scholarly journals 1198. Lyme Disease Post-Exposure Prophylaxis by Single-Dose Doxycycline in Three Healthcare Systems

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S690-S690
Author(s):  
Grace E Marx ◽  
Anna M Schotthoefer ◽  
Brian S Schwartz ◽  
Evan Draper ◽  
Christina G Rivera ◽  
...  
Keyword(s):  
Single Dose ◽  
Lyme Disease ◽  
Disease Prevention ◽  
Healthcare Systems ◽  
Post Exposure Prophylaxis ◽  
Material Support ◽  
Post Exposure ◽  
Blacklegged Tick ◽  
High Incidence ◽  
Exposure Prophylaxis

Abstract Background Lyme disease, the most common tickborne disease in the United States, may be prevented by taking a single 200-mg dose of oral doxycycline after a high-risk bite from a blacklegged tick. Currently, it is not known how Lyme disease post-exposure prophylaxis (PEP) might vary by region and healthcare system. We identified single-dose doxycycline medication orders in three healthcare systems in states with high incidence of Lyme disease and compared associated patient and provider characteristics. Methods Electronic health record data during 2012 – 2016 were obtained from three healthcare systems: Geisinger (Pennsylvania), Marshfield Clinic (Wisconsin), and Mayo Clinic (Minnesota/Wisconsin). Creation of analytic variables and analysis were harmonized across the three sites. Medication orders for single-dose doxycycline ≤200 mg that were accompanied by specific key words or diagnostic codes (e.g., tick bite; Lyme disease prevention) were considered evidence of PEP. Manual chart review was performed from a random subset to evaluate the algorithms used to identify PEP. Results Among 2,937,585 patients with at least one medication order or clinical encounter during the study period, 14,102 single-dose doxycycline orders for Lyme disease PEP for 13,172 unique patients were identified. The typical patient receiving PEP was older (mean age 51 – 58 years), male (56 – 59%), and non-Hispanic White (81 – 98%). The annual seasonality of medication orders was bimodal, with peaks occurring during April – July and October – November. The most common encounter setting was an outpatient clinic or urgent care center (80 – 91%); medication orders after patient phone calls in the absence of an in-person visit occurred frequently (14 – 19%) in two health systems. Chart abstractions (n=600) revealed instances of PEP prescribed inappropriately (e.g., bite from a non-blacklegged tick; patient with symptoms of acute Lyme disease). Conclusion Lyme disease PEP with a single dose of doxycycline was frequently prescribed in healthcare systems where there is a high incidence of Lyme disease. PEP was most commonly prescribed to non-Hispanic Whites over the age of 50 years. Public health initiatives for tickborne disease prevention should include clinician education on the appropriate use of Lyme disease PEP. Disclosures Anna M. Schotthoefer, PhD, HelixBind (Other Financial or Material Support, salary support) John Zeuli, PharmD, INSMED (Other Financial or Material Support, honoraria for educational speaking)

scholarly journals 153. Utilization of Post-Exposure Prophylaxis to Prevent Lyme Disease in a Large US Healthcare Database

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S188-S188
Author(s):  
Grace E Marx ◽  
Candace C Fuller ◽  
Nicole Haug ◽  
Dave Martin ◽  
Catherine Corey ◽  
...  
Keyword(s):  
Single Dose ◽  
Lyme Disease ◽  
Disease Incidence ◽  
The United States ◽  
Emergency Department Visits ◽  
Tick Bite ◽  
Post Exposure Prophylaxis ◽  
Tick Bites ◽  
Post Exposure ◽  
Exposure Prophylaxis

