Last data update: May 13, 2024. (Total: 46773 publications since 2009)
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Hospitalizations associated with respiratory syncytial virus (RSV) and influenza in children, including children having a diagnosis of asthma (preprint)
Goldstein E , Finelli L , O'Halloran A , Liu P , Karaca Z , Steiner CA , Viboud C , Lipsitch M . bioRxiv 2019 161067 Background There is uncertainty about the burden of hospitalization associated with RSV and influenza in children, including those with underlying medical conditions.Methods We applied previously developed methodology (Goldstein et al., Epidemiology 2012) to HealthCare Cost and Utilization Project (HCUP) hospitalization data and additional data related to asthma diagnosis/previous history in hospitalized children to estimate RSV and influenza-associated hospitalization rates in different subpopulations of US children between 2003-2010.Results The estimated average annual rates (per 100,000 children) of RSV-associated hospitalization with a respiratory cause (ICD-9 codes 460-519) present anywhere in the discharge diagnosis were 2381 (95% CI(2252,2515)) in age <1y; 710.6(609.1,809.2) (age 1y); 395(327.7,462.4) (age 2y); 211.3(154.6,266.8) (age 3y); 111.1(62.4,160.1) (age 4y); 72.3(29.3,116.4) (ages 5-6y); 35.6(9.9,62.2) (ages 7-11y); and 39(17.5,60.6) (ages 12-17y).The corresponding rates of influenza-associated hospitalization were lower, ranging from 181(142.5,220.3) in age <1y to 17.9(11.7,24.2) in ages 12-17y. The relative risks for RSV-related hospitalization associated with a prior diagnosis of asthma in age groups under 5y ranged between 3.1(2.1,4.7) (age <1y) to 6.7(4.2,11.8) (age 2y); the corresponding risks for influenza-related hospitalization ranged from 2.8(2.1,4) (age <1y) to 4.9(3.8,6.4) (age 3y).Conclusions RSV-associated hospitalization rates in young children are high and decline rapidly with age. Young children with an asthma diagnosis should be target groups for RSV and influenza-related mitigation efforts, possibly including RSV prophylaxis for the youngest children. |
Longer-term direct and indirect effects of infant rotavirus vaccination across all ages in the United States in 2000-2013: Analysis of a large hospital discharge data set
Baker JM , Tate JE , Steiner CA , Haber MJ , Parashar UD , Lopman BA . Clin Infect Dis 2019 68 (6) 976-983 BACKGROUND: Rotavirus disease rates dramatically declined among children <5 years of age since the rotavirus vaccine was introduced in 2006; population-level impacts remain to be fully elucidated. METHODS: Data from the Healthcare Cost and Utilization Project State Inpatient Databases were used to conduct a time-series analysis of monthly hospital discharges across age groups for acute gastroenteritis and rotavirus from 2000 to 2013. Rate ratios were calculated comparing prevaccine and postvaccine eras. RESULTS: Following vaccine introduction, a decrease in rotavirus hospitalizations occurred with a shift toward biennial patterns across all ages. The 0-4-year age group experienced the largest decrease in rotavirus hospitalizations (rate ratio, 0.14; 95% confidence interval, .09-.23). The 5-19-year and 20-59-year age groups experienced significant declines in rotavirus hospitalization rates overall; the even postvaccine calendar years were characterized by progressively lower rates, and the odd postvaccine years were associated with reductions in rates that diminished over time. Those aged >/=60 years experienced the smallest change in rotavirus hospitalization rates overall, with significant reductions in even postvaccine years compared with prevaccine years (rate ratio, 0.51; 95% confidence interval, .39-.66). CONCLUSIONS: Indirect impacts of infant rotavirus vaccination are apparent in the emergence of biennial patterns in rotavirus hospitalizations that extend to all age groups ineligible for vaccination. These observations are consistent with the notion that young children are of primary importance in disease transmission and that the initial postvaccine period of dramatic population-wide impacts will be followed by more complex incidence patterns across the age range in the long term. |
Hospitalizations associated with respiratory syncytial virus and influenza in children, including children diagnosed with asthma
Goldstein E , Finelli L , O'Halloran A , Liu P , Karaca Z , Steiner CA , Viboud C , Lipsitch M . Epidemiology 2019 30 (6) 918-926 BACKGROUND: There is uncertainty about the burden of hospitalization associated with respiratory syncytial virus (RSV) and influenza in children, including those with underlying medical conditions. METHODS: We applied previously developed methodology to Health Care Cost and Utilization Project hospitalization data and additional data related to asthma diagnosis/previous history in hospitalized children to estimate RSV and influenza-associated hospitalization rates in different subpopulations of US children between 2003 and 2010. RESULTS: The estimated average annual rates (per 100,000 children) of RSV-associated hospitalization with a respiratory cause (ICD-9 codes 460-519) present anywhere in the discharge diagnosis were 2,381 (95% CI(2252,2515)) in children <1 year of age; 710.6 (609.1, 809.2) (1 y old); 395 (327.7, 462.4) (2 y old); 211.3 (154.6, 266.8) (3 y old); 111.1 (62.4, 160.1) (4 y old); 72.3 (29.3, 116.4) (5-6 y of age); 35.6 (9.9,62.2) (7-11 y of age); and 39 (17.5, 60.6) (12-17 y of age). The corresponding rates of influenza-associated hospitalization were lower, ranging from 181 (142.5, 220.3) in <1 year old to 17.9 (11.7, 24.2) in 12-17 years of age. The relative risks for RSV-related hospitalization associated with a prior diagnosis of asthma in age groups <5 y ranged between 3.1 (2.1, 4.7) (<1 y old) and 6.7 (4.2, 11.8) (2 y old; the corresponding risks for influenza-related hospitalization ranged from 2.8 (2.1, 4) (<1y old) to 4.9 (3.8, 6.4) (3 y old). CONCLUSION: RSV-associated hospitalization rates in young children are high and decline rapidly with age. There are additional risks for both RSV and influenza hospitalization associated with a prior diagnosis of asthma, with the rates of RSV-related hospitalization in the youngest children diagnosed with asthma being particularly high. |
