Incidence of Pharyngitis, Sinusitis, Acute Otitis Media, and Outpatient Antibiotic Prescribing Preventable by Vaccination Against Group A Streptococcus in the United States

Abstract Background Group A Streptococcus (GAS) is a leading cause of acute respiratory conditions that frequently result in antibiotic prescribing. Vaccines against GAS are currently in development. Methods We estimated the incidence rates of healthcare visits and antibiotic prescribing for pharyngitis, sinusitis, and acute otitis media (AOM) in the United States using nationally representative surveys of outpatient care provision, supplemented by insurance claims data. We estimated the proportion of these episodes attributable to GAS and to GAS emm types included in a proposed 30-valent vaccine. We used these outputs to estimate the incidence rates of outpatient visits and antibiotic prescribing preventable by GAS vaccines with various efficacy profiles under infant and school-age dosing schedules. Results GAS pharyngitis causes 19.1 (95% confidence interval [CI], 17.3–21.1) outpatient visits and 10.2 (95% CI, 9.0–11.5) antibiotic prescriptions per 1000 US persons aged 0–64 years, annually. GAS pharyngitis causes 93.2 (95% CI, 82.3–105.3) visits and 53.2 (95% CI, 45.2–62.5) antibiotic prescriptions per 1000 children ages 3–9 years, annually, representing 5.9% (95% CI, 5.1–7.0%) of all outpatient antibiotic prescribing in this age group. Collectively, GAS-attributable pharyngitis, sinusitis, and AOM cause 26.9 (95% CI, 23.9–30.8) outpatient visits and 16.1 (95% CI, 14.0–18.7) antibiotic prescriptions per 1000 population, annually. A 30-valent GAS vaccine meeting the World Health Organization’s 80% efficacy target could prevent 5.4% (95% CI, 4.6–6.4%) of outpatient antibiotic prescriptions among children aged 3–9 years. If vaccine prevention of GAS pharyngitis made the routine antibiotic treatment of pharyngitis unnecessary, up to 17.1% (95% CI, 15.0–19.6%) of outpatient antibiotic prescriptions among children aged 3–9 years could be prevented. Conclusions An efficacious GAS vaccine could prevent substantial incidences of pharyngitis infections and associated antibiotic prescribing in the United States.

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Trends in broad-spectrum antibiotic prescribing for children with acute otitis media in the United States, 1998–2004

BMC Pediatrics ◽

10.1186/1471-2431-9-41 ◽

2009 ◽

Vol 9 (1) ◽

Cited By ~ 33

Author(s):

Andrew S Coco ◽

Michael A Horst ◽

Angela S Gambler

Keyword(s):

United States ◽

Otitis Media ◽

Broad Spectrum ◽

Acute Otitis Media ◽

The United States ◽

Antibiotic Prescribing ◽

Broad Spectrum Antibiotic

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23. Regional Variation in Outpatient Antibiotic Prescribing in a Commercially-insured Population, United States, 2017

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa417.022 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S12-S12

Author(s):

Destani J Bizune ◽

Danielle Palms ◽

Laura M King ◽

Monina Bartoces ◽

Ruth Link-Gelles ◽

...

Keyword(s):

United States ◽

Otitis Media ◽

Acute Otitis Media ◽

Urgent Care ◽

Antibiotic Prescribing ◽

Tier 2 ◽

Regional Variability ◽

Patient Age ◽

Patient Âgé ◽

Tier 3

Abstract Background Studies have shown that the Southern United States has higher rates of outpatient antibiotic prescribing compared to other regions in the country, but reasons for this variation are unclear. We aimed to determine whether the regional variability in outpatient antibiotic prescribing for respiratory diagnoses can be explained by differences in patient age, care setting, comorbidities, and diagnosis in a commercially-insured population. Methods We analyzed the 2017 IBM® MarketScan® Commercial Database of commercially-insured individuals aged < 65 years. We included visits with acute respiratory tract infection (ARTI) diagnoses from retail clinics, urgent care centers, emergency departments, and physician offices. ARTI diagnoses were categorized as: Tier 1, antibiotics are almost always indicated (pneumonia); Tier 2, antibiotics are sometimes indicated (sinusitis, acute otitis media, pharyngitis); and Tier 3, antibiotics are not indicated (asthma, allergy, bronchitis, bronchiolitis, influenza, nonsuppurative otitis media, viral upper respiratory infections, viral pneumonia). We calculated risk ratios and 95% confidence intervals (CI) stratified by US Census region and ARTI tier using log-binomial models controlling for patient age, comorbidities (Elixhauser and Complex Chronic Conditions for Children), and setting of care, with Tier 3 visits in the West, the strata with the lowest antibiotic prescription rate, as the reference for all strata. Results A total of 100,104,860 visits were analyzed. In multivariable modeling, ARTI visits in the South and Midwest were highly associated with receiving an antibiotic for Tier 2 conditions vs. patients in other regions (Figure 1). Figure 1. Multivariable model comparing risk of receiving an antibiotic for an ARTI by region and diagnostic tier in urgent care, retail health, emergency department, and office visits, MarketScan® 2017, United States Conclusion Regional variability in outpatient antibiotic prescribing for Tier 2 and 3 ARTIs remained even after controlling for patient age, comorbidities, and setting of care. It is likely that this variability is in part due to non-clinical factors such as regional differences in clinicians’ prescribing habits and patient expectations. Targeted and enhanced public health stewardship interventions are needed to address cultural factors that affect antibiotic prescribing in outpatient settings. Disclosures All Authors: No reported disclosures