Abstract Background In the United States, at least 50,000 emergency department visits for tick bite and an estimated 476,000 Lyme disease diagnoses occur annually, with incidence of both high among children. The majority of these healthcare visits occur in the northeastern and midwestern states having high Lyme disease incidence and during the summer and fall months, corresponding to peak opportunities for exposure to blacklegged ticks. Post-exposure prophylaxis (PEP) with a single dose of doxycycline can effectively prevent Lyme disease after a tick bite that is high risk for transmission of Lyme disease. We describe characteristics of patients with dispensings of single-dose doxycycline in a large US-based system that includes patients enrolled in private and public health insurance plans. Methods Single-dose doxycycline (≤200 mg) dispensings during January 2009 – February 2020 were identified for patients enrolled in seven Data Partners that contributed electronic healthcare data to the Food and Drug Administration Sentinel Distributed Database, including large national insurers, an integrated delivery care network, a state Medicaid, and the 100% Medicare fee-for-service plan. We examined patient and PEP dispensing characteristics by patient age, state of residence, and month of dispensing. Results We identified 408,897 patients with PEP (n=474,414 total dispensings) with a mean age of 60 years at first dispensing. Overall, there were 21 patients per 10,000 eligible members with PEP dispensings. Dispensings were less common in children (< 1 and 4 patients per 10,000 eligible members aged < 8 and 8-18 years, respectively). Most dispensings (72%) occurred in states with high incidence of Lyme disease. Seasonality of dispensings was bimodal, with most occurring during April – July and October – November (71 – 83%, by year). Conclusion Lyme disease PEP was relatively common and mirrored geographic and seasonal trends observed for ED visits for tick bites and Lyme disease diagnoses. However, we observed more PEP among older adults, and few dispensings among children. Despite healthcare visits for tick bites and Lyme disease occurring disproportionately among pediatric age groups, PEP appears to be underutilized in children. Disclosures All Authors: No reported disclosures

scholarly journals Leprosy Post-Exposure Prophylaxis (LPEP) programme: study protocol for evaluating the feasibility and impact on case detection rates of contact tracing and single dose rifampicin

BMJ Open ◽  
2016 ◽  
Vol 6 (11) ◽  
pp. e013633 ◽  
Author(s):  
Tanja Barth-Jaeggi ◽  
Peter Steinmann ◽  
Liesbeth Mieras ◽  
Wim van Brakel ◽  
Jan Hendrik Richardus ◽  
...  
Keyword(s):  
Single Dose ◽  
Study Protocol ◽  
Contact Tracing ◽  
Post Exposure Prophylaxis ◽  
Case Detection ◽  
Detection Rates ◽  
Post Exposure ◽  
Exposure Prophylaxis

scholarly journals Effectiveness Analysis of Single Dose Rifampicin-Post-Exposure Prophylaxis (SDR-PEP) as A Preventive Intervention for Leprosy Transmission: A Systematic Review of Randomized Controlled Trials

2021 ◽  
Vol 4 (2) ◽  
pp. 35-43
Author(s):  
Muhammad Mikail Athif Zhafir Asyura ◽  
Ilma Ranjani Wijaya ◽  
Theetouch Toshukowong ◽  
Rui Sheng Wang
Keyword(s):  
Systematic Review ◽  
Single Dose ◽  
Randomized Controlled Trials ◽  
Large Scale ◽  
Preventive Intervention ◽  
Post Exposure Prophylaxis ◽  
Controlled Trials ◽  
Post Exposure ◽  
Randomized Controlled ◽  
Exposure Prophylaxis

Introduction: Leprosy is a skin disease that reaches 200,000 cases annually. Considered a neglected tropical disease, 80% of annual leprosy remained in countries such as Brazil, India, and Indonesia. Multi-drug treatment is effective in curing leprosy but ineffective in preventing further transmission. The implementation of large-scale single dose rifampicin-post exposure prophylaxis suggests the inhibition of leprosy transmission and thus needs validation.Methods: This systematic review was carried out based on the PRISMA statement from multiple databases using set keywords. A total of 646 studies were identified, followed by 4 randomized controlled trials included after screening.Results: 86,502 subjects were divided into control and interventional groups and were to be followed up in 2-6 years. Most studies showed a significant decrease of leprosy cases by 50-60%. Furthermore, a complementary effect between single-dose rifampicin-post exposure prophylaxis and Bacillus Calmette–Guérin vaccine was identified. Moreover, the cost-effectiveness of the intervention was analyzed which resulted in IDR 80,414,775 being averted in its 25th year of implementationConclusion: The review established promising results of implementing single dose rifampicin-post exposure prophylaxis to prevent leprosy transmission. Further national scale intervention with a multi-layered approach is suggested to ensure full support and continuity of the large-scale intervention 

scholarly journals Leprosy post-exposure prophylaxis with single-dose rifampicin (LPEP): an international feasibility programme

