Influenza hospitalizations in Australian children 2010–2019: The impact of medical comorbidities on outcomes, vaccine coverage, and effectiveness

Abstract Background All aged individuals with a chronic condition and those with 65 and more years are at increased risk of severe influenza post-infection complications. There is limited research on cases averted by the yearly vaccination programs in high-risk individuals. The objective was to estimate the impact of trivalent seasonal influenza vaccination on averted hospitalizations and death among the high-risk population in Portugal. Methods The impact of trivalent seasonal influenza vaccination was estimated using vaccine coverage, vaccine effectiveness and the number of influenza-related hospitalizations and deaths. The number of averted events (NAE), prevented fraction (PF) and number needed to vaccinate (NVN) were estimated for seasons 2014/15 to 2016/17. Results The vaccination strategy averted on average approximately 1833 hospitalizations and 383 deaths per season. Highest NAE was observed in the ≥65 years population (85% of hospitalizations and 95% deaths) and in the 2016/17 season (1957 hospitalizations and 439 deaths). On average, seasonal vaccination prevented 21% of hospitalizations in the population aged 65 and more, and 18.5% in the population with chronic conditions. The vaccination also prevented 29% and 19.5% of deaths in each group of the high-risk population. It would be needed to vaccinate 3360 high-risk individuals, to prevent one hospitalization and 60,471 high-risk individuals to prevent one death. Conclusion The yearly influenza vaccination campaigns had a sustained positive benefit for the high-risk population, reducing hospitalizations and deaths. These results can support public health plans toward increased vaccine coverage in high-risk groups.

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The Impact of Medical Comorbidities on Patient Satisfaction in Chronic Rhinosinusitis

Annals of Otology Rhinology & Laryngology ◽

10.1177/00034894211015736 ◽

2021 ◽

pp. 000348942110157

Author(s):

Amarbir S. Gill ◽

Joshua Hwang ◽

Angela M. Beliveau ◽

Jeremiah A. Alt ◽

Edward Bradley Strong ◽

...

Keyword(s):

Patient Satisfaction ◽

Hearing Impairment ◽

Chronic Rhinosinusitis ◽

Medical Comorbidities ◽

Patient Demographics ◽

Significant Difference ◽

Comorbidity Index ◽

The Mean ◽

Therapy Compliance ◽

The Impact

Background: Patient satisfaction has a significant bearing on medical therapy compliance and patient outcomes. The purpose of this study was to (1) describe patient satisfaction, as characterized by the Patient Satisfaction Questionnaire-18 (PSQ-18), in the care of patients with chronic rhinosinusitis (CRS) and (2) analyze the impact of comorbidities on satisfaction using the functional comorbidity index (FCI). Methods: Patient demographics, disease severity measures, and PSQ-18 scores for patients with CRS presenting to a tertiary rhinology clinic between November 2019 and April 2020 were collected and analyzed. FCI was calculated retrospectively using the electronic medical record; individual comorbidities were tabulated. Spearman’s correlations followed by multivariate regression was used to assess the relationship between medical comorbidities and PSQ-18. Results: Sixty-nine patients met criteria for analysis. There were no significant differences in age, gender, and Sinonasal Outcomes Test-22 scores between CRS patients with (CRSwNP) and without (CRSsNP) nasal polyps. There was no significant difference in the mean FCI for patients with CRSwNP versus CRSsNP (5.1 and 4.3, respectively) ( P = .843). Similarly, there was no significant difference in the mean sum PSQ-18 score (78/100 in both) between these cohorts ( P = .148). The mean sum PSQ-18 score was not significantly associated with anxiety ( P = .728), depression ( P = .624), or FCI ( P = .282), but was significantly associated with hearing impairment ( P < .001). Conclusion: Patient satisfaction in the care of CRS is generally high with a diagnosis of comorbid hearing impairment demonstrating a negative association with satisfaction in this cohort.

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Vaccine Coverage Across the Life Course in Michigan During the COVID-19 Pandemic: January–September 2020

American Journal of Public Health ◽

10.2105/ajph.2021.306474 ◽

2021 ◽

pp. e1-e9

Author(s):

Angela K. Shen ◽

Cristi A. Bramer ◽

Lynsey M. Kimmins ◽

Robert Swanson ◽

Patricia Vranesich ◽

...

