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Maggio LA, Byington CL, Toner ES, Kanter SL. A Chief Health Security Officer for Every Academic Health Center: Improving Readiness, Response, Recovery, and Resilience. Acad Med 2023; 98:1247-1250. [PMID: 37556815 DOI: 10.1097/acm.0000000000005435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/11/2023]
Abstract
Academic health centers (AHCs) require expertise to ensure readiness for health security events, such as cyberattacks, natural disasters, and pandemics, as well as the ability to respond to and recover from these events. However, most AHCs lack an individual to coordinate efforts at an enterprise level across academic and operational units during an emergency; elevate the coordination of individual AHCs with local and state public health entities; and through professional organizations, coordinate the work of AHCs across national and international public health entities. Informed by AHCs' responses to the COVID-19 pandemic and a series of focused meetings in 2021 of the Association of Academic Health Centers President's Council on Health Security, the authors propose creating a new C-suite role to meet these critical needs: the chief health security officer (CHSO). The CHSO would be responsible for the AHC's overall health security and would report to the AHC's chief executive officer or president. The authors describe the role of CHSO in relation to the preparation, response, and recovery phases of public health events necessary for health security. They also propose key duties for this position and encourage institutions to offer training and credentials to facilitate the creation and define the portfolios of CHSO positions at AHCs and beyond.
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Affiliation(s)
- Lauren A Maggio
- L.A. Maggio is professor of medicine and health professions education, Uniformed Services University of the Health Sciences, Bethesda, Maryland; ORCID: http://orcid.org/0000-0002-2997-6133
| | - Carrie L Byington
- C.L. Byington is executive vice president, University of California Health, Oakland, California; ORCID: https://orcid.org/0000-0002-7350-9495
| | - Eric S Toner
- E.S. Toner is senior associate, Center for Health Security, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; ORCID: https://orcid.org/0000-0001-5292-9450
| | - Steven L Kanter
- S.L. Kanter is special advisor to the president and CEO, Association of American Medical Colleges, Washington, DC; ORCID: https://orcid.org/0000-0002-0436-1503
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Vashisht R, Patel A, Dahm L, Han C, Medders KE, Mowers R, Byington CL, Koliwad SK, Butte AJ. Second-Line Pharmaceutical Treatments for Patients with Type 2 Diabetes. JAMA Netw Open 2023; 6:e2336613. [PMID: 37782497 PMCID: PMC10546239 DOI: 10.1001/jamanetworkopen.2023.36613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 08/24/2023] [Indexed: 10/03/2023] Open
Abstract
Importance Assessing the relative effectiveness and safety of additional treatments when metformin monotherapy is insufficient remains a limiting factor in improving treatment choices in type 2 diabetes. Objective To determine whether data from electronic health records across the University of California Health system could be used to assess the comparative effectiveness and safety associated with 4 treatments in diabetes when added to metformin monotherapy. Design, Setting, and Participants This multicenter, new user, multidimensional propensity score-matched retrospective cohort study with leave-one-medical-center-out (LOMCO) sensitivity analysis used principles of emulating target trial. Participants included patients with diabetes receiving metformin who were then additionally prescribed either a sulfonylurea, dipeptidyl peptidase-4 inhibitor (DPP4I), sodium-glucose cotransporter-2 inhibitor (SGLT2I), or glucagon-like peptide-1 receptor agonist (GLP1RA) for the first time and followed-up over a 5-year monitoring period. Data were analyzed between January 2022 and April 2023. Exposure Treatment with sulfonylurea, DPP4I, SGLT2I, or GLP1RA added to metformin monotherapy. Main Outcomes and Measures The main effectiveness outcome was the ability of patients to maintain glycemic control, represented as time to metabolic failure (hemoglobin A1c [HbA1c] ≥7.0%). A secondary effectiveness outcome was assessed by monitoring time to new incidence of any of 28 adverse outcomes, including diabetes-related complications while treated with the assigned drug. Sensitivity analysis included LOMCO. Results This cohort study included 31 852 patients (16 635 [52.2%] male; mean [SD] age, 61.4 [12.6] years) who were new users of diabetes treatments added on to metformin monotherapy. Compared with sulfonylurea in random-effect meta-analysis, treatment with SGLT2I (summary hazard ratio [sHR], 0.75 [95% CI, 0.69-0.83]; I2 = 37.5%), DPP4I (sHR, 0.79 [95% CI, 0.75-0.84]; I2 = 0%), GLP1RA (sHR, 0.62 [95% CI, 0.57-0.68]; I2 = 23.6%) were effective in glycemic control; findings from LOMCO sensitivity analysis were similar. Treatment with SGLT2I showed no significant difference in effectiveness compared with GLP1RA (sHR, 1.26 [95% CI, 1.12-1.42]; I2 = 47.3%; no LOMCO) or DPP4I (sHR, 0.97 [95% CI, 0.90-1.04]; I2 = 0%). Patients treated with DPP4I and SGLT2I had fewer cardiovascular events compared with those treated with sulfonylurea (DPP4I: sHR, 0.84 [95% CI, 0.74-0.96]; I2 = 0%; SGLT2I: sHR, 0.78 [95% CI, 0.62-0.98]; I2 = 0%). Patients treated with a GLP1RA or SGLT2I were less likely to develop chronic kidney disease (GLP1RA: sHR, 0.75 [95% CI 0.6-0.94]; I2 = 0%; SGLT2I: sHR, 0.77 [95% CI, 0.61-0.97]; I2 = 0%), kidney failure (GLP1RA: sHR, 0.69 [95% CI, 0.56-0.86]; I2 = 9.1%; SGLT2I: sHR, 0.72 [95% CI, 0.59-0.88]; I2 = 0%), or hypertension (GLP1RA: sHR, 0.82 [95% CI, 0.68-0.97]; I2 = 0%; SGLT2I: sHR, 0.73 [95% CI, 0.58-0.92]; I2 = 38.5%) compared with those treated with a sulfonylurea. Patients treated with an SGLT2I, vs a DPP4I, GLP1RA, or sulfonylurea, were less likely to develop indicators of chronic hepatic dysfunction (sHR vs DPP4I, 0.68 [95% CI, 0.49-0.95]; I2 = 0%; sHR vs GLP1RA, 0.66 [95% CI, 0.48-0.91]; I2 = 0%; sHR vs sulfonylurea, 0.60 [95% CI, 0.44-0.81]; I2 = 0%), and those treated with a DPP4I were less likely to develop new incidence of hypoglycemia (sHR, 0.48 [95% CI, 0.36-0.65]; I2 = 22.7%) compared with those treated with a sulfonylurea. Conclusions and Relevance These findings highlight familiar medication patterns, including those mirroring randomized clinical trials, as well as providing new insights underscoring the value of robust clinical data analytics in swiftly generating evidence to help guide treatment choices in diabetes.
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Affiliation(s)
- Rohit Vashisht
- Bakar Computational Health Sciences Institute, University of California, San Francisco
| | - Ayan Patel
- Bakar Computational Health Sciences Institute, University of California, San Francisco
- Center for Data-driven Insights and Innovation, University of California Health, Oakland
| | - Lisa Dahm
- Center for Data-driven Insights and Innovation, University of California Health, Oakland
| | - Cora Han
- Center for Data-driven Insights and Innovation, University of California Health, Oakland
| | | | - Robert Mowers
- Managed Care Pharmacy Services, University of California, Davis School of Medicine, Davis
| | - Carrie L. Byington
- Center for Data-driven Insights and Innovation, University of California Health, Oakland
- Department of Pediatrics, University of California, San Francisco
| | - Suneil K. Koliwad
- Division of Endocrinology and Metabolism, Department of Medicine, and Diabetes Center, University of California, San Francisco
| | - Atul J. Butte
- Bakar Computational Health Sciences Institute, University of California, San Francisco
- Center for Data-driven Insights and Innovation, University of California Health, Oakland
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Holsti M, Keenan HT, Kadish HA, Sapiro HK, Giardino AP, Osborn KA, Cline KL, Byington CL. Developing a clinical research infrastructure embedded in an academic medicine center that equitably supports future clinician scientists. Clin Transl Sci 2023; 16:1547-1553. [PMID: 37278119 PMCID: PMC10499416 DOI: 10.1111/cts.13565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 05/05/2023] [Accepted: 05/24/2023] [Indexed: 06/07/2023] Open
Abstract
Clinical research in academic medical centers can be difficult to conduct and meet enrollment goals. Students under-represented in medicine (URiM) are also under-represented in academic leadership positions and as physician-scientists but are critical to help solve health disparities. Barriers in pursuing medicine as a career may be high for URiM students, therefore it is important to create pre-medicine opportunities accessible to all students interested in healthcare careers. We describe an undergraduate clinical research platform, the Academic Associate (AcA) program, embedded in the medical system that supports clinical research for academic physician scientists and provides students equitable access to experiences and mentoring opportunities. Students have the opportunity of completing a Pediatric Clinical Research Minor (PCRM) degree. This program satisfies many pre-medicine opportunities for undergraduate students, including those URiM, and allows access to physician mentors and unique educational experiences for graduate school or employment. Since 2009, 820 students participated in the AcA program (17.5% URiM) and 235 students (18% URiM) completed the PCRM. Of the 820 students, 126 (10% URiM) students matriculated to medical school, 128 (11%URiM) to graduate school, and 85 (16.5% URiM) gained employment in biomedical research fields. Students in our program supported 57 publications and were top-enrollers for several multicentered studies. The AcA program is cost-effective and achieves a high level of success enrolling patients into clinical research. Additionally, the AcA program provides equitable access for students URiM to physician mentorship, pre-medical experiences, and an avenue to early immersion in academic medicine.
