital (SCH) and data from health utilization surveys conducted in the catchment area of SCH, age-specific estimates of influenza vaccination coverage in Suzhou from the Expanded Program on Immunization database, and influenza vaccine effectiveness estimates from previous publications. Averted influenza estimations were presented as absolute numbers and in terms of the prevented fraction (PF). A hypothetical scenario with 50% coverage (but identical vaccine effectiveness) over the study period was also modeled. RESULTS: In ~250,000 children, influenza vaccination prevented an estimated 731 (CI: 549-960) influenza hospitalizations (PF: 6.2% of expected, CI: 5.8-6.6%) and 10,024 (7593-12,937) influenza illnesses (PF: 6.5%, 6.4-6.7%), of which 8342 (6338-10,768) were MA (PF: 6.6%, 6.4-6.7%) from 2011 to 2016. The PFs declined each year along with decreasing influenza vaccination coverage. If 50% of the study population had been vaccinated over time, the estimated numbers of averted cases during the study period would have been 4059 (3120-5762) influenza hospitalizations (PF: 27.2%, 26.4-27.9%) and 56,215 (42,925-78,849) influenza illnesses (PF: 28.5%, 28.3-28.7%), of which 46,596 (35,662-65,234) would be MA (PF: 28.5%, 28.3-28.7%). CONCLUSION: Influenza vaccination is estimated to have averted influenza-associated illness outcomes even with low coverage in children aged 6-59 months in Suzhou. Increasing influenza vaccination coverage in this population could further reduce illnesses and hospitalizations. |
Using a hepatitis B surveillance system evaluation in Fujian, Hainan, and Gansu provinces to improve data quality and assess program effectiveness, China, 2015
Zheng H , Millman AJ , Rainey JJ , Wang F , Zhang R , Chen H , Yin Z , Wang H , Zhang G . BMC Infect Dis 2020 20 (1) 547 BACKGROUND: Monitoring hepatitis B surveillance data is important for evaluating progress towards global hepatitis B elimination goals. Accurate classification of acute and chronic hepatitis infections is essential for assessing program effectiveness. METHODS: We evaluated hepatitis B case-reporting at six hospitals in Fujian, Hainan and Gansu provinces in 2015 to assess the accuracy of case classification. We linked National Notifiable Disease Reporting System (NNDRS) HBV case-reports with hospital information systems and extracted information on age, gender, admission ward and viral hepatitis diagnosis from medical records. To assess accuracy, we compared NNDRS reported case-classifications with the national HBV case definitions. Multivariable logistic regression was used to identify factors associated with misclassification. RESULTS: Of the 1420 HBV cases reported to NNDRS, 23 (6.5%) of the 352 acute reports and 648 (60.7%) of the 1068 chronic reports were correctly classified. Of the remaining, 318 (22.4%) were misclassified and 431 (30.4%) could not be classified due to the lack of supporting information. Based on the multivariable analysis, HBV cases reported from Hainan (aOR = 1.8; 95% CI: 1.3-2.4) and Gansu (aOR = 12.7; 95% CI: 7.7-20.1) along with reports from grade 2 hospitals (aOR = 1.6; 95% CI:1.2-2.2) and those from non-HBV related departments (aOR = 5.3; 95% CI: 4.1-7.0) were independently associated with being 'misclassified' in NNDRS. CONCLUSIONS: We identified discrepancies in the accuracy of HBV case-reporting in the project hospitals. Onsite training on the use of anti-HBc IgM testing as well as on HBV case definitions and reporting procedures are needed to accurately assess program effectiveness and ensure case-patients are referred to appropriate treatment and care. Routine surveillance evaluations such as this can be useful for improving data quality and monitoring program effectiveness. |
Sharing the cure: Building primary care and public health infrastructure to improve the hepatitis C care continuum in Maryland
