Impact of childhood and maternal vaccination against diphtheria, tetanus, and pertussis in Colombia

Background: In Latin America, there are few studies of the impact of vaccination against diphtheria, tetanus, and pertussis. We estimate the impact of infant and maternal vaccination on the incidence of these diseases in Colombia.Design and methods: an interrupted time series study analyzing the incidence before and after of vaccination with DwPT (1975-2018) and with Tdap in pregnant women (2008-2018). A segmented regression model with negative binomial distribution estimated the change in level and trend of the predicted incidence ratio after vaccination in relation to the incidence if vaccination had not been started (IRR), using a Prais Winsten regression.Results: The pertussis IRR decreased immediately after the start of childhood vaccination (0.91, p=0.51), but this was only significant (1.01, p<0.001) along with the trend per year, after the start of maternal vaccination (0.98, p<0.001). In the absence of vaccination, the incidence would not have been reduced. Neonatal tetanus had the highest rate of change with significant reduction -1.69 - CI 95%: -2.91, -0.48). The trend after vaccination was the highest with an annual reduction of 19% (0.81, p=0.001). The change in incidence of diphtheria was significant, although slow (-0.02 - CI 95%: -0.04, -0.004). The sustained effect in the post-vaccination period was smaller (0.95, p=0.79).Conclusions: Childhood and maternal vaccination markedly reduced the incidence of pertussis and neonatal tetanus. It is necessary to maintain optimal vaccination coverage and surveillance, within an integrated elimination plan, which prevents the resurgence of these diseases.

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Impact of a patient-specific national programme aimed at increasing the use of emollient moisturisers to reduce the risk of skin tears: a longitudinal cohort study

BMJ Open ◽

10.1136/bmjopen-2020-039579 ◽

2020 ◽

Vol 10 (10) ◽

pp. e039579

Author(s):

Anna K Moffat ◽

Kerrie P Westaway ◽

Jemisha Apajee ◽

Oliver Frank ◽

Russell Shute ◽

...

Keyword(s):

Interrupted Time Series ◽

Self Report ◽

Additional Patient ◽

Patient Specific ◽

Department Of Veterans Affairs ◽

National Programme ◽

Sustained Effect ◽

Skin Tears ◽

Comparison Groups ◽

The Impact

ObjectivesTo evaluate the impact of a patient-specific national programme targeting older Australians and health professionals that aimed to increase use of emollient moisturisers to reduce to the risk of skin tears.DesignA prospective cohort intervention.ParticipantsThe intervention targeted 52 778 Australian Government’s Department of Veterans’ Affairs patients aged over 64 years who had risk factors for wound development, and their general practitioners (GPs) (n=14 178).Outcome measuresAn interrupted time series model compared the rate of dispensing of emollients in the targeted cohort before and up to 23 months after the intervention. Commitment questions were included in self-report forms.ResultsIn the first month after the intervention, the rate of claims increased 6.3-fold (95% CI: 5.2 to 7.6, p<0.001) to 10 emollient dispensings per 1000 patients in the first month after the intervention. Overall, the intervention resulted in 10 905 additional patient-months of treatment. The increased rate of dispensing among patients who committed to talking to their GP about using an emollient was six times higher (rate ratio: 6.2, 95% CI: 4.4 to 8.7) than comparison groups.ConclusionsThe intervention had a sustained effect over 23 months. Veterans who responded positively to commitment questions had higher uptake of emollients than those who did not.

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Changes in the Use of Broad-Spectrum Antibiotics after Cefepime Shortage: a Time Series Analysis

Antimicrobial Agents and Chemotherapy ◽

10.1128/aac.05560-11 ◽

2011 ◽

Vol 56 (2) ◽

pp. 989-994 ◽

Cited By ~ 12

Author(s):

C. Plüss-Suard ◽

A. Pannatier ◽

C. Ruffieux ◽

A. Kronenberg ◽

K. Mühlemann ◽

...