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Affiliation(s)
- Maija Holsti
- Department of PediatricsUniversity of UtahSalt Lake CityUtahUSA
| | | | | | | | | | | | | | - Carrie L. Byington
- University of California HealthUniversity of CaliforniaOaklandCaliforniaUSA
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Devaskar SU, Cunningham CK, Steinhorn RH, Haq C, Spisso J, Dunne W, Gutierrez JR, Kivlahan C, Bholat M, Barakat S, de Leon Siantz ML, Romero S, Lefteris CT, Gaffney S, Deville J, Lerner C, Liu J, Kuelbs CL, Kukreja S, Golden C, Nelson Z, Elton K, Byington CL. Academic Health Centers and Humanitarian Crises: One Health System's Response to Unaccompanied Children at the Border. Acad Med 2023; 98:322-328. [PMID: 36512839 PMCID: PMC9944367 DOI: 10.1097/acm.0000000000005097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
University of California Health (UCH) provided a system-wide, rapid response to the humanitarian crisis of unaccompanied children crossing the southern U.S. border in the midst of the COVID-19 pandemic in 2021. In collaboration with multiple federal, state, and local agencies, UCH mobilized a multidisciplinary team to deliver acute general and specialty pediatric care to unaccompanied children at 2 Californian emergency intake sites (EISs). The response, which did not disrupt normal UCH operations, mobilized the capacities of the system and resulted in a safe and developmentally appropriate environment that supported the physical and mental health of migrant children during this traumatic period. The capacities of UCH's 6 academic health centers ensured access to trauma-informed medical care and culturally sensitive psychological and social support. Child life professionals provided access to exercise, play, and entertainment. Overall, 260 physicians, 42 residents and fellows, 4 nurse practitioners participated as treating clinicians and were supported by hundreds of staff across the 2 EISs. Over 5 months and across both EISs, a total of 4,911 children aged 3 to 17 years were cared for. A total of 782 children had COVID-19, most infected before arrival. Most children (3,931) were reunified with family or sponsors. Continuity of care after reunification or placement in a long-term shelter was enhanced by use of an electronic health record. The effort provided an educational experience for residents and fellows with instruction in immigrant health and trauma-informed care. The effort benefitted from UCH's recent experience of providing a system-wide response to the COVID-19 pandemic. Lessons learned are reported to encourage the alignment and integration of academic health centers' capacities with federal, state, and local plans to better prepare for and respond to the accelerating need to care for those in the wake of disasters and humanitarian crises.
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Affiliation(s)
- Sherin U. Devaskar
- S.U. Devaskar is distinguished professor of pediatrics, David Geffen School of Medicine at UCLA, executive chair, Department of Pediatrics, UCLA, physician-in-chief, UCLA Mattel Children’s Hospital, assistant vice chancellor of children’s health, UCLA Health, and executive director, UCLA Children’s Discovery and Innovation Institute, Los Angeles, California
| | - Coleen K. Cunningham
- C.K. Cunningham is pediatrician, UCI Health, Orange, chair, Department of Pediatrics, University of California, Irvine, School of Medicine, Irvine, and senior vice president and pediatrician-in-chief, Children’s Hospital of Orange County, Orange, California
| | - Robin H. Steinhorn
- R.H. Steinhorn is professor and vice dean for children’s clinical services, University of California San Diego, and president of children’s specialists of San Diego and senior vice president, Rady Children’s Specialists of San Diego, San Diego, California
| | - Cynthia Haq
- C. Haq is clinical professor and chair, Department of Family Medicine, UCI Medical Center, Orange, California
| | - Johnese Spisso
- J. Spisso is president, UCLA Health, chief executive officer, UCLA Hospital System, and associate vice chancellor, UCLA Health Sciences, Los Angeles, California
| | - William Dunne
- W. Dunne was administrative director of emergency preparedness, security, and safety services, UCLA Health, Los Angeles, California, at the time of writing. The author is currently director of emergency management, Penn State Health, Hershey, Pennsylvania
| | - Juan Raul Gutierrez
- J.R. Gutierrez is associate clinical professor, Department of Pediatrics, UCSF School of Medicine, co-director of pediatrics, UCSF Health and Human Rights Initiative and the Center of Excellence for Immigrant Child Health and Wellbeing, San Francisco, California
| | - Coleen Kivlahan
- C. Kivlahan is medical director, UCSF Human Rights Clinic, UCSF Health and Human Rights Initiative, San Francisco, California
| | - Michelle Bholat
- M. Bholat is professor and executive vice-chair, Department of Family Medicine, David Geffen School of Medicine at UCLA, and executive director and co-founder, International Medical Graduate Program, UCLA Health, Los Angeles, California
| | - Suzanne Barakat
- S. Barakat is assistant professor, Family Community Medicine, and executive director, UCSF Health and Human Rights Initiative, San Francisco, California
| | - Mary Lou de Leon Siantz
- M.L. de Leon Siantz is professor emeritus, Betty Irene Moore School of Nursing at UC Davis, and founding director, Center for the Advancement of Multicultural Perspectives on Science, Sacramento, California
| | - Stephanie Romero
- S. Romero is program manager, UCSF Health and Human Rights Initiative, San Francisco, California
| | - Chad T. Lefteris
- C.T. Lefteris is chief executive officer, UCI Health, Orange, California
| | - Samantha Gaffney
- S. Gaffney is manager in executive administration, UCLA Medical Center, Los Angeles, California
| | - Jaime Deville
- J. Deville is clinical professor of pediatrics, Division of Infectious Diseases, David Geffen School of Medicine at UCLA, and UCLA Mattel Children’s Hospitaldirector, Care-4-Families Clinic, UCLA Health, Los Angeles, California
| | - Carlos Lerner
- C. Lerner is professor of clinical pediatrics and chair in pediatrics, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Jasen Liu
- J. Liu is pediatrician, UCLA Health and UCLA Mattel Children’s Hospital, Los Angeles, California
| | - Cynthia L. Kuelbs
- C.L. Kuelbs is clinical professor of pediatrics, UC San Diego School of Medicinechief medical information officer, Rady Children’s Hospital, San Diego, California
| | - Sudeep Kukreja
- S. Kukreja is associate medical director and director of quality improvement, Neonatal Intensive Care Unit, Children’s Hospital of Orange County, medical director, Newborn Hearing Screening Program, Children’s Hospital of Orange County, and Mission Hospitalspecialist in neonatology, Children’s Hospital of Orange County, Orange, California
| | - Charles Golden
- C. Golden is pediatrician and executive medical director, Primary Care Network, Children’s Hospital of Orange County, Orange, California
| | - Zoanne Nelson
- Z. Nelson is associate vice president, Finance and Administration, University of California Health, Oakland, California
| | - Kristie Elton
- K. Elton is systemwide program manager for environment, health, and safety, UC Office of the President, Oakland, California
| | - Carrie L. Byington
- C.L. Byington is professor of pediatrics and pediatric infectious diseases, UCSF School of Medicine, San Francisco, and executive vice president, University of California Health, Oakland, California
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Rodriguez-Watson CV, Sheils NE, Louder AM, Eldridge EH, Lin ND, Pollock BD, Gatz JL, Grannis SJ, Vashisht R, Ghauri K, Valo G, Chakravarty AG, Lasky T, Jung M, Lovell SL, Major JM, Kabelac C, Knepper C, Leonard S, Embi PJ, Jenkinson WG, Klesh R, Garner OB, Patel A, Dahm L, Barin A, Cooper DM, Andriola T, Byington CL, Crews BO, Butte AJ, Allen J. Real-world utilization of SARS-CoV-2 serological testing in RNA positive patients across the United States. PLoS One 2023; 18:e0281365. [PMID: 36763574 PMCID: PMC9916659 DOI: 10.1371/journal.pone.0281365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 01/22/2023] [Indexed: 02/11/2023] Open
Abstract
BACKGROUND As diagnostic tests for COVID-19 were broadly deployed under Emergency Use Authorization, there emerged a need to understand the real-world utilization and performance of serological testing across the United States. METHODS Six health systems contributed electronic health records and/or claims data, jointly developed a master protocol, and used it to execute the analysis in parallel. We used descriptive statistics to examine demographic, clinical, and geographic characteristics of serology testing among patients with RNA positive for SARS-CoV-2. RESULTS Across datasets, we observed 930,669 individuals with positive RNA for SARS-CoV-2. Of these, 35,806 (4%) were serotested within 90 days; 15% of which occurred <14 days from the RNA positive test. The proportion of people with a history of cardiovascular disease, obesity, chronic lung, or kidney disease; or presenting with shortness of breath or pneumonia appeared higher among those serotested compared to those who were not. Even in a population of people with active infection, race/ethnicity data were largely missing (>30%) in some datasets-limiting our ability to examine differences in serological testing by race. In datasets where race/ethnicity information was available, we observed a greater distribution of White individuals among those serotested; however, the time between RNA and serology tests appeared shorter in Black compared to White individuals. Test manufacturer data was available in half of the datasets contributing to the analysis. CONCLUSION Our results inform the underlying context of serotesting during the first year of the COVID-19 pandemic and differences observed between claims and EHR data sources-a critical first step to understanding the real-world accuracy of serological tests. Incomplete reporting of race/ethnicity data and a limited ability to link test manufacturer data, lab results, and clinical data challenge the ability to assess the real-world performance of SARS-CoV-2 tests in different contexts and the overall U.S. response to current and future disease pandemics.
