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

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.

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Prospects for Vaccine Prevention of Meningococcal Infection

Clinical Microbiology Reviews ◽

10.1128/cmr.19.1.142-164.2006 ◽

2006 ◽

Vol 19 (1) ◽

pp. 142-164 ◽

Cited By ~ 115

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.

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Exposure to air pollution and COVID-19 mortality in the United States: A nationwide cross-sectional study

10.1101/2020.04.05.20054502 ◽

2020 ◽

Cited By ~ 191

Author(s):

Xiao Wu ◽

Rachel C Nethery ◽

M Benjamin Sabath ◽

Danielle Braun ◽

Francesca Dominici

Keyword(s):

United States ◽

Air Pollution ◽

Death Rate ◽

The United States ◽

Sensitivity Analyses ◽

List Type ◽

County Level ◽

Cross Sectional ◽

Increased Risk

AbstractObjectivesUnited States government scientists estimate that COVID-19 may kill tens of thousands of Americans. Many of the pre-existing conditions that increase the risk of death in those with COVID-19 are the same diseases that are affected by long-term exposure to air pollution. We investigated whether long-term average exposure to fine particulate matter (PM2.5) is associated with an increased risk of COVID-19 death in the United States.DesignA nationwide, cross-sectional study using county-level data.Data sourcesCOVID-19 death counts were collected for more than 3,000 counties in the United States (representing 98% of the population) up to April 22, 2020 from Johns Hopkins University, Center for Systems Science and Engineering Coronavirus Resource Center.Main outcome measuresWe fit negative binomial mixed models using county-level COVID-19 deaths as the outcome and county-level long-term average of PM2.5 as the exposure. In the main analysis, we adjusted by 20 potential confounding factors including population size, age distribution, population density, time since the beginning of the outbreak, time since state’s issuance of stay-at-home order, hospital beds, number of individuals tested, weather, and socioeconomic and behavioral variables such as obesity and smoking. We included a random intercept by state to account for potential correlation in counties within the same state. We conducted more than 68 additional sensitivity analyses.ResultsWe found that an increase of only 1 μg/m3 in PM2.5 is associated with an 8% increase in the COVID-19 death rate (95% confidence interval [CI]: 2%, 15%). The results were statistically significant and robust to secondary and sensitivity analyses.ConclusionsA small increase in long-term exposure to PM2.5 leads to a large increase in the COVID-19 death rate. Despite the inherent limitations of the ecological study design, our results underscore the importance of continuing to enforce existing air pollution regulations to protect human health both during and after the COVID-19 crisis. The data and code are publicly available so our analyses can be updated routinely.Summary BoxWhat is already known on this topicLong-term exposure to PM2.5 is linked to many of the comorbidities that have been associated with poor prognosis and death in COVID-19 patients, including cardiovascular and lung disease.PM2.5 exposure is associated with increased risk of severe outcomes in patients with certain infectious respiratory diseases, including influenza, pneumonia, and SARS.Air pollution exposure is known to cause inflammation and cellular damage, and evidence suggests that it may suppress early immune response to infection.What this study addsThis is the first nationwide study of the relationship between historical exposure to air pollution exposure and COVID-19 death rate, relying on data from more than 3,000 counties in the United States. The results suggest that long-term exposure to PM2.5 is associated with higher COVID-19 mortality rates, after adjustment for a wide range of socioeconomic, demographic, weather, behavioral, epidemic stage, and healthcare-related confounders.This study relies entirely on publicly available data and fully reproducible, public code to facilitate continued investigation of these relationships by the broader scientific community as the COVID-19 outbreak evolves and more data become available.A small increase in long-term PM2.5 exposure was associated with a substantial increase in the county’s COVID-19 mortality rate up to April 22, 2020.

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

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.2403 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S959-S960 ◽

Cited By ~ 1

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.