Keyword(s):

Time Series ◽

Pseudomonas Aeruginosa ◽

Broad Spectrum ◽

Interrupted Time Series ◽

Antibiotic Policy ◽

Content Type ◽

Broad Spectrum Antibiotics ◽

Before And After ◽

Alternative Antibiotic ◽

The Impact

ABSTRACTThe original cefepime product was withdrawn from the Swiss market in January 2007 and replaced by a generic 10 months later. The goals of the study were to assess the impact of this cefepime shortage on the use and costs of alternative broad-spectrum antibiotics, on antibiotic policy, and on resistance ofPseudomonas aeruginosatoward carbapenems, ceftazidime, and piperacillin-tazobactam. A generalized regression-based interrupted time series model assessed how much the shortage changed the monthly use and costs of cefepime and of selected alternative broad-spectrum antibiotics (ceftazidime, imipenem-cilastatin, meropenem, piperacillin-tazobactam) in 15 Swiss acute care hospitals from January 2005 to December 2008. Resistance ofP. aeruginosawas compared before and after the cefepime shortage. There was a statistically significant increase in the consumption of piperacillin-tazobactam in hospitals with definitive interruption of cefepime supply and of meropenem in hospitals with transient interruption of cefepime supply. Consumption of each alternative antibiotic tended to increase during the cefepime shortage and to decrease when the cefepime generic was released. These shifts were associated with significantly higher overall costs. There was no significant change in hospitals with uninterrupted cefepime supply. The alternative antibiotics for which an increase in consumption showed the strongest association with a progression of resistance were the carbapenems. The use of alternative antibiotics after cefepime withdrawal was associated with a significant increase in piperacillin-tazobactam and meropenem use and in overall costs and with a decrease in susceptibility ofP. aeruginosain hospitals. This warrants caution with regard to shortages and withdrawals of antibiotics.

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Impact of Monovalent Rotavirus Vaccine on Rotavirus Hospitalizations among Children Younger Than 5 Years of Age in the Ouest and Artibonite Departments, Haiti, 2013 to 2019

American Journal of Tropical Medicine and Hygiene ◽

10.4269/ajtmh.21-0414 ◽

2021 ◽

Author(s):

Anne-Marie Desormeaux ◽

Eleanor Burnett ◽

Gérard Joseph ◽

Mentor Ali Ber Lucien ◽

Negar Aliabadi ◽

...

Keyword(s):

Negative Binomial ◽

Hospital Admissions ◽

Absolute Number ◽

Sensitivity Analyses ◽

Rotavirus Vaccine ◽

Vaccine Introduction ◽

Rotavirus Vaccination ◽

Before And After ◽

Rotavirus Diarrhea ◽

The Impact

Rotavirus is responsible for 26% of diarrheal deaths in Latin America and the Caribbean. Haiti introduced the monovalent rotavirus vaccine in April 2014. The objective of this analysis is to describe the impact of the rotavirus vaccine on hospitalizations among Haitian children younger than 5 years old during the first 5 years after introduction. This analysis includes all children with diarrhea who were enrolled as part of a sentinel surveillance system at two hospitals from May 2013 to April 2019. We compare the proportion of rotavirus-positive specimens in each post-vaccine introduction year to the pre-vaccine period. To account for the potential dilution of the proportion of rotavirus-positive specimens from a waning cholera outbreak, we also analyzed annual trends in the absolute number of positive stools, fit a two-component finite-mixture model to the negative specimens, and fit a negative binomial time series model to the pre-vaccine rotavirus-positive specimens to predict the number of rotavirus diarrhea hospital admissions in the absence of rotavirus vaccination. The overall percentage of rotavirus-positive specimens declined by 22% the first year after introduction, increased by 17% the second year, and declined by 33% to 50% the subsequent 3 years. All sensitivity analyses confirmed an overall decline. We observed a clear annual rotavirus seasonality before and after vaccine introduction, with the greatest activity in December through April, and a biennial pattern, with high sharp peaks and flatter longer periods of increased rotavirus activity in alternating years, consistent with suboptimal vaccination coverage. Overall, our study shows evidence that the introduction of the rotavirus vaccine reduced the burden of severe rotavirus diarrhea.

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Impact of campaign-style delivery of routine vaccines during Intensified Mission Indradhanush in India: a controlled interrupted time-series analysis

10.1101/2020.05.01.20087288 ◽

2020 ◽

Author(s):

Emma Clarke-Deelder ◽

Christian Suharlim ◽

Susmita Chatterjee ◽

Logan Brenzel ◽

Arindam Ray ◽

...