Irvin R , Ntiri-Reid B , Kleinman M , Agee T , Hitt J , Anaedozie O , Arowolo T , Cassidy-Stewart H , Bush C , Wilson LE , Millman AJ , Nelson NP , Canary L , Brinkley S , Moon J , Falade-Nwulia O , Sulkowski MS , Thomas DL , Melia MT . J Viral Hepat 2020 27 (12) 1388-1395 In 2014, trained health care provider capacity was insufficient to deliver care to an estimated 70,000 persons in Maryland with chronic hepatitis C virus (HCV) infection. The goal of Maryland Community Based Programs to Test and Cure Hepatitis C, a public health implementation project, was to improve HCV treatment access by expanding the workforce. Sharing the Cure (STC) was a package of services deployed 10/1/14 to 9/30/18 that included enhanced information technology and public health infrastructure, primary care provider training, and practice transformation. Nine primary care sites enrolled. HCV clinical outcomes were documented among individuals who presented for care at sites and met criteria for HCV testing including risk factor or birth cohort (born between 1945 and 1965) based testing. Fifty-three providers completed the STC training. STC providers identified 3,237 HCV antibody positive patients of which 2,624 (81%) were RNA+. Of those HCV RNA+, 1,739 (66%) were staged, 932 (36%) were prescribed treatment, 838 (32%) started treatment, 721 (28%) completed treatment, and 543 (21%) achieved cure. Among 1,739 patients staged, 693 (40%) patients had a liver fibrosis assessment score < F2, rendering them ineligible for treatment under Maryland Medicaid guidelines. HCV RNA testing among HCV antibody positive people increased from 40% (baseline) to 95% amongst STC providers. Of 554 patients with virologic data reported, 543 (98%) achieved cure. Primary care practices can effectively serve as HCV treatment centers to expand treatment access. However, criteria by insurance providers in Maryland was a major barrier to treatment. |
Screening and linkage to care for hepatitis C among inpatients in Georgia's national hospital screening program
Shadaker S , Nasrullah M , Gamkrelidze A , Ray J , Gvinjilia L , Kuchuloria T , Butsashvili M , Getia V , Metreveli D , Tsereteli M , Tsertsvadze T , Link-Gelles R , Millman AJ , Turdziladze A , Averhoff F . Prev Med 2020 138 106153 The country of Georgia initiated an ambitious national hepatitis C elimination program. To facilitate elimination, a national hospital hepatitis C screening program was launched in November 2016, offering all inpatients screening for HCV infection. This analysis assesses the effectiveness of the first year of the screening program to identify HCV-infected persons and link them to care. Data from Georgia's electronic Health Management Information System and ELIMINATION-C treatment database were analyzed for patients aged >/=18 years hospitalized from November 1, 2016 to October 31, 2017. We described patient characteristics and screening results and compared linked-to-care patients to those not linked to care, defined as having a test for viremia following an HCV antibody (anti-HCV) positive hospital screening. Of 291,975 adult inpatients, 252,848 (86.6%) were screened. Of them, 4.9% tested positive, with a high of 17.4% among males aged 40-49. Overall, 19.8% of anti-HCV+ patients were linked to care, which differed by sex (20.6% for males vs. 18.4% for females; p = .019), age (23.9% for age 50-59 years vs. 10.7% for age >/= 70 years; p < .0001), and length of hospitalization (21.8% among patients hospitalized for 1 day vs. 16.1% for those hospitalized 11+ days; p = .023). Redundant screening is a challenge; 15.6% of patients were screened multiple times and 27.6% of anti-HCV+ patients had a prior viremia test. This evaluation demonstrates that hospital-based screening programs can identify large numbers of anti-HCV+ persons, supporting hepatitis C elimination. However, low linkage-to-care rates underscore the need for screening programs to be coupled with effective linkage strategies. |
Case management and capacity building to enhance hepatitis C treatment uptake at community health centers in a large urban setting
Boodram B , Kaufmann M , Aronsohn A , Hamlish T , Peregrine Antalis E , Kim K , Wolf J , Rodriguez I , Millman AJ , Johnson D . Fam Community Health 2020 43 (2) 150-160 An estimated 4.1 million people in the United States are infected with hepatitis C virus (HCV). In 2014, the Hepatitis C Community Alliance to Test and Treat (HepCCATT) collaborative was formed to address hepatitis C in Chicago. From 2014 to 2017, the HepCCATT Case Management Program case managed 181 HCV-infected people and performed on-site capacity building at a 6-site community health center (CHC) that produced codified protocols, which were translated into a telehealth program to build capacity within CHCs to deliver hepatitis C care. HepCCATT's innovative approach to addressing multilevel barriers is a potential model for increasing access to hepatitis C care and treatment. |