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

Vaccine ◽

10.1016/s0264-410x(01)00209-2 ◽

2001 ◽

Vol 19 (31) ◽

pp. 4566-4575 ◽

Cited By ~ 27

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

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US College Students Are at Increased Risk for Serogroup B Meningococcal Disease

Journal of the Pediatric Infectious Diseases Society ◽

10.1093/jpids/piz024 ◽

2019 ◽

Vol 9 (2) ◽

pp. 244-247 ◽

Cited By ~ 5

Author(s):

Gary S Marshall ◽

Amanda F Dempsey ◽

Amit Srivastava ◽

Raul E Isturiz

Keyword(s):

United States ◽

College Students ◽

Disease Control ◽

Meningococcal Disease ◽

Data Centers ◽

The United States ◽

Surveillance Data ◽

Increased Risk ◽

Average Annual Incidence ◽

Control And Prevention

Abstract Publicly available surveillance data, Centers for Disease Control and Prevention reports, and other sources suggest that college students in the United States are at increased risk for meningococcus serogroup B (MenB) disease. US surveillance data from 2015 to 2017 show that the incidence of invasive meningococcal disease (IMD) was greater among college students than among those not attending college; the average annual incidence of MenB disease was >5-fold higher among college students, and all college IMD outbreaks between 2011 and March 2019 were caused by MenB.

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Increased Risk for Meningococcal Disease Among Men Who Have Sex With Men in the United States, 2012–2015

Clinical Infectious Diseases ◽

10.1093/cid/cix438 ◽

2017 ◽

Vol 65 (5) ◽

pp. 756-763 ◽

Cited By ~ 37

Author(s):

Temitope A Folaranmi ◽

Cecilia B Kretz ◽

Hajime Kamiya ◽

Jessica R MacNeil ◽

Melissa J Whaley ◽

...

Keyword(s):

United States ◽

Meningococcal Disease ◽

The United States ◽

Increased Risk ◽

Sex With Men

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The disease of theories: unravelling the mechanisms of pre-eclampsia

The Biochemist ◽

10.1042/bio03901022 ◽

2017 ◽

Vol 39 (1) ◽

pp. 22-25 ◽

Cited By ~ 1

Author(s):

Eric M. George

Keyword(s):

United States ◽

Cardiovascular Disease ◽

Premature Birth ◽

Molecular Mechanisms ◽

The United States ◽

Life Meaning ◽

Increased Risk ◽

Health Complications ◽

Developed World

Perhaps no disease of pregnancy has been more thoroughly studied than pre-eclampsia (PE), and yet despite all of our efforts we are only beginning to understand the molecular mechanisms which underpin the disease. Many people are surprised by the frequency of PE in the population, as it is believed to occur in approximately one pregnancy out of 20 in the United States, with similar rates throughout the developed world. In severe cases the disorder can progress to eclampsia, which is characterized by maternal seizures and can lead to death. PE can only be treated by ending the pregnancy, often by inducing labour prior to term, making PE a leading cause of premature birth and all of the associated health complications which accompany it. All in all, PE is one of the leading causes of maternal and fetal morbidity and mortality. It is now also becoming apparent that PE disposes both the mother and the baby to increased risk of cardiovascular disease throughout life, meaning that we still don't fully understand the long-term implications of the disease.

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Universal Healthcare in the United States of America: A Healthy Debate

Medicina ◽

10.3390/medicina56110580 ◽

2020 ◽

Vol 56 (11) ◽

pp. 580

Author(s):

Gabriel Zieff ◽

Zachary Y. Kerr ◽

Justin B. Moore ◽

Lee Stoner

Keyword(s):

United States ◽

Economic Status ◽

The United States ◽

Economic Costs ◽

Quality Healthcare ◽

Universal Healthcare ◽

Increased Risk ◽

Pros And Cons ◽

Universal Healthcare System

This commentary offers discussion on the pros and cons of universal healthcare in the United States. Disadvantages of universal healthcare include significant upfront costs and logistical challenges. On the other hand, universal healthcare may lead to a healthier populace, and thus, in the long-term, help to mitigate the economic costs of an unhealthy nation. In particular, substantial health disparities exist in the United States, with low socio–economic status segments of the population subject to decreased access to quality healthcare and increased risk of non-communicable chronic conditions such as obesity and type II diabetes, among other determinants of poor health. While the implementation of universal healthcare would be complicated and challenging, we argue that shifting from a market-based system to a universal healthcare system is necessary. Universal healthcare will better facilitate and encourage sustainable, preventive health practices and be more advantageous for the long-term public health and economy of the United States.