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Affiliation(s)
| | | | | | | | - Nancy D. Lin
- Health Catalyst, Salt Lake City, Utah, United States of America
| | | | - Jennifer L. Gatz
- Regenstrief Institute, Indianapolis, Indiana, United States of America
| | - Shaun J. Grannis
- Regenstrief Institute, Indianapolis, Indiana, United States of America
- Department of Informatics and Health Services Research, Indiana University School of Medicine, Indianapolis, Indiana, United States of America
| | - Rohit Vashisht
- Bakar Computational Health Sciences Institute, University of California San Francisco, San Francisco, California, United States of America
| | - Kanwal Ghauri
- Reagan-Udall Foundation for the FDA, Washington, District of Columbia, United States of America
| | - Gina Valo
- Office of the Commissioner, U.S. Food and Drug Administration, Silver Spring, Maryland, United States of America
| | - Aloka G. Chakravarty
- Office of the Commissioner, U.S. Food and Drug Administration, Silver Spring, Maryland, United States of America
| | - Tamar Lasky
- Office of the Commissioner, U.S. Food and Drug Administration, Silver Spring, Maryland, United States of America
| | - Mary Jung
- Center for Devices and Radiological Health, U.S. Food and Drug Administration, Silver Spring, Maryland, United States of America
| | - Stephen L. Lovell
- Center for Devices and Radiological Health, U.S. Food and Drug Administration, Silver Spring, Maryland, United States of America
| | - Jacqueline M. Major
- Center for Devices and Radiological Health, U.S. Food and Drug Administration, Silver Spring, Maryland, United States of America
| | - Carly Kabelac
- Aetion, New York, New York, United States of America
| | | | - Sandy Leonard
- HealthVerity, Philadelphia, Pennsylvania, United States of America
| | - Peter J. Embi
- Regenstrief Institute, Indianapolis, Indiana, United States of America
- Department of Informatics and Health Services Research, Indiana University School of Medicine, Indianapolis, Indiana, United States of America
| | | | - Reyna Klesh
- HealthVerity, Philadelphia, Pennsylvania, United States of America
| | - Omai B. Garner
- Department of Pathology and Laboratory Medicine, UCLA Medical Center, Los Angeles, California, United States of America
| | - Ayan Patel
- Center for Data-driven Insights and Innovation, University of California Health, Oakland, California, United States of America
| | - Lisa Dahm
- Center for Data-driven Insights and Innovation, University of California Health, Oakland, California, United States of America
| | - Aiden Barin
- Center for Data-driven Insights and Innovation, University of California Health, Oakland, California, United States of America
| | - Dan M. Cooper
- Center for Data-driven Insights and Innovation, University of California Health, Oakland, California, United States of America
- Pediatric Exercise and Genomics Research Center, University of California Irvine School of Medicine, Irvine, California, United States of America
| | - Tom Andriola
- Center for Data-driven Insights and Innovation, University of California Health, Oakland, California, United States of America
- Office of Data and Information Technology, University of California, Irvine, California, United States of America
| | - Carrie L. Byington
- Center for Data-driven Insights and Innovation, University of California Health, Oakland, California, United States of America
| | - Bridgit O. Crews
- Department of Pathology and Laboratory Medicine, University of California, Irvine, California, United States of America
| | - Atul J. Butte
- Bakar Computational Health Sciences Institute, University of California San Francisco, San Francisco, California, United States of America
- Center for Data-driven Insights and Innovation, University of California Health, Oakland, California, United States of America
| | - Jeff Allen
- Friends of Cancer Research, Washington, District of Columbia, United States of America
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6
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Rodriguez-Watson CV, Louder AM, Kabelac C, Frederick CM, Sheils NE, Eldridge EH, Lin ND, Pollock BD, Gatz JL, Grannis SJ, Vashisht R, Ghauri K, Knepper C, Leonard S, Embi PJ, Jenkinson G, Klesh R, Garner OB, Patel A, Dahm L, Barin A, Cooper DM, Andriola T, Byington CL, Crews BO, Butte AJ, Allen J. Real-world performance of SARS-Cov-2 serology tests in the United States, 2020. PLoS One 2023; 18:e0279956. [PMID: 36735683 PMCID: PMC9897562 DOI: 10.1371/journal.pone.0279956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 12/19/2022] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Real-world performance of COVID-19 diagnostic tests under Emergency Use Authorization (EUA) must be assessed. We describe overall trends in the performance of serology tests in the context of real-world implementation. METHODS Six health systems estimated the odds of seropositivity and positive percent agreement (PPA) of serology test among people with confirmed SARS-CoV-2 infection by molecular test. In each dataset, we present the odds ratio and PPA, overall and by key clinical, demographic, and practice parameters. RESULTS A total of 15,615 people were observed to have at least one serology test 14-90 days after a positive molecular test for SARS-CoV-2. We observed higher PPA in Hispanic (PPA range: 79-96%) compared to non-Hispanic (60-89%) patients; in those presenting with at least one COVID-19 related symptom (69-93%) as compared to no such symptoms (63-91%); and in inpatient (70-97%) and emergency department (93-99%) compared to outpatient (63-92%) settings across datasets. PPA was highest in those with diabetes (75-94%) and kidney disease (83-95%); and lowest in those with auto-immune conditions or who are immunocompromised (56-93%). The odds ratios (OR) for seropositivity were higher in Hispanics compared to non-Hispanics (OR range: 2.59-3.86), patients with diabetes (1.49-1.56), and obesity (1.63-2.23); and lower in those with immunocompromised or autoimmune conditions (0.25-0.70), as compared to those without those comorbidities. In a subset of three datasets with robust information on serology test name, seven tests were used, two of which were used in multiple settings and met the EUA requirement of PPA ≥87%. Tests performed similarly across datasets. CONCLUSION Although the EUA requirement was not consistently met, more investigation is needed to understand how serology and molecular tests are used, including indication and protocol fidelity. Improved data interoperability of test and clinical/demographic data are needed to enable rapid assessment of the real-world performance of in vitro diagnostic tests.
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Affiliation(s)
- Carla V. Rodriguez-Watson
- Reagan-Udall Foundation for the FDA, Washington, District of Columbia, United States of America
- * E-mail:
| | | | - Carly Kabelac
- Aetion, New York, New York, United States of America
| | | | | | | | - Nancy D. Lin
- Health Catalyst, Salt Lake City, Utah, United States of America
| | | | - Jennifer L. Gatz
- Regenstrief Institute, Indianapolis, Indiana, United States of America
| | - Shaun J. Grannis
- Regenstrief Institute, Indianapolis, Indiana, United States of America
- Department of Family Medicine, Indiana University School of Medicine, Indianapolis, Indiana, United States of America
| | - Rohit Vashisht
- Bakar Computational Health Sciences Institute, University of California, San Francisco, San Francisco, California, United States of America
| | - Kanwal Ghauri
- Reagan-Udall Foundation for the FDA, Washington, District of Columbia, United States of America
| | | | - Sandy Leonard
- HealthVerity, Philadelphia, Pennsylvania, United States of America
| | - Peter J. Embi
- Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
| | | | - Reyna Klesh
- HealthVerity, Philadelphia, Pennsylvania, United States of America
| | - Omai B. Garner
- Department of Pathology and Laboratory Medicine, UCLA Medical Center, Los Angeles, California, United States of America
| | - Ayan Patel
- Center for Data-Driven Insights and Innovation, University of California Health, Oakland, California, United States of America
| | - Lisa Dahm
- Center for Data-Driven Insights and Innovation, University of California Health, Oakland, California, United States of America
| | - Aiden Barin
- Center for Data-Driven Insights and Innovation, University of California Health, Oakland, California, United States of America
| | - Dan M. Cooper
- Center for Data-Driven Insights and Innovation, University of California Health, Oakland, California, United States of America
- Pediatric Exercise and Genomics Research Center, University of California Irvine School of Medicine, Irvine, California, United States of America
| | - Tom Andriola
- Center for Data-Driven Insights and Innovation, University of California Health, Oakland, California, United States of America
- Office of Data and Information Technology, University of California, Irvine, Irvine, California, United States of America
| | - Carrie L. Byington
- Center for Data-Driven Insights and Innovation, University of California Health, Oakland, California, United States of America
| | - Bridgit O. Crews
- Department of Pathology and Laboratory Medicine, University of California, Irvine, Irvine, California, United States of America
| | - Atul J. Butte
- Bakar Computational Health Sciences Institute, University of California, San Francisco, San Francisco, California, United States of America
- Center for Data-Driven Insights and Innovation, University of California Health, Oakland, California, United States of America
| | - Jeff Allen
- Friends of Cancer Research, Washington, District of Columbia, United States of America
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Pollock BH, Kilpatrick AM, Eisenman DP, Elton KL, Rutherford GW, Boden-Albala BM, Souleles DM, Polito LE, Martin NK, Byington CL. Safe reopening of college campuses during COVID-19: The University of California experience in Fall 2020. PLoS One 2021; 16:e0258738. [PMID: 34735480 PMCID: PMC8568179 DOI: 10.1371/journal.pone.0258738] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Accepted: 10/05/2021] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Epidemics of COVID-19 in student populations at universities were a key concern for the 2020-2021 school year. The University of California (UC) System developed a set of recommendations to reduce campus infection rates. SARS-CoV-2 test results are summarized for the ten UC campuses during the Fall 2020 term. METHODS UC mitigation efforts included protocols for the arrival of students living on-campus students, non-pharmaceutical interventions, daily symptom monitoring, symptomatic testing, asymptomatic surveillance testing, isolation and quarantine protocols, student ambassador programs for health education, campus health and safety pledges, and lowered density of on-campus student housing. We used data from UC campuses, the UC Health-California Department of Public Health Data Modeling Consortium, and the U.S. Census to estimate the proportion of each campus' student populations that tested positive for SARS-CoV-2 and compared it to the fraction individuals aged 20-29 years who tested positive in their respective counties. RESULTS SARS-CoV-2 cases in campus populations were generally low in September and October 2020, but increased in November and especially December, and were highest in early to mid-January 2021, mirroring case trajectories in their respective counties. Many students were infected during the Thanksgiving and winter holiday recesses and were detected as cases upon returning to campus. The proportion of students who tested positive for SARS-CoV-2 during Fall 2020 ranged from 1.2% to 5.2% for students living on campus and was similar to students living off campus. For most UC campuses the proportion of students testing positive was lower than that for the 20-29-year-old population in which campuses were located. CONCLUSIONS The layered mitigation approach used on UC campuses, informed by public health science and augmented perhaps by a more compliant population, likely minimized campus transmission and outbreaks and limited transmission to surrounding communities. University policies that include these mitigation efforts in Fall 2020 along with SARS-CoV-2 vaccination, may alleviate some local concerns about college students returning to communities and facilitate resumption of normal campus operations and in-person instruction.
