scholarly journals Assessing real-world vaccine effectiveness against severe forms of SARS-CoV-2 infection from routine surveillance data in Switzerland

2021 ◽  
Author(s):  
Nanina Anderegg ◽  
Christian L Althaus ◽  
Samuel Colin ◽  
Anthony Hauser ◽  
Anne Laube ◽  
...  
Keyword(s):  
Relative Risk ◽  
Vaccination Coverage ◽  
Vaccine Coverage ◽  
Age Groups ◽  
Vaccine Effectiveness ◽  
Surveillance Data ◽  
Age Group ◽  
Routine Surveillance ◽  
Vaccination Campaigns ◽  
Over Time

Background. In Switzerland, SARS-CoV-2 vaccination campaigns started early 2021. Vaccine coverage reached 65% of the population in December 2021, mostly using mRNA vaccines from Moderna and Pfizer-BioNtech. Simultaneously, the proportion of vaccinated among COVID-19-related hospitalizations and deaths rose, creating some confusion in the general population. We aim to assess vaccine effectiveness against severe forms of SARS-CoV-2 infection using routine surveillance data on the vaccination status of COVID-19-related hospitalizations and deaths and data on vaccination coverage in Switzerland.Methods. We consider all routine surveillance data on COVID-19-related hospitalizations and deaths received at the Swiss Federal Office of Public Health from 1 July 2021 to 1 December 2021. We estimate the relative risk of COVID-19 related hospitalization or death for non-fully vaccinated compared to fully vaccinated individuals, adjusted for the dynamics of vaccination coverage over time, by age and location. We stratify the analysis by age group and by calendar month. We assess variations in the relative risk of hospitalization associated with the time since vaccination.Results. We include a total of 5,948 COVID-19-related hospitalizations of which 1,245 (21%) were fully vaccinated, and a total of 739 deaths of which 259 (35%) were fully vaccinated. We find that the relative risk of COVID-19 related hospitalization is 12.5 (95%CI: 11.7 to 13.4) times higher for non-fully vaccinated than for fully vaccinated individuals. This translates into a vaccine effectiveness against hospitalization of 92.0% (95%CI: 91.4 to 92.5%). Vaccine effectiveness against death is estimated to 90.3% (95%CI: 88.6 to 91.8%). Effectiveness appears comparatively lower in age groups over 70 and during the months of October and November 2021. We also find evidence of a decrease in vaccine effectiveness against hospitalization for individuals vaccinated for 25 weeks or more, but this decrease only appears in age groups below 70.Conclusions. The observed proportions of vaccinated among COVD-19-related hospitalizations and deaths in Switzerland are compatible with a high effectiveness of mRNA vaccines from Moderna and Pfizer-BioNtech against hospitalization and death in all age groups. Effectiveness appears comparatively lower in older age groups, suggesting the importance of booster vaccinations. We find inconclusive evidence that vaccine effectiveness is waning over time. Repeated analyses will be able to better assess waning and the effect of boosters.

scholarly journals Effectiveness of Mass Vaccination in Brazil against Severe COVID-19 Cases

2021 ◽  
Author(s):  
Daniel A.M. Villela ◽  
Tatiana Guimarães de Noronha ◽  
Leonardo S Bastos ◽  
Antonio G. F. Pacheco ◽  
Oswaldo G. Cruz ◽  
...  
Keyword(s):  
Age Groups ◽  
Vaccine Effectiveness ◽  
Mass Vaccination ◽  
Vulnerable Groups ◽  
Age Group ◽  
Vaccine Platform ◽  
National Immunization ◽  
Younger Age ◽  
National Cohort ◽  
Vaccination Campaigns