Trends in rate of seizure-associated hospitalizations among children <5 years old before and after rotavirus vaccine introduction in the United Sates, 2000-2013
Pringle KD , Burke RM , Steiner CA , Parashar UD , Tate JE . J Infect Dis 2018 217 (4) 581-588 Background: Rotavirus is a common cause of acute gastroenteritis and has also been associated with generalized tonic-clonic afebrile seizures. Since rotavirus vaccine introduction, hospitalizations for treatment of acute gastroenteritis have decreased. We assess whether there has been an associated decrease in seizure-associated hospitalizations. Methods: We used discharge codes to abstract data on seizure hospitalizations among children <5 years old from the State Inpatient Databases of the Healthcare Cost and Utilization Project. We compared seizure hospitalization rates before and after vaccine introduction, using Poisson regression, stratifying by age and by month and year of admission. We performed a time-series analysis with negative binomial models, constructed using prevaccine data from 2000 to 2006 and controlling for admission month and year. Results: We examined 962899 seizure hospitalizations among children <5 years old during 2000-2013. Seizure rates after vaccine introduction were lower than those before vaccine introduction by 1%-8%, and rate ratios decreased over time. Time-series analyses demonstrated a decrease in the number of seizure-coded hospitalizations in 2012 and 2013, with notable decreases in children 12-17 months and 18-23 months. Conclusions: Our analysis provides evidence for a decrease in seizure hospitalizations following rotavirus vaccine introduction in the United States, with the greatest impact in age groups with a high rotavirus-associated disease burden and during rotavirus infection season. |
National estimates of reductions in acute gastroenteritis-related hospitalizations and associated costs in US children after implementation of rotavirus vaccines
Leshem E , Tate JE , Steiner CA , Curns AT , Lopman BA , Parashar UD . J Pediatric Infect Dis Soc 2017 7 (3) 257-260 We compared acute gastroenteritis (AGE)-related hospitalization rates among children <5 years of age during the pre-rotavirus vaccine (2000-2006) and post-rotavirus vaccine (2008-2013) periods to estimate national reductions in AGE-related hospitalizations and associated costs. We estimate that between 2008 and 2013, AGE-related hospitalizations declined by 382000, and $1.228 billion in medical costs were averted. |
Million Hearts: Description of the national surveillance and modeling methodology used to monitor the number of cardiovascular events prevented during 2012-2016
Ritchey MD , Loustalot F , Wall HK , Steiner CA , Gillespie C , George MG , Wright JS . J Am Heart Assoc 2017 6 (5) BACKGROUND: This study describes the national surveillance and modeling methodology developed to monitor achievement of the Million Hearts initiative's aim of preventing 1 million acute myocardial infarctions, strokes, and other related cardiovascular events during 2012-2016. METHODS AND RESULTS: We calculate sex- and age-specific cardiovascular event rates (combination of emergency department, hospitalization, and death events) among US adults aged ≥18 from 2006 to 2011 and, based on log-linear models fitted to the rates, calculate their annual percent change. We describe 2 baseline strategies to be used to compare observed versus expected event totals during 2012-2016: (1) stable baselines assume no rate changes, with modeled 2011 rates held constant through 2016; and (2) trend baselines assume 2006-2011 rate trends will continue, with the annual percent changes applied to the modeled 2011 rates to calculate expected 2012-2016 rates. Events prevented estimates during 2012-2013 were calculated using available data: 115 210 (95% CI, 60 858, 169 562) events were prevented using stable baselines and an excess of 43 934 (95% CI, -14 264, 102 132) events occurred using trend baselines. Women aged ≥75 had the most events prevented (stable, 76 242 [42 067, 110 417]; trend, 39 049 [1901, 76 197]). Men aged 45 to 64 had the greatest number of excess events (stable, 22 912 [95% CI, 855, 44 969]; trend, 38 810 [95% CI, 15 567, 62 053]). CONCLUSIONS: Around 115 000 events were prevented during the initiative's first 2 years compared with what would have occurred had 2011 rates remained stable. Recent flattening or reversals in some event rate trends were observed supporting intensifying national action to prevent cardiovascular events. |
Use of internet search data to monitor rotavirus vaccine impact in the United States, United Kingdom, and Mexico
Shah MP , Lopman BA , Tate JE , Harris J , Esparza-Aguilar M , Sanchez-Uribe E , Richardson V , Steiner CA , Parashar UD . J Pediatric Infect Dis Soc 2017 7 (1) 56-63 Background.: Previous studies have found a strong correlation between internet search and public health surveillance data. Less is known about how search data respond to public health interventions, such as vaccination, and the consistency of responses in different countries. In this study, we aimed to study the correlation between internet searches for "rotavirus" and rotavirus disease activity in the United States, United Kingdom, and Mexico before and after introduction of rotavirus vaccine. Methods.: We compared time series of internet searches for "rotavirus" from Google Trends with rotavirus laboratory reports from the United States and United Kingdom and with hospitalizations for acute gastroenteritis in the United States and Mexico. Using time and location parameters, Google quantifies an internet query share (IQS) to measure the relative search volume for specific terms. We analyzed the correlation between IQS and laboratory and hospitalization data before and after national vaccine introductions. Results.: There was a strong positive correlation between the rotavirus IQS and laboratory reports in the United States (R2 = 0.79) and United Kingdom (R2 = 0.60) and between the rotavirus IQS and acute gastroenteritis hospitalizations in the United States (R2 = 0.87) and Mexico (R2 = 0.69) (P < .0001 for all correlations). The correlations were stronger in the prevaccine period than in the postvaccine period. After vaccine introduction, the mean rotavirus IQS decreased by 40% (95% confidence interval [CI], 25%-55%) in the United States and by 70% (95% CI, 55%-86%) in Mexico. In the United Kingdom, there was a loss of seasonal variation after vaccine introduction. Conclusions.: Rotavirus internet search data trends mirrored national rotavirus laboratory trends in the United States and United Kingdom and gastroenteritis-hospitalization data in the United States and Mexico; lower correlations were found after rotavirus vaccine introduction. |
