175. Assessment of Institutional Uptake of Vancomycin AUC Monitoring One-Year Post Guideline Publication in Hospitals Across the United States

Abstract Background A new therapeutic monitoring of vancomycin for serious methicillin resistant Staphylococcus aureus infections guideline was published in March 2020. The guideline recommends a change in monitoring from trough to AUC/MIC based to improve patient outcomes. The purpose of this study was to determine institutional uptake of vancomycin AUC monitoring 1-year post guideline publication in hospitals across the U.S. Methods An electronic survey was created to assess vancomycin AUC monitoring practices and distributed to the American College of Clinical Pharmacy Infections Diseases Practice and Research Network (ACCP IDprn) and American Society of Health System Pharmacists (ASHP). Initial survey distribution (phase 1) occurred May-June 2020 and aimed to serve as baseline data. The survey was re-distributed (phase 2) to the ACCP IDprn and ASHP one year later, May-June 2021. Prior to re-distribution the survey was updated to assess the impact of COVID-19 on uptake. Results were analyzed and reported using descriptive statistics. Chi-Square tests were used to compare categorical data. Results A total of 202 responses to phase 1 and 138 responses to phase 2 were recorded. Significantly more respondents implemented AUC monitoring 1-year post guideline than at baseline (42.8% vs 29.8%, p= 0.013). In both phases, 57% of those who had not implemented AUC monitoring had plans to do so over the next year. Additionally, 46.2% phase 2 respondents reported COVID-19 impacted their ability to transition to AUC monitoring citing issues such as lack of time and inadequate resources. The most common AUC monitoring programs utilized at baseline and 1-year post guideline were purchased Bayesian software (38.3% vs. 35.6%) and homemade software (26.1% vs 23.7%). Perceived challenges to implementing AUC monitoring included cost, difficult use and integration. Conclusion Increased uptake of vancomycin AUC monitoring occurred from baseline to 1-year post guideline publication. However, less than half of hospitals implemented this recommendation. Although COVID-19 impacted a large portion respondents’ ability to implement AUC monitoring, majority plan to transition to vancomycin AUC monitoring over the next year. AUC monitoring should be adapted by all hospitals to optimize vancomycin efficacy and safety. Disclosures All Authors: No reported disclosures

Download Full-text

Differential impact of on-site or telepharmacy in the intensive care unit: a controlled before–after study

International Journal for Quality in Health Care ◽

10.1093/intqhc/mzab011 ◽

2021 ◽

Vol 33 (1) ◽

Author(s):

Joao Gabriel Rosa Ramos ◽

Sandra Cristina Hernandes ◽

Talita Teles Teixeira Pereira ◽

Shana Oliveira ◽

Denis de Melo Soares ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Phase 1 ◽

Phase 2 ◽

Differential Impact ◽

Scarce Resources ◽

Clinical Pharmacists ◽

Versus Phase ◽

Quasi Experimental ◽

The Impact

Abstract Background Clinical pharmacists have an important role in the intensive care unit (ICU) team but are scarce resources. Our aim was to evaluate the impact of on-site pharmacists on medical prescriptions in the ICU. Methods This is a retrospective, quasi-experimental, controlled before-after study in two ICUs. Interventions by pharmacists were evaluated in phase 1 (February to November 2016) and phase 2 (February to May 2017) in ICU A (intervention) and ICU B (control). In phase 1, both ICUs had a telepharmacy service in which medical prescriptions were evaluated and interventions were made remotely. In phase 2, an on-site pharmacist was implemented in ICU A, but not in ICU B. We compared the number of interventions that were accepted in phase 1 versus phase 2. Results During the study period, 8797/9603 (91.6%) prescriptions were evaluated, and 935 (10.6%) needed intervention. In phase 2, there was an increase in the proportion of interventions that were accepted by the physician in comparison to phase 1 (93.9% versus 76.8%, P < 0.001) in ICU A, but there was no change in ICU B (75.2% versus 73.9%, P = 0.845). Conclusion An on-site pharmacist in the ICU was associated with an increase in the proportion of interventions that were accepted by physicians.