Background. Mass vaccination campaigns started in Brazil on January/2021 with CoronaVac followed by ChAdOx1 nCov-19, and BNT162b2 mRNA vaccines. Target populations initially included vulnerable groups such as people older than 80 years, with comorbidities, of indigenous origin, and healthcare workers. Younger age groups were gradually included. Methods. A national cohort of 66.3 million records was compiled by linking registry-certified COVID-19 vaccination records from the Brazilian National Immunization Program with information on severe COVID-19 cases and deaths. Cases and deaths were aggregated by state and age group. Mixed-effects Poisson models were used to estimate the rate of severe cases and deaths among vaccinated and unvaccinated individuals, and the corresponding estimates of vaccine effectiveness by vaccine platform and age group. The study period is from mid-January to mid-July 2021. Results. Estimates of vaccine effectiveness preventing deaths were highest at 97.9% (95% CrI: 93.5-99.8) among 20-39 years old with ChAdOx1 nCov-19, at 82.7% (95% CrI: 80.7-84.6) among 40-59 years old with CoronaVac, and at 89.9% (87.8--91.8) among 40-59 years old with partial immunization of BNT162b2. For all vaccines combined in the full regimen, the effectiveness preventing severe cases among individuals aged 80+ years old was 35.9% (95% CrI: 34.9-36.9) which is lower than that observed for individuals aged 60-79 years (61.0%, 95% CrI: 60.5-61.5). Conclusion. Despite varying effectiveness estimates, Brazil′s population benefited from vaccination in preventing severe COVID-19 outcomes. Results, however, suggest significant vaccine-specific reductions in effectiveness by age, given by differences between age groups 60-79 years and over 80 years.

P033 POPULATION-LEVEL HPV VACCINATION COVERAGE AMONG U.S. ADULT IBD PATIENTS: STILL NOT ENOUGH

2020 ◽  
Vol 26 (Supplement_1) ◽  
pp. S65-S65
Author(s):  
Ryan Suk ◽  
Heetae Suk ◽  
Keith Sigel ◽  
Kalyani Sonawane ◽  
Ashish Deshmukh
Keyword(s):  
Vaccination Coverage ◽  
Hpv Vaccine ◽  
Vaccine Coverage ◽  
Hpv Vaccination ◽  
Age Groups ◽  
Population Level ◽  
Vaccine Uptake ◽  
Population Estimate ◽  
Age Group ◽  
Old Patients

Abstract Background Evidence suggests that the inflammatory bowel disease (IBD) patients may have an elevated risk of Human papillomavirus (HPV)-associated cancers when compared with those without IBD. HPV vaccination has been recommended for 11 to 26 years old males and females. Recently, the Centers for Disease Control and Prevention (CDC) has updated the guideline to include adults aged 27 to 45 who are not adequately vaccinated. To the best of our knowledge, population-level HPV vaccine uptake rates among patients with IBD remains unknown. Methods We used 2015–2016 National Health Information Survey (NHIS) data to assess the HPV vaccination coverage among people with IBD in the US. Weighted counts and percentages were estimated using survey design for the population-level results. We identified those who reportedly were told by a doctor or healthcare professional that they have IBD. Then we stratified the patients into two age groups: HPV-vaccine eligible age group (age 18–26) and newly approved age group (age 27–45). Our outcome was vaccine coverage status assessed as vaccine initiation age and number of doses. When the initiation age was less than 15, two doses were defined as “completed” and when the age was 15 and older, three doses were defined as “completed”. When the participants had initiated the vaccine but have not completed all the required doses according to their initiation age, it was defined as “incomplete” while no dose was defined as “no vaccine”. We estimated the coverage rate by age group and sex. We used Wald chi-square test to examine differences in completion rate by sex. Results We identified 951 participants (population estimate: 3,121,387) who self-reportedly had IBD. Among those, 51 persons (population estimate: 191,830) were HPV vaccine-eligible aged and 219 persons (population estimate: 859,711) were newly approved aged. Only 3.2% men while 63.2% of eligible women completed vaccination series as recommended. Eligible men had higher rates of incompletion compared to women (13.8% vs 1.3%). A higher proportion of vaccine-eligible men (83.0%) did not initiate the HPV vaccine compared to women (35.5%) (p=0.001). Among the newly approved age group, only 0.5% of men completed vaccine and 1.3% did not complete their doses. In women, 2.3% was complete with the doses and 9.6% initiated but did not complete the vaccine (p <0.001). Conclusion IBD patients might greatly benefit from receiving HPV vaccination given the possibly high risk of HPV-associated cancers. However, the coverage for vaccine-eligible IBD patients was not enough and much lower than the goal of 80% coverage in Healthy People 2020. Moreover, according to the updated guideline, 27 to 45 years old patients who are not adequately vaccinated would be able to catch up their vaccination. Further study needs to be focused on promoting and informing HPV vaccination in IBD patients, for both currently vaccine-eligible patients and those who are aged between 27 and 45 and not adequately vaccinated.