Infectious disease hospitalizations among American Indian/Alaska Native and non-American Indian/Alaska Native persons in Alaska, 2010-2011
Gounder PP , Holman RC , Seeman SM , Rarig AJ , McEwen M , Steiner CA , Bartholomew ML , Hennessy TW . Public Health Rep 2017 132 (1) 65-75 OBJECTIVE: Reports about infectious disease (ID) hospitalization rates among American Indian/Alaska Native (AI/AN) persons have been constrained by data limited to the tribal health care system and by comparisons with the general US population. We used a merged state database to determine ID hospitalization rates in Alaska. METHODS: We combined 2010 and 2011 hospital discharge data from the Indian Health Service and the Alaska State Inpatient Database. We used the merged data set to calculate average annual age-adjusted and age-specific ID hospitalization rates for AI/AN and non-AI/AN persons in Alaska. We stratified the ID hospitalization rates by sex, age, and ID diagnosis. RESULTS: ID diagnoses accounted for 19% (6501 of 34 160) of AI/AN hospitalizations, compared with 12% (7397 of 62 059) of non-AI/AN hospitalizations. The average annual age-adjusted hospitalization rate was >3 times higher for AI/AN persons (2697 per 100 000 population) than for non-AI/AN persons (730 per 100 000 population; rate ratio = 3.7, P < .001). Lower respiratory tract infection (LRTI), which occurred in 38% (2486 of 6501) of AI/AN persons, was the most common reason for ID hospitalization. AI/AN persons were significantly more likely than non-AI/AN persons to be hospitalized for LRTI (rate ratio = 5.2, P < .001). CONCLUSIONS: A substantial disparity in ID hospitalization rates exists between AI/AN and non-AI/AN persons, and the most common reason for ID hospitalization among AI/AN persons was LRTI. Public health programs and policies that address the risk factors for LRTI are likely to benefit AI/AN persons. |
Potentially preventable hospitalizations for acute and chronic conditions in Alaska, 2010-2012
Gounder PP , Seeman SM , Holman RC , Rarig A , McEwen MK , Steiner CA , Bartholomew ML , Hennessy TW . Prev Med Rep 2016 4 614-621 Objective: The U.S. Agency for Healthcare Research and Quality's Prevention Quality Indicators comprise acute and chronic conditions for which hospitalization can be potentially prevented by high-quality ambulatory care. The Healthy Alaska 2020 initiative (HA2020) targeted reducing potentially preventable hospitalizations (PPH) for acute and chronic conditions among its health indicators. We estimated the PPH rate for adults aged ≥ 18 years in Alaska during 2010-2012. Methods: We conducted a cross-sectional analysis of state-wide hospital discharge data obtained from the Healthcare Cost and Utilization Project and the Indian Health Service. We calculated average annual PPH rates/1000 persons for acute/chronic conditions. Age-adjusted rate ratios (aRRs) were used for evaluating PPH rate disparities between Alaska Native (AN) and non-AN adults. Results: Among 127,371 total hospitalizations, 4911 and 6721 were for acute and chronic PPH conditions, respectively. The overall crude PPH rate was 7.3 (3.1 for acute and 4.2 for chronic conditions). AN adults had a higher rate than non-AN adults for acute (aRR: 4.7; . p < 0.001) and chronic (aRR: 2.6; p < 0.001) PPH conditions. Adults aged ≥ 85. years had the highest PPH rate for acute (43.5) and chronic (31.6) conditions. Acute conditions with the highest PPH rate were bacterial pneumonia (1.8) and urinary tract infections (0.8). Chronic conditions with the highest PPH rate were chronic obstructive pulmonary disease (COPD; 1.6) and congestive heart failure (CHF; 1.3). Conclusion: Efforts to reduce PPHs caused by COPD, CHF, and bacterial pneumonia, especially among AN people and older adults, should yield the greatest benefit in achieving the HA2020 goal. |
Intussusception rates before and after the introduction of rotavirus vaccine
Tate JE , Yen C , Steiner CA , Cortese MM , Parashar UD . Pediatrics 2016 138 (3) BACKGROUND: Recent US studies have identified a small increased risk of intussusception after rotavirus vaccination, mainly after the first dose. We examined trends in intussusception hospitalizations before (2000-2005) and after (2007-2013) rotavirus vaccine introduction to assess whether this observed temporal risk translates into more hospitalized cases at the population level. METHODS: Intussusception hospitalizations in children <12 months of age were abstracted from the State Inpatient Database maintained by the Healthcare Cost and Utilization Project for 26 states that provided data from 2000 to 2013. Rates were calculated using bridged-race postcensal population estimates. Trends were analyzed by age groups (6-14 weeks, 15-24 weeks, and 25-34 weeks) based on the recommended ages for vaccine administration as well as 8-11 weeks when the majority of first doses are given. Rate ratios were calculated by using Poisson regression. RESULTS: No consistent change in intussusception hospitalization rates was observed among all children <12 months of age and among children 15 to 24 weeks and 25 to 34 weeks of age. The intussusception hospitalization rate for children aged 8 to 11 weeks was significantly elevated by 46% to 101% (range: 16.7-22.9 per 100 000) in all postvaccine years except 2011 and 2013 compared with the prevaccine baseline (11.7 per 100 000). CONCLUSIONS: The increase in the intussusception hospitalization rate in children 8 to 11 weeks when the majority of first doses of vaccine are given is consistent with recent US postlicensure studies. Given the magnitude of declines in rotavirus disease compared with this small increase in intussusception, the benefits of rotavirus vaccination outweigh the increase risk of intussusception. |