Download Full-text

Towards Including Dynamic Vegetation Parameters in the EUMETSAT H SAF ASCAT Soil Moisture Products

Remote Sensing ◽

10.3390/rs13081463 ◽

2021 ◽

Vol 13 (8) ◽

pp. 1463

Author(s):

Susan C. Steele-Dunne ◽

Sebastian Hahn ◽

Wolfgang Wagner ◽

Mariette Vreugdenhil

Keyword(s):

Soil Moisture ◽

Interannual Variability ◽

Incidence Angle ◽

Pearson Correlation ◽

The United States ◽

Research Network ◽

Window Width ◽

High Frequency Variability ◽

Vegetation Parameters ◽

The Impact

The TU Wien Soil Moisture Retrieval (TUW SMR) approach is used to produce several operational soil moisture products from the Advanced Scatterometer (ASCAT) on the Metop series of satellites as part of the EUMETSAT Satellite Application Facility on Support to Operational Hydrology and Water Management (H SAF). The incidence angle dependence of backscatter is described by a second-order Taylor polynomial, the coefficients of which are used to normalize ASCAT observations to the reference incidence angle of 40∘ and for correcting vegetation effects. Recently, a kernel smoother was developed to estimate the coefficients dynamically, in order to account for interannual variability. In this study, we used the kernel smoother for estimating these coefficients, where we distinguished for the first time between their two uses, meaning that we used a short and fixed window width for the backscatter normalisation while we tested different window widths for optimizing the vegetation correction. In particular, we investigated the impact of using the dynamic vegetation parameters on soil moisture retrieval. We compared soil moisture retrievals based on the dynamic vegetation parameters to those estimated using the current operational approach by examining their agreement, in terms of the Pearson correlation coefficient, unbiased RMSE and bias with respect to in situ soil moisture. Data from the United States Climate Research Network were used to study the influence of climate class and land cover type on performance. The sensitivity to the kernel smoother half-width was also investigated. Results show that estimating the vegetation parameters with the kernel smoother can yield an improvement when there is interannual variability in vegetation due to a trend or a change in the amplitude or timing of the seasonal cycle. However, using the kernel smoother introduces high-frequency variability in the dynamic vegetation parameters, particularly for shorter kernel half-widths.

Download Full-text

Emergency Stroke Calls: Obtaining Rapid Telephone Triage (ESCORTT) – a programme of research to facilitate recognition of stroke by emergency medical dispatchers

Programme Grants for Applied Research ◽

10.3310/pgfar02010 ◽

2014 ◽

Vol 2 (1) ◽

pp. 1-124 ◽

Cited By ~ 1

Author(s):

Caroline L Watkins ◽

Stephanie P Jones ◽

Michael J Leathley ◽

Gary A Ford ◽

Tom Quinn ◽

...

Keyword(s):