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LB9. Rising High Rate of Invasive Group A Streptococcus Infections Among Persons Experiencing Homelessness in San Francisco, 2010–2017

Open Forum Infectious Diseases ◽

10.1093/ofid/ofy229.2183 ◽

2018 ◽

Vol 5 (suppl_1) ◽

pp. S762-S762

Author(s):

Tara Scheuer ◽

Tanya Libby ◽

Chris Van Beneden ◽

James Watt ◽

Arthur Reingold ◽

...

Keyword(s):

United States ◽

San Francisco ◽

Group A Streptococcus ◽

Disease Incidence ◽

Case Fatality ◽

The United States ◽

Invasive Group ◽

Incidence Trends ◽

Disease Case ◽

Group A

Abstract Background Rates of invasive group A Streptococcus (iGAS) disease in the United States have risen since 2014; reasons remain unclear. Outbreaks of iGAS infection among persons experiencing homelessness (PEH) and persons who inject drugs in Europe, Canada, and the United States have been described. Using active, population-based surveillance data from California’s Emerging Infections Program, we describe incidence trends and characteristics of iGAS infection among PEH and persons not experiencing homelessness (PNEH) in San Francisco (SF) County during 2010–2017. Methods We defined an iGAS case as infection with GAS isolated from a normally sterile site (e.g., blood) in an SF resident. We calculated annual iGAS disease incidence rates (cases per 100,000 population) for PEH and PNEH using denominators from SF’s Department of Homelessness and Supportive Housing and the State of California Department of Finance. Demographic, clinical, and exposure characteristics of PEH and PNEH were compared by chi-square or t-test. Results We identified 673 iGAS cases in SF during 2010–2017. Among these, 34% (229/673) were among PEH. Annual iGAS incidence among PEH rose from ~300 (2010–2014) to 547 (95% CI: 379–714) per 100,000 in 2017 (P < 0.001, Cochran-Armitage trend test); rates peaked at 758 (95% CI: 561–955) in 2016. Annual iGAS incidence in PNEH rose from a mean of 5 in 2010–2013 to 9.3 (95% CI: 7.3–11.4) per 100,000 in 2017 (P < 0.001). Annual iGAS incidence in PEH was 42–72 times that in PNEH. PEH with iGAS infections were significantly younger and more likely to be male, white, and uninsured or enrolled in Medicaid (P < 0.05 for each) compared with PNEH with iGAS disease. Case fatality ratios, ICU admission, infection type, and length of hospital stay did not differ significantly. Smoking, current injection drug use, current alcohol abuse, and AIDS diagnosis were significantly more common among PEH with iGAS. Obesity, diabetes, and cancer were significantly more common among PNEH with iGAS. Conclusion In San Francisco, iGAS rates among both PEH and PNEH have risen significantly. Incidence of iGAS is strikingly higher in PEH than in PNEH and exposures differed between PEH and PNEH with iGAS. This information could inform development of disease control and prevention strategies. Disclosures All authors: No reported disclosures.

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Unnecessary antibiotic prescribing in pediatric ambulatory care visits for bronchitis and bronchiolitis in the United States, 2006–2015

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2020.1231 ◽

2020 ◽

pp. 1-4

Author(s):

Rachel L. Snyder ◽

Laura M. King ◽

Adam L. Hersh ◽

Katherine E. Fleming-Dutra

Keyword(s):

United States ◽

Ambulatory Care ◽

The United States ◽

Antibiotic Prescribing ◽

Outpatient Visits ◽

Nationally Representative

Abstract Antibiotics are not indicated for the treatment of bronchitis and bronchiolitis. Using a nationally representative database from 2006–2015, we found that antibiotics were prescribed in 58% of outpatient visits for bronchitis and bronchiolitis in children, serving as a possible baseline for the expanded HEDIS 2020 measure regarding antibiotic prescribing for bronchitis.