Decline in emergency department visits for acute gastroenteritis among children in 10 US states following implementation of rotavirus vaccination, 2003-2013
Shah MP , Tate JE , Steiner CA , Parashar UD . Pediatr Infect Dis J 2016 35 (7) 782-6 BACKGROUND: Rotavirus vaccination of all infants began in the United States in 2006. While the effect of vaccination on childhood hospitalizations for rotavirus have been well described, the effects of rotavirus vaccine on ED visits are less well documented. METHODS: Using the State Emergency Department Databases (SEDD) for 10 US states, we compared rates of gastroenteritis- and rotavirus-coded ED visits among children < 5 years of age in pre-vaccine (2003-2006) with post-vaccine (2008-2013) years; 2007 was excluded as a transition year. We analyzed ED visit rates by age group, sex, race, and rotavirus season. RESULTS: The pre-vaccine annual gastroenteritis-coded ED visit rate among children < 5 years of age of 426 per 10,000 (annual range, 396-477 per 10,000) declined to 382 per 10,000 in post-vaccine years, a 10.3% (+/-0.3%, p<.0001) rate reduction overall. Compared with pre-vaccine years, annual ED visit rates for gastroenteritis decreased by 6.5% (+/-0.6%) in 2008, 12.3% (+/-0.6%) in 2010, 14.8% (+/-0.5%) in 2011, 20.4% (+/-0.5%) in 2012 and 10.1% (+/-0.6%) in 2013; a small increase of 1.8% (+/-0.6%) was seen in 2009 (p<.0001 for all individual comparisons). Declines were similar by sex and race and were greater in children <2 years of age (range 14.1-20.6%, p<.0001) than in older children (increase of 3.3% +/- 0.6%, p<.0001). A decline of 21.2% (+/-0.4%, p<.0001) in ED visits was seen during the rotavirus season months from January through June versus an increase of 9.5% (+/-0.6%, p<.0001) during July to December. ED visits specifically coded for rotavirus showed more prominent declines than for all gastroenteritis. CONCLUSIONS: ED visits for gastroenteritis in US children have declined since introduction of rotavirus vaccine. |
Lower respiratory tract infection hospitalizations among American Indian/Alaska Native children and the general United States child population
Foote EM , Singleton RJ , Holman RC , Seeman SM , Steiner CA , Bartholomew M , Hennessy TW . Int J Circumpolar Health 2015 74 29256 BACKGROUND: The lower respiratory tract infection (LRTI)-associated hospitalization rate in American Indian and Alaska Native (AI/AN) children aged <5 years declined during 1998-2008, yet remained 1.6 times higher than the general US child population in 2006-2008. PURPOSE: Describe the change in LRTI-associated hospitalization rates for AI/AN children and for the general US child population aged <5 years. METHODS: A retrospective analysis of hospitalizations with discharge ICD-9-CM codes for LRTI for AI/AN children and for the general US child population <5 years during 2009-2011 was conducted using Indian Health Service direct and contract care inpatient data and the Nationwide Inpatient Sample, respectively. We calculated hospitalization rates and made comparisons to previously published 1998-1999 rates prior to pneumococcal conjugate vaccine introduction. RESULTS: The average annual LRTI-associated hospitalization rate declined from 1998-1999 to 2009-2011 in AI/AN (35%, p<0.01) and the general US child population (19%, SE: 4.5%, p<0.01). The 2009-2011 AI/AN child average annual LRTI-associated hospitalization rate was 20.7 per 1,000, 1.5 times higher than the US child rate (13.7 95% CI: 12.6-14.8). The Alaska (38.9) and Southwest regions (27.3) had the highest rates. The disparity was greatest for infant (<1 year) pneumonia-associated and 2009-2010 H1N1 influenza-associated hospitalizations. CONCLUSIONS: Although the LRTI-associated hospitalization rate declined, the 2009-2011 AI/AN child rate remained higher than the US child rate, especially in the Alaska and Southwest regions. The residual disparity is likely multi-factorial and partly related to household crowding, indoor smoke exposure, lack of piped water and poverty. Implementation of interventions proven to reduce LRTI is needed among AI/AN children. |
Acute gastroenteritis hospitalizations among US children following implementation of the rotavirus vaccine
Leshem E , Tate JE , Steiner CA , Curns AT , Lopman BA , Parashar UD . JAMA 2015 313 (22) 2282-4 Routine rotavirus vaccination of US children was implemented in 2006, with 2 or 3 doses recommended before the age of 8 months.1 Previous studies have demonstrated the association of rotavirus vaccine introduction with reductions in health care use during the early postintroduction period or with limited insurance databases.2-4 Because laboratory testing and coding for rotavirus are not routinely performed for patients with diarrhea, we examined both all-cause acute gastroenteritis and rotavirus-coded hospitalizations among children younger than 5 years from 2000 through 2012. |
Environmental drivers of the spatiotemporal dynamics of respiratory syncytial virus in the United States
Pitzer VE , Viboud C , Alonso WJ , Wilcox T , Metcalf CJ , Steiner CA , Haynes AK , Grenfell BT . PLoS Pathog 2015 11 (1) e1004591 Epidemics of respiratory syncytial virus (RSV) are known to occur in wintertime in temperate countries including the United States, but there is a limited understanding of the importance of climatic drivers in determining the seasonality of RSV. In the United States, RSV activity is highly spatially structured, with seasonal peaks beginning in Florida in November through December and ending in the upper Midwest in February-March, and prolonged disease activity in the southeastern US. Using data on both age-specific hospitalizations and laboratory reports of RSV in the US, and employing a combination of statistical and mechanistic epidemic modeling, we examined the association between environmental variables and state-specific measures of RSV seasonality. Temperature, vapor pressure, precipitation, and potential evapotranspiration (PET) were significantly associated with the timing of RSV activity across states in univariate exploratory analyses. The amplitude and timing of seasonality in the transmission rate was significantly correlated with seasonal fluctuations in PET, and negatively correlated with mean vapor pressure, minimum temperature, and precipitation. States with low mean vapor pressure and the largest seasonal variation in PET tended to experience biennial patterns of RSV activity, with alternating years of "early-big" and "late-small" epidemics. Our model for the transmission dynamics of RSV was able to replicate these biennial transitions at higher amplitudes of seasonality in the transmission rate. This successfully connects environmental drivers to the epidemic dynamics of RSV; however, it does not fully explain why RSV activity begins in Florida, one of the warmest states, when RSV is a winter-seasonal pathogen. Understanding and predicting the seasonality of RSV is essential in determining the optimal timing of immunoprophylaxis. |
Burden of encephalitis-associated hospitalizations in the United States, 1998-2010
Vora NM , Holman RC , Mehal JM , Steiner CA , Blanton J , Sejvar J . Neurology 2014 82 (5) 443-51 OBJECTIVE: To estimate the burden of encephalitis-associated hospitalizations in the United States for 1998-2010. METHODS: Using the Nationwide Inpatient Sample, a nationally representative database of hospitalizations, estimated numbers and rates of encephalitis-associated hospitalizations for 1998-2010 were calculated. Etiology and outcome of encephalitis-associated hospitalizations were examined, as well as accompanying diagnoses listed along with encephalitis on the discharge records. Total hospital charges (in 2010 US dollars) were assessed. RESULTS: An estimated 263,352 (standard error: 3,017) encephalitis-associated hospitalizations occurred in the United States during 1998-2010, which corresponds to an average of 20,258 (standard error: 232) encephalitis-associated hospitalizations per year. A fatal outcome occurred in 5.8% (95% confidence interval [CI]: 5.6%-6.0%) of all encephalitis-associated hospitalizations and in 10.1% (95% CI: 9.2%-11.2%) and 17.1% (95% CI: 14.6%-20.0%) of encephalitis-associated hospitalizations in which a code for HIV or a tissue or organ transplant was listed, respectively. The proportion of encephalitis-associated hospitalizations in which an etiology for encephalitis was specified was 50.3% (95% CI: 49.6%-51.0%) and that for which the etiology was unspecified was 49.7% (95% CI: 49.0%-50.4%). Total charges for encephalitis-associated hospitalizations in 2010 were an estimated $2.0 billion. CONCLUSIONS: Encephalitis remains a major public health concern in the United States. Among the large number of encephalitis-associated hospitalizations for which an etiology is not reported may be novel infectious and noninfectious forms of encephalitis. Associated conditions such as HIV or transplantation increase the risk of a fatal outcome from an encephalitis-associated hospitalization and should be monitored. |
Impact of varicella vaccination on varicella-related hospitalizations among American Indian/Alaska Native people
Singleton RJ , Holman RC , Person MK , Steiner CA , Redd JT , Hennessy TW , Groom A , Holve S , Seward JF . Pediatr Infect Dis J 2013 33 (3) 276-9 BACKGROUND: Routine childhood varicella vaccination, implemented in 1995, has resulted in significant declines in varicella-related hospitalizations in the United States. Varicella hospitalization rates among the American Indian and Alaska Native (AI/AN) population have not been previously documented. METHODS: We selected varicella-related hospitalizations, based on a published definition, from the Indian Health Service inpatient database for AI/ANs in the Alaska, Southwest and Northern Plains regions (1995-2010) and from the Nationwide Inpatient Sample for the general US population (2007-2010). We analyzed average annual hospitalization rates pre-vaccine (1995-1998) and post-vaccine (2007-2010) for the AI/AN population, and post-vaccine for the general US population. RESULTS: From 1995-1998 to 2007-2010, the average annual varicella-related hospitalization rate for AI/ANs in the three regions decreased 95% (0.66 to 0.03/10,000 persons); the post-vaccine rate appears lower than the general US rate (0.06, 95% CI 0.05-0.06). The rate declined in all AI/AN pediatric age groups. Infants experienced the highest pre-vaccine (14.07) and post-vaccine (0.83) hospitalization rates. Adults experienced low rates in both time periods. Varicella vaccination rates in 19-35 month old AI/AN children during fiscal years 2008-2010 were 88.1% to 91.0%. CONCLUSIONS: Widespread use of varicella vaccine in AI/AN children was accompanied by substantial declines in varicella-related hospitalizations consistent with high varicella vaccine effectiveness in preventing severe varicella outcomes. |
Trends in intussusception hospitalizations among US infants before and after implementation of the rotavirus vaccination program, 2000-2009
Yen C , Tate JE , Steiner CA , Cortese MM , Patel MM , Parashar UD . J Infect Dis 2012 206 (1) 41-8 BACKGROUND: In 1999, a rotavirus vaccine was withdrawn due to an association with intussusception. While US data have not documented an intussusception risk with current rotavirus vaccines, international data indicate a possible low risk, primarily after the first dose. METHODS: Among infants in 26 US states comprising 75% of the birth cohort, we conducted an ecological analysis to examine age-specific trends in population-level intussusception hospitalization rates before (2000-2005) and after (2007-2009) rotavirus vaccine introduction. RESULTS: Compared with 2000-2005 (35.3/100,000), the rate was greater in 2007 (39.0/100,000; rate ratio [RR]=1.10;95% confidence interval [CI]: 1.04-1.18), similar in 2008 (33.4/100,000; RR=0.95[0.89-1.01]), and lower in 2009 (32.9/100,000; RR=0.93[0.87-0.99]). Among 8-11 week-olds, compared with 2000-2005 (6.9/100,000), a small, significant increase was observed in each of 2007 (11.4/100,000; RR=1.64[1.08-2.50]), 2008 (12.2/100,000; RR=1.76[1.17-2.65]), and 2009 (11.0/100,000; RR=1.59[1.04-2.44]). CONCLUSIONS: Following rotavirus vaccine introduction, a small increase in intussusception rates was seen among US 8-11 week-olds who receive most first doses of vaccine; no sustained population-level change in overall rates was observed. While this ecologic analysis alone cannot establish an association between intussusception and rotavirus vaccination, even if a low risk with the first dose exists, it is outweighed by the well-documented benefits of vaccination among US infants. |