Keyword(s):

Time Series ◽

Time Series Analysis ◽

Immunization Coverage ◽

Interrupted Time Series ◽

Childhood Vaccination ◽

World Health ◽

Interrupted Time Series Analysis ◽

Series Analysis ◽

The World ◽

The Impact

AbstractIntroductionThe world is not on track to achieve the goals for immunization coverage and equity described by the World Health Organization’s Global Vaccine Action Plan. In India, only 62% of children had received a full course of basic vaccines in 2016. We evaluated the Intensified Mission Indradhanush (IMI), a campaign-style intervention to increase routine immunization coverage and equity in India, implemented in 2017-2018.MethodsWe conducted a comparative interrupted time-series analysis using monthly district-level data on vaccine doses delivered, comparing districts participating and not participating in IMI. We estimated the impact of IMI on coverage and under-coverage (defined as the proportion of children who were unvaccinated) during the four-month implementation period and in subsequent months.FindingsDuring implementation, IMI increased delivery of thirteen infant vaccines by between 1.6% (95% CI: −6.4, 10.2%) and 13.8% (3.0%, 25.7%). We did not find evidence of a sustained effect during the 8 months after implementation ended. Over the 12 months from the beginning of implementation, IMI reduced under-coverage of childhood vaccination by between 3.9% (−6.9%, 13.7%) and 35.7% (−7.5%, 77.4%). The largest estimated effects were for the first doses of vaccines against diptheria-tetanus-pertussis and polio.InterpretationIMI had a substantial impact on infant immunization delivery during implementation, but this effect waned after implementation ended. Our findings suggest that campaign-style interventions can increase routine infant immunization coverage and reach formerly unreached children in the shorter term, but other approaches may be needed for sustained coverage improvements.FundingBill & Melinda Gates Foundation.

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Implementation of the Targeted Assessment for Prevention Strategy in a healthcare system to reduce Clostridioides difficile infection rates

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2019.358 ◽

2020 ◽

Vol 41 (3) ◽

pp. 295-301

Author(s):

Katelyn A. White ◽

Minn M. Soe ◽

Amy Osborn ◽

Christie Walling ◽

Lucy V. Fike ◽

...

Keyword(s):

Healthcare System ◽

Negative Binomial ◽

Interrupted Time Series ◽

Strategy Implementation ◽

System Level ◽

National Goal ◽

Clostridioides Difficile ◽

National Priority ◽

Before And After ◽

Prevention Interventions

AbstractBackground:Prevention of Clostridioides difficile infection (CDI) is a national priority and may be facilitated by deployment of the Targeted Assessment for Prevention (TAP) Strategy, a quality improvement framework providing a focused approach to infection prevention. This article describes the process and outcomes of TAP Strategy implementation for CDI prevention in a healthcare system.Methods:Hospital A was identified based on CDI surveillance data indicating an excess burden of infections above the national goal; hospitals B and C participated as part of systemwide deployment. TAP facility assessments were administered to staff to identify infection control gaps and inform CDI prevention interventions. Retrospective analysis was performed using negative-binomial, interrupted time series (ITS) regression to assess overall effect of targeted CDI prevention efforts. Analysis included hospital-onset, laboratory-identified C. difficile event data for 18 months before and after implementation of the TAP facility assessments.Results:The systemwide monthly CDI rate significantly decreased at the intervention (β2, −44%; P = .017), and the postintervention CDI rate trend showed a sustained decrease (β1 + β3; −12% per month; P = .008). At an individual hospital level, the CDI rate trend significantly decreased in the postintervention period at hospital A only (β1 + β3, −26% per month; P = .003).Conclusions:This project demonstrates TAP Strategy implementation in a healthcare system, yielding significant decrease in the laboratory-identified C. difficile rate trend in the postintervention period at the system level and in hospital A. This project highlights the potential benefit of directing prevention efforts to facilities with the highest burden of excess infections to more efficiently reduce CDI rates.