Keyword(s):

Life Course ◽

Vaccination Coverage ◽

Vaccine Coverage ◽

Childhood Vaccination ◽

Local Health ◽

Immunization Registry ◽

Immunization Services ◽

Vaccines For Children ◽

The Life Course ◽

The Impact

Objectives. To assess the impact of the COVID-19 pandemic on immunization services across the life course. Methods. In this retrospective study, we used Michigan immunization registry data from 2018 through September 2020 to assess the number of vaccine doses administered, number of sites providing immunization services to the Vaccines for Children population, provider location types that administer adult vaccines, and vaccination coverage for children. Results. Of 12 004 384 individual vaccine doses assessed, 48.6%, 15.6%, and 35.8% were administered to children (aged 0–8 years), adolescents (aged 9–18 years), and adults (aged 19–105 years), respectively. Doses administered overall decreased beginning in February 2020, with peak declines observed in April 2020 (63.3%). Overall decreases in adult doses were observed in all settings except obstetrics and gynecology provider offices and pharmacies. Local health departments reported a 66.4% decrease in doses reported. For children, the total number of sites administering pediatric vaccines decreased while childhood vaccination coverage decreased 4.4% overall and 5.8% in Medicaid-enrolled children. Conclusions. The critical challenge is to return to prepandemic levels of vaccine doses administered as well as to catch up individuals for vaccinations missed. (Am J Public Health. Published online ahead of print October 7, 2021: e1–e9. https://doi.org/10.2105/AJPH.2021.306474 )

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Abstract P305: Post-Stroke Aphasia as a Predictor of 30-Day Readmission Associated With Infection: A Retrospective Chart Review

Stroke ◽

10.1161/str.52.suppl_1.p305 ◽

2021 ◽

Vol 52 (Suppl_1) ◽

Author(s):

Emma M Loebel ◽

Mary Rojas ◽

Connor Mensching ◽

Danielle Wheelwright ◽

Laura K Stein

Keyword(s):

Chart Review ◽

Retrospective Chart Review ◽

Mount Sinai Hospital ◽

Index Admission ◽

Negative Consequences ◽

Medical Comorbidities ◽

Post Stroke ◽

Increased Risk ◽

Adjusted Model ◽

The Impact

Introduction: Studies have demonstrated that aphasia may negatively impact morbidity and mortality among ischemic stroke (IS) patients. However, the association between post-stroke aphasia and readmission with infection (RI) is poorly understood. We sought to assess the impact of aphasia on post-stroke RI. We hypothesized that aphasic patients are at increased risk of infection in the 30-day post-stroke period. Methods: We performed retrospective chart review of the Mount Sinai Hospital IS patients with 30-day all cause readmission from January 2016 - December 2019. All variables were abstracted from the index admission (IA) electronic medical records except for aspects related to the readmission (RA). Aphasia was present if a neurologist diagnosed the patient with acquired language dysfunction during IA. We performed chi square and logistic regression analyses to compare readmitted patients with and without aphasia at IA. Our fully adjusted model controlled for age, sex, medical comorbidities, NIHSS ≥ 8, IA LOS > 7, IA infection, discharge to facility. We completed all analyses with SPSS. Results: During IA, 36% (n=42) were diagnosed with aphasia. At IA, there were no significant differences in age (dichotomized at 65), sex, or medical comorbidities between aphasic and non-aphasic cohorts. However, more aphasic patients had admission NIHSS ≥ 8 (89% vs 35%, p<0.0001), LOS > 7 (76% vs 42%, p=0.0004), discharge to facility (79% vs 49%, p=0.0016), and RI (52% vs 19%, p=0.002). The presence of aphasia predicted RI in both unadjusted (OR=4.6, p<0.001) and adjusted (OR= 3.3, p=0.014) multivariate analyses. The Kappa inter-reliability ranged from 0.7-1.0 for the key variables included in our adjusted model. Conclusions: The adjusted odds of 30-day readmission with infection were significantly greater in those with diagnosis of aphasia at the time of index admission compared to those without. Our study provides preliminary evidence that the presence of aphasia may have negative consequences on a patient’s health beyond the language disturbance. Further study is needed to better understand the reasons and risk reduction strategies in this vulnerable population.