2021 ◽  
Vol 9 (1) ◽  
pp. e81-e90 ◽  
Author(s):  
Jan Hendrik Richardus ◽  
Anuj Tiwari ◽  
Tanja Barth-Jaeggi ◽  
Mohammad A Arif ◽  
Nand Lal Banstola ◽  
...  
Keyword(s):  
Single Dose ◽  
Post Exposure Prophylaxis ◽  
Post Exposure ◽  
Exposure Prophylaxis

scholarly journals 1614. Single-Dose Doxycycline as Lyme Disease Post-Exposure Prophylaxis in a National Commercial Insurance Claims Database―the United States, 2014–2017

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S589-S589
Author(s):  
Grace E Marx ◽  
Amy M Schwartz ◽  
Camay On ◽  
Alison F Hinckley
Keyword(s):  
United States ◽  
Single Dose ◽  
Lyme Disease ◽  
Disease Incidence ◽  
The United States ◽  
Post Exposure Prophylaxis ◽  
Insurance Claims ◽  
Claims Database ◽  
Tick Activity ◽  
Exposure Prophylaxis

Abstract Background Approximately 300,000 cases of Lyme disease occur annually in the UNITED STATES, with children aged 5–9 years disproportionately affected. A single dose of doxycycline administered within 72 hours of a high-risk tick bite is recommended for post-exposure prophylaxis (PEP) to prevent Lyme disease in areas of high incidence. However, it is not known how often or for which patients PEP is used. We aimed to describe recent patterns of single-dose doxycycline medication claims in states with high and low Lyme disease incidence, and the associated patient and prescription characteristics in a large national commercial insurance claims database. Methods Outpatient medication claims in the IBM Watson Health MarketScan Database®, a large nation-wide database of de-identified insurance claims filed between January 1, 2014–December 31, 2017 were reviewed. Claims of single-dose doxycycline were identified and associated patient demographics and medication characteristics were analyzed. Results During 2014–2017, 66,210 medication claims for single-dose doxycycline were filed by 63,112 enrollees; mean annual incidence of receiving at least one single-dose doxycycline prescription was 56 per 100,000 enrollees. Mean patient age was 43 years (IQR 33–56 years); only 8% were for children aged <18 years. About half (46%) were male patients. Most claims (71%) were made by patients residing in the 14 states with high Lyme disease incidence, defined as an average annual incidence of ≥ 10 confirmed Lyme disease cases per 100,000 population. The majority (80%) of medication claims were during the 6 months of peak tick activity (April–July for nymphal ticks and October–November for adult ticks). Conclusion Single-dose doxycycline medication claims are common in states with high Lyme disease incidence and are highest during months of peak tick activity, consistent with the assumption that most single-dose doxycycline is used for Lyme disease PEP. Use of single-dose doxycycline to prevent Lyme disease is infrequent in children, despite being a group at high risk for Lyme disease. Efforts to educate pediatric healthcare providers and parents should be made to increase Lyme disease PEP access for children. Disclosures All authors: No reported disclosures.

scholarly journals Improving access to post-exposure prophylaxis for Lyme disease: a role for community pharmacists

2019 ◽  
Vol 29 (Supplement_4) ◽  
Author(s):  
G Baron ◽  
L Pinsonneault ◽  
A Binet ◽  
C-A Philie ◽  
M Bonapace-Potvin ◽  
...  
Keyword(s):  
Lyme Disease ◽  
Health Knowledge ◽  
Community Pharmacists ◽  
Integrative Model ◽  
Post Exposure Prophylaxis ◽  
Global Score ◽  
Post Exposure ◽  
Collaborative Practice Agreement ◽  
Facilitators And Barriers ◽  
Exposure Prophylaxis