scholarly journals Estimating age-specific vaccine effectiveness using data from a large measles outbreak in Berlin, Germany, 2014/15: evidence for waning immunity

2019 ◽  
Vol 24 (17) ◽  
Author(s):  
Julia Bitzegeio ◽  
Shannon Majowicz ◽  
Dorothea Matysiak-Klose ◽  
Daniel Sagebiel ◽  
Dirk Werber
Keyword(s):  
Scenario Analysis ◽  
Vaccine Coverage ◽  
Screening Method ◽  
Age Groups ◽  
Vaccine Effectiveness ◽  
Natural Immunity ◽  
Age Group ◽  
Measles Outbreak ◽  
Waning Immunity ◽  
Using Data

Background Measles elimination is based on 95% coverage with two doses of a measles-containing vaccine (MCV2), high vaccine effectiveness (VE) and life-long vaccine-induced immunity. Longitudinal analysis of antibody titres suggests existence of waning immunity, but the relevance at the population-level is unknown. Aim We sought to assess presence of waning immunity by estimating MCV2 VE in different age groups (2–5, 6–15, 16–23, 24–30 and 31–42 years) in Berlin. Methods We conducted a systematic literature review on vaccination coverage and applied the screening-method using data from a large measles outbreak (2014/15) in Berlin. Uncertainty in input variables was incorporated by Monte Carlo simulation. In a scenario analysis, we estimated the proportion vaccinated with MCV2 in those 31-42 years using VE of the youngest age group, where natural immunity was deemed negligible. Results Of 773 measles cases (median age: 20 years), 40 had received MCV2. Average vaccine coverage per age group varied (32%–88%). Estimated median VE was  > 99% (95% credible interval (CrI): 98.6–100) in the three youngest age groups, but lower (90.9%, 95% CrI: 74.1–97.6) in the oldest age group. In the scenario analysis, the estimated proportion vaccinated was 98.8% (95% CrI: 96.5–99.8). Conclusion VE for MCV2 was generally high, but lower in those aged 31-42 years old. The estimated proportion with MCV2 should have led to sufficient herd immunity in those aged 31-42 years old. Thus, lower VE cannot be fully explained by natural immunity, suggesting presence of waning immunity.

scholarly journals Epidemiology of Measles in the Philippines

2018 ◽  
Vol 52 (4) ◽  
Author(s):  
Michelle C. Ylade
Keyword(s):  
Birth Cohort ◽  
Vaccine Coverage ◽  
Age Distribution ◽  
Age Groups ◽  
The Philippines ◽  
Incidence Rates ◽  
Vaccine Effectiveness ◽  
Age Group ◽  
Measles Vaccine ◽  
Measles Incidence

Background. Measles cases have decreased ever since vaccination has been introduced through the DOH Expanded Program on Immunization (DOH EPI) in the Philippines. Elimination is the current goal. However, despite high vaccine coverage, a nationwide outbreak occurred in 2013. Objectives. This study aimed to present measles incidence rates before and after the introduction of the measles vaccine, describe the changing epidemiology of measles, and assess the effectiveness of measles vaccination and baseline measles reporting. Methods. National data from 1960 to 2014 were used to determine incidence of measles and describe its epidemiology. Vaccine coverage and data on measles surveillance were used to estimate vaccine effectiveness by birth cohort and age group. Results. Reported measles incidence decreased after the introduction of measles vaccine compared to prevaccination levels (pre-vaccination: 36 per 100,000 to 73 per 100,000; 2008-2014 confirmed measles incidence: 1.47 to 23.76 per 100,000, suspected measles-5.7 to 58.08 per 100,000). A shift in the age distribution of cases was noted during the outbreak. Vaccine effectiveness by birth cohort ranged from 85-96% while the lowest VE estimate by age group was seen among those aged 26-30 years. Conclusion. Measles vaccine coverage should target wider age groups. Measles surveillance should be improved to help in evidence-based decisions for a more effective plan towards measles elimination.

scholarly journals Estimating the early impact of immunization against COVID-19 on deaths among elderly people in Brazil: analyses of secondary data on vaccine coverage and mortality

2021 ◽  
Author(s):  
Cesar Victora ◽  
Marcia C Castro ◽  
Susie Gurzenda ◽  
Aluisio J D Barros
Keyword(s):  
Vaccination Coverage ◽  
Health Workers ◽  
Vaccine Coverage ◽  
Age Groups ◽  
Secondary Data ◽  
The Elderly ◽  
Mortality Rates ◽  
Age Group ◽  
Rate Ratios ◽  
Two Age Groups