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Third doses of COVID-19 vaccines reduce infection and transmission of SARS-CoV-2 and could prevent future surges in some populations

10.1101/2021.10.25.21265500 ◽

2021 ◽

Author(s):

Billy J Gardner ◽

A. Marm Kilpatrick

Keyword(s):

Vaccine Coverage ◽

Severe Disease ◽

Neutralizing Antibody ◽

Reproductive Number ◽

Vaccine Protection ◽

Contact Rates ◽

Previous Infection ◽

Antibody Titers ◽

Protection Against Infection ◽

The Impact

Background Vaccines have greatly reduced the impact of COVID-19 globally. Unfortunately, evidence indicates that immunity wanes following vaccination, especially with the Delta variant (B.1.617.2). Protection against severe disease and death remain high, but protection against milder disease and infection have dropped significantly. A third booster dose of two-dose vaccines has been approved in several countries to individuals at higher risk of severe disease to protect those individuals, but the benefit to boosting immunity in younger healthy individuals and the effects on transmission are less clear. Methods Here we use relationships between neutralizing antibody titers and vaccine protection against infection and transmission, combined with data on waning and boosting of neutralizing antibody titers to examine the impact of a third dose of the Pfizer vaccine on infection and transmission and its impact on the pathogen effective reproductive number Rt. Findings Eight months of waning reduced protection of the Pfizer vaccine against all infections from 80.0% (95% CI: 77% to 83%) to 60.4% (95% CI: 53% to 67%); a third dose (which increased neutralizing antibody titers 25.9- fold relative to levels after 8 months of waning) increased protection to 87.2% (95% CI: 83% to 91%). Increased protection against infection and transmission from third doses reduced Rt by 21% to 66% depending on vaccine coverage and previous infection and reduced Rt below 1 when vaccination coverage was high or contact rates were well below pre-pandemic levels. Interpretation A third dose of the Pfizer vaccine could reduce transmission of SARS-CoV-2, which would reduce infection in unvaccinated individuals and breakthrough infections in vaccinated individuals. While vaccination of unvaccinated individuals, especially in developing countries, would be more effective for reducing disease than providing a third dose to vaccinated individuals, the benefit of a third dose in reducing transmission is sizeable and increases with vaccine coverage and contact rates among individuals.

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The Impact of Medical Comorbidities on Primary Total Knee Arthroplasty Reimbursements

The Journal of Knee Surgery ◽

10.1055/s-0038-1651529 ◽

2018 ◽

Vol 32 (06) ◽

pp. 475-482 ◽

Cited By ~ 5

Author(s):

Karim G. Sabeh ◽

Samuel Rosas ◽

Leonard T. Buller ◽

Andrew A. Freiberg ◽

Cynthia L. Emory ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Perioperative Complications ◽

Primary Total Knee Arthroplasty ◽

Cost Of Care ◽

Chronic Obstructive ◽

Level Of Evidence ◽

Medical Comorbidities ◽

Total Knee ◽

The Impact

AbstractMedical comorbidities have been shown to cause an increase in peri-and postoperative complications following total knee arthroplasty (TKA). However, the increase in cost associated with these complications has yet to be determined. Factors that influence cost have been of great interest particularly after the initiation of bundled payment initiatives. In this study, we present and quantify the influence of common medical comorbidities on the cost of care in patients undergoing primary TKA. A retrospective level of evidence III study was performed using the PearlDiver supercomputer to identify patients who underwent primary TKA between 2007 and 2015. Patients were stratified by medical comorbidities and compared using analysis of variance for reimbursements for the day of surgery and over 90 days postoperatively. A cohort of 137,073 US patients was identified as having undergone primary TKA between 2007 and 2015. The mean entire episode-of-care reimbursement was $23,701 (range: $21,294–26,299; standard deviation [SD] $2,611). The highest reimbursements were seen in patients with chronic obstructive pulmonary disease (mean $26,299; SD $3,030), hepatitis C (mean $25,662; SD $2,766), morbid obesity (mean $25,450; SD $2,154), chronic kidney disease (mean $25,131, $3,361), and cirrhosis (mean $24,890; SD $2,547). Medical comorbidities significantly impact reimbursements, and therefore cost, after primary TKA. Comprehensive preoperative optimization for patients with medical comorbidities undergoing TKA is highly recommended and may reduce perioperative complications, improve patient outcome, and ultimately reduce cost.

