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Horn EK, Herrera-Restrepo O, Acosta AM, Simon A, Jackson B, Lucas E. The Burden of Hepatitis A Outbreaks in the United States: Health Outcomes, Economic Costs, and Management Strategies. J Infect Dis 2024; 230:e199-e218. [PMID: 39052742 PMCID: PMC11272058 DOI: 10.1093/infdis/jiae087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 02/08/2024] [Accepted: 02/26/2024] [Indexed: 03/01/2024] Open
Abstract
BACKGROUND Hepatitis A (HepA) vaccines are recommended for US adults at risk of HepA. Ongoing United States (US) HepA outbreaks since 2016 have primarily spread person-to-person, especially among at-risk groups. We investigated the health outcomes, economic burden, and outbreak management considerations associated with HepA outbreaks from 2016 onwards. METHODS A systematic literature review was conducted to assess HepA outbreak-associated health outcomes, health care resource utilization (HCRU), and economic burden. A targeted literature review evaluated HepA outbreak management considerations. RESULTS Across 33 studies reporting on HepA outbreak-associated health outcomes/HCRU, frequently reported HepA-related morbidities included acute liver failure/injury (n = 6 studies of 33 studies) and liver transplantation (n = 5 of 33); reported case fatality rates ranged from 0% to 10.8%. Hospitalization rates reported in studies investigating person-to-person outbreaks ranged from 41.6% to 84.8%. Ten studies reported on outbreak-associated economic burden, with a national study reporting an average cost of over $16 000 per hospitalization. Thirty-four studies reported on outbreak management; challenges included difficulty reaching at-risk groups and vaccination distrust. Successes included targeted interventions and increasing public awareness. CONCLUSIONS This review indicates a considerable clinical and economic burden of ongoing US HepA outbreaks. Targeted prevention strategies and increased public awareness and vaccination coverage are needed to reduce HepA burden and prevent future outbreaks.
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German PH, Lazenby M, Phillips S, Jun A. The Effect of a Quality Improvement Project on Improving Patients' Willingness to Receive an Influenza Vaccination in the Emergency Department. J Immigr Minor Health 2024; 26:474-481. [PMID: 38172454 PMCID: PMC11096210 DOI: 10.1007/s10903-023-01574-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/21/2023] [Indexed: 01/05/2024]
Abstract
The aim of this project was to increase willingness to receive the influenza vaccine to the optimal rate of ≥ 70%. Low acuity adult patients who visited an Emergency Department (ED) were assessed regarding their willingness to receive the influenza vaccine before and after an educational intervention that included a provider recommendation and an educational handout. A total of seventy-six patients (n = 76) were assessed. Patients' willingness to receive the influenza vaccine rose from 29% pre-intervention to 72% post-intervention without disrupting the clinical flow in a busy ED. Similar vaccine educational strategies can be applied to influenza and other vaccines in EDs to increase vaccination willingness in patients, including those who use the ED as a primary point of contact for healthcare, decreasing the burden of influenza illness in the community.
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Affiliation(s)
- Paola H German
- Sue and Bill Gross School of Nursing, University of California Irvine, 854 Health Sciences Road, Irvine, CA, 92697, USA.
| | - Mark Lazenby
- Sue and Bill Gross School of Nursing, University of California Irvine, 854 Health Sciences Road, Irvine, CA, 92697, USA
| | - Susanne Phillips
- Sue and Bill Gross School of Nursing, University of California Irvine, 854 Health Sciences Road, Irvine, CA, 92697, USA
| | - Angela Jun
- Sue and Bill Gross School of Nursing, University of California Irvine, 854 Health Sciences Road, Irvine, CA, 92697, USA
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Fassas E, Fischer K, Schenkel S, David Gatz J, Gingold DB. Public Health Interventions in the Emergency Department: A Framework for Evaluation. West J Emerg Med 2024; 25:415-422. [PMID: 38801049 PMCID: PMC11112666 DOI: 10.5811/westjem.18316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Revised: 12/14/2023] [Accepted: 12/15/2023] [Indexed: 05/29/2024] Open
Abstract
Emergency departments (ED) in the United States serve a dual role in public health: a portal of entry to the health system and a safety net for the community at large. Public health officials often target the ED for public health interventions due to the perception that it is uniquely able to reach underserved populations. However, under time and resource constraints, emergency physicians and public health officials must make calculated decisions in choosing which interventions in their local context could provide maximal impact to achieve public health benefit. We identify how decisions regarding public health interventions are affected by considerations of cost, time, and available personnel, and further consider the role of local community needs, health department goals, and political environment. We describe a sample of ED-based public health interventions and demonstrate how to use a proposed framework to assess interventions. We posit a series of questions and variables to consider: local disease prevalence; ability of the ED to perform the intervention; relative efficacy of the ED vs community partnerships as the primary intervention location; and expected outcomes. In using this framework, clinicians should be empowered to improve the public health in their communities.