Phase 1 ◽

Research Programme ◽

Online Training ◽

Final Diagnosis ◽

Phase 2 ◽

The Public ◽

Training Package ◽

Emergency Medical ◽

Emergency Medical Dispatchers ◽

The Impact

BackgroundRapid access to emergency stroke care can reduce death and disability by enabling immediate provision of interventions such as thrombolysis, physiological monitoring and stabilisation. One of the ways that access to services can be facilitated is through emergency medical service (EMS) dispatchers. The sensitivity of EMS dispatchers for identifying stroke is < 50%. Studies have shown that activation of the EMSs is the single most important factor in the rapid triage and treatment of acute stroke patients.ObjectivesTo facilitate recognition of stroke by emergency medical dispatchers (EMDs).DesignAn eight-phase mixed-methods study. Phase 1: a retrospective cohort study exploring stroke diagnosis. Phase 2: semi-structured interviews exploring public and EMS interactions. Phases 3 and 4: a content analysis of 999 calls exploring the interaction between the public and EMDs. Phases 5–7: development and implementation of stroke-specific online training (based on phases 1–4). Phase 8: an interrupted time series exploring the impact of the online training.SettingOne ambulance service and four hospitals.ParticipantsPatients arriving at hospital by ambulance with stroke suspected somewhere on the stroke pathway (phases 1 and 8). Patients arriving at hospital by ambulance with a final diagnosis of stroke (phase 2). Calls to the EMSs relating to phase 1 patients (phases 3 and 4). EMDs (phase 7).InterventionsStroke-specific online training package, designed to improve recognition of stroke for EMDs.Main outcome measuresPhase 1: symptoms indicative of a final and dispatch diagnosis of stroke. Phase 2: factors involved in the decision to call the EMSs when stroke is suspected. Phases 3 and 4: keywords used by the public when describing stroke and non-stroke symptoms to EMDs. Phase 8: proportion of patients with a final diagnosis of stroke correctly dispatched as stroke by EMDs.ResultsPhase 1: for patients with a final diagnosis of stroke, facial weakness and speech problems were significantly associated with an EMD code of stroke. Phase 2: four factors were identified – perceived seriousness; seeking and receiving lay or professional advice; caller’s description of symptoms and emotional response to symptoms. Phases 3 and 4: mention of ‘stroke’ or one or more Face Arm Speech Test (FAST) items is much more common in stroke compared with non-stroke calls. Consciousness level was often difficult for callers to determine and/or communicate. Phase 8: there was a significant difference (p = 0.003) in proportions correctly dispatched as stroke – before the training was implemented 58 out of 92 (63%); during implementation of training 42 out of 48 (88%); and after training implemented 47 out of 59 (80%).ConclusionsEMDs should be aware that callers are likely to describe loss of function (e.g. unable to grip) rather than symptoms (e.g. weakness) and that callers using the word ‘stroke’ or describing facial weakness, limb weakness or speech problems are likely to be calling about a stroke. Ambiguities and contradictions in dialogue about consciousness level arise during ambulance calls for suspected and confirmed stroke. The online training package improved recognition of stroke by EMDs. Recommendations for future research include testing the effectiveness of the Emergency Stroke Calls: Obtaining Rapid Telephone Triage (ESCORTT) training package on the recognition of stroke across other EMSs in England; and exploring the impact of the early identification of stroke by call handlers on patient and process outcomes.FundingThe National Institute for Health Research Programme Grants for Applied Research programme.

Download Full-text

Implementation, Evolution and Impact of ICU Telepharmacy Services Across a Health care System

Hospital Pharmacy ◽

10.1177/0018578719851720 ◽

2019 ◽

Vol 54 (4) ◽

pp. 232-240 ◽

Cited By ~ 2

Author(s):

Desiree E. Kosmisky ◽

Sonia S. Everhart ◽

Carrie L. Griffiths

Keyword(s):

Critical Care ◽

Patient Care ◽

Healthcare System ◽

Improve Patient Care ◽

The United States ◽

Hospital Length ◽

Hospital Length Of Stay ◽

Use Of Technology ◽

American Society ◽

The Impact

Purpose: A review of the implementation and development of telepharmacy services that ensure access to a critical care-trained pharmacist across a healthcare system. Summary: Teleintensive care unit (tele-ICU) services use audio, video, and electronic databases to assist bedside caregivers. Telepharmacy, as defined by the American Society of Health-System Pharmacists, is a method in which a pharmacist uses telecommunication technology to oversee aspects of pharmacy operations or provide patient care services. Telepharmacists can ensure accurate and timely order verification, recommend interventions to improve patient care, provide drug information to clinicians, assist in standardization of care, and promote medication safety. This tele-ICU pharmacy team is one of the only entirely clinical-based tele-ICU pharmacy models among the tele-ICU programs across the United States. The use of technology for customized alert generation and intervention proposal with medication orders and chart notation are unique. In a 34-month period from September 2015 to July 2018, more than 110 000 alerts were generated and 13 000 interventions were performed by telepharmacists. Conclusions: Tele-ICU pharmacists employ limited resources to provide critical care pharmacy expertise to multiple sites within a healthcare system during nontraditional hours with documented clinical and financial benefits. Further study is needed to determine the impact of tele-ICU pharmacists on ICU and hospital length of stay, morbidity, and mortality.