ABSTRACTBackgroundImmunization against COVID-19 in Brazil started in January 2021, with health workers and the elderly as the priority groups. We assessed whether there was an impact of immunizations on the mortality of individuals aged 80+ years.MethodsBy April 22, 2021, 147,454 COVID-19 deaths had been reported to the Brazilian Mortality Information System. Denominators for mortality rates were calculated by correcting population estimates for all-cause deaths reported in 2020. Proportionate mortality at ages 80+ and 90+ years relative to deaths at all ages were calculated, and mortality rate ratios compared these two age groups with individuals aged 0-79 years. Vaccine coverage data were obtained from the Ministry of Health vaccination monitoring website. All results were tabulated by two-week periods from epidemiological weeks 1-14, 2021.FindingsAs the P.1 variant spread throughout Brazil, the total number of deaths increased over time starting in epidemiological week 9 of 2021. The proportion of all deaths occurring at ages 80+ years was over 25% in weeks 1-6 and declined rapidly to 13.1% in weeks 13-14. Mortality rates were over 13 times higher in the 80+ years age group compared to that of 0-79 year olds up to week 6, and declined to 6.9 times in weeks 13-14. Coronavac accounted for 77.3% and AstraZeneca for 15.9% of all doses administered. Vaccination coverage (first dose) increased rapidly among individuals aged 80+ years, reaching 49.1% in weeks 5-6 and over 90% after week 9.InterpretationRapid scaling up of vaccination coverage among elderly Brazilians was associated with an important decline in relative mortality compared to younger individuals, in a setting where the P.1 variant predominates. Had mortality rates among the elderly remained proportionate to what was observed up to week 6, an estimated additional 13,824 deaths would have been expected up to week 14.

scholarly journals A Study of Varicella Seroprevalence in a Pediatric and Adolescent Population in Florence (Italy). Natural Infection and Vaccination-Acquired Immunization

Vaccines ◽  
2021 ◽  
Vol 9 (2) ◽  
pp. 152
Author(s):  
Beatrice Zanella ◽  
Angela Bechini ◽  
Benedetta Bonito ◽  
Marco Del Riccio ◽  
Alessandra Ninci ◽  
...  
Keyword(s):  
Natural Infection ◽  
Age Groups ◽  
Varicella Vaccination ◽  
Age Group ◽  
Disease Notification ◽  
Test Elisa ◽  
Vaccine Schedule ◽  
Almost All ◽  
Vaccination Campaigns ◽  
Dose Vaccine

Background: Varicella is a well-known infectious disease that can have severe complications, also in young children. The Universal Varicella Vaccination (UVV) program was introduced in Tuscany (Italy) in 2003, with a two-dose vaccine schedule given to children between their 13th and 15th month, and at 5–6 years old, as a monovalent for varicella (V) or tetravalent (measles, mumps, rubella and varicella (MMRV)) formulation. Although varicella notifications have dramatically fallen in the last two decades, varicella disease underreporting remains a challenge. Methods: A qualitative immunoenzymatic test (ELISA) was used to measure the presence of anti-varicella antibodies in 165 sera of subjects aged 1–18 years residing in the province of Florence (Italy). Information regarding the anamnestic and vaccination status (including disease notification) was also collected. Results: Our study showed an overall varicella seropositivity of 75.8% (reaching the maximum at 96.3% in the 15–18 years age group). We found that varicella disease notification had been recorded for only 7/165 subjects; however, since 42/165 recalled having had the disease, we can hypothesize that some of them must have been underreported. Furthermore, our study showed that the presence of antibodies after the varicella vaccination remained over time, lasting up to 12 years. Conclusions: Although varicella seroprevalence is <95% in almost all our age groups (except for the 15–18 years age group), our data are encouraging and reflect the success of the introduction of the UVV program and the vaccination campaigns promoted in the Tuscany region.

scholarly journals OP0248 PREMATURE MORTALITY BURDEN FOR SYSTEMIC SCLEROSIS: NATIONWIDE POPULATION-BASED STUDY

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 156.1-156
Author(s):  
E. Yen ◽  
D. Singh ◽  
M. Wu ◽  
R. Singh
Keyword(s):  
Rheumatoid Arthritis ◽  
United States ◽  
Disease Burden ◽  
Age Groups ◽  
Premature Mortality ◽  
Population Based ◽  
Age Group ◽  
Population Based Study ◽  
Mortality Burden ◽  
Over Time