Design of an enhanced public health surveillance system for hepatitis C virus elimination in King County, Washington
Baer A , Fagalde MS , Drake CD , Sohlberg EH , Barash E , Glick S , Millman AJ , Duchin JS . Public Health Rep 2020 135 (1) 33-39 INTRODUCTION: With the goal of eliminating hepatitis C virus (HCV) as a public health problem in Washington State, Public Health-Seattle & King County (PHSKC) designed a Hepatitis C Virus Test and Cure (HCV-TAC) data system to integrate surveillance, clinical, and laboratory data into a comprehensive database. The intent of the system was to promote identification, treatment, and cure of HCV-infected persons (ie, HCV care cascade) using a population health approach. MATERIALS AND METHODS: The data system automatically integrated case reports received via telephone and fax from health care providers and laboratories, hepatitis test results reported via electronic laboratory reporting, and data on laboratory and clinic visits reported by 6 regional health care systems. PHSKC examined patient-level laboratory test results and established HCV case classification using Council of State and Territorial Epidemiologists criteria, classifying patients as confirmed if they had detectable HCV RNA. RESULTS: The data enabled PHSKC to report the number of patients at various stages along the HCV care cascade. Of 7747 HCV RNA-positive patients seen by a partner site, 5377 (69%) were assessed for severity of liver fibrosis, 3932 (51%) were treated, and 2592 (33%) were cured. PRACTICE IMPLICATIONS: Data supported local public heath surveillance and HCV program activities. The data system could serve as a foundation for monitoring future HCV prevention and control programs. |
One Hundred Years of Influenza Since the 1918 Pandemic - Is China Prepared Today?
Zhang R , Dong X , Wang D , Feng L , Zhou L , Ren R , Greene C , Song Y , Millman AJ , Azziz-Baumgartner E , Feng Z . China CDC Wkly 2019 1 (4) 56-61 Almost 100 years after the 1918 influenza pandemic, China experienced its largest, most widespread epidemic of human infections with avian influenza A (H7N9), the influenza virus with the greatest pandemic potential of all influenza viruses assessed to date by the United States Centers for Disease Control and Prevention's Influenza Risk Assessment Tool. This historical review describes how China was affected by the 1918, 1958, 1968, and 2009 influenza pandemics, records milestones in China's capacity to detect and respond to influenza threats, and identifies remaining challenges for pandemic preparedness. This review suggests that past influenza pandemics have improved China's national capabilities such that China has become a global leader in influenza detection and response. Further enhancing China's pandemic preparedness to address remaining challenges requires government commitment and increased investment in China's public health and healthcare systems. |
Review of the status and challenges associated with increasing influenza vaccination coverage among pregnant women in China
Zhou S , Greene CM , Song Y , Zhang R , Rodewald LE , Feng L , Millman AJ . Hum Vaccin Immunother 2019 16 (3) 1-10 Influenza vaccination coverage in pregnant women in China remains low. In this review, we first provide an overview of the evidence for the use of influenza vaccination during pregnancy. Second, we discuss influenza vaccination policy and barriers to increased seasonal influenza vaccination coverage in pregnant women in China. Third, we provide case studies of successes and challenges of programs for increasing seasonal influenza vaccination in pregnant women from other parts of Asia with lessons learned for China. Finally, we assess opportunities and challenges for increasing influenza vaccination coverage among pregnant women in China. |
Missed opportunities for prevention and treatment of hepatitis C among persons with HIV/HCV coinfection