Download Full-text

4468 Evaluating the Emerging Investigators Website as an Educational Resource for Early Career Researchers

Journal of Clinical and Translational Science ◽

10.1017/cts.2020.211 ◽

2020 ◽

Vol 4 (s1) ◽

pp. 61-62

Author(s):

Layla Fattah ◽

Inga Peter ◽

Jenny Lin ◽

Janice Lynn Gabrilove

Keyword(s):

Phase 1 ◽

Early Career ◽

Second Phase ◽

Phase 2 ◽

Web Based ◽

Educational Value ◽

Early Career Researchers ◽

Content Relevance ◽

Mount Sinai ◽

Initial Survey

OBJECTIVES/GOALS: The aim of this project is to assess the usability and acceptance of a web-based educational resource for early career researchers. The Emerging Investigators website is designed to bring together resources, provide educational support and foster a community of early career researchers throughout the Mount Sinai Health System (MSHS). Locally designed and built, this web-based platform is developed using the principles of Community of Inquiry (COI), which considers how the design of online learning environments might best create and sustain a sense of community among learners. Developing a resource that meets the needs of this cohort of researchers requires an iterative implementation strategy guided by user feedback. A formal website roll-out strategy and accompanied evaluation aims to determine the design, navigability, content, relevance and educational value of this online resource from a user perspective. METHODS/STUDY POPULATION: In order to ensure this resource effectively meets the needs of this cohort of researchers, a mixed process of evaluation and design was utilized. An initial phase 1 survey was conducted with TL1 and KL2 scholars. Surveys consisted of standardized questions with answers arranged as Likert-type scales and additional written responses to collect valuable qualitative data. A convenience sample of early career researchers at Mount Sinai were contacted for initial survey participation (N = 10). A total of 3 junior faculty KL2 scholars, 3 TL1 post-doc and 4 TL1 pre-doc scholars responded to the survey. Participants were initially asked to comment on design, functionality and usefulness of content on a Likert scale with qualitative comments to support the given scores. They were subsequently asked to consider what key topics or resources were missing from the website. Based on the initial survey, changes were made to the format and content of the Emerging Investigators website to improve content relevance and usability. For phase 2, an evaluation rubric was developed to assess design, navigability, content, relevance, along with three key COI criteria to determine the educational value of this online resource. The rubric will be utilized to collect feedback in the wider phase 2 roll out of the website. RESULTS/ANTICIPATED RESULTS: The first phase of survey feedback shaped overall design of the resource. The second phase will comprehensively evaluate the value of the website in the context of teaching and learning for emerging investigators. Ten surveys were captured in the first phase. Data collection is ongoing for the second phase. Phase 1 feedback was primarily qualitative, and valuable in informing overall design choices and content. Overall the website was well received, with participants commenting on the value of the resource in terms of content and educational value. Participants particularly appreciated the regularly updated calendar function and the links provided to a wide range of resources. Functionality issues, such as broken links, were reported by participants and repaired for phase 2. Further topics of content were identified, and additional links and multimedia resources were added to address this feedback. The second phase evaluation is ongoing with data collection being conducted via an evaluation rubric. DISCUSSION/SIGNIFICANCE OF IMPACT: The Emerging Investigators website, developed using the principles of COI provides key learning, reading and resources for early career investigators in a format that is well received by a sample group of early career researchers at Mount Sinai. The website has aimed to address the reported need for communication, collaboration and social interaction with peers and other researchers across the MSHS through the addition of further web-based resources such as a LinkedIn page, a blog to feature research and provide a sounding board for research efforts, and a calendar of events targeted specifically at early career researchers. These were highlighted as areas of particular value by the participants. We anticipate the results of phase 2 rubric-based evaluations will provide actionable data that will lead to further refinement of the website, an optimized interface, and improved usability.