Impact of rotavirus vaccine on diarrhea-associated disease burden among American Indian and Alaska Native children
Desai R , Haberling D , Holman RC , Singleton RJ , Cheek JE , Groom AV , Steiner CA , Parashar UD , Esposito DH . Pediatrics 2012 129 (4) e907-13 OBJECTIVE: Beginning in 2006, the Indian Health Service (IHS) began rotavirus vaccination of American Indian and Alaska Native (AI/AN) infants. To assess vaccine impact, we examined trends in IHS diarrhea-associated hospitalization and outpatient visits among AI/AN children in the pre- and postrotavirus vaccine era. METHODS: Diarrhea-associated hospitalizations and outpatient visits among AI/AN children <5 years of age during 2001 through 2010 were examined by gender, age group, and region for prevaccine years 2001-2006 and postvaccine years 2008, 2009, and 2010. To account for secular declining trends observed in prevaccine years, expected diarrhea-associated hospitalization and outpatient rates for postvaccine years were generated by using Poisson regression analysis of the 2001-2006 annual rates. RESULTS: Coverage with at least 1 dose of rotavirus vaccine among AI/AN infants aged 3 to 5 months in the first half of 2008, 2009, and 2010 ranged from 48% to 80% in various IHS regions. The prevaccine average annual diarrhea-associated hospitalization rates among AI/AN children <5 years of age was 63 per 10,000 persons (range: 57-75 per 10,000), and declined to 39, 31, and 27 per 10,000 in 2008, 2009, and 2010, respectively. Observed 2008, 2009, and 2010 rates were 24%, 37%, and 44% lower than expected rates, respectively. Decreases in diarrhea-associated hospitalizations and outpatient visits were observed in all IHS regions. CONCLUSIONS: Diarrhea-associated hospitalization and outpatient visit rates among AI/AN children have declined after implementation of rotavirus vaccination in AI/AN populations. |
All cause gastroenteritis and rotavirus-coded hospitalizations among US children from 2000-2009
Desai R , Curns AT , Steiner CA , Tate JE , Patel MM , Parashar UD . Clin Infect Dis 2012 55 (4) e28-34 INTRODUCTION: Rotavirus vaccine was recommended for US infants in 2006. We estimated baseline, pre-vaccine burden and monitored post-vaccine trends in gastroenteritis-coded and rotavirus-coded hospitalizations among US children. METHODS: We analyzed data from the State Inpatient Databases (SID) for 29-44 US states over a 10-year period (2000-2009) to calculate gastroenteritis and rotavirus-coded hospitalization rates by age group, sex, and region, among children <5 years of age. By extrapolating observed pre- and post-vaccine gastroenteritis hospitalization rates to the US population <5 years and based on the 2009 cost of a diarrhea hospitalization, we estimated national reductions in diarrhea hospitalizations and associated treatment costs. RESULTS: The pre-vaccine (2000-2006) annual average gastroenteritis-coded hospitalization rate among children <5 years of age was 74 per 10,000 (annual range: 71-82 per 10,000), and declined to 51 and 50 per 10,000 in 2008 and 2009, respectively (p < 0.001). The pre-vaccine (2000-2006) annual average rotavirus-coded hospitalization rate among children <5 years of age was 15 per 10,000 (annual range: 13-18 per 10,000), and declined to 5 and 6 per 10,000 in 2008 and 2009, respectively (p < 0.001). The decreases in rotavirus-coded hospitalization rates in 2008 and 2009 compared with rates in pre-vaccine years were observed among all age-groups and US regions. Nationally, during 2008 and 2009 combined, we estimated a reduction of ~77,000 diarrhea hospitalizations and approximately $242 million in hospital costs. CONCLUSION: Since implementation of the US rotavirus vaccination program, a marked reduction in diarrhea hospitalizations and related hospital charges has occurred among US children. |
Trends in lower respiratory tract infection hospitalizations among American Indian/Alaska Native children and the general US child population
Singleton RJ , Holman RC , Folkema AM , Wenger JD , Steiner CA , Redd JT . J Pediatr 2012 161 (2) 296-302 e2 OBJECTIVE: To describe trends in the rate of hospitalization for lower respiratory tract infection (LRTI) among American Indian/Alaska Native (AI/AN) children and the general US population of children aged <5 years. STUDY DESIGN: This was a retrospective analysis of trends and hospitalization rates for LRTI-associated hospitalizations in 1998-2008 among AI/AN children aged <5 years using the Indian Health Service direct/contract inpatient data, and also among the general population of US children aged <5 years using the Nationwide Inpatient Sample. RESULTS: The 2006-2008 LRTI-associated hospitalization rate for AI/AN children aged <5 years (21.8 per 1000/year) was 32% lower than the 1998-1999 rate, and 1.6-fold higher than the general US children rate (13.8 per 1000/year; 95% CI, 12.8-14.8). Higher rates were seen in AI/AN children aged <5 years in the Alaska and the Southwest regions of the United States (41.2 and 28.0 per 1000/year, respectively). In infants, these rates were 136.4 and 82.4 per 1000/year, respectively, exceeding the rate in the general US infant population (37.1 per 1000/year; 95% CI, 34.3-40.0). The greatest disparity in the LRTI-associated hospitalization rate between AI/AN infants and the general US infant population was seen for pneumonia, with a 3-fold higher rate in AI/AN infants (36.2 per 1000/year vs 12.7 per 1000/year; 95% CI, 11.8-13.6). CONCLUSION: The LRTI-associated hospitalization rate is higher in AI/AN children, particularly infants from Alaska and the American Southwest, compared with the general US child population. Closing this gap will require addressing housing and sanitation inequities and ensuring high immunization rates and access to care. |