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Vancomycin Use: Room for Improvement Among Hospitalized Children

Journal of Pharmacy Practice ◽

10.1177/0897190016635478 ◽

2016 ◽

Vol 30 (3) ◽

pp. 296-299 ◽

Cited By ~ 8

Author(s):

Jessica Gillon ◽

Meng Xu ◽

James Slaughter ◽

M. Cecilia Di Pentima

Keyword(s):

Real Time ◽

Interrupted Time Series ◽

Antibiotic Use ◽

Hospitalized Children ◽

Interrupted Time Series Analysis ◽

Prospective Audit ◽

Children's Hospitals ◽

Children’S Hospitals ◽

Before And After ◽

The Impact

Introduction: The use of vancomycin is common among hospitalized children. We sought to evaluate the impact of prospective audit with real-time feedback on vancomycin use and pharmacy costs. Methods: Vancomycin use was evaluated at Monroe Carell Jr Children’s Hospital at Vanderbilt (MCJCHV) before and after the implementation of prospective audit with intervention and feedback to providers in 2012. Antibiotic use was compared to academic children’s hospitals with established antimicrobial stewardship programs (ASPs). Two similar pediatric academic institutions without an ASP were used as nonintervention controls. Analysis of monthly days of antibiotic therapy (DoT) per 1000 patient-days was performed by interrupted time series analysis. Results: Monthly vancomycin use decreased from 114 DoTs/1000 patient-days to 89 DoTs/1000 patient-days ( P < .0001). We did not find significant differences in the slope of change in vancomycin use between MCJCHV and institutions with ASPs either before or after the intervention ( P = .86 and P = .71, respectively). When compared to children’s hospitals without ASPs, the use of vancomycin was significantly lower at MCJCHV ( P < .001). Conclusion: The use of vancomycin at academic children’s hospitals with an ASP is declining. In our experience, prospective audit with real-time intervention and feedback to providers significantly reduced the use and costs associated with vancomycin.

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Effect of Median Design on Rural Freeway Safety

Transportation Research Record Journal of the Transportation Research Board ◽

10.3141/2060-04 ◽

2008 ◽

Vol 2060 (1) ◽

pp. 29-37 ◽

Cited By ~ 17

Author(s):

Andrew P. Tarko ◽

Natalie M. Villwock ◽

Nicolas Blond

Keyword(s):

Opposite Direction ◽

Negative Binomial ◽

Prediction Models ◽

Negative Binomial Regression ◽

Well Being ◽

Crash Severity ◽

Before And After ◽

Single Vehicle ◽

Median Width ◽

The Impact

Although median barriers are an absolute means of preventing drivers from crossing road medians and colliding with vehicles moving in the opposite direction, they may cause additional crashes. This perhaps complex safety effect of median barriers has not been investigated well. Being able to predict the safety impact of most types of median barriers on rural freeways is becoming more desirable because some state departments of transportation plan to expand many of their four-lane rural freeways to six lanes to accommodate increases in traffic volume. Realistic crash prediction models sensitive to the median design would provide the needed guidance useful in designing adequate median treatments on widened freeways. The impact of median designs on crash frequency was investigated in this study through negative binomial regression and before-and-after studies based on data collected in eight participating states. The impact on crash severity was investigated with a logit model. The separate effects of changes in median geometry were quantified for single-vehicle, multiple-vehicle same direction, and multiple-vehicle opposite direction crashes. The results were significantly different and indicated that reducing the median width without adding barriers (the remaining median width is still reasonably wide) increases the severity of crashes, particularly opposite direction crashes. Further, reducing the median and installing concrete barriers eliminates opposite direction crashes but doubles the frequency of single-vehicle crashes and tends to lessen the frequency of same direction crashes. The crash severity also tends to increase.

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Transit-oriented economic development: The impact of light rail on new business starts in the Phoenix, AZ Region, USA

Urban Studies ◽

10.1177/0042098017724119 ◽

2017 ◽

Vol 55 (13) ◽

pp. 2838-2862 ◽

Cited By ~ 15

Author(s):

Kevin Credit

Keyword(s):

Service Sector ◽

Interrupted Time Series ◽

Light Rail ◽

Initial Increase ◽

New Business Formation ◽

Before And After ◽

New Business ◽

Quasi Experimental ◽

And Control ◽

The Impact

This article examines the impact of Phoenix’s light rail system, which opened in 2008, on new firm formation in specific industries. Individual business data from 1990–2014 are used in a quasi-experimental adjusted-interrupted time series (AITS) regression to compare the impact of the transit system’s construction on new business starts in ‘treatment’ and ‘control’ areas before and after the opening of the line. Findings show that the transit adjacency is worth an 88% increase in knowledge sector new starts, a 40% increase in service sector new starts and a 28% increase in retail new starts at the time the system opened, when compared with automobile-accessible control areas. However, the light rail also appears to suffer from a ‘novelty factor’– after the initial increase in new establishment activity in adjacent block groups, the effect diminishes at the rate of 8%, 6% and 7% per year, respectively. The results also provide insight into the spatial extent of light rail impacts to new business formation, with areas 1 mile from stations observing 21% fewer retail new business starts and 12% fewer knowledge sector new starts than areas within a quarter of a mile of stations.

