scholarly journals 2726. Meningococcal Vaccination Among Patients Newly Diagnosed at High-Risk for Meningococcal Disease in the United States

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S959-S960 ◽  
Author(s):  
Lindsay Bengtson ◽  
Gary S Marshall ◽  
Ami R Buikema ◽  
Eleena Koep ◽  
Patricia Novy ◽  
...  
Keyword(s):  
United States ◽  
High Risk ◽  
Hiv Infection ◽  
Meningococcal Disease ◽  
Index Date ◽  
The United States ◽  
Vaccine Uptake ◽  
Newly Diagnosed ◽  
Medical Claims ◽  
Meningococcal Vaccines

Abstract Background Quadrivalent conjugate and polysaccharide meningococcal vaccines (MenACWY) have been recommended in the United States for patients at high-risk due to functional or anatomic asplenia, complement component deficiency (CD) and human immunodeficiency virus (HIV) infection. Serogroup B vaccines (MenB) are recommended for patients ≥10 years of age with asplenia or CD. Little is currently known about meningococcal vaccine uptake and time to vaccination among patients with incident high-risk diagnoses. Methods Patients newly diagnosed (1 inpatient or ≥2 outpatient medical claims with evidence of the condition ≥30 days apart) with functional or anatomic asplenia (excluding sickle cell disease), CD or HIV infection were identified in the Optum Research Database. Continuous enrollment for ≥12 months before and ≥6 months after the diagnosis date (index date) was required. Patients with evidence of pre-existing conditions were excluded. MenACWY uptake was assessed among patients ≥2 years of age at index date from January 1, 2010 for asplenia and CD, and January 1, 2016 for HIV infection, through March 31, 2018; and MenB uptake among patients ≥10 years of age at index date from January 1, 2015 through March 31, 2018. Current Procedural Terminology and National Drug Codes on medical claims were used to capture vaccinations. For each condition, Kaplan–Meier analysis was used to estimate uptake and time to receipt of ≥1 dose of each vaccine for up to 5 years post-index date; vaccinations within 90 days before the index date were also included in calculations. Results Among asplenia patients, the percentage with receipt of ≥1 dose of MenACWY at 1, 2.5, and 5 years post-index date was 6.6%, 9.4%, and 13.3%, respectively; for CD patients the corresponding percentages were 2.2%, 4.8%, and 8.3%; and for HIV patients at 1 and 2.5 years post-index date the percentages were 10.8% and 19.8% (Figure 1). Receipt of ≥1 dose of MenB at 1 and 2.5 years post-index date was 1.7% and 3.1%, respectively, for asplenia patients and 1.1% and 2.5%, respectively, for CD patients (Figure 2). Conclusion Uptake of meningococcal vaccines in patients newly diagnosed with high-risk conditions is very low and the time to vaccination is long, leaving patients vulnerable to invasive meningococcal disease for extended periods of time. Disclosures All authors: No reported disclosures.

Douching Practices Among Women at High Risk of HIV Infection in the United States

2002 ◽  
Vol 29 (7) ◽  
pp. 406-410 ◽  
Author(s):  
BERYL A. KOBLIN ◽  
KENNETH MAYER ◽  
ANTHONY MWATHA ◽  
PAMELA BROWN-PETERSIDE ◽  
RENEE HOLT ◽  
...  
Keyword(s):  
United States ◽  
High Risk ◽  
Hiv Infection ◽  
The United States

scholarly journals Incorporating Rapid HIV Testing into Partner Counseling and Referral Services

2008 ◽  
Vol 123 (3_suppl) ◽  
pp. 126-135 ◽  
Author(s):  
Elin B. Begley ◽  
Alexandra M. Oster ◽  
Binwei Song ◽  
Linda Lesondak ◽  
Kelly Voorhees ◽  
...  
Keyword(s):  
High Risk ◽  
Hiv Infection ◽  
Hiv Testing ◽  
The United States ◽  
High Risk Population ◽  
Newly Diagnosed ◽  
Infected People ◽  
Rapid Hiv Testing ◽  
Undiagnosed Hiv ◽  
Locating Information