Download Full-text

100 Sequential feeding with diets that differ in amino acid content can significantly increase performance of growing and finishing pigs

Journal of Animal Science ◽

10.1093/jas/skz258.167 ◽

2019 ◽

Vol 97 (Supplement_3) ◽

pp. 81-81

Author(s):

Alini Veira ◽

Luan S Santos ◽

Alicia Fraga ◽

Paulo Campos ◽

Raphael Caetano ◽

...

Keyword(s):

Amino Acid ◽

Acid Content ◽

Phase 1 ◽

Amino Acid Content ◽

Experimental Period ◽

Finishing Pigs ◽

Phase 2 ◽

Nutrient Metabolism ◽

Feeding Programs ◽

The Impact

Abstract Recent studies have shown that feed intake, nutrient metabolism and utilization may vary during the 24-h circadian period. In this regard, this study aimed at evaluating the impact on performance from the switching of conventional to sequential feeding programs with diets that differ in amino acid content over the day for growing–finishing pigs. Sixty-eight 25-kg (±2.04) BW barrows were assigned to 4 feeding programs (17 animals per treatment): 1) conventional feeding (CONV), in which pigs received 100% of standardized ileal digestible (SID) AA recommendations for the entire day; 2) sequential feeding (SEQ80-120), providing 80% SID AA recommendations from 2400 to 1159 h and 120% from 1200 to 2359 h; 3) sequential feeding (SEQ70-130) providing 70% SID AA recommendations from 2400 to 1159 h and 130% from 1200 to 2359 h; and 4) sequential feeding (SEQ60-140) providing 60% SID AA recommendations from 2400 to 1159 h and 140% from 1200 to 2359 h. The experimental period lasted 82 d and was subdivided in 3 phases: phase 1 (0 to 28 d), phase 2 (29 to 54 d) and phase 3 (55 to 82 d). The data were analyzed using the MIXED procedure in SAS (SAS Inst. Inc., Cary, NC). SEQ80-120 and SEQ60-140 did not improve performance compared to CONV (P > 0.05). However, ADFI, ADG and BW was higher for SEQ70-130 than CONV during phase 1 (1.49 vs 1.3 kg/d; 0.74 vs 0.65 kg/d; 46.55 vs 43.40 kg, respectively; P < 0.05). During phase 2, BW tended to be higher for SEQ70-130 than CONV (69.20 vs 63.60 kg; P = 0.08). In the entire experimental period, ADFI tended to be higher for SEQ70-130 than CONV (2.08 vs 1.89 kg/d; P = 0.10). According to our results, sequential feeding program improves performance of growing–finishing at the beginning of the period.

Download Full-text

Sociodemographic Characteristics of Mission of Mercy Attendees in Wisconsin

JDR Clinical & Translational Research ◽

10.1177/2380084419859846 ◽

2019 ◽

Vol 5 (2) ◽

pp. 127-132

Author(s):

C. Okunseri ◽

E. Eggert ◽

C. Zheng ◽

F. Eichmiller ◽

E. Okunseri ◽

...

Keyword(s):