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Hepatitis B vaccine coverage in short and long stay prisons in Wales, UK 2013–2017 and the impact of the global vaccine shortage

Vaccine ◽

10.1016/j.vaccine.2019.02.065 ◽

2019 ◽

Vol 37 (35) ◽

pp. 4872-4876 ◽

Cited By ~ 2

Author(s):

Stephanie E. Perrett ◽

Simon Cottrell ◽

Anandar Giri Shankar

Keyword(s):

Hepatitis B ◽

Vaccine Coverage ◽

Hepatitis B Vaccine ◽

The Impact ◽

Vaccine Shortage

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Impact of Rotavirus Vaccine Introduction in Children Less Than 2 Years of Age Presenting for Medical Care With Diarrhea in Rural Matlab, Bangladesh

Clinical Infectious Diseases ◽

10.1093/cid/ciz133 ◽

2019 ◽

Vol 69 (12) ◽

pp. 2059-2070 ◽

Cited By ~ 5

Author(s):

Lauren M Schwartz ◽

K Zaman ◽

Md Yunus ◽

Ahasan-ul H Basunia ◽

Abu Syed Golam Faruque ◽

...

Keyword(s):

Vaccine Coverage ◽

Controlled Trial ◽

Population Level ◽

Diarrhoeal Disease ◽

Incidence Rates ◽

Service Area ◽

Rotavirus Vaccine ◽

Rotavirus Vaccines ◽

Time Period ◽

The Impact

Abstract Background Following the conclusion of a human rotavirus vaccine (HRV) cluster-randomized, controlled trial (CRT) in Matlab, Bangladesh, HRV was included in Matlab’s routine immunization program. We describe the population-level impact of programmatic rotavirus vaccination in Bangladesh in children <2 years of age. Methods Interrupted time series were used to estimate the impact of HRV introduction. We used diarrheal surveillance collected between 2000 and 2014 within the 2 service delivery areas (International Centre for Diarrhoeal Disease Research, Bangladesh [icddr,b] service area [ISA] and government service area [GSA]) of the Matlab Health and Demographic Surveillance System, administered by icddr,b. Age group–specific incidence rates were calculated for both rotavirus-positive (RV+) and rotavirus-negative (RV–) diarrhea diagnoses of any severity presenting to the hospital. We used 2 models to assess the impact within each service area: Model 1 used the pre-vaccine time period in all villages (HRV– and control-only) and Model 2 combined the pre-vaccine time period and the CRT time period, using outcomes from control-only villages. Results Both models demonstrated a downward trend in RV+ diarrheal incidences in the ISA villages during 3.5 years of routine HRV use, though only Model 2 was statistically significant. Significant impacts of HRV on RV+ diarrhea incidences in GSA villages were not observed in either model. Differences in population-level impacts between the 2 delivery areas may be due to the varied rotavirus vaccine coverage and presentation rates to the hospital. Conclusions This study provides initial evidence of the population-level impact of rotavirus vaccines in children <2 years of age in Matlab, Bangladesh. Further studies are needed of the rotavirus vaccine impact after the nationwide introduction in Bangladesh.

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Possible Impact of Wide-scale Vaccination Against Serogroup B Neisseria Meningitidis on Gonorrhea Incidence Rates in One Region of Quebec, Canada

Open Forum Infectious Diseases ◽

10.1093/ofid/ofx180.002 ◽

2017 ◽

Vol 4 (suppl_1) ◽

pp. S734-S735 ◽

Cited By ~ 7

Author(s):

Jean Longtin ◽

Rejean Dion ◽

Marc Simard ◽

Jean-Francois Betala Belinga ◽

Yves Longtin ◽

...