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Affiliation(s)
- Brad H. Pollock
- Department of Public Health Sciences, University of California Davis, Davis, California, United States of America
| | - A. Marm Kilpatrick
- Department of Ecology and Evolutionary Biology, University of California Santa Cruz, Santa Cruz, California, United States of America
| | - David P. Eisenman
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, Fielding School of Public Health, University of California, Los Angeles, California, United States of America
- Center for Public Health and Disasters, Fielding School of Public Health, University of California, Los Angeles, California, United States of America
| | - Kristie L. Elton
- University of California Office of the President, Oakland, California, United States of America
| | - George W. Rutherford
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, United States of America
| | - Bernadette M. Boden-Albala
- Department of Health Society and Behavior, Program in Public Health, Department of Neurology, School of Medicine, Susan and Henry Samueli College of Health Sciences, University of California Irvine, Irvine, California, United States of America
| | - David M. Souleles
- Department of Health Society and Behavior, Program in Public Health, Department of Neurology, School of Medicine, Susan and Henry Samueli College of Health Sciences, University of California Irvine, Irvine, California, United States of America
| | - Laura E. Polito
- Student Health, University of California Santa Barbara, Santa Barbara, California, United States of America
| | - Natasha K. Martin
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, San Diego, California, United States of America
| | - Carrie L. Byington
- University of California Office of the President, Oakland, California, United States of America
- Division of Pediatric Infectious Diseases, Department of Pediatrics, University of California San Francisco, San Francisco, California, United States of America
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Hobson WL, Olson LM, Hopf HW, Winter LC, Byington CL. "The Adjunct Faculty Are Our Lifeblood" An Institution's Response to Deliver Value to Volunteer Community Faculty. Fam Med 2021; 53:133-138. [PMID: 33566349 DOI: 10.22454/fammed.2021.565994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND AND OBJECTIVES Because of the importance of and increasing competition for unpaid community faculty's time, we qualitatively evaluated the adjunct community faculty experience in order to identify mechanisms to improve the recruitment, training, and retention of these faculty members. METHODS The authors captured community faculty and key stakeholder opinion through interviews, focus groups, and a survey to elucidate their perspective of roles, responsibilities, facilitators, and barriers for providing quality teaching and learning experiences. After evaluating the data, we created an impact/effort matrix to guide suggested changes. RESULTS Key medical education stakeholders reported adjunct community faculty members were critical to delivery of the medical school curriculum and shared methods and barriers for retaining members. Adjunct community faculty focus groups revealed two major themes: (1) personal experience and motivation, and (2) individual advantages and institutional barriers that influence being a faculty member. The survey and impact/effort matrix led to interventions including an Office of Community Faculty to implement recruitment and retention programs and provide more comprehensive oversight, a clinical scheduling hub, improved access to specialists for community faculty, and awards to recognize the critical contributions of community faculty members. CONCLUSIONS As competition for community placements increases, including community faculty voices to inform action is an effective investment that enables an institution to direct resources towards interventions that maximize their support and engagement. Including community faculty perspectives also increases faculty's ability to participate in training the next generation of physicians.
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Affiliation(s)
- Wendy L Hobson
- Department of Pediatrics, University of Utah, Salt Lake City, UT
| | - Lenora M Olson
- Department of Pediatrics, University of Utah, Salt Lake City, UT
| | - Harriet W Hopf
- Department of Anesthesiology, University of Utah, Salt Lake City, UT
| | - Lisa C Winter
- Department of Pediatrics, University of Utah, Salt Lake City, UT
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Holsti M, Clark EB, Fisher S, Hawkins S, Keenan H, Just S, Lee J, Napia E, Rodriguez JE, Taylor F, White R, Willie S, Byington CL. Lessons From the First Decade of the Native American Summer Research Internship at the University of Utah. Acad Med 2021; 96:522-528. [PMID: 33003036 PMCID: PMC8005502 DOI: 10.1097/acm.0000000000003759] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
PROBLEM American Indian/Alaska Native (AI/AN) populations are facing multiple health crises, including limited access to care, high rates of chronic disease, and early mortality that is far worse than other underrepresented minorities in the United States. According to the Association of American Indian Physicians, AI/AN people represent 2.0% of the U.S. population but only 0.2% of medical students and 0.1% of full-time faculty at MD-granting institutions. Increasing the number of AI/AN clinicians and scientists is one strategy to improve health outcomes in the AI/AN population and address these crises. APPROACH In 2010, the University of Utah partnered with research, cultural, and professional mentors to create a 10-week summer Native American Research Internship (NARI) program for AI/AN college students across the United States who are interested in pursuing biomedical careers. NARI attracts and supports AI/AN students by offering mentored summer research internships in an innovative, culturally aware framework that adapts to observed challenges to optimize educational experiences and support biomedical career aspirations. OUTCOMES During the first decade of the NARI program, 128 students from 22 U.S. states, representing 46 tribal nations and 57 colleges and universities, participated. Of those 128 students, 113 (88%) have completed a bachelor's degree and the remaining 15 (12%) are currently working toward a bachelor's degree. No NARI student has dropped out of college. Twenty-six (20%) NARI alumni have matriculated to medical school and 30 (23%) to graduate school. Eight (6%) participants have completed medical school, and 3 (2%) are pursuing a PhD in science. An additional 36 (28%) have gained employment in biomedical research fields. NEXT STEPS The NARI program has increased the participation of AI/AN students in medicine and the biomedical sciences. The innovative, culturally aware, and adaptive framework is a model for other programs for AI/AN students and students in other underrepresented communities.
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Affiliation(s)
- Maija Holsti
- M. Holsti is professor, Department of Pediatrics, University of Utah, Salt Lake City, Utah; ORCID: https://orcid.org/0000-0001-6405-3687
| | - Edward B Clark
- E.B. Clark is professor, Department of Pediatrics, and associate vice president for clinical affairs, University of Utah, Salt Lake City, Utah
| | - Simon Fisher
- S. Fisher is professor, Department of Medicine, University of Utah, Salt Lake City, Utah
| | - Sam Hawkins
- S. Hawkins is a second-year emergency medicine resident, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Heather Keenan
- H. Keenan is professor, Department of Pediatrics, University of Utah, Salt Lake City, Utah
| | - Steven Just
- S. Just is a pharmacist, Walgreens, Minneapolis, Minnesota, and a recent graduate, College of Pharmacy, University of Minnesota, Minneapolis, Minnesota
| | - Jaymus Lee
- J. Lee is a second-year graduate student in applied biosciences, Controlled Environmental Agriculture Center, University of Arizona, Tucson, Arizona
| | - Ed Napia
- E. Napia is program coordinator, Urban Indian Center of Salt Lake, Salt Lake City, Utah
| | - Jose E Rodriguez
- J.E. Rodriguez is associate vice president for health equity and inclusion, Department of Family Medicine, University of Utah, Salt Lake City, Utah
| | - Franci Taylor
- F. Taylor is director, American Indian Resource Center, University of Utah, Salt Lake City, Utah
| | - Richard White
- R. White is program coordinator, American Indian/Alaska Native Clinical and Translational Research Program, Montana State University, Bozeman, Montana
| | - Scott Willie
- S. Willie is NARI program coordinator, Department of Pediatrics, University of Utah, Salt Lake City, Utah
| | - Carrie L Byington
- C.L. Byington is executive vice president, University of California, Oakland, California; ORCID: https://orcid.org/0000-0002-7350-9495
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Jacobson CE, Beeler WH, Griffith KA, Flotte TR, Byington CL, Jagsi R. Common pathways to Dean of Medicine at U.S. medical schools. PLoS One 2021; 16:e0249078. [PMID: 33765033 PMCID: PMC7993860 DOI: 10.1371/journal.pone.0249078] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 03/10/2021] [Indexed: 11/19/2022] Open
Abstract
PURPOSE We sought to evaluate common leadership experiences and academic achievements obtained by current U.S. Medical School Deans of Medicine (DOMs) prior to their first appointment as Dean in order to elucidate a common pathway for promotion. METHODS In April-June 2019 the authors requested a curriculum vitae from each of the 153 LCME-accredited U.S. Medical School DOMs. The authors abstracted data on prior appointments, demographics, and achievements from CVs and online databases. Differences by gender and institutional rank were then evaluated by the Fisher's exact and Wilcoxon rank sum tests. RESULTS CVs were obtained for 62% of DOMs (95 of 153), with women comprising 16% of the responding cohort (15/95). Prior to appointment as DOM, 34% of respondents had served as both permanent Department Chair and Associate Dean, 39% as permanent Department Chair but not Associate Dean, and 17% as Associate Deans but not permanent Department Chair. There was a non-significant trend for men to have been more likely to have been a permanent Department Chair (76% vs 53%, p = 0.11) and less likely to have been an Associate Dean (48% vs 67%, p = 0.26) compared to women. Responding DOMs at Top-25 research institutions were mostly male (15/16), more likely to have been appointed before 2010 (38% vs 14%, p = 0.025), and had higher H-indices (mean (SD): 73.1 (32.3) vs 33.5 (22.5), p<0.01) than non-Top-25 Deans. CONCLUSIONS The most common pathway to DOM in this study cohort was prior service as Department Chair. This suggests that diversification among Department Chair positions or expansion of search criteria to seek leaders from pools other than Department Chairs may facilitate increased diversity, equity, and inclusion among DOM overall.