Background:Premature mortality is an important way to quantify disease burden. Patients with systemic sclerosis (SSc) can die prematurely of disease, however, the premature mortality burden of SSc is unknown. The years of potential life lost (YPLL), in addition to age-standardized mortality rate (ASMR) in younger ages, can be used as measures of premature death.Objectives:To evaluate the premature mortality burden of SSc by calculating: 1) the proportions of SSc deaths as compared to deaths from all other causes (non-SSc) by age groups over time, 2) ASMR for SSc relative to non-SSc-ASMR by age groups over time, and 3) the YPLL for SSc relative to other autoimmune diseases.Methods:This is a population-based study using a national mortality database of all United States residents from 1968 through 2015, with SSc recorded as the underlying cause of death in 46,798 deaths. First, we calculated the proportions of deaths for SSc and non-SSc by age groups for each of 48 years and performed joinpoint regression trend analysis1to estimate annual percent change (APC) and average APC (AAPC) in the proportion of deaths by age. Second, we calculated ASMR for SSc and non-SSc causes and ratio of SSc-ASMR to non-SSc-ASMR by age groups for each of 48 years, and performed joinpoint analysis to estimate APC and AAPC for these measures (SSc-ASMR, non-SSc-ASMR, and SSc-ASMR/non-SSc-ASMR ratio) by age. Third, to calculate YPLL, each decedent’s age at death from a specific disease was subtracted from an arbitrary age limit of 75 years for years 2000 to 2015. The years of life lost were then added together to yield the total YPLL for each of 13 preselected autoimmune diseases.Results:23.4% of all SSc deaths as compared to 13.5% of non-SSc deaths occurred at <45 years age in 1968 (p<0.001, Chi-square test). In this age group, the proportion of annual deaths decreased more for SSc than for non-SSc causes: from 23.4% in 1968 to 5.7% in 2015 at an AAPC of -2.2% (95% CI, -2.4% to -2.0%) for SSc, and from 13.5% to 6.9% at an AAPC of -1.5% (95% CI, -1.9% to -1.1%) for non-SSc. Thus, in 2015, the proportion of SSc and non-SSc deaths at <45 year age was no longer significantly different. Consistently, SSc-ASMR decreased from 1.0 (95% CI, 0.8 to 1.2) in 1968 to 0.4 (95% CI, 0.3 to 0.5) per million persons in 2015, a cumulative decrease of 60% at an AAPC of -1.9% (95% CI, -2.5% to -1.2%) in <45 years old. The ratio of SSc-ASMR to non-SSc-ASMR also decreased in this age group (cumulative -20%, AAPC -0.3%). In <45 years old, the YPLL for SSc was 65.2 thousand years as compared to 43.2 thousand years for rheumatoid arthritis, 18.1 thousand years for dermatomyositis,146.8 thousand years for myocarditis, and 241 thousand years for type 1 diabetes.Conclusion:Mortality at younger ages (<45 years) has decreased at a higher pace for SSc than from all other causes in the United States over a 48-year period. However, SSc accounted for more years of potential life lost than rheumatoid arthritis and dermatomyositis combined. These data warrant further studies on SSc disease burden, which can be used to develop and prioritize public health programs, assess performance of changes in treatment, identify high-risk populations, and set research priorities and funding.References:[1]Yen EY….Singh RR. Ann Int Med 2017;167:777-785.Disclosure of Interests:None declared

scholarly journals Rubella outbreak in Poland in 2013 – an analysis of surveillance data at the national and province level

2015 ◽  
Vol 125 (2) ◽  
pp. 65-71
Author(s):  
Dorota Mrozek-Budzyn ◽  
Renata Majewska ◽  
Agnieszka Kiełtyka ◽  
Małgorzata Augustyniak
Keyword(s):  
Incidence Rate ◽  
Vaccination Coverage ◽  
Vaccine Coverage ◽  
Clinical Signs ◽  
Vaccination Strategy ◽  
Disease Outbreak ◽  
Surveillance Data ◽  
Good Time ◽  
Adult Males ◽  
Laboratory Confirmation