Dental Care ◽

Dental Health ◽

The United States ◽

County Level ◽

Chi Square ◽

Access To Dental Care ◽

Event Location ◽

Chi Square Test ◽

Population Ratio ◽

The Impact

Objective: Mission of Mercy (MoM) events are scheduled to provide care to populations suffering from urgent needs and inadequate access to dental care in the United States. This study examined individual and county-level characteristics of MoM attendees and the factors associated with changes in the rate of attendance. Methods: Deidentified archival data for MoM events available from the America’s Dentists Care Foundation (2013–2016) were analyzed. Summary statistics were calculated separately for each year. Chi-square test was performed to identify changes in attendance distribution over time. Poisson regression analyses were conducted to test changes in the rate of attendance with and without adjustment for county-level characteristics and history of prior MoM events. Results: Total numbers of attendees at Wisconsin MoM events were 1,560, 1,635, 1,187, and 951 in 2013, 2014, 2015, and 2016, respectively. Attendees were mostly female (>50%) and White (58%–81%), and mean age ranged between 36.5 and 39.2 y. The average travel distance ranged between 27 and 80 miles. Residents of counties where MoM events were held in previous years were more likely to attend another MoM event after adjusting for county distance to current location. After adjusting for dentists-to-population ratio, event history, and county distance to event location, we found that there was no statistically significant change in the rate of attendance from 2013 to 2016. Conclusions: Previous attendees with experience of attending a MoM event in their counties of residence were more likely to attend another MoM event. Higher rates of attendance were associated with shorter travel distances to MoM events. Knowledge Transfer Statement: The Mission of Mercy (MoM) events are promoted by local dental organizations to highlight the issue of access to dental care and bring greater awareness to the problem by providing urgent dental care to populations in need. Through the data-sharing practices and analyses, policy makers, dental health advocates, and program organizers will have a better understanding of the impact and reach of the program. Findings from this study will help to expand program practices, promote efficiency, and aid in the identification of appropriate event locations, innovative strategies, and public policies relevant to addressing access to dental care.

Download Full-text

The Impact of Broadband Access on Social and Economic Integration: Results from the RefugeeMobile Pilot

Journal of Refugee Studies ◽

10.1093/jrs/fez067 ◽

2019 ◽

Author(s):

William N Evans ◽

Brendan Perry ◽

Rachel Factor

Keyword(s):

United States ◽

Research Question ◽

Risk Groups ◽

The United States ◽

Control Group ◽

Broadband Access ◽

Office Visits ◽

Group Members ◽

One Year ◽

The Impact

Abstract The Internet is a ubiquitous feature of everyday life and an important research question is whether improving broadband access for at-risk groups such as refugees enhances social and economic outcomes. The article reports the results of the RefugeeMobile pilot where a sample of refugees to the United States were randomly assigned a smartphone (n = 82) with eight months of free service and pre-loaded apps designed to help them adjust to life in the United States, or not (n = 74). At a one-year follow-up, results indicate that assignment to treatment generates statistically significant increases in smartphone ownership and Internet access, and some measures of social integration. Results for employment and earnings were positive but statistically insignificant. Treatment-group members had fewer interactions with their case worker, a smaller fraction of in-office visits and hence a larger fraction of interactions by phone than control-group members, suggesting the pilot may have increased programme efficiency.

Download Full-text

Phase I/II study of MKC-1 and pemetrexed (PEM) as second-line therapy in patients (pts) with advanced non-small cell lung cancer (NSCLC)

Journal of Clinical Oncology ◽

10.1200/jco.2009.27.15_suppl.e19005 ◽

2009 ◽

Vol 27 (15_suppl) ◽

pp. e19005-e19005

Author(s):

N. H. Hanna ◽

D. Estes ◽

J. Arnott ◽

S. Marcotte ◽

A. Hannah ◽

...

Keyword(s):