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Affiliation(s)
- Clare E. Jacobson
- University of Michigan Medical School, Ann Arbor, MI, United States of America
| | - Whitney H. Beeler
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, United States of America
| | - Kent A. Griffith
- The Center for Cancer Biostatistics, University of Michigan, Ann Arbor, MI, United States of America
| | - Terence R. Flotte
- School of Medicine, University of Massachusetts Medical School, Massachusetts, United States of America
| | - Carrie L. Byington
- University of California Health System, University of California, Oakland, CA, United States of America
- Department of Pediatrics, UCSF, San Francisco, CA, United States of America
| | - Reshma Jagsi
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, United States of America
- Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor, MI, United States of America
- * E-mail:
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Cooper DM, Afghani B, Byington CL, Cunningham CK, Golub S, Lu KD, Radom-Aizik S, Ross LF, Singh J, Smoyer WE, Lucas CT, Tunney J, Zaldivar F, Ulloa ER. SARS-CoV-2 vaccine testing and trials in the pediatric population: biologic, ethical, research, and implementation challenges. Pediatr Res 2021; 90:966-970. [PMID: 33627824 PMCID: PMC7903864 DOI: 10.1038/s41390-021-01402-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 01/18/2021] [Indexed: 01/30/2023]
Abstract
As the nation implements SARS-CoV-2 vaccination in adults at an unprecedented scale, it is now essential to focus on the prospect of SARS-CoV-2 vaccinations in pediatric populations. To date, no children younger than 12 years have been enrolled in clinical trials. Key challenges and knowledge gaps that must be addressed include (1) rationale for vaccines in children, (2) possible effects of immune maturation during childhood, (3) ethical concerns, (4) unique needs of children with developmental disorders and chronic conditions, (5) health inequities, and (6) vaccine hesitancy. Because COVID-19 is minimally symptomatic in the vast majority of children, a higher acceptable risk threshold is required when evaluating pediatric clinical trials. Profound differences in innate and adaptive immunity during childhood and adolescence are known to affect vaccine responsiveness for a variety of childhood diseases. COVID-19 and the accompanying social disruption, such as the school shutdowns, has been disproportionately damaging to minority and low-income children. In this commentary, we briefly address each of these key issues, specify research gaps, and suggest a broader learning health system approach to accelerate testing and clinical trial development for an ethical and effective strategy to implement a pediatric SARS-CoV-2 vaccine as rapidly and safely as possible. IMPACT: As the US begins an unprecedented implementation of SARS-CoV-2 vaccination, substantial knowledge gaps have yet to be addressed regarding vaccinations in the pediatric population. Maturational changes in the immune system during childhood have influenced the effectiveness of pediatric vaccines for other diseases and conditions, and could affect SARS-CoV-2 vaccine responsiveness in children. Given that COVID-19 disease is far milder in the majority of children than in adults, the risk-benefit of a pediatric SARS-CoV-2 vaccine must be carefully weighed. The needs of children with developmental disabilities and with chronic disease must be addressed. Minority and low-income children have been disproportionately adversely affected by the COVID-19 pandemic; care must be taken to address issues of health equity regarding pediatric SARS-CoV-2 vaccine trials and allocation. Research and strategies to address general vaccine hesitancy in communities must be addressed in the context of pediatric SARS-CoV-2 vaccines.
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Affiliation(s)
- Dan M. Cooper
- grid.266093.80000 0001 0668 7243Institute for Clinical and Translational Science, UC Irvine, Irvine, CA USA
| | - Behnoush Afghani
- grid.266093.80000 0001 0668 7243Department of Pediatrics, UC Irvine School of Medicine, Irvine, CA USA
| | | | - Coleen K. Cunningham
- grid.26009.3d0000 0004 1936 7961Department of Pediatrics, Duke University School of Medicine, Durham, NC USA
| | - Sidney Golub
- grid.266093.80000 0001 0668 7243Institute for Clinical and Translational Science, UC Irvine, Irvine, CA USA
| | - Kim D. Lu
- grid.266093.80000 0001 0668 7243Pediatric Exercise and Genomics Research Center, UC Irvine School of Medicine, Irvine, CA USA
| | - Shlomit Radom-Aizik
- grid.266093.80000 0001 0668 7243Pediatric Exercise and Genomics Research Center, UC Irvine School of Medicine, Irvine, CA USA
| | - Lainie Friedman Ross
- grid.170205.10000 0004 1936 7822Department of Pediatrics, University of Chicago, Chicago, IL USA
| | - Jasjit Singh
- grid.414164.20000 0004 0442 4003Division of Infectious Diseases, CHOC Children’s Hospital, Orange, CA USA
| | - William E. Smoyer
- grid.261331.40000 0001 2285 7943Department of Pediatrics, The Ohio State University and Nationwide Children’s Hospital, Columbus, OH USA
| | - Candice Taylor Lucas
- grid.266093.80000 0001 0668 7243Institute for Clinical and Translational Science, UC Irvine, Irvine, CA USA
| | | | | | - Erlinda R. Ulloa
- grid.266093.80000 0001 0668 7243Institute for Clinical and Translational Science, UC Irvine, Irvine, CA USA ,grid.414164.20000 0004 0442 4003Division of Infectious Diseases, CHOC Children’s Hospital, Orange, CA USA
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12
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Pershing NL, Kapusta A, Nielsen S, Crandall H, Korgenski K, Byington CL, Ampofo K, Blascke A. 43. The Capsule and Beyond: Genetic Determinants of Pediatric streptococcus Pneumoniae empyema. Open Forum Infect Dis 2020. [PMCID: PMC7776047 DOI: 10.1093/ofid/ofaa417.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Streptococcus pneumoniae is the most common cause of pneumonia in children, including empyema, a severe complication with increasing incidence in the post-pneumococcal vaccine era. Only a subset of > 90 serotypes cause empyema. Virulence determinants of empyema remain largely unknown. Methods We performed Illumina sequencing of invasive Pneumococcal isolates from pediatric patients at Primary Children’s Hospital (Salt Lake City, UT) isolated between 1996–2018, de novo genome assembly (SPADES), annotation (PROKKA), serotyping (Quelling and SeroBA), and pan-genome assembly (ROARY). SCOARY and pyseer were used for microbial GWAS. Maximum likelihood phylogeny was calculated using RAxML/Gubbins. Results 366 pneumococcal isolates were analyzed from 39 serotypes and multiple phenotypes including pneumonia (n=76), empyema (n=63), CNS infection (n=54), and isolated bacteremia (n=79). Serotypes and empyema phenotype clustered roughly by phylogeny. Most analyzed empyema isolates after 2010 were serotype 3 (19/25); prior to PCV-13 introduction serotypes 1 (8/38), 7F (7/38), and 19A (11/38) were more highly represented. Genes implicated in capsule synthesis, transposases, and metabolism were statistically correlated with the empyema phenotype. Conclusion Specific capsular or metabolic genes may confer optimal fitness for pleural disease. Further characterization of these genetic associations is needed and will inform future treatment and prevention. Disclosures Carrie L. Byington, MD, BioFire (Other Financial or Material Support, Royalties for Intellectual Property)IDbyDNA (Advisor or Review Panel member) Krow Ampofo, MBChB, Merck (Grant/Research Support)
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Ross PT, Lypson ML, Byington CL, Sánchez JP, Wong BM, Kumagai AK. Learning From the Past and Working in the Present to Create an Antiracist Future for Academic Medicine. Acad Med 2020; 95:1781-1786. [PMID: 33031120 DOI: 10.1097/acm.0000000000003756] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- Paula T Ross
- Administrative director, Research. Innovation. Scholarship. Education. (RISE)-Michigan Medicine, University of Michigan, Ann Arbor, Michigan
| | - Monica L Lypson
- Vice chair and director, Division of General Internal Medicine, and professor, Department of Medicine, The George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Carrie L Byington
- Executive vice president, University of California Health, Oakland, California
| | - John P Sánchez
- Professor, Emergency Medicine, University of New Mexico School of Medicine, Albuquerque, New Mexico
| | - Brian M Wong
- Associate professor of medicine, Sunnybrook Health Sciences Centre, Department of Medicine, University of Toronto, and director, Centre for Quality Improvement and Patient Safety, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Arno K Kumagai
- Vice chair for education, Department of Medicine, and F.M. Hill Chair in Humanism Education, Women's College Hospital and University of Toronto, Toronto, Ontario, Canada
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14
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Cooper DM, Guay-Woodford L, Blazar BR, Bowman S, Byington CL, Dome J, Forthal D, Konstan MW, Kuppermann N, Liem RI, Ochoa ER, Pollock BH, Price OA, Ramsey BW, Ross LF, Sokol RJ, Wright RJ. Reopening Schools Safely: The Case for Collaboration, Constructive Disruption of Pre-Coronavirus 2019 Expectations, and Creative Solutions. J Pediatr 2020; 223:183-185. [PMID: 32445649 PMCID: PMC7239776 DOI: 10.1016/j.jpeds.2020.05.022] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 05/13/2020] [Accepted: 05/14/2020] [Indexed: 12/11/2022]
Affiliation(s)
- Dan M. Cooper
- Institute for Clinical and Translational Science, University of California at Irvine, School of Medicine, Irvine, CA,Reprint requests: Dan M. Cooper, MD, Institute for Clinical and Translational Sciences, 843 Health Sciences Rd, Hewitt Hall 1113, Irvine, CA 92697
| | - Lisa Guay-Woodford
- Children's National Research Institute, George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Bruce R. Blazar
- University of Minnesota Medical School, Pediatrics, Minneapolis, Minnesota
| | - Scott Bowman
- Irvine Unified School District. California State University, Los Angeles, Irvine, California
| | - Carrie L. Byington
- University of California Health, Office of the President, Oakland, California
| | - Jeffrey Dome
- Children's National Hospital, George Washington University School of Medicine and Health Sciences, Washington, D.C
| | - Donald Forthal
- University of California, Irvine School of Medicine & School of Biological Sciences, Center for Cancer and Blood Disorders, Washington, D.C
| | | | - Nathan Kuppermann
- University of California, Davis School of Medicine, Pediatrics and Emergency Medicine, Sacramento, California
| | - Robert I. Liem
- Ann & Robert H. Lurie Children's Hospital of Chicago, Pediatrics, Chicago, Illinois