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453. High Burden of Invasive and Severe Group A Streptococcus Disease Among Native Americans on the White Mountain Apache Tribal Lands

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.526 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S223-S223

Author(s):

Catherine Sutcliffe ◽

Ryan M Close ◽

Anne M Davidson ◽

Angelina Reid ◽

Dianna Quay ◽

...

Keyword(s):

Native American ◽

Native Americans ◽

Group A Streptococcus ◽

Penetrating Trauma ◽

The United States ◽

Incidence Rates ◽

Significant Difference ◽

White Mountain Apache ◽

Group A ◽

Tribal Lands

Abstract Background Native Americans are overrepresented in outbreaks of Group A Streptococcus (GAS) in the United States (US). In 2016, several invasive cases of GAS were detected at the Whiteriver Indian Health Service (IHS) Hospital in Arizona that primarily serves the White Mountain Apache (WMA) Tribe. The objective of this study was to determine the burden of invasive and severe GAS disease among Native Americans on the WMA Tribal lands. Methods Prospective population and laboratory-based surveillance for invasive and severe GASinfections was conducted for two years from March 2017 through February 2019. A case was defined as a Native American individual living on or around WMA Tribal lands with GAS isolated from a normally sterile body site (invasive) or from a non-sterile site (e.g., wound, throat, ear) requiring hospitalization (severe). Incidence rates were calculated using the IHS User Population as the denominators. Age-standardized incidence rates were calculated using US Census data from 2015 as the reference group. Results 157 cases were identified (Year 1: 85; Year 2: 72), including 42 (27%) invasive and 115 (73%) severe cases. Most cases were adults (88.5%; median age: 40.5 years) and had ≥1 underlying medical condition (99.4%), including alcoholism (57.1%), hypertension (37.2%), and diabetes (34.0%). 47.8% of cases had a trigger in the past two weeks, including penetrating trauma (31.8%) and blunt force trauma (14.0%). For 72.9% of cases, a co-infection was detected (most commonly Staphylocccus aureus: 96.8%). 4.5% of cases required amputation and 1.9% died within 30 days of initial culture. The incidence of invasive and severe GAS was 460.9 per 100,000 persons (95% confidence interval: 394.3, 538.8), with no significant difference by year. The incidence was highest among adults ≥65 and lowest among children 5–17 years of age. Age-standardized incidence rates of invasive and severe GAS and invasive only GAS are presented in the Figure. Conclusion The WMA community has experienced disproportionately high rates of invasive and severe GAS for over two years. Studies to determine the reservoirs for transmission are urgently needed, as are interventions to reduce the morbidity and mortality associated with these infections. Disclosures All authors: No reported disclosures.

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Has survival improved for nasopharyngeal carcinoma in the United States?

Otolaryngology ◽

10.1016/j.otohns.2004.09.018 ◽

2005 ◽

Vol 132 (2) ◽

pp. 303-308 ◽

Cited By ~ 29

Author(s):

Jivianne T. Lee ◽

Clifford Y. Ko

Keyword(s):

United States ◽

Nasopharyngeal Carcinoma ◽

Survival Rates ◽

The United States ◽

Incidence Rates ◽

World Health ◽

Type Iii ◽

Favorable Histology ◽

Health Organization ◽

Over Time

OBJECTIVE: To analyze the epidemiologic patterns and survival rates for patients with nasopharyngeal carcinoma over the last three decades. METHODS: The National Cancer Institute (NCI) Surveillance, Epidemiology, and End Results (SEER) program tumor registries were used to identify patients with nasopharyngeal carcinoma in the United States from 1973 to 1999. Incidence and survival rates for each decade were then determined according to age, gender, race, histological type, and stage using the SEER statistical program. RESULTS: From 1973 to 1999, 4680 cases of patients with nasopharyngeal carcinoma in the United States were sampled by the NCI/SEER database. Overall incidence rates for each decade essentially remained unchanged over time (0.7/100,000). Asians exhibited the highest incidence rates (3.0–4.2), followed by blacks (0.7–1.1) and then whites (0.4–0.7). In contrast, survival rates have gradually improved over time for all stages and histological types (35.7% 5-year survival in the 1970s vs. 44.1% in the 1980, and 51% in the 1990s). With respect to race, Asians demonstrated the best 5-year survival rate (62.9%) followed by whites (42.6%) and then blacks (36.2%). However, this may be due to histology, because Asians were also found to have a greater proportion of World Health Organization (WHO) type III cases (27.6%) in comparison to the other 2 groups (22.4% for blacks and 15% for whites). CONCLUSIONS: Although the incidence rates of nasopharyngeal carcinoma have remained essentially unchanged in the United States in the last 3 decades, survival rates for each stage and histological subtype have exhibited considerable improvement over time. The higher survival rates in Asians may be partially attributed to the more favorable histology (type III) often seen in this group. EBM rating: B-3.

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