Millman AJ , Luo Q , Nelson NP , Vellozzi C , Weiser J . AIDS Care 2019 32 (7) 1-9 Hepatitis C (HCV) and HIV have common modes of transmission but information about HCV transmission risk, prevention, and treatment among persons with coinfection is lacking. The Medical Monitoring Project produces nationally representative estimates describing adults with diagnosed HIV in the United States. Using medical record data recorded during 6/2013-5/2017, we identified persons with detectable HCV RNA documented during the past 24 months. Among persons with coinfection, we described HCV transmission risk factors and receipt of HCV prevention services during the past 12 months and prescription of HCV treatment during the past 24 months. Overall, 4.9% had documented active HCV coinfection, among whom 30.2% were men who have sex with men (MSM), 6.7% reported injection drug use, and 62.1% were prescribed HCV treatment. Among MSM, 45.5% reported condomless anal sex and 45.5% received free condoms. Among persons who used drugs, 30.8% received drug or alcohol counseling, and among persons who injected drugs, 79.2% received sterile syringes. Among persons with HIV/HCV coinfection, recent drug injection was uncommon and most received sterile syringes. However, 1 in 3 were MSM, of whom half reported recent HCV sexual transmission risk behaviors. More than one-third of those with coinfection were not prescribed curative HCV treatment. |
Defining the hepatitis C cure cascade in an urban health system using the electronic health record
Miller LS , Millman AJ , Lom J , Osinubi A , Ahmed F , Dupont S , Rein D , Vellozzi C , Harris AM . J Viral Hepat 2019 27 (1) 13-19 Hepatitis C virus (HCV) infection is a public health threat. The electronic health record (EHR) can be used to monitor patients along the HCV cure cascade and highlight opportunities for interventions to improve cascade outcomes. We developed an HCV patient registry using data from Grady Health System's (GHS) EHR and performed a cross sectional analysis of 72,745 GHS patients who received anti-HCV testing from 2004-2016. We created a testing cascade: 1) anti-HCV reactive, 2) HCV RNA tested, and 3) HCV RNA detectable; and a cure cascade: 1) HCV RNA detectable, 2) engaged in care, 3) treatment prescribed, 4) sustained virologic response (SVR) tested, and 5) SVR documented. 9,893 (14%) had reactive anti-HCV tests of 72,745 patients tested, 5,109 (52%) of these had HCV RNA tested, and 4,224 (43%) were HCV RNA detectable. 2,738 (65%) of 4,224 with detectable RNA were engaged in care, 909 (22%) were prescribed antiviral therapy, and 354 (8%) achieved SVR. Factors associated with HCV treatment included cirrhosis, tobacco use, depression, diabetes, obesity, alcohol use, male gender, black race, and Medicare insurance. Uninsured patients were significantly less likely to be prescribed HCV treatment. In conclusion, Using EHR data, we identified high anti-HCV prevalence and noted gaps in HCV RNA testing, linkage to care, and treatment. The EHR can be used to evaluate the effectiveness of targeted interventions to overcome these gaps. |
Lessons from an active surveillance pilot to assess the pneumonia of unknown etiology surveillance system in China, 2016: the need to increase clinician participation in the detection and reporting of emerging respiratory infectious diseases
Xiang N , Song Y , Wang Y , Wu J , Millman AJ , Greene CM , Ding Z , Sun J , Yang W , Guo G , Wang R , Guo P , Ren Z , Gong L , Xu P , Zhou S , Lin D , Ni D , Feng Z , Li Q . BMC Infect Dis 2019 19 (1) 770 BACKGROUND: We sought to assess reporting in China's Pneumonia of Unknown Etiology (PUE) passive surveillance system for emerging respiratory infections and to identify ways to improve the PUE surveillance system's detection of respiratory infections of public health significance. METHODS: From February 29-May 29, 2016, we actively identified and enrolled patients in two hospitals with acute respiratory infections (ARI) that met all PUE case criteria. We reviewed medical records for documented exposure history associated with respiratory infectious diseases, collected throat samples that were tested for seasonal and avian influenza, and interviewed clinicians regarding