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Affiliation(s)
| | - Kyle Fischer
- University of Maryland School of Medicine, Baltimore, Maryland
| | | | - John David Gatz
- University of Maryland School of Medicine, Baltimore, Maryland
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Wessman BT, Yeary J, Newland H, Jotte R. Operation CoVER Saint Louis (COVID-19 Vaccine in the Emergency Room): Impact of a Vaccination Program in the Emergency Department. West J Emerg Med 2024; 25:374-381. [PMID: 38801044 PMCID: PMC11112669 DOI: 10.5811/westjem.18325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 01/04/2024] [Accepted: 01/09/2024] [Indexed: 05/29/2024] Open
Abstract
Introduction Coronavirus 2019 (COVID-19) inequitably impacted minority populations and regions with limited access to healthcare resources. The Barnes-Jewish Emergency Department in St. Louis, MO, serves such a population. The COVID-19 vaccine is an available defense to help achieve community immunity. The emergency department (ED) is a potential societal resource to provide access to a vaccination intervention. Our objective in this study was to describe and evaluate a novel ED COVID-19 vaccine program, including its impact on the local surrounding underserved community. Methods This was a retrospective, post-protocol implementation review of an ED COVID-19 vaccination program. Over the initial six-month period, we compiled data on all vaccinated patients out of the ED to evaluate demographic data and the impact on underserved regional areas. Results We report a successful ED-based COVID-19 vaccine program (with over 1,000 vaccines administered). This program helped raise regional and state vaccination rates. Over 50% of the population that received the COVID-19 vaccine from the ED were from defined socially vulnerable patient populations. No adverse effects were documented. Conclusion Operation CoVER (COVID-19 Vaccine in the Emergency Room) Saint Louis was able to successfully vaccinate a socially vulnerable patient population. This free, COVID-19 ED-based vaccine program with dedicated pharmacy support, was novel in emergency medicine practice. Similar ED-based vaccine programs could help with future vaccine distribution.
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Affiliation(s)
- Brian T. Wessman
- Washington University in Saint Louis, Department of Emergency Medicine, St. Louis, Missouri
- Washington University in Saint Louis, Department of Anesthesiology, Division of Critical Care Medicine, St. Louis, Missouri
| | - Julianne Yeary
- BJC HealthCare, Department of Pharmacy Services, St. Louis, Missouri
| | - Helen Newland
- BJC HealthCare, Department of Pharmacy Services, St. Louis, Missouri
| | - Randy Jotte
- Washington University in Saint Louis, Department of Emergency Medicine, St. Louis, Missouri
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Bukhsh MA, Thyagarajan R, Todd B, Chen NW, Qu L, Swaminathan L. An electronic medical record-based intervention to improve hepatitis A vaccination rates in the emergency department during a regional outbreak. BMJ Open Qual 2022; 11:bmjoq-2022-001876. [DOI: 10.1136/bmjoq-2022-001876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 10/24/2022] [Indexed: 11/23/2022] Open
Abstract
BackgroundIn response to the severe hepatitis A outbreak that occurred in Michigan between August 2016 and September 2019, our multihospital health system implemented an electronic medical record (EMR)-based vaccination intervention across its nine emergency departments (EDs). The objectives were to explore the impact of this intervention on increasing vaccination rates among high-risk individuals and to assess the barriers to use of a computerised vaccine reminder system.MethodsAll patients who were 18 years or older were screened using an electronic nursing questionnaire. If a patient was at high risk based on the questionnaire, an electronic best practice advisory (BPA) would trigger and give the physician or advanced practice provider the option to order the hepatitis A vaccine. We explored the vaccination rates in the 24-month preintervention and the 18-month intervention periods. We then administered a survey to physicians, advanced practice providers and nurses evaluating their perceptions and barriers to use of the EMR intervention.ResultsDuring the preintervention period, 49 vaccines were ordered (5.5 per 100 000 patient visits) and 32 were administered (3.6 per 100 000 patient visits). During the intervention period, 574 865 patient visits (74.3%) were screened. 2494 vaccines (322 per 100 000 patient visits) were ordered, and 1205 vaccines (155 per 100 000 patients visits) were administered. Physicians and advanced practice providers were initially compliant with the BPA’s use, but compliance declined over time. Surveys revealed that the major barrier to use was lack of time.ConclusionsEMR screening tools and BPAs can be used in the ED as an effective strategy to vaccinate high-risk individuals. This may be translatable to outbreaks of other vaccine-preventable illnesses like influenza, measles or SARS-CoV-2. Providing ongoing education about the public health initiative and giving feedback to physicians, advanced practice providers and nurses about tool compliance are needed to sustain the improvement over time.