Objectives. Partner counseling and referral services (PCRS) provide a unique opportunity to decrease transmission of human immunodeficiency virus (HIV) by notifying sex and drug-injection partners of HIV-infected individuals of their exposure to HIV. We incorporated rapid HIV testing into PCRS to reduce barriers associated with conventional HIV testing and identify undiagnosed HIV infection within this high-risk population. Methods. From April 2004 through June 2006, HIV-infected people (index clients) were interviewed, and their partners were notified of their potential exposure to HIV and offered rapid HIV testing at six sites in the United States. The numbers of index clients participating and the numbers of partners interviewed and tested were compared by site. Descriptive and bivariate analyses were performed. Results. A total of 2,678 index clients were identified, of whom 779 (29%) provided partner locating information. A total of 1,048 partners were elicited, of whom 463 (44%) were both interviewed and tested for HIV. Thirty-seven partners (8%) were newly diagnosed with HIV. The number of index clients interviewed to identify one partner with newly diagnosed HIV infection ranged from 10 to 137 at the participating sites. Conclusions. PCRS provides testing and prevention services to people at high risk for HIV infection. Incorporating rapid HIV testing into PCRS and identifying previously undiagnosed infections likely confer individual and public health benefits. Further evaluation is needed to determine the best methods of identifying partners with previously unrecognized HIV infection.

scholarly journals Prospects for Vaccine Prevention of Meningococcal Infection

2006 ◽  
Vol 19 (1) ◽  
pp. 142-164 ◽  
Author(s):  
Lee H. Harrison
Keyword(s):  
United States ◽  
High Risk ◽  
Bacterial Meningitis ◽  
Neisseria Meningitidis ◽  
Meningococcal Disease ◽  
Risk Groups ◽  
The United States ◽  
Meningococcal Infection ◽  
Meningococcal Vaccine ◽  
The Military

SUMMARY Neisseria meningitidis is the leading cause of bacterial meningitis in the United States and worldwide. A serogroup A/C/W-135/Y polysaccharide meningococcal vaccine has been licensed in the United States since 1981 but has not been used universally outside of the military. On 14 January 2005, a polysaccharide conjugate vaccine that covers meningococcal serogroups A, C, W-135, and Y was licensed in the United States for 11- to 55-year-olds and is now recommended for the routine immunization of adolescents and other high-risk groups. This review covers the changing epidemiology of meningococcal disease in the United States, issues related to vaccine prevention, and recommendations on the use of the new vaccine.

scholarly journals Piloting a System for Behavioral Surveillance Among Heterosexuals at Increased Risk of HIV in the United States

2012 ◽  
Vol 6 (1) ◽  
pp. 169-176 ◽  
Author(s):  
Elizabeth A DiNenno ◽  
Alexandra M Oster ◽  
Catlainn Sionean ◽  
Paul Denning ◽  
Amy Lansky
Keyword(s):  
United States ◽  
Pilot Study ◽  
Hiv Infection ◽  
Risk Behaviors ◽  
The United States ◽  
Hiv Prevalence ◽  
Newly Diagnosed ◽  
The Past ◽  
Increased Risk ◽  
Definition Of

Objectives: During the past decade, the number and proportion of reported HIV cases in the United States acquired through heterosexual contact has increased markedly. CDC employs the National HIV Behavioral Surveillance System (NHBS) to monitor risk behaviors and HIV prevalence in high-risk populations. To identify a target population for conducting NHBS among heterosexuals at increased risk for HIV (NHBS-HET), CDC designed, implemented and evaluated a pilot study. Methods: The pilot study was conducted in 25 US metropolitan statistical areas in 2006-7. We recruited men and women who reported sex with at least one opposite-sex partner during the past year for a behavioral survey and HIV test. We investigated the relationship between newly diagnosed HIV infection and individual risk behaviors, sexual network characteristics, and social-structural characteristics to arrive at a definition of a heterosexual at increased risk of HIV. Results: Of 14,750 participants in the analysis, 207 (1.4%) had newly diagnosed HIV infection. Using low socioeconomic status (SES) as a criterion for defining a heterosexual at increased risk for HIV resulted in optimal rates of HIV prevalence, specificity, sensitivity and practicality. Conclusions: Results from the NHBS pilot study underscore the key role of social factors as determinants of HIV infection risk among U.S. heterosexuals, and low SES was incorporated into the definition of a heterosexual at increased risk for HIV in NHBS-HET cycles. Future cycles of NHBS-HET will help tailor prevention programs for those populations most at risk of HIV in the US.