reasons for reporting or not reporting PUE cases. We described and analyzed the proportion of PUE cases reported and clinician awareness of and practices related to the PUE system. RESULTS: Of 2619 ARI admissions in two hospitals, 335(13%) met the PUE case definition; none were reported. Of 311 specimens tested, 18(6%) were seasonal influenza virus-positive; none were avian influenza-positive. < 10% PUE case medical records documented whether or not there were exposures to animals or others with respiratory illness. Most commonly cited reasons for not reporting cases were no awareness of the PUE system (76%) and not understanding the case definition (53%). CONCLUSIONS: Most clinicians have limited awareness of and are not reporting to the PUE system. Exposures related to respiratory infections are rarely documented in medical records. Increasing clinicians' awareness of the PUE system and including relevant exposure items in standard medical records may increase reporting. |
Implementation of liver cancer education among health care providers and community coalitions in the Cherokee Nation
Momin B , Mera J , Essex W , Gahn D , Burkhart M , Nielsen D , Mezzo J , Millman AJ . Prev Chronic Dis 2019 16 E112 INTRODUCTION: The Cherokee Nation Comprehensive Cancer Control Program collaborated with the Cherokee Nation Hepatitis C Virus (HCV) Elimination Program within Cherokee Nation's Health Services to plan and implement activities to increase knowledge and awareness of liver cancer prevention among health care providers and the Cherokee Nation community. From August 2017 to April 2018, the 2 programs implemented liver cancer prevention interventions that focused on education of health care providers and community members. We used descriptive statistics to analyze data collected from a brief, retrospective pre-post survey for each intervention. We assessed overall awareness and knowledge of liver cancer and ability and intention to address it on a scale of 1 to 5. Project Extension for Community Healthcare Outcomes didactic sessions resulted in a 1.1-point improvement, provider education workshops resulted in a 1.4-point improvement, and presentations at community coalition meetings resulted in a 1.7-point improvement. Our study shows that HCV interventions can be used by public health and medical professionals interested in controlling HCV and related diseases such as liver cancer. |
Hepatitis B testing, care linkage, and vaccination coverage within a registry of hepatitis C infected patients
Harris AM , Millman AJ , Lora M , Osinubi A , Lom J , Miller LS . Vaccine 2019 37 (16) 2188-2193 BACKGROUND: Hepatitis B virus (HBV) infection testing among persons with hepatitis C virus (HCV) infection is necessary to appropriately care for these patients, yet uptake of HBV testing and vaccination in this population is suboptimal. METHODS: In a retrospective cohort analysis, we describe the prevalence of hepatitis B testing, linkage to hepatitis B care, and hepatitis B vaccination in patients with HCV infection within a large urban safety-net health system. Using a registry of HCV-infected patients with patient-level electronic health record data, that included demographic, clinical, and laboratory information from 2004 to 2016 from Grady Health System in Atlanta, GA, we describe (1) The prevalence of hepatitis B testing (hepatitis B surface antigen [HBsAg], core antibody [anti-HBc], surface antibody [anti-HBs]); (2) The proportion of HBsAg-positive persons receiving HBV DNA and e-antigen (HBeAg) as indicators for linkage to hepatitis B-directed care; and (3) The proportion of persons receiving hepatitis B vaccine. RESULTS: Of 4224 HCV-infected patients, 3629 (86%) had test results for HBsAg and 43 (1.2%) were HBsAg-positive. Of 2342 (55%) with test results for all three HBV serological markers, median age was 60 years, 67% were male, and 83% were African-American, 789 (34%) anti-HBc positive only, 678 (29%) anti-HBc/anti-HBs positive, 190 (8.1%) anti-HBs positive only, and 642 (27%) were HBV-susceptible. Of HBsAg-positive patients, 21% received HBV DNA and 40% HBeAg testing. The proportion of HBV-susceptible patients receiving at least 1 dose of hepatitis B vaccine was 322/642 (50%). CONCLUSIONS: In a large cohort of HCV-infected patients, we found a high prevalence of current or past HBV infection, but there were gaps in complete hepatitis B testing, hepatitis B-directed care, and hepatitis B vaccination. Strategies are needed to increase hepatitis B testing, linkage to care, and administration of the hepatitis B vaccine for HCV-infected persons in this healthcare system. |