| | - Eduardo R. Ochoa
- University of Arkansas for Medical Sciences College of Medicine, Community Pediatrics, Little Rock, Arkansas
| | - Brad H. Pollock
- University of California, Davis School of Medicine & Clinical Translational Science Center, Public Health Sciences, Sacramento, California
| | - Olga Acosta Price
- University of Washington School of Medicine, Prevention and Community Health, Washington, DC
| | - Bonnie W. Ramsey
- George Washington University Milken Institute School of Public Health, Center for Clinical and Translational Research, Seattle, Washington
| | - Lainie Friedman Ross
- University of Chicago MacLean Center for Clinical Medical Ethics & Institute for Translational Medicine, Pediatrics, Chicago, Illinois
| | - Ronald J. Sokol
- University of Colorado School of Medicine, Colorado Clinical and Translational Sciences Institute, Aurora, Colorado
| | - Rosalind J. Wright
- Kravis Children's Hospital, Icahn School of Medicine at Mount Sinai, Pediatrics, New York, New York
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15
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Gladstone RA, Lo SW, Goater R, Yeats C, Taylor B, Hadfield J, Lees JA, Croucher NJ, van Tonder AJ, Bentley LJ, Quah FX, Blaschke AJ, Pershing NL, Byington CL, Balaji V, Hryniewicz W, Sigauque B, Ravikumar K, Almeida SCG, Ochoa TJ, Ho PL, du Plessis M, Ndlangisa KM, Cornick JE, Kwambana-Adams B, Benisty R, Nzenze SA, Madhi SA, Hawkins PA, Pollard AJ, Everett DB, Antonio M, Dagan R, Klugman KP, von Gottberg A, Metcalf BJ, Li Y, Beall BW, McGee L, Breiman RF, Aanensen DM, Bentley SD. Visualizing variation within Global Pneumococcal Sequence Clusters (GPSCs) and country population snapshots to contextualize pneumococcal isolates. Microb Genom 2020; 6:e000357. [PMID: 32375991 PMCID: PMC7371119 DOI: 10.1099/mgen.0.000357] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 03/03/2020] [Indexed: 11/21/2022] Open
Abstract
Knowledge of pneumococcal lineages, their geographic distribution and antibiotic resistance patterns, can give insights into global pneumococcal disease. We provide interactive bioinformatic outputs to explore such topics, aiming to increase dissemination of genomic insights to the wider community, without the need for specialist training. We prepared 12 country-specific phylogenetic snapshots, and international phylogenetic snapshots of 73 common Global Pneumococcal Sequence Clusters (GPSCs) previously defined using PopPUNK, and present them in Microreact. Gene presence and absence defined using Roary, and recombination profiles derived from Gubbins are presented in Phandango for each GPSC. Temporal phylogenetic signal was assessed for each GPSC using BactDating. We provide examples of how such resources can be used. In our example use of a country-specific phylogenetic snapshot we determined that serotype 14 was observed in nine unrelated genetic backgrounds in South Africa. The international phylogenetic snapshot of GPSC9, in which most serotype 14 isolates from South Africa were observed, highlights that there were three independent sub-clusters represented by South African serotype 14 isolates. We estimated from the GPSC9-dated tree that the sub-clusters were each established in South Africa during the 1980s. We show how recombination plots allowed the identification of a 20 kb recombination spanning the capsular polysaccharide locus within GPSC97. This was consistent with a switch from serotype 6A to 19A estimated to have occured in the 1990s from the GPSC97-dated tree. Plots of gene presence/absence of resistance genes (tet, erm, cat) across the GPSC23 phylogeny were consistent with acquisition of a composite transposon. We estimated from the GPSC23-dated tree that the acquisition occurred between 1953 and 1975. Finally, we demonstrate the assignment of GPSC31 to 17 externally generated pneumococcal serotype 1 assemblies from Utah via Pathogenwatch. Most of the Utah isolates clustered within GPSC31 in a USA-specific clade with the most recent common ancestor estimated between 1958 and 1981. The resources we have provided can be used to explore to data, test hypothesis and generate new hypotheses. The accessible assignment of GPSCs allows others to contextualize their own collections beyond the data presented here.
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Affiliation(s)
| | - Stephanie W. Lo
- Parasites and microbes, Wellcome Sanger InstituteHinxton, UK
| | - Richard Goater
- Centre for Genomic Pathogen Surveillance, Wellcome Genome CampusHinxton, UK
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford, UK
| | - Corin Yeats
- Centre for Genomic Pathogen Surveillance, Wellcome Genome CampusHinxton, UK
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford, UK
| | - Ben Taylor
- Centre for Genomic Pathogen Surveillance, Wellcome Genome CampusHinxton, UK
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford, UK
| | - James Hadfield
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - John A. Lees
- Faculty of Medicine, School of Public Health, Imperial College London, UK
| | | | - Andries J. van Tonder
- Parasites and microbes, Wellcome Sanger InstituteHinxton, UK
- Department of Veterinary Medicine, University of Cambridge, Cambridge, UK
| | - Leon J. Bentley
- Parasites and microbes, Wellcome Sanger InstituteHinxton, UK
| | - Fu Xiang Quah
- Parasites and microbes, Wellcome Sanger InstituteHinxton, UK
| | - Anne J. Blaschke
- Division of Pediatric Infectious Diseases, Department of Pediatrics, School of Medicine, University of Utah, 295 Chipeta Way, Salt Lake City, UT, 84108, USA
| | - Nicole L. Pershing
- Division of Pediatric Infectious Diseases, Department of Pediatrics, School of Medicine, University of Utah, 295 Chipeta Way, Salt Lake City, UT, 84108, USA
| | | | | | - Waleria Hryniewicz
- National Medicines Institute, Division of Clinical Microbiology and Infection Prevention, Warsaw, Poland
| | - Betuel Sigauque
- Fundação Manhiça / Centro de Investigação em Saúde da Manhiça (CISM), Maputo Mozambique, Instituto Nacional de Saúde, inistério de Saúde, Maputo, Mozambique
| | - K.L. Ravikumar
- Central Research Laboratory, Department of Microbiology, Kempegowda Institute of Medical Sciences Hospital & Research Center, Bangalore, India
| | | | - Theresa J. Ochoa
- Instituto de Medicina Tropical, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Pak Leung Ho
- Department of Microbiology and Carol Yu Centre for Infection, The University of Hong Kong, Queen Mary Hospital, Hong Kong, PR China
| | - Mignon du Plessis
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases, Johannesburg, South Africa
| | - Kedibone M. Ndlangisa
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases, Johannesburg, South Africa
| | | | - Brenda Kwambana-Adams
- NIHR Global Health Research Unit on Mucosal Pathogens, Division of Infection and Immunity, University College London, London, UK
- WHO Collaborating Centre for New Vaccines Surveillance, Medical Research Council Unit The Gambia at The London School of Hygiene & Tropical Medicine, Fajara, The Gambia
| | - Rachel Benisty
- The Faculty of Health Sciences, Ben-Gurion University of the NegevBeer-Sheva, Israel
| | - Susan A. Nzenze
- Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, University of the Witwatersrand, Johannesburg, South Africa
- Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases, University of the Witwatersrand, Johannesburg, South Africa
| | - Shabir A. Madhi
- Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, University of the Witwatersrand, Johannesburg, South Africa
- Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Andrew J. Pollard
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, and the NIHR Oxford Biomedical Research Centre, Oxford, UK
| | | | - Martin Antonio
- WHO Collaborating Centre for New Vaccines Surveillance, Medical Research Council Unit The Gambia at The London School of Hygiene & Tropical Medicine, Fajara, The Gambia
| | - Ron Dagan
- The Faculty of Health Sciences, Ben-Gurion University of the NegevBeer-Sheva, Israel
| | | | - Anne von Gottberg
- Department of Microbiology and Carol Yu Centre for Infection, The University of Hong Kong, Queen Mary Hospital, Hong Kong, PR China
| | | | - Yuan Li
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Lesley McGee
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Robert F. Breiman
- Rollins School Public Health, Emory University, GA, USA
- Emory Global Health Institute, Atlanta, GA, USA
| | - David M. Aanensen
- Centre for Genomic Pathogen Surveillance, Wellcome Genome CampusHinxton, UK
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford, UK
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16
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Krah NM, Bardsley T, Nelson R, Esquibel L, Crosby M, Byington CL, Pavia AT, Hersh AL. Economic Burden of Home Antimicrobial Therapy: OPAT Versus Oral Therapy. Hosp Pediatr 2020; 9:234-240. [PMID: 30885919 DOI: 10.1542/hpeds.2018-0193] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND There is increasing evidence that outpatient parenteral antimicrobial therapy (OPAT) is overused for children and that outcomes with oral therapy are equivalent. Our objective was to compare economic burden between OPAT and oral therapy, accounting for direct and indirect costs and caregiver quality of life (QoL). METHODS We conducted a prospective cohort study of caregivers for children after hospitalization who were treated with prolonged antimicrobial therapy. We collected data about missed work and school and time spent administering therapy. Caregivers completed the Pediatric Quality of Life Inventory to assess QoL. Clinical information included length of stay, treatment indication, and type of therapy (OPAT versus oral therapy). Direct medical costs were obtained by using a microcosting system and accounted for medication, supplies, and home-nursing visits. The primary cost outcome was the mean daily cost of therapy. Multivariable models were developed to adjust for potential confounders. RESULTS Two hundred and twelve caregivers completed surveys: 123 (58%) for oral therapy and 89 (42%) for OPAT. Caregivers administering OPAT reported more missed work, missed school for their children, time with daily medication administration (90 vs 6 minutes; P < .01) and lower QoL scores (77.8 vs 68.9) than caregivers administering oral therapy. The mean daily cost was $65 (95% confidence interval: $51-$78) for OPAT and $7 (95% confidence interval: $4-$9) for oral therapy. Relative differences in cost and QoL between groups did not change after model adjustment. CONCLUSIONS The overall burden of OPAT is substantially higher than that of oral therapy, including higher direct and indirect costs and greater impact on caregiver QoL. These findings strongly support efforts to use oral therapy in place of OPAT when clinically appropriate.