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Long-Term Association of Air Pollution and Hospital Admissions Among Medicare Participants Using a Doubly Robust Additive Model

Circulation ◽

10.1161/circulationaha.120.050252 ◽

2021 ◽

Vol 143 (16) ◽

pp. 1584-1596 ◽

Cited By ~ 1

Author(s):

Mahdieh Danesh Yazdi ◽

Yan Wang ◽

Qian Di ◽

Yaguang Wei ◽

Weeberb J. Requia ◽

...

Keyword(s):

United States ◽

Atrial Fibrillation ◽

Tropospheric Ozone ◽

Hospital Admissions ◽

Fine Particulate Matter ◽

The United States ◽

Fine Particulate ◽

Increased Risk ◽

Doubly Robust

Background: Studies examining the nonfatal health outcomes of exposure to air pollution have been limited by the number of pollutants studied and focus on short-term exposures. Methods: We examined the relationship between long-term exposure to fine particulate matter with an aerodynamic diameter <2.5 micrometers (PM 2.5 ), NO 2 , and tropospheric ozone and hospital admissions for 4 cardiovascular and respiratory outcomes (myocardial infarction, ischemic stroke, atrial fibrillation and flutter, and pneumonia) among the Medicare population of the United States. We used a doubly robust method for our statistical analysis, which relies on both inverse probability weighting and adjustment in the outcome model to account for confounding. The results from this regression are on an additive scale. We further looked at this relationship at lower pollutant concentrations, which are consistent with typical exposure levels in the United States, and among potentially susceptible subgroups. Results: Long-term exposure to fine PM 2.5 was associated with an increased risk of all outcomes with the highest effect seen for stroke with a 0.0091% (95% CI, 0.0086–0.0097) increase in the risk of stroke for each 1-µg/m 3 increase in annual levels. This translated to 2536 (95% CI, 2383–2691) cases of hospital admissions with ischemic stroke per year, which can be attributed to each 1-unit increase in fine particulate matter levels among the study population. NO 2 was associated with an increase in the risk of admission with stroke by 0.00059% (95% CI, 0.00039–0.00075) and atrial fibrillation by 0.00129% (95% CI, 0.00114–0.00148) per ppb and tropospheric ozone was associated with an increase in the risk of admission with pneumonia by 0.00413% (95% CI, 0.00376–0.00447) per parts per billion. At lower concentrations, all pollutants were consistently associated with an increased risk for all our studied outcomes. Conclusions: Long-term exposure to air pollutants poses a significant risk to cardiovascular and respiratory health among the elderly population in the United States, with the greatest increase in the association per unit of exposure occurring at lower concentrations.

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Speech-Language Pathology in the Peace Corps: Necessity and Sustainability

Perspectives on Global Issues in Communication Sciences and Related Disorders ◽

10.1044/gics2.1.11 ◽

2012 ◽

Vol 2 (1) ◽

pp. 11-18

Author(s):

Melissa A. Pierce

Keyword(s):

United States ◽

Special Education ◽

Peace Corps ◽

People With Disabilities ◽

Communication Disorders ◽

The United States ◽

Speech Language Pathology ◽

Speech Language Pathologists ◽

Language Pathology

In countries other than the United States, the study and practice of speech-language pathology is little known or nonexistent. Recognition of professionals in the field is minimal. Speech-language pathologists in countries where speech-language pathology is a widely recognized and respected profession often seek to share their expertise in places where little support is available for individuals with communication disorders. The Peace Corps offers a unique, long-term volunteer opportunity to people with a variety of backgrounds, including speech-language pathologists. Though Peace Corps programs do not specifically focus on speech-language pathology, many are easily adapted to the profession because they support populations of people with disabilities. This article describes how the needs of local children with communication disorders are readily addressed by a Special Education Peace Corps volunteer.

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