Disparities in infectious disease hospitalizations for American Indian/ Alaska Native people
Holman RC , Folkema AM , Singleton RJ , Redd JT , Christensen KY , Steiner CA , Schonberger LB , Hennessy TW , Cheek JE . Public Health Rep 2011 126 (4) 508-21 OBJECTIVES: We described disparities in infectious disease (ID) hospitalizations for American Indian/Alaska Native (AI/AN) people. METHODS: We analyzed hospitalizations with an ID listed as the first discharge diagnosis in 1998-2006 for AI/AN people from the Indian Health Service National Patient Information Reporting System and compared them with records for the general U.S. population from the Nationwide Inpatient Survey. RESULTS: The ID hospitalization rate for AI/AN people declined during the study period. The 2004-2006 mean annual age-adjusted ID hospitalization rate for AI/AN people (1,708 per 100,000 populiation) was slightly higher than that for the U.S. population (1,610 per 100,000 population). The rate for AI/AN people was highest in the Southwest (2,314 per 100,000 population), Alaska (2,063 per 100,000 population), and Northern Plains West (1,957 per 100,000 population) regions, and among infants (9,315 per 100,000 population). ID hospitalizations accounted for approximately 22% of all AI/AN hospitalizations. Lower-respiratory-tract infections accounted for the largest proportion of ID hospitalizations among AI/AN people (35%) followed by skin and soft tissue infections (19%), and infections of the kidney, urinary tract, and bladder (11%). CONCLUSIONS: Although the ID hospitalization rate for AI/AN people has declined, it remains higher than that for the U.S. general population, and is highest in the Southwest, Northern Plains West, and Alaska regions. Lower-respiratory-tract infections; skin and soft tissue infections; and kidney, urinary tract, and bladder infections contributed most to these health disparities. Future prevention strategies should focus on high-risk regions and age groups, along with illnesses contributing to health disparities. |
Trends in hospitalization for empyema in Alaska native children yournger than 10 years of age
Singleton RJ , Holman RC , Wenger J , Christensen KY , Bulkow LR , Zulz T , Steiner CA , Cheek JE . Pediatr Infect Dis J 2010 30 (6) 528-30 We analyzed hospitalizations for empyema among Alaska Native (AN) children and the general population of US children <10 years during the years 1998 to 2007. We also analyzed invasive pneumococcal disease in AN children. Between 1998 and 2000, the average annual hospitalization rate for empyema was higher for AN children (51.8 per 100,000/yr) than that for US children (24.2 [95% confidence interval: 20.4, 27.9] per 100,000/yr), and had increased in 2004-2007 in both populations (59.6 and 36.0 [95% confidence interval: 30.1, 41.8], respectively). Pneumococcal empyema increased in AN children despite a decrease in invasive pneumococcal disease pneumonia. |
Racial disparities in diarrhea-associated hospitalizations among children in five US States, before and after introduction of rotavirus vaccine
Yen C , Steiner CA , Barrett M , Curns AT , Hunter K , Wilson E , Parashar UD . Vaccine 2010 28 (46) 7423-6 Racial differences in diarrheal disease have not been systematically examined, and the impact of rotavirus vaccine on these differences has not been assessed. We compared diarrhea-associated hospitalizations by race/ethnicity among children <5 years pre- (2000-2006) and post- (2007 and 2008) rotavirus vaccine introduction in five US states. Pre-vaccine hospitalization rates were greater among whites versus blacks and Hispanics. However, black (versus non-black) infants <6 months and white (versus non-white) children ≥1 year had higher rates. In 2008, racial disparities for children 12-35 months resolved, but higher hospitalization rates among black infants <6 months persisted, highlighting the need for timely vaccination. |
Racial/ethnic differences in the incidence of Kawasaki Syndrome among children in Hawaii
Holman RC , Christensen KY , Belay ED , Steiner CA , Effler PV , Miyamura J , Forbes S , Schonberger LB , Melish M . Hawaii Med J 2010 69 (8) 194-197 OBJECTIVE: To describe the occurrence of Kawasaki syndrome (KS) among different racial/ethnic groups in Hawaii. METHODS: Retrospective analysis of children <18 years of age, with a focus on children <5 years of age, living in Hawaii who were hospitalized with KS using the 1996-2006 Hawaii State Inpatient Data. RESULTS: Children <5 years of age accounted for 84% of the 528 patients <18 years of age with KS. The average annual incidence among this age group was 50.4 per 100,000 children <5 years of age, ranging from 45.5 to 56.5. Asian and Pacific Islander children accounted for 92% of the children <5 years of age with KS during the study period; the average annual incidence was 62.9 per 100,000. Within this group, Japanese children had the highest incidence (210.5), followed by Native Hawaiian children (86.9), other Asian children (84.9), and Chinese children (83.2). The incidence for white children (13.7) was lower than for these racial/ethnic groups. The median age of KS admission for children <5 years of age was 21 months overall, 24 months for Japanese children, 14.5 months for Native Hawaiian children and 26.5 months for white children. CONCLUSIONS: The high average annual KS incidence for children <5 years of age in Hawaii compared to the rest of the United States population reflects an increased KS incidence among Asian and Pacific Islander children, especially Japanese children. The incidence for white children was slightly higher than or similar to that generally reported nationwide. |
Reduction in acute gastroenteritis hospitalizations among US children after introduction of rotavirus vaccine: analysis of hospital discharge data from 18 US states