Phase 1 ◽

Combined Treatment ◽

Single Agent ◽

Second Line ◽

Phase 2 ◽

Second Line Therapy ◽

Line Therapy ◽

Best Response ◽

Grade 3 ◽

One Year

e19005 Background: MKC-1 is a novel oral cell cycle inhibitor with preclinical activity against NSCLC cell lines including multi-drug resistant lines, and single agent activity in NSCLC pts. Binding targets of MKC-1 include microtubules, members of the importin-β family and AKT-mTOR. This phase 1/2 study evaluated MKC-1 in combination with PEM as second-line therapy in pts with advanced NSCLC. Methods: Eligible pts had NSCLC previously treated with one regimen for metastatic disease or disease progression within one year following adjuvant and neoadjuvant therapy. Phase 1 dose escalation used 3+3 design. Phase 2 pts were treated with MKC-1 at 75 mg/m2 given p.o. BID for 14 days along with PEM at 500 mg/m2 given i.v. on day 1 of each 21 day cycle. Following 4 cycles of combined treatment, single agent MKC-1 was continued as maintenance therapy. An interim analysis after 17 pts in phase 2 would allow accrual to continue provided one response was confirmed. Results: 27 pts were enrolled (8 in phase 1 and 19 in phase 2). Median age/PS for phase 2 is 64/1 and 89% had adenocarcinoma. Total # of treatment cycles to date for phase 2 pts is 95, with a median of 4 cycles. Of the 19 phase 2 pts, 18 were evaluable for tumor response. The best response was confirmed PR, noted in 3 pts. 5 additional pts (4 confirmed) had minor responses (>10% but <30% shrinkage). One additional pt continues on study with stable disease for >18 months. In phase 2 (n=19), all grade toxicities were anorexia (59%), fatigue (63%), nausea (58%), and dyspnea (48%). Grade 3/4 toxicities included fatigue (26%); neutropenia (22%); dyspnea, anorexia, AST and ALT elevation (11% each); nausea and constipation (5% each). 7 pts had at least one dose reduction of both PEM and MKC-1 and 3 additional pts had only MKC-1 reduced. Median PFS was 86 days with two pts continuing on study (treated for 530+ days and 140+ days, respectively). Conclusions: The phase 2 dose of MKC-1 (75 mg/m2 BID) and PEM (500 mg/m2) has been defined. The combination is well tolerated with 17% of patients achieving a confirmed PR thus far. A decision to proceed with additional accrual in this single arm study versus initiating a randomized phase 2 study of this combination is pending. [Table: see text]

Download Full-text

Identifying silent COVID-19 infections among children is critical for controlling the pandemic

10.1101/2021.01.06.21249349 ◽

2021 ◽

Author(s):

Seyed M. Moghadas ◽

Meagan C. Fitzpatrick ◽

Affan Shoukat ◽

Kevin Zhang ◽

Alison P. Galvani

Keyword(s):

Vaccination Coverage ◽

Vaccine Efficacy ◽

The United States ◽

Sensitivity Analyses ◽

Transmission Model ◽

Base Case ◽

Age Group ◽

One Year ◽

The Impact ◽

Targeted Approach

Importance: A significant proportion of COVID-19 transmission occurs silently during the pre-symptomatic and asymptomatic stages of infection. Children, while being important drivers of silent transmission, are not included in COVID-19 vaccination campaigns given their exclusion from clinical trials thus far. Objective: To investigate the impact of a targeted approach to identifying silent infections among children as a proxy for their vaccination. Design: This study used an age-structured disease transmission model to simulate the synergistic impact of interventions in reducing attack rates over the course of one year. Setting: A synthetic population representative of the demographics of the United States (US). Participants: Six age groups of 0-4, 5-10, 11-18, 19-49, 50-64, 65+ years old, stratified for their population size based on US census data. Exposures: Vaccination of adults, self-isolation of all symptomatic cases within 24 hours of symptom onset, and detection of silent infections. Main Outcomes and Measures: Vaccination of adults was implemented to reach a 40% coverage over the course of one year with a vaccine efficacy of 95% against symptomatic and severe COVID-19. Without vaccination of children, we determined the proportion and speed that would be required for identifying silent infections among this age group to suppress future attack rates below 5%. Results: A targeted approach that identifies 20.6% and 28.6% of silent infections among children within 2 or 3 days post-infection, respectively, would be required to bring attack rates under 5% with vaccination of adults. If silent infections among children remained undetected, achieving the same attack rates would require an unrealistically high vaccination coverage (at least 82%) of this age group, in addition to the base-case 40% vaccination coverage of adults. The results were robust in sensitivity analyses with respect to vaccine efficacy against infection and reduced susceptibility of children to infection. Conclusions and Relevance: In the absence of vaccine availability for children, a targeted approach to rapid identification of silent COVID-19 infections in this age group can significantly mitigate disease burden. Without measures to interrupt transmission chains from silent infections, vaccination of adults is unlikely to contain the outbreaks in the near term.

Download Full-text