Surveillance for meningococcal disease and strategies for use of conjugate meningococcal vaccines in the United States

Vaccine ◽  
2001 ◽  
Vol 19 (31) ◽  
pp. 4566-4575 ◽  
Author(s):  
Jairam R. Lingappa ◽  
Nancy Rosenstein ◽  
Elizabeth R. Zell ◽  
Kathleen A. Shutt ◽  
Anne Schuchat ◽  
...  
Keyword(s):  
United States ◽  
Meningococcal Disease ◽  
The United States ◽  
Meningococcal Vaccines

scholarly journals 2720. Potential Public Health Impact of a Pentavalent vaccine targeting Neisseria meningitidis Serogroups A, B, C, W, and Y

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S957-S957
Author(s):  
Sonya J Snedecor ◽  
Amit K Sirvastava ◽  
Paul Palmer ◽  
Liping Huang
Keyword(s):  
Public Health ◽  
United States ◽  
Meningococcal Disease ◽  
Health Impact ◽  
The United States ◽  
Vaccine Uptake ◽  
Sensitivity Analyses ◽  
Public Health Impact ◽  
Pentavalent Vaccine ◽  
Potential Public Health

Abstract Background In the United States, most invasive meningococcal disease (IMD) is caused by serogroup B, followed by C, W, and Y. ACIP recommends universal vaccination against MenACWY (Category A) and MenB based on individual clinical decision-making (Category B) (Figure 1). In 2017, MenACWY vaccine uptake among adolescents was 44.3% for ≥2 doses and MenB uptake was 14.5% for ≥1 dose of a multi-dose series. A pentavalent vaccine (MenABCWY or Penta) has the potential to simplify immunization schedules and improve uptake to achieve further reductions in IMD. Our objective was to estimate the potential public health impact of Penta. Methods Using CDC’s enhanced meningococcal disease surveillance data (2015–2017 average), a dynamic transmission model was constructed to estimate the reduction in IMD over 10 years resulting from various implementation strategies including Penta within the existing United States meningococcal vaccination platform. The model assumed that 2-doses of Penta could provide 95% and 85% direct and 25.5% and 0% indirect protection, respectively, against serogroups ACWY and B for 5 years, with 10% relative waning per year. For partial compliance (1 dose Penta only), we assumed protection against ACWY equal to 2-doses but partial protection against B. Future uptake of Penta was assumed higher than 2017 uptake, and sensitivity analyses with lower uptake were conducted. Results Based on 2015–2017 epidemiology, the current schedule and uptake of MenACWY and MenB vaccines (total 4 doses) was estimated to avert 149 IMD cases over 10 years. Replacing MenACWY and/or MenB doses with Penta at 11 and/or 16 years could avert more cases, ranging from 172 to 243 (Figure 2). The most beneficial schedule was 2-doses of Penta at 11 years and 1-dose Penta at 16 years. Additional sensitivity analyses indicated that, even assuming current uptake rates, more cases could be prevented by utilizing Penta. Conclusion Replacing one or more MenACWY/MenB vaccine doses with Penta could improve prevention of IMD caused by all 5 meningococcal serogroups among the US adolescent population and provide substantial public health benefit while reducing the recommended number of vaccine administrations. Disclosures All authors: No reported disclosures.

scholarly journals Potential Contributions of Clinical and Community Testing in Identifying Persons with Undiagnosed HIV Infection in the United States

2020 ◽  
Vol 19 ◽  
pp. 232595822095090
Author(s):  
James G. Kahn ◽  
Eran Bendavid ◽  
Patricia M. Dietz ◽  
Angela Hutchinson ◽  
Hacsi Horvath ◽  
...  
Keyword(s):  
United States ◽  
High Risk ◽  
Hiv Infection ◽  
Hiv Testing ◽  
Clinical Care ◽  
The United States ◽  
Low Risk ◽  
Published Data ◽  
Community Settings ◽  
Undiagnosed Hiv