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Transformation of the Tanzania Medical Store Department through Global Fund support: lessons learned from the field

10.1101/2020.04.14.20065813 ◽

2020 ◽

Author(s):

Patrick Githendu ◽

Linden Morrison ◽

Rosemary Silaa ◽

Sai Pothapregada ◽

Sarah Asiimwe ◽

...

Keyword(s):

Global Fund ◽

Interrupted Time Series ◽

Lessons Learned ◽

Interrupted Time Series Analysis ◽

Monthly Basis ◽

Quantitative And Qualitative Research ◽

Before And After ◽

Multi Stakeholder ◽

Health Commodities ◽

The Impact

AbstractBackgroundThe Tanzania government sought support from The Global Fund to Fight AIDs, Tuberculosis and Malaria (Global Fund) to reform its Medical Stores Department (MSD), with the aim of improving performance. Our study aimed to assess the impact of the reforms and document the lessons learned.MethodsWe applied quantitative and qualitative research methods to assess the impact of the reforms. The quantitative part entailed a review of operational and financial data covering the period before and after the implementation of the reforms. We applied interrupted time series analysis to determine the change in average availability of essential health commodities at health zones. Qualitative data was collected through 41 key informant interviews. Participants were identified through stakeholder mapping, purposive and snowballing sampling techniques, and responses were analyzed through thematic content analysis.ResultsAvailability of essential health commodities increased significantly by 12.6% (95%CI, 9.6-15.6), after the reforms and continued to increase on a monthly basis by 0.2% (95%CI, 0.0-0.3) relative to the preintervention trend. Sales increased by 56.6% while the cost of goods sold increased by 88.6% between 2014/15 and 2017/18. Surplus income increased by 56.4% between 2014/15 and 2017/18, with reductions in rent and fuel expenditure. There was consensus among participants that the reforms, were instrumental in improving performance of MSD.ConclusionMany positive results were realized through the reforms at MSD. However, despite the progress, there were risks such as the increasing government receivable that could jeopardize the gains. Multi-stakeholder efforts are necessary, to sustain the progress and expand public health.

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Trends of case-fatality rate by acute coronary syndrome in Portugal: Impact of a fast track to the coronary unit

JRSM Cardiovascular Disease ◽

10.1177/2048004019851952 ◽

2019 ◽

Vol 8 ◽

pp. 204800401985195

Author(s):

D Abreu ◽

FJ Pinto ◽

C Matias-Dias ◽

P Sousa

Keyword(s):

Acute Coronary Syndrome ◽

Fast Track ◽

Case Fatality ◽

Interrupted Time Series ◽

P Value ◽

Coronary Syndrome ◽

Health Authorities ◽

Track System ◽

Before And After ◽

The Impact

Introduction Efforts were made to improve management of coronary disease as the fast-track system to the Coronary Unit. We aim to analyse case-fatality rates by acute coronary syndrome in Portugal from 2000 to 2016, mainly the impact of the fast-track system and the proportion of patients that activate the fast-track system. Methods We analysed monthly acute coronary syndrome case-fatality before and after the implementation of the fast-track system in 2007. Impact of the system was assessed through regression models for interrupted time-series. We calculated annual proportion of fast-track system admissions. Results After 2007 case-fatality by acute coronary syndrome decreased (β=−1.27, p-value < 0.01). The estimates obtained for ST Elevation Myocardial Infarction suggest a reduction of nearly 86 monthly deaths prevented after 2007. The highest percentage of patients admitted through the fast-track system was 35%. Conclusions Our results suggest fast-track system may have contributed to a decline in acute coronary syndrome case-fatality. However, more than half of patients were not admitted through the system. This should encourage health authorities to make efforts to ensure compliance.

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