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O'Conor KJ, Golden SH, Hughes MT, Sisson SD, Kachalia A. COVID-19 Vaccination: Health Care Organizations' Responsibility and Opportunity. Am J Public Health 2022; 112:213-215. [PMID: 35080955 PMCID: PMC8802584 DOI: 10.2105/ajph.2021.306633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/16/2021] [Indexed: 11/04/2022]
Affiliation(s)
- Katie J O'Conor
- Katie J. O'Conor is with the Department of Emergency Medicine and the Department of Anesthesiology and Critical Care Medicine, Office of Critical Event Preparedness and Response, Johns Hopkins Medicine, Baltimore, MD. Sherita H. Golden is with the Department of Medicine, Office of Diversity, Inclusion, and Health Equity, Johns Hopkins Medicine. Mark T. Hughes is with the Department of Medicine, Berman Institute of Bioethics, Johns Hopkins Medicine. Stephen D. Sisson is with the Department of Medicine, Johns Hopkins Medicine. Allen Kachalia is with the Armstrong Institute for Patient Safety and Quality, Department of Medicine, Johns Hopkins Medicine
| | - Sherita H Golden
- Katie J. O'Conor is with the Department of Emergency Medicine and the Department of Anesthesiology and Critical Care Medicine, Office of Critical Event Preparedness and Response, Johns Hopkins Medicine, Baltimore, MD. Sherita H. Golden is with the Department of Medicine, Office of Diversity, Inclusion, and Health Equity, Johns Hopkins Medicine. Mark T. Hughes is with the Department of Medicine, Berman Institute of Bioethics, Johns Hopkins Medicine. Stephen D. Sisson is with the Department of Medicine, Johns Hopkins Medicine. Allen Kachalia is with the Armstrong Institute for Patient Safety and Quality, Department of Medicine, Johns Hopkins Medicine
| | - Mark T Hughes
- Katie J. O'Conor is with the Department of Emergency Medicine and the Department of Anesthesiology and Critical Care Medicine, Office of Critical Event Preparedness and Response, Johns Hopkins Medicine, Baltimore, MD. Sherita H. Golden is with the Department of Medicine, Office of Diversity, Inclusion, and Health Equity, Johns Hopkins Medicine. Mark T. Hughes is with the Department of Medicine, Berman Institute of Bioethics, Johns Hopkins Medicine. Stephen D. Sisson is with the Department of Medicine, Johns Hopkins Medicine. Allen Kachalia is with the Armstrong Institute for Patient Safety and Quality, Department of Medicine, Johns Hopkins Medicine
| | - Stephen D Sisson
- Katie J. O'Conor is with the Department of Emergency Medicine and the Department of Anesthesiology and Critical Care Medicine, Office of Critical Event Preparedness and Response, Johns Hopkins Medicine, Baltimore, MD. Sherita H. Golden is with the Department of Medicine, Office of Diversity, Inclusion, and Health Equity, Johns Hopkins Medicine. Mark T. Hughes is with the Department of Medicine, Berman Institute of Bioethics, Johns Hopkins Medicine. Stephen D. Sisson is with the Department of Medicine, Johns Hopkins Medicine. Allen Kachalia is with the Armstrong Institute for Patient Safety and Quality, Department of Medicine, Johns Hopkins Medicine
| | - Allen Kachalia
- Katie J. O'Conor is with the Department of Emergency Medicine and the Department of Anesthesiology and Critical Care Medicine, Office of Critical Event Preparedness and Response, Johns Hopkins Medicine, Baltimore, MD. Sherita H. Golden is with the Department of Medicine, Office of Diversity, Inclusion, and Health Equity, Johns Hopkins Medicine. Mark T. Hughes is with the Department of Medicine, Berman Institute of Bioethics, Johns Hopkins Medicine. Stephen D. Sisson is with the Department of Medicine, Johns Hopkins Medicine. Allen Kachalia is with the Armstrong Institute for Patient Safety and Quality, Department of Medicine, Johns Hopkins Medicine