Keyword(s):

Neisseria Meningitidis ◽

Vaccine Coverage ◽

Vaccination Campaign ◽

Age Groups ◽

Incidence Rates ◽

Study Objective ◽

Grant Recipient ◽

Invasive Infections ◽

Wide Scale ◽

The Impact

Abstract Background Owing to a persistent increase of serogroup B Neisseria meningitidis (Nm) invasive infections in the Saguenay-Lac-Saint-Jean (SLSJ) region of the province of Quebec (Canada) since 2006, a wide-scale vaccination campaign of individuals aged 6 months to 20 years was conducted between May and December 2014 using the 4-component protein-based meningococcus serogroup B vaccine (4CMenB). Components of this vaccine have shown to potentially cross-react with Neisseria gonorrhoeae (Ng). The study objective was to assess the impact of the vaccination campaign on Ng incidence rate (IR). Methods Ng cases notified to public health authorities during prevaccination period (January 2006 to June 2014) and postvaccination period (July 2014 to June 2017) were analyzed. The impact of this mass campaign was estimated by a Poisson regression model, including the year (11 July–June categories), age (14–20 vs. 21 years and older), and the intervention (0 by default and 1 in those 14–20 years in the period of July 2014 to June 2017). Results Overall vaccine coverage was 82% in the target group. A total of 231 Ng cases were reported among persons 14 years and older (IR: 8.4/100,000 person-years) of the SLSJ region from January 2006 to June 2017. A decrease in the Ng number of cases and IR among individuals 14–20 years was observed during the post-vaccination period whereas it increased in those 21 years and older (figure). Estimate of vaccination impact was an Ng risk reduction of 59% (95% CI: −22% to 84%; P = 0.1). During the same period, Chlamydia trachomatis (Ct) infections increased among persons of both age groups in the SLSJ region. Conclusion Although the estimate of the impact of the campaign was not statistically significant, possibly due to limited size of the study population and the low incidence of the disease, it is congruent with results of a case–control study in New Zealand showing an OMV-MeNZB vaccine effectiveness of 31%. A higher effectiveness of 4CMenB is a plausible hypothesis as three additional proteins also found in Ng are included in the vaccine used in the SLSJ region. The results of this ecologic study suggest cross-protection of 4CMenB vaccine against Ng infections. Further studies on this topic are warranted. Disclosures P. De Wals, GlaxoSmithKline: Grant Investigator and Scientific Advisor, Grant recipient and travel expenses. Pfizer: Grant Investigator and Scientific Advisor, Grant recipient and travel expenses. Sanofi-Pasteur: Grant Investigator and Scientific Advisor, Grant recipient and travel expenses. Novartis: Grant Investigator and Scientific Advisor, Grant recipient and travel expenses.

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Modelling the impact of varicella vaccination on varicella and zoster

Epidemiology and Infection ◽

10.1017/s0950268809990768 ◽

2009 ◽

Vol 138 (4) ◽

pp. 469-481 ◽

Cited By ~ 38

Author(s):

M. KARHUNEN ◽

T. LEINO ◽

H. SALO ◽

I. DAVIDKIN ◽

T. KILPI ◽

...

Keyword(s):

Large Scale ◽

Vaccine Coverage ◽

Varicella Vaccine ◽

Age Groups ◽

Varicella Vaccination ◽

Negative Consequences ◽

Serological Data ◽

Notification Data ◽

The Impact ◽

Case Notification

SUMMARYIt has been suggested that the incidence of herpes zoster may increase due to lack of natural boosting under large-scale vaccination with the varicella vaccine. To study the possibility and magnitude of such negative consequences of mass vaccination, we built a mathematical model of varicella and zoster epidemiology in the Finnish population. The model was based on serological data on varicella infection, case-notification data on zoster, and new knowledge about close contacts relevant to transmission of infection. According to the analysis, a childhood programme against varicella will increase the incidence of zoster by one to more than two thirds in the next 50 years. This will be due to increase in case numbers in the ⩾35 years age groups. However, high vaccine coverage and a two-dose programme will be very effective in stopping varicella transmission in the population.

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