Background: An estimated 166,155 individuals in the United States have undiagnosed HIV infection. We modeled the numbers of HIV-infected individuals who could be diagnosed in clinical and community settings by broadly implementing HIV screening guidelines. Setting: United States. Methods: We modeled testing for general population (once lifetime) and high-risk populations (annual): men who have sex with men, people who inject drugs, and high-risk heterosexuals. We used published data on HIV infections, HIV testing, engagement in clinical care, and risk status disclosure. Results: In clinical settings, about 76 million never-tested low-risk and 2.6 million high-risk individuals would be tested, yielding 36,000 and 55,000 HIV diagnoses, respectively. In community settings, 30 million low-risk and 4.4 million high-risk individuals would be tested, yielding 75,000 HIV diagnoses. Conclusion: HIV testing in clinical and community settings diagnoses similar numbers of individuals. Lifetime and risk-based testing are both needed to substantially reduce undiagnosed HIV.

scholarly journals Characteristics of and meningococcal disease prevention strategies for commercially insured persons receiving eculizumab in the United States

PLoS ONE ◽  
2020 ◽  
Vol 15 (11) ◽  
pp. e0241989
Author(s):  
Catherine H. Bozio ◽  
Cheryl Isenhour ◽  
Lucy A. McNamara
Keyword(s):  
United States ◽  
Disease Prevention ◽  
Meningococcal Disease ◽  
The United States ◽  
Prescription Data ◽  
Meningococcal Vaccine ◽  
Prevention Strategies ◽  
Meningococcal Vaccines ◽  
Increased Risk

Introduction Eculizumab is a licensed treatment for several rare, complement-mediated diseases. Eculizumab use is associated with an approximately 2,000-fold increased meningococcal disease risk. In the United States, meningococcal vaccines are recommended for eculizumab recipients but there are no recommendations on use of long-term antibiotic prophylaxis. We describe characteristics of and meningococcal vaccine and antibiotic receipt in U.S. eculizumab recipients to inform meningococcal disease prevention strategies. Methods Persons in the IBM® MarketScan® Research Databases with ≥1 claim for eculizumab injection during 2007–2017 were included. Indication for eculizumab use, meningococcal vaccine receipt, and antibiotic receipt were assessed using International Classification of Diseases-9/10 diagnosis codes, vaccine administration procedure codes, and antibiotic codes from pharmacy claims, respectively. Results Overall 696 persons met the inclusion criteria. Paroxysmal nocturnal hemoglobinuria (PNH) and atypical hemolytic uremic syndrome (aHUS) were the most common indications for eculizumab use (41% and 37%, respectively); 20% had an undetermined indication. From June 2015 through December 2017, 28% (41/148) of continuously-enrolled patients received ≥1 serogroup B vaccine dose. For serogroup ACWY conjugate vaccine, 45% (91/201) of patients received ≥1 dose within five years of their most recent eculizumab dose, as recommended. Of eculizumab recipients with outpatient prescription data, 7% (41/579) received antibiotics for ≥50% of the period of increased risk for meningococcal disease. Conclusion Many eculizumab recipients had an undetermined indication for eculizumab use; few were up-to-date for recommended meningococcal vaccines or were prescribed antibiotics long-term. These findings can inform further investigation of how to best protect this population from meningococcal disease.

scholarly journals Hematopoietic Cell Transplantation in First Remission Amongst Adolescent and Young Adult Acute Lymphoblastic Leukemia: A Population-Level Analysis across the United States

Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 3965-3965
Author(s):  
Lori S Muffly ◽  
Qian Li ◽  
Elysia Alvarez ◽  
Justine M. Kahn ◽  
Lena E. Winestone ◽  
...  
Keyword(s):  
United States ◽  
Acute Lymphoblastic Leukemia ◽  
High Risk ◽  
Research Funding ◽  
Hematopoietic Cell Transplantation ◽  
Lymphoblastic Leukemia ◽  
The United States ◽  
Newly Diagnosed ◽  
Front Line ◽  
Allogeneic Hct