Abstract Introduction. Poland is a member of the WHO European Region where a complete eradication of measles and rubella is planned to be finished by 2015. Poland accounted for 99% of all reported rubella cases in 27 EU/EEA countries in 2013. It is a good time to evaluate whether the established Polish vaccination strategy was sufficient to reach the goal of rubella elimination in the near future. Aim. The aim of this study was to analyze the epidemiology of rubella in Poland when the disease outbreak took place in 2013, to determine the reasons of that situation and to find the solution for future rubella elimination strategies. Material and methods. To analyze the epidemiology of rubella in Poland during the disease outbreak in 2013 the authors used rubella surveillance data collected by the Provincial and National Notifiable Disease Reporting System in 2004-2013. The information at the provincial level derived from one of the 16 provinces (Malopolska). The data on MMR vaccination coverage in 2003-2012 derived from the National Surveillance System. The percentages of rubella cases and vaccine coverage between Poland with Malopolska province were compared. Results. The outbreak started in late 2012 and continued through 2013, when 38548 rubella cases (incidence rate 100.1/ 100 000) were notified. Geographically, rubella cases were reported from the entire country, with the highest incidence rate in Malopolska province (254.9/100 000). Only 5 cases from Malopolska and 120 in whole country were laboratory confirmed, the remaining 99.7% were reported solely on the basis of clinical signs. The vaccination coverage was not sufficient to protect the population against rubella outbreak in Poland, especially among adolescents and young adult males. Conclusions. The strengthening of routine immunization program and implementation of some additional vaccination campaigns in young adults as well as laboratory confirmation of all suspected cases are the challenges that will have to be met to eliminate rubella in Poland

scholarly journals Secular trends in emergency department encounters for concussion at US children's hospitals by age group (2008–2017)

Neurology ◽  
2018 ◽  
Vol 91 (23 Supplement 1) ◽  
pp. S22.2-S22
Author(s):  
Amy Linabery ◽  
Kara Seaton ◽  
Alicia Zagel ◽  
Alicen Spaulding ◽  
Gretchen Cutler ◽  
...  
Keyword(s):  
Emergency Department ◽  
Public Awareness ◽  
Weighted Least Squares ◽  
Age Groups ◽  
Secular Trends ◽  
Medical Attention ◽  
Age Group ◽  
Admission Rates ◽  
Pediatric Hospitals ◽  
Over Time

BackgroundIncreased concussion rates in US youth have been documented since 2000. Concomitant rises in healthcare utilization for concussion are likely attributable to public health, media, and legislative initiatives aimed at increasing public awareness of the importance of seeking medical attention after injury. Utilization trends in young children have not been well-documented, however.ObjectiveTo characterize recent secular trends in pediatric emergency department (ED) encounters for concussion by 4-year age group.MethodsUsing Children's Hospital Association's Pediatric Health Information System data, we examined a retrospective cohort of patients aged 2–17 years with an ED encounter for concussion at 22 US pediatric hospitals with continuous data between 2008 and 2017. Average annual change in rates of ED visits for concussion and sports-/recreation-related concussion, imaging, and admissions were estimated via weighted least-squares regression.ResultsED encounters with a primary indication of concussion comprised 0.8% (n = 86,393) of all ED encounters in 2008–2017. Over time, ED concussion visits in 6–17-year-olds increased by 0.5–1.1 per 1,000 ED encounters per year (all Ptrend< 0.0001), while rates among 2-5-year-olds remained stable (Ptrend = 0.72). Rates for sports-/recreation-related concussions increased significantly across all age groups (<0.0001 ≤ Ptrend ≤ 0.01). Absolute number undergoing any imaging increased in all age groups; however, due to increased ED concussion encounters, the rate of imaging decreased overall (−29.7/1,000 ED concussion encounters/year; Ptrend < 0.0001) and across all age groups; the imaging rate decreased less for 2-5-year-olds (−19.6/1,000 encounters/year; Ptrend < 0.0001). Likewise, admission rates declined significantly over time overall (−10.1/1,000 encounters/y; Ptrend = 0.0006) and for all age groups.ConclusionsED concussion encounter rates in US youth aged 6–17 years continue to increase at pediatric hospitals, suggesting awareness efforts have been effective. Conversely, imaging and admission rates have decreased, indicating efforts to curtail unnecessary irradiation and intervention have also been successful. Trends in 2-5-year-olds were somewhat different from older youth and should be explored further.

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