Abstract Issue Virtually non-existent in Eastern Townships (ET) before 2010, Lyme disease incidence rate reached 52 confirmed cases per 100 000 in some districts in 2018, leading to post-exposure prophylaxis (PEP) recommendation by public health. To improve access to PEP, community pharmacists can now screen and initiate PEP under a collaborative practice agreement (CPA) with the regional Medical Officer of Health. Knowledge, attitudes and practices of pharmacists regarding Lyme disease PEP were surveyed after implementation of this measure. Description of the problem 312 community pharmacists practicing in ET were invited, in October 2018, to complete an online survey, based on Godin’s integrative model (2012), with questions on professional characteristics, knowledge of CPA, attitudes about PEP, and facilitators and barriers to the use of CPA. Pharmacist’s practices were evaluated using 8 clinical vignettes. Vignette-specific and a global score were calculated. Bivariate analyses were done to test the association between global score and knowledge, attitudes, facilitators and barriers. Results Response rate was 13.8%. Most pharmacists knew (97.4%) and were in favor (93.1%) of the CPA, and believed it was effective to prevent Lyme disease (96.4%). The main barriers reported to using the CPA were related to the assessment of PEP criteria. With regards to practice, pharmacists answered correctly for clients presenting all criteria for PEP (80.6%), aged &lt; 8 y.o. (51.6%), who had their tick removed for &gt;72 hrs (67.7%), already presenting with symptoms (32.3%) or who had exposure in a non-endemic area (38.7%). Finally, none of the variables studied were associated with the global score. Lessons This measure has now been expanded in other endemic regions in Quebec and a provincial CPA is under development. These results will help guide the development of the provincial CPA, specifically to better consider and to provide guidance regarding PEP contraindications. Key messages Pharmacist-initiated PEP is an innovative approach to increase timely population access to an essential preventive measure in the fight against Lyme disease in endemic districts. Additional guidance is required for pharmacists with regards to assessment of PEP criteria in future CPAs.

scholarly journals Protocol, rationale and design of PEOPLE (Post ExpOsure Prophylaxis for LEprosy in the Comoros and Madagascar): a cluster randomized trial on effectiveness of different modalities of implementation of post-exposure prophylaxis of leprosy contacts

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Nimer Ortuno-Gutierrez ◽  
Assoumani Younoussa ◽  
Andriamira Randrianantoandro ◽  
Sofie Braet ◽  
Bertrand Cauchoix ◽  
...  
Keyword(s):  
Randomized Trial ◽  
Cluster Randomized Trial ◽  
Post Exposure Prophylaxis ◽  
Post Exposure ◽  
Link Type ◽  
High Incidence ◽  
Leprosy Patients ◽  
Household Members ◽  
Cluster Randomized ◽  
Exposure Prophylaxis

Abstract Background Leprosy is an ancient infectious disease with a global annual incidence that has plateaued above 200,000 new cases since over a decade. New strategies are required to overcome this stalemate. Post-exposure prophylaxis (PEP) with a single dose of Rifampicin (SDR) has conditionally been recommended by the World Health Organization (WHO), based on a randomized-controlled-trial in Bangladesh. More evidence is required. The Post ExpOsure Prophylaxis for Leprosy (PEOPLE) trial will assess effectiveness of different modalities of PEP on the Comoros and Madagascar. Methods PEOPLE is a cluster-randomized trial with villages selected on previous leprosy-incidence and randomly allocated to four arms. Four annual door-to-door surveys will be performed in all arms. All consenting permanent residents will be screened for leprosy. Leprosy patients will be treated according to international guidelines and eligible contacts will be provided with SDR-PEP. Arm-1 is the comparator in which no PEP will be provided. In arms 2, 3 and 4, SDR-PEP will be provided at double the regular dose (20 mg/kg) to eligible contacts aged two years and above. In arm 2 all household-members of incident leprosy patients are eligible. In arm 3 not only household-members but also neighbourhood contacts living within 100-m of an incident case are eligible. In arm 4 such neighbourhood contacts are only eligible if they test positive to anti-PGL-I, a serological marker. Incidence rate ratios calculated between the comparator arm 1 and each of the intervention arms will constitute the primary outcome. Discussion Different trials on PEP have yielded varying results. The pivotal COLEP trial in Bangladesh showed a 57% reduction in incidence over a two-year period post-intervention without any rebound in the following years. A study in a high-incidence setting in Indonesia showed no effect of PEP provided to close contacts but a major effect of PEP provided as a blanket measure to an entire island population. High background incidence could be the reason of the lack of effect of PEP provided to individual contacts. The PEOPLE trial will assess effectiveness of PEP in a high incidence setting and will compare three different approaches, to identify who benefits most from PEP. Trial registration Clinicaltrials.Gov. NCT03662022. Initial Protocol Version 1.2, 27-Aug-2018.

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