Abstract Background: The optimal role of allogeneic hematopoietic cell transplantation (HCT) for adolescents and young adults (AYA) with acute lymphoblastic leukemia (ALL) is an area of clinical debate. In this population-based evaluation of AYA ALL patients across the United States (US), we sought to describe recent patterns of care and outcomes regarding HCT in first complete remission (CR1) amongst AYAs with ALL. Methods: Data were abstracted from the National Cancer Institute Surveillance, Epidemiology, and End Results (SEER) Patterns of Care (POC) study focused on AYA cancers. AYAs (15-39 years) with ALL newly diagnosed between January 1, 2012 through December 31, 2013 and registered in the SEER program were included. Allogeneic HCT in CR1 was defined as occurrence of HCT without relapse/progression prior to the HCT date; HCT was considered a time-dependent variable in survival models. Multivariable logistic regression was used to evaluate associations with HCT in CR1; cox proportional hazards regression was used to evaluate associations with survival. Results: Three-hundred and ninety-nine AYAs (15-39 years) with newly diagnosed ALL between 2012-2013 were included; median follow-up for survival was 19 months (range, 0-35 months). The median age was 24 years; 85% had B-cell ALL, 27% had high risk ALL cytogenetics. One-third of AYA ALL patients received care from pediatric oncologists while two-thirds were treated by adult hematologist/oncologists; a majority (86%) received care at a teaching hospital. Fifty-eight percent received an asparaginase-containing ALL front-line regimen, 32% received hyperCVAD; 5.9% and 4.5% received another/unknown regimens, respectively. One-hundred and two (29%) AYAs underwent allogeneic HCT in CR1. Excluding patients with relapse/progression or death within three months of diagnosis (n=32), older age, high-risk ALL cytogenetics, treatment by an adult hematologist/oncologist, and front-line therapy with hyperCVAD were variables significantly associated (all P< 0.05) with increased odds of HCT in CR1 in univariate analysis, while Hispanic ethnicity and public or no/other insurance were associated with significantly lower odds of HCT in CR1. In multivariate adjusted analysis, only high-risk cytogenetics (odds ratio (OR) 4.84, 95% confidence interval (CI) 2.99-7.83) and receipt of hyperCVAD (OR 1.84, 95% CI 1.07-3.16) retained significant associations with HCT in CR1. The two-year cumulative incidence of relapse, relapse-free survival (RFS), and overall survival (OS) of the entire cohort were 28.3% (95% CI 23.4%-33.4%), 69.3% (95% CI, 63.6%-74.3%), and 84.1% (95% CI 79.7%-87.5%), respectively. Two-year cumulative incidence of relapse was significantly lower in patients receiving HCT in CR1 as opposed to those not receiving HCT in CR1 (15.1%, 95% CI 8.1%-24.1% vs 32.8%, 95% CI 26.9%-38.9%). This translated into a significant improvement in 2-year RFS (83.6%, 95% CI 72.6%-90.5% vs 64.3%, 95% CI 57.5%-70.3%), but no statistically significant differences in 2-year OS (88.9%, 95% CI 80.8%-93.7% vs 82.5%, 95% CI 77.2%-86.7%). Among all patients, receipt of care at a non-teaching hospital (hazard ratio (HR) 2.14, 95% CI 1.22-3.75) and use of another/unknown regimen (HR 9.08, 95% CI, 4.83-17.06) were significantly associated with inferior OS. Conclusions: In the US, allogeneic HCT in CR1 is most commonly administered to AYA ALL with high risk cytogenetics and as consolidation therapy for those who receive front-line hyperCVAD, as opposed to asparaginase-containing ALL regimens. Consistent with prior studies, AYA ALL patients treated at non-teaching hospitals have inferior survival. Although the landscape of ALL therapy is changing, these data provide an important snapshot of the modern state of HCT in CR1 for AYA ALL. Disclosures Muffly: Shire Pharmaceuticals: Research Funding; Adaptive Biotechnologies: Research Funding.

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