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Reichenbach ZW, Hogan C, Piech G, Shah S, Lambrou T, Radcliffe M, Kiani A, Peng L. Characterization of a hepatitis a outbreak in underserved urban tertiary safety net hospitals. Ann Epidemiol 2021; 64:111-119. [PMID: 34563568 DOI: 10.1016/j.annepidem.2021.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 09/12/2021] [Accepted: 09/12/2021] [Indexed: 11/28/2022]
Abstract
Outbreaks of Hepatitis A, caused by the Hepatitis A Virus (HAV), remain a worldwide health concern. We conducted a retrospective chart review to characterize patients with acute HAV during an outbreak at our urban tertiary care center to better characterize patients infected with HAV. We searched our electronic records for patients with positive HAV IgM antibodies during a period of outbreak in Philadelphia, May 2017-December 2019. Characteristics of patients were recorded. We searched an equal period of time prior to the outbreak, September 2014-April 2017, to compare the two patient populations. During the outbreak we diagnosed 205 cases of acute HAV compared to just 23 during an equal time period prior to the onset of the outbreak. When compared to the results reported by the public health department for 2019, this accounted for 39.9% of patients documented in the city. A history of drug use was found in 49.4% of our patients while 19.5% of patients were homeless. Our analysis of homelessness and drug usage among documented cases of HAV during the outbreak period mirrored data reported by the city. Further, our analysis found that 7 zip codes accounted for 60% of our patients. Biochemical measures of liver function were higher in patients examined during the outbreak.
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Affiliation(s)
- Zachary Wilmer Reichenbach
- Division of Hepatology, Temple University Hospital, Philadelphia, PA; Center for Substance Abuse Research (CSAR), Lewis Katz School of Medicine, Temple University, Philadelphia, PA.
| | - Carolyn Hogan
- Division of Hepatology, Temple University Hospital, Philadelphia, PA
| | - Gregory Piech
- Division of Hepatology, Temple University Hospital, Philadelphia, PA
| | - Samik Shah
- Division of Hepatology, Temple University Hospital, Philadelphia, PA
| | - Tiffany Lambrou
- Division of Hepatology, Temple University Hospital, Philadelphia, PA
| | - Marlana Radcliffe
- Division of Hepatology, Temple University Hospital, Philadelphia, PA
| | - Amirali Kiani
- Division of Hepatology, Temple University Hospital, Philadelphia, PA
| | - Lee Peng
- Division of Hepatology, Temple University Hospital, Philadelphia, PA
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Heinert SW, McCoy J, Eisenstein R, Rowley J. Reaching the hard to reach: Characteristics of patients who received a COVID-19 vaccine in the emergency department. Acad Emerg Med 2021; 28:1081-1083. [PMID: 34245636 PMCID: PMC8441694 DOI: 10.1111/acem.14334] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 06/24/2021] [Accepted: 06/25/2021] [Indexed: 12/04/2022]
Affiliation(s)
- Sara W. Heinert
- Department of Emergency Medicine Rutgers Robert Wood Johnson Medical School New Brunswick New Jersey USA
| | - Jonathan McCoy
- Department of Emergency Medicine Rutgers Robert Wood Johnson Medical School New Brunswick New Jersey USA
| | - Robert Eisenstein
- Department of Emergency Medicine Rutgers Robert Wood Johnson Medical School New Brunswick New Jersey USA
| | - Jessica Rowley
- Department of Nursing Robert Wood Johnson University Hospital New Brunswick New Jersey USA
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