Curns AT , Steiner CA , Barrett M , Hunter K , Wilson E , Parashar UD . J Infect Dis 2010 201 (11) 1617-24 BACKGROUND: In 2006, RotaTeq (RV5) was recommended for routine vaccination of United States (US) infants. We compared hospitalization rates for acute gastroenteritis among US children aged <5 years during pre-RV5 rotavirus seasons from 2000 through 2006 with those during the post-RV5 2007 and 2008 seasons. METHODS: Using 100% hospital discharge data from 18 states, accounting for 49% of the US population, we calculated acute gastroenteritis hospitalization rates for children aged <5 years by rotavirus season, 8 age groups (0-2, 3-5, 6-11, 12-17, 18-23, 24-35, 36-47, and 48-59 months), and state. RESULTS: Compared with the median rate for the 2000-2006 rotavirus seasons (101.1 hospitalizations per 10,000 children), the rates for 2007 and 2008 (85.5 and 55.5 hospitalizations per 10,000 children) were 16% and 45% lower, respectively. Children aged 0-2 months had a 28% reduction, those aged 6-23 months had a reduction of 50%, and children aged 3-5 months and 24-59 months had reductions ranging between 42% and 45% during the 2008 rotavirus season, compared with the median rate for 2000-2006 rotavirus seasons. CONCLUSIONS: The introduction of the RV5 vaccine was associated with a dramatic reduction in hospitalizations for acute gastroenteritis among US children during the 2008 rotavirus season. |
Hospitalizations for Kawasaki syndrome among children in the United States, 1997-2007
Holman RC , Belay ED , Christensen KY , Folkema AM , Steiner CA , Schonberger LB . Pediatr Infect Dis J 2010 29 (6) 483-8 BACKGROUND: The present study describes the rate and trends of childhood hospitalizations with Kawasaki syndrome (KS) in the United States. METHODS: Retrospective analysis of hospitalizations with KS among children <18 years of age in the United States using the Kids' Inpatient Database (1997, 2000, 2003, and 2006) and the Nationwide Inpatient Sample (1998-2007). RESULTS: The KS-associated hospitalization rate for children <5 years of age was 20.8 (95% CI: 18.5-23.1) per 100,000 children in 2006. Annual rates remained constant during the study period, except for a peak in 2005. In 2006, 76.8% (SE = 0.9%) of an estimated 5523 (SE = 289) KS-associated hospitalizations among children <18 years of age were <5 years of age. The mean age for all children at hospitalization was 1.6 years (SE <0.1); 25.7 months (SE = 0.3) for children <5 years of age, and 24.8 months (SE = 0.4) and 27.1 months (SE = 0.5) for boys and girls, respectively. The rate for boys was higher than that for girls (24.2 [95% CI: 21.3-27.1] and 16.8 [95% CI: 14.7-18.9], respectively). The rate for Asian/Pacific Islander children (30.3 [95% CI: 20.2-40.4]) was the highest among the racial groups. CONCLUSIONS: The national KS-associated annual hospitalization rate for children <5 years of age from 1997 to 2007 was relatively stable and was similar to previously published rates, except for an increase in 2005. Most hospitalizations were in children <3 years of age with few hospitalizations during the first 2 months of age. Children of Asian/Pacific Islander descent had the highest hospitalization rate. |
Evaluation of seasonal patterns of Kawasaki syndrome- and rotavirus-associated hospitalizations in California and New York, 2000-2005
MacNeil A , Holman RC , Yorita KL , Steiner CA , Parashar UD , Belay ED . BMC Pediatr 2009 9 65 BACKGROUND: Kawasaki Syndrome (KS) is an uncommon childhood disease with unknown etiology. It has been suggested that rotavirus infection may play a causative role in the development of KS. METHODS: To examine potential temporal associations between KS and rotavirus infection, seasonal patterns of KS- and rotavirus-associated hospitalizations among children in California and New York during 2000-2005 were compared. RESULTS: Rotavirus hospital admissions were markedly winter seasonal, with very few summer hospitalizations. KS hospitalizations occurred year-round but also peaked slightly during winter and spring. CONCLUSION: The strong winter seasonal pattern of rotavirus clearly differed from the year-round pattern of KS hospitalizations. While the present study cannot completely rule out rotavirus as having a role in the development of KS, other agents must be involved in the etiology of KS. |
Infectious disease hospitalizations in the United States
Christensen KL , Holman RC , Steiner CA , Sejvar JJ , Stoll BJ , Schonberger LB . Clin Infect Dis 2009 49 (7) 1025-35 BACKGROUND: Infectious diseases (IDs) cause widespread morbidity and mortality. We describe the epidemiology of ID hospitalizations in the United States with use of a nationally representative database. METHODS: First-listed ID hospitalizations in the United States were analyzed using the Nationwide Inpatient Sample for 1998-2006. Hospitalization rates were calculated overall for IDs and for specific ID groups. RESULTS: An estimated 40,085,978 (standard error, 255,418) hospitalizations with a first-listed ID occurred during 1998-2006, for an age-adjusted hospitalization rate of 154.4 (95% confidence interval, 153.3-155.5) hospitalizations per 10,000 persons. The rate increased slightly over the study period (152.5 [95% confidence interval, 149.6-155.4] in 1998 vs 162.2 [95% confidence interval, 158.7-165.5] in 2006); an increase was seen for both sexes, for older patients, and for Hispanic patients. Among those aged 5-39 years, female patients had a significantly higher hospitalization rate than did male patients; male patients had higher rates among the youngest children and adults aged > or = 40 years. Approximately 4.5 million hospital days and $865 billion in hospital charges were associated with primary ID hospitalizations over the study period. Lower respiratory tract infections were the most commonly listed ID (34.4%), followed by kidney, urinary tract, and bladder infections; cellulitis; and abdominal and rectal infections. CONCLUSIONS: The ID hospitalization rate increased during 1998-2006, reflecting an increase in ID hospitalizations among adults aged > or = 30 years, particularly older adults. Differences in trends and patterns of ID hospitalizations were noted by sex, age group, and race. Lower respiratory tract infections accounted for the largest proportion of ID hospitalizations. Future efforts should focus on preventive measures and improving early interventions for IDs. |
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