Promising practices for the prevention of liver cancer: a review of the literature and cancer plan activities in the National Comprehensive Cancer Control Program
Momin B , Millman AJ , Nielsen DB , Revels M , Steele CB . Cancer Causes Control 2018 29 (12) 1265-1275 INTRODUCTION: Hepatitis B virus (HBV) and hepatitis C virus (HCV) infections are risk factors for hepatocellular carcinoma, a type of primary liver cancer, and are most prevalent in people born 1945-1965. Relatively little information is available for liver cancer prevention, compared to other cancers. In this review, we provide a summary of current promising public health practices for liver cancer prevention from the literature, as well as liver cancer-related initiatives in the National Comprehensive Cancer Control Program (NCCCP). METHODS: Two types of source materials were analyzed for this review: published literature (2005-present), and current cancer plans from the NCCCP (2005-2022). A search strategy was developed to include a review of several scientific databases. Of the 73 articles identified as potentially eligible, 20 articles were eligible for inclusion in the review. Eligible articles were abstracted using a data abstraction tool. Three independent keyword searches on 65 NCCCP plans were conducted. Keyword searches within each of the plans to identify activities related to liver cancer were conducted. Relevant information was abstracted from the plans and saved in a data table. RESULTS: Of the 20 eligible articles, 15 articles provided information on interventions related to liver cancer and hepatitis B or hepatitis C prevention. All 15 of the intervention articles were related to hepatitis; 13 were hepatitis B-focused, two were hepatitis C-focused, and 14 focused on Asian/Pacific Islander American populations. The independent keyword search of NCCCP plans produced 46 results for liver, 27 results for hepatitis, and 52 results for alcohol. Two plans included activities related to liver cancer. Twenty-four plans included activities related to hepatitis. DISCUSSION: A majority of the intervention articles published focused on HBV infection in Asian/Pacific Islander American populations, and a small percentage of NCCCP plans included liver-related content. The findings from this review will inform the development of an Action Plan on liver cancer prevention for the NCCCP, which will assist programs with the adoption and uptake of promising practices for the prevention of liver cancer. |
Evaluation of performance of algorithms using serial hepatitis C RNA tests to predict treatment initiation and sustained virologic response among patients infected with hepatitis C
Osinubi A , Harris AM , Vellozzi C , Lom J , Miller L , Millman AJ . Am J Epidemiol 2018 188 (3) 555-561 Electronic medical record data structure prevents easy population-level monitoring of hepatitis C virus (HCV) treatment uptake and cure. Using an HCV registry from a public hospital system in Atlanta, Georgia, we developed multiple algorithms using serial HCV RNA test results as proxy measures for direct acting antiviral (DAA) treatment initiation and sustained virologic response (SVR). We calculated sensitivity and positive predictive values by comparing the algorithms to the DAA initiation and SVR results from the registry. From December 2013 - August 2016, 1,807 persons actively infected with HCV were identified in the registry. Of those, 698 initiated DAA treatment based on medical record abstraction; of 442 patients with treatment start and/or end dates, 314 had documented SVR. Treatment algorithm 2 (detectable HCV RNA result followed by 2 sequential HCV RNA tests results) and treatment algorithm 5 (detectable HCV RNA result followed by 2 sequential HCV RNA tests results > 6 weeks apart) had the highest sensitivity (87% and 85% respectively) and positive predictive value (80% and 82% respectively) combinations. Four SVR algorithms relied on fulfilling treatment algorithm definitions and having an undetectable HCV RNA test result >/= 12 weeks after the last HCV RNA result; sensitivity for all was 79% and positive predictive value was 92-93%. Algorithms using serial quantitative HCV RNA results can serve as proxy measures for evaluating population-level DAA treatment and SVR outcomes. |