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Affiliation(s)
- Nathan M Krah
- Infectious Disease, Department of Pediatrics, School of Medicine and
| | - Tyler Bardsley
- Divisions of Epidemiology and.,Study Design and Biostatistics Center, University of Utah, Salt Lake City, Utah
| | - Richard Nelson
- Divisions of Epidemiology and.,Informatics, Decision-Enhancement and Analytic Sciences Center, Department of Veterans Affairs Salt Lake City Health Care System, Salt Lake City, Utah
| | - Lawanda Esquibel
- Infectious Disease, Department of Pediatrics, School of Medicine and
| | - Mark Crosby
- Intermountain Homecare Pharmacy, Intermountain Healthcare, Salt Lake City, Utah; and
| | | | - Andrew T Pavia
- Infectious Disease, Department of Pediatrics, School of Medicine and
| | - Adam L Hersh
- Infectious Disease, Department of Pediatrics, School of Medicine and
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17
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Fink AK, Graff G, Byington CL, Loeffler DR, Rosenfeld M, Saiman L. Palivizumab and Long-term Outcomes in Cystic Fibrosis. Pediatrics 2019; 144:peds.2018-3495. [PMID: 31239289 DOI: 10.1542/peds.2018-3495] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/23/2019] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND The American Academy of Pediatrics does not recommend routine use of palivizumab prophylaxis for infants with cystic fibrosis (CF) but recommends consideration in infants with clinical evidence of chronic lung disease or nutritional compromise. However, the beneficial impact of palivizumab on longer-term outcomes is uncertain. METHODS We used Cystic Fibrosis Foundation Patient Registry data to assess the association of receiving palivizumab during the first 2 years of life with longer-term outcomes, including lung function at 7 years old, time to first positive Pseudomonas respiratory culture, and pulmonary-related hospitalizations during the first 7 years of life. Eligible infants were born from 2008 to 2015 and diagnosed with CF during the first 6 months of life. Demographic and clinical confounders of association between palivizumab receipt and outcomes were explored. We created propensity scores to adjust for potential confounding by indication (ie, sicker infants were more likely to receive palivizumab). For each outcome, we performed regression analyses adjusted by propensity scores. RESULTS The sample included 4267 infants; 1588 (37%) received palivizumab. Mean percent forced expiratory volume in 1 second predicted at 7 years old was similar among those who did (98.2; 95% confidence interval: 96.9-99.5) and did not (97.3; 95% confidence interval: 96.1-98.5) received palivizumab, adjusting for propensity scores. Time to first positive Pseudomonas aeruginosa culture and annual risk of hospitalization were similar among those who did and did not receive palivizumab. CONCLUSIONS At the population level, palivizumab receipt was not associated with improved longer-term outcomes in children with CF.
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Affiliation(s)
| | - Gavin Graff
- Penn State Children's Hospital, Hershey, Pennsylvania
| | | | | | | | - Lisa Saiman
- Columbia University Herbert and Florence Irving Medical Center, New York, New York
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18
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Choo EK, Byington CL, Johnson NL, Jagsi R. From #MeToo to #TimesUp in health care: can a culture of accountability end inequity and harassment? Lancet 2019; 393:499-502. [PMID: 30739670 DOI: 10.1016/s0140-6736(19)30251-x] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2018] [Accepted: 01/21/2019] [Indexed: 12/21/2022]
Affiliation(s)
- Esther K Choo
- Center for Policy and Research in Emergency Medicine, Oregon Health and Science University, Portland, OR 97239, USA.
| | | | - Niva-Lubin Johnson
- Mercy Hospital and Medical Center, University of Illinois, Chicago, IL, USA
| | - Reshma Jagsi
- Center for Bioethics and Social Sciences in Medicine and Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, USA
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19
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Puopolo KM, Benitz WE, Zaoutis TE, Cummings J, Juul S, Hand I, Eichenwald E, Poindexter B, Stewart DL, Aucott SW, Goldsmith JP, Watterberg K, Byington CL, Maldonado YA, Banerjee R, Barnett ED, Campbell JD, Gerber JS, Lynfield R, Munoz FM, Nolt D, Nyquist AC, O’Leary ST, Rathore MH, Sawyer MH, Steinbach WJ, Tan TQ. Management of Neonates Born at ≤34 6/7 Weeks' Gestation With Suspected or Proven Early-Onset Bacterial Sepsis. Pediatrics 2018; 142:peds.2018-2896. [PMID: 30455344 DOI: 10.1542/peds.2018-2896] [Citation(s) in RCA: 129] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Early-onset sepsis (EOS) remains a serious and often fatal illness among infants born preterm, particularly among newborn infants of the lowest gestational age. Currently, most preterm infants with very low birth weight are treated empirically with antibiotics for risk of EOS, often for prolonged periods, in the absence of a culture-confirmed infection. Retrospective studies have revealed that antibiotic exposures after birth are associated with multiple subsequent poor outcomes among preterm infants, making the risk/benefit balance of these antibiotic treatments uncertain. Gestational age is the strongest single predictor of EOS, and the majority of preterm births occur in the setting of other factors associated with risk of EOS, making it difficult to apply risk stratification strategies to preterm infants. Laboratory tests alone have a poor predictive value in preterm EOS. Delivery characteristics of extremely preterm infants present an opportunity to identify those with a lower risk of EOS and may inform decisions to initiate or extend antibiotic therapies. Our purpose for this clinical report is to provide a summary of the current epidemiology of preterm neonatal sepsis and provide guidance for the development of evidence-based approaches to sepsis risk assessment among preterm newborn infants.
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Affiliation(s)
- Karen M. Puopolo
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
- Children’s Hospital of Philadelphia, and
| | - William E. Benitz
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, School of Medicine, Stanford University, Palo Alto, California
| | - Theoklis E. Zaoutis
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
- Roberts Center for Pediatric Research, Philadelphia, Pennsylvania; and
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20
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Puopolo KM, Benitz WE, Zaoutis TE, Cummings J, Juul S, Hand I, Eichenwald E, Poindexter B, Stewart DL, Aucott SW, Goldsmith JP, Watterberg K, Byington CL, Maldonado YA, Banerjee R, Barnett ED, Campbell JD, Gerber JS, Lynfield R, Munoz FM, Nolt D, Nyquist AC, O’Leary ST, Rathore MH, Sawyer MH, Steinbach WJ, Tan TQ. Management of Neonates Born at ≥35 0/7 Weeks' Gestation With Suspected or Proven Early-Onset Bacterial Sepsis. Pediatrics 2018; 142:peds.2018-2894. [PMID: 30455342 DOI: 10.1542/peds.2018-2894] [Citation(s) in RCA: 178] [Impact Index Per Article: 29.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
The incidence of neonatal early-onset sepsis (EOS) has declined substantially over the last 2 decades, primarily because of the implementation of evidence-based intrapartum antimicrobial therapy. However, EOS remains a serious and potentially fatal illness. Laboratory tests alone are neither sensitive nor specific enough to guide EOS management decisions. Maternal and infant clinical characteristics can help identify newborn infants who are at risk and guide the administration of empirical antibiotic therapy. The incidence of EOS, the prevalence and implications of established risk factors, the predictive value of commonly used laboratory tests, and the uncertainties in the risk/benefit balance of antibiotic exposures all vary significantly with gestational age at birth. Our purpose in this clinical report is to provide a summary of the current epidemiology of neonatal sepsis among infants born at ≥35 0/7 weeks' gestation and a framework for the development of evidence-based approaches to sepsis risk assessment among these infants.