Comparison of hepatitis C virus testing recommendations in high-income countries
Irvin R , Ward K , Agee T , Nelson NP , Vellozzi C , Thomas DL , Millman AJ . World J Hepatol 2018 10 (10) 743-751 AIM: To investigate hepatitis C virus (HCV) testing recommendations from the United States and other high-income countries. METHODS: A comprehensive search for current HCV testing recommendations from the top quartile of United Nations Human Development Index (HDI) countries (very high HDI) was performed using Google and reviewed from May 1 - October 30, 2014 and re-reviewed April 1 - October 2, 2017. RESULTS: Of the 51 countries identified, 16 had HCV testing recommendations from a government body or recommendations issued collaboratively between a government and a medical organization. Of these 16 countries, 15 had HCV testing recommendations that were primarily risk-based and highlight behaviors, exposures, and conditions that are associated with HCV transmission in that region. In addition to risk-based testing, the HCV Guidance Panel (United States) incorporates recommendations for a one-time test for individuals born during 1945-1965 (the birth cohort) without prior ascertainment of risk into their guidance. In addition to the United States, six other countries either have an age-based testing recommendation or recommend one-time testing for all adults independent of risk factors typical of the region. CONCLUSION: This review affirmed the similarities of the HCV Guidance Panel's guidance with those of recommendations from very high HDI countries. |
Influenza-Associated Parotitis During the 2014-2015 Influenza Season in the United States.
Rolfes MA , Millman AJ , Talley P , Elbadawi LI , Kramer NA , Barnes JR , Blanton L , Davis JP , Cole S , Dreisig JJ , Garten R , Haupt T , Jackson MA , Kocharian A , Leifer D , Lynfield R , Martin K , McHugh L , Robinson S , Turabelidze G , Webber LA , Pearce Weinberg M , Wentworth DE , Finelli L , Jhung MA . Clin Infect Dis 2018 67 (4) 485-492 ![]() ![]() Background: During the 2014-2015 influenza season in the United States, 256 cases of influenza-associated parotitis were reported from 27 states. We conducted a case-control study and laboratory investigation to further describe this rare clinical manifestation of influenza. Methods: During February 2015-April 2015, we interviewed 50 cases (with parotitis) and 124 ill controls (without parotitis) with laboratory-confirmed influenza; participants resided in 11 states and were matched by age, state, hospital admission status, and specimen collection date. Influenza viruses were characterized using real-time polymerase chain reaction and next-generation sequencing. We compared cases and controls using conditional logistic regression. Specimens from additional reported cases were also analyzed. Results: Cases, 73% of whom were aged <20 years, experienced painful (86%), unilateral (68%) parotitis a median of 4 (range, 0-16) days after onset of systemic or respiratory symptoms. Cases were more likely than controls to be male (76% vs 51%; P = .005). We detected influenza A(H3N2) viruses, genetic group 3C.2a, in 100% (32/32) of case and 92% (105/108) of control specimens sequenced (P = .22). Influenza B and A(H3N2) 3C.3 and 3C.3b genetic group virus infections were detected in specimens from additional cases. Conclusions: Influenza-associated parotitis, as reported here and in prior sporadic case reports, seems to occur primarily with influenza A(H3N2) virus infection. Because of the different clinical and infection control considerations for mumps and influenza virus infections, we recommend clinicians consider influenza in the differential diagnoses among patients with acute parotitis during the influenza season. |
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