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Affiliation(s)
- Karen M. Puopolo
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
- Children’s Hospital of Philadelphia, and
| | - William E. Benitz
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, School of Medicine, Stanford University, Palo Alto, California
| | - Theoklis E. Zaoutis
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
- Roberts Center for Pediatric Research, Philadelphia, Pennsylvania; and
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21
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Abstract
Background Fever in infants 1–90 days of age is common. Bacterial meningitis (BM) is a rare, potentially fatal infection that may occur in well-appearing febrile infants (FI). Our objectives were to identify infants with BM in a large population of well-appearing FI and evaluate factors associated with the diagnosis of BM in this population. Methods The Intermountain Healthcare System (IHS) is comprised of 22 hospitals across Utah and Idaho and includes Primary Children’s Hospital, the only pediatric hospital in a catchment of 400,000 miles2. IHS has a care process model for the well-appearing FI. We queried the IHS EHR from July 1, 2004 to September 30, 2016 and captured data on age, laboratory testing, and outcomes. Diagnosis of BM required positive CSF culture. Results We identified 21,135 FI episodes; 54 infants (0.26%) had a diagnosis of BM. Gram-negative organisms predominated in FI 1–28 days [15/24 (63%)] and caused 28/54 (52%) cases overall (Figure 1). FI 1–28 days were significantly more likely to have BM than those 29–90 days (0.41% vs. 0.20%; RR 2.11, 95% CI 1.24–3.61). Laboratory screening showed abnormal white blood cell count in 63% of FI 1–28 days with BM and 50% of FI 29–90 days (P = 0.42); bands were abnormal in 33% and 47% respectively (P = 0.41); urinalysis was abnormal in 21% and 11% (P = 0.42). CSF profile was performed and interpretable in 48/54 (89%); CSF pleocytosis was present in 30/48 [(63%; 15/21 (71%) 1–28 days and 15/27 (56%) P = 0.34]. Nine of 54 (17%) FI with BM would not have been considered “high-risk” based on laboratory criteria alone. Of FI with BM, only 31/54 (57%) had bacteremia with the same organism [17/24 (71%) in those 1–28 days; and 14/30 (47%) in those 29–90 days; P = 0.099]. Conclusion BM is rare and challenging to predict in well-appearing FI. Abnormal screening laboratory values identified 83% of FI with BM. Awaiting blood culture results before performing lumbar puncture would potentially miss 40%. Age was the only predictor for BM risk in our cohort. Disclosures A. J. Blaschke, BIoFire Diagnostics, LLC: I have intellectual property licensed to BioFire through the University of Utah, Independent Contractor and Investigator, Consulting fee and Licensing agreement or royalty. C. L. Byington, BIoFire Diagnostics, LLC: I have intellectual property licensed to BioFire through the University of Utah, Licensing agreement or royalty.
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Affiliation(s)
- Anne J Blaschke
- Department of Pediatrics, Division of Pediatric Infectious Diseases, University of Utah School of Medicine, Salt Lake City, Utah
| | - E Kent Korgenski
- Department of Pediatrics, Pediatric Clinical Program, University of Utah School of Medicine and Intermountain Healthcare, Salt Lake City, Utah
| | - Carrie L Byington
- Department of Pediatrics, Division of Pediatric Infectious Diseases, University of Utah School of Medicine, Salt Lake City, Utah
- University of Utah Health Sciences Center, Salt Lake City, Utah
- Health Sciences Center, Texas A & M University, Bryan, Texas
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22
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Chow CJ, Byington CL, Olson LM, Ramirez KPG, Zeng S, López AM. A Conceptual Model for Understanding Academic Physicians' Performances of Identity: Findings From the University of Utah. Acad Med 2018; 93:1539-1549. [PMID: 29794525 PMCID: PMC6156991 DOI: 10.1097/acm.0000000000002298] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
PURPOSE To explore how academic physicians perform social and professional identities and how their personal experiences inform professional identity formation. METHOD Semistructured interviews and observations were conducted with 25 academic physicians of diverse gender and racial/ethnic backgrounds at the University of Utah School of Medicine from 2015 to 2016. Interviews explored the domains of social identity, professional identity, and relationships with patients and colleagues. Patient interactions were observed. Interviews and observations were audio-recorded, transcribed, and analyzed using grounded theory. RESULTS Three major themes emerged: Physicians' descriptions of identity differed based on social identities, as women and racially/ethnically minoritized participants linked their gender and racial/ethnic identities, respectively, to their professional roles more than men and white, non-Latino/a participants; physicians' descriptions of professional practice differed based on social identities, as participants who associated professional practices with personal experiences often drew from events connected to their minoritized identities; and physicians' interactions with patients corresponded to their self-described actions. CONCLUSIONS Professional identity formation is an ongoing process, and the negotiation of personal experiences is integral to this process. This negotiation may be more complex for physicians with minoritized identities. Implications for medical education include providing students, trainees, and practicing physicians with intentional opportunities for reflection and instruction on connecting personal experiences and professional practice.
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Affiliation(s)
- Candace J Chow
- C.J. Chow is a research associate, Utah Education Policy Center, University of Utah College of Education, Salt Lake City, Utah. C.L. Byington is Jean and Thomas McMullin Professor and Dean of Medicine, senior vice president, Health Science Center, and vice chancellor for health services, Texas A&M University, Bryan, Texas. L.M. Olson is professor, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah. K.P.G. Ramirez was a research assistant and graduate, College of Health, University of Utah, Salt Lake City, Utah. S. Zeng is an undergraduate student and research assistant, University of Utah, Salt Lake City, Utah. A.M. López is vice chair, Medical Oncology, and chief, New Jersey Division, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, Pennsylvania
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23
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Fairchild AL, Holyfield LJ, Byington CL. National Academies of Sciences, Engineering, and Medicine Report on Sexual Harassment: Making the Case for Fundamental Institutional Change. JAMA 2018; 320:873-874. [PMID: 30128569 DOI: 10.1001/jama.2018.10840] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Amy L Fairchild
- School of Public Health, Texas A&M University Health Sciences Center, Bryan, Texas
| | - Lavern J Holyfield
- College of Dentistry, Texas A&M University Health Sciences Center, Dallas, Texas
| | - Carrie L Byington
- College of Medicine, Texas A&M University Health Sciences Center, Bryan, Texas
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24
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Adler FR, Stockmann C, Ampofo K, Pavia AT, Byington CL. Transmission of rhinovirus in the Utah BIG-LoVE families: Consequences of age and household structure. PLoS One 2018; 13:e0199388. [PMID: 30044794 PMCID: PMC6059387 DOI: 10.1371/journal.pone.0199388] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Accepted: 06/06/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Common cold viruses create significant health and financial burdens, and understanding key loci of transmission would help focus control strategies. This study (1) examines factors that influence when individuals transition from a negative to positive test (acquisition) or a positive to negative test (loss) of rhinovirus (HRV) and other respiratory tract viruses in 26 households followed weekly for one year, (2) investigates evidence for intrahousehold and interhousehold transmission and the characteristics of individuals implicated in transmission, and (3) builds data-based simulation models to identify factors that most strongly affect patterns of prevalence. METHODS We detected HRV, coronavirus, paramyxovirus, influenza and bocavirus with the FilmArray polymerase chain reaction (PCR) platform (BioFire Diagnostics, LLC). We used logistic regression to find covariates affecting acquisition or loss of HRV including demographic characteristics of individuals, their household, their current infection status, and prevalence within their household and across the population. We apply generalized linear mixed models to test robustness of results. RESULTS Acquisition of HRV was less probable in older individuals and those infected with a coronavirus, and higher with a higher proportion of other household members infected. Loss of HRV is reduced with a higher proportion of other household members infected. Within households, only children and symptomatic individuals show evidence for transmission, while between households only a higher number of infected older children (ages 5-19) increases the probability of acquisition. Coronaviruses, paramyxoviruses and bocavirus also show evidence of intrahousehold transmission. Simulations show that age-dependent susceptibility and transmission have the largest effects on mean HRV prevalence. CONCLUSIONS Children are most likely to acquire and most likely to transmit HRV both within and between households, with infectiousness concentrated in symptomatic children. Simulations predict that the spread of HRV and other respiratory tract viruses can be reduced but not eliminated by practices within the home.
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Affiliation(s)
- Frederick R. Adler
- Department of Mathematics and Department of Biology, University of Utah, Salt Lake City, UT, United States of America
| | - Chris Stockmann
- Department of Pediatrics Medicine, University of Utah, Salt Lake City, UT, United States of America
| | - Krow Ampofo
- Department of Pediatrics Medicine, University of Utah, Salt Lake City, UT, United States of America
| | - Andrew T. Pavia
- Department of Pediatrics Medicine, University of Utah, Salt Lake City, UT, United States of America
| | - Carrie L. Byington
- Health Sciences Center, Texas A&M University, College Station, TX, United States of America
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25
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Rothwell E, Botkin JR, Cheek-O'Donnell S, Wong B, Case GA, Johnson E, Matheson T, Wilson A, Robinson NR, Rawlings J, Horejsi B, Lopez AM, Byington CL. An empirical assessment of the short-term impacts of a reading of Deborah Zoe Laufer's drama Informed Consent on attitudes and intentions to participate in genetic research. AJOB Empir Bioeth 2018; 9:69-76. [PMID: 29513089 PMCID: PMC6092928 DOI: 10.1080/23294515.2018.1449771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVE This study assessed the short-term impact of the play "Informed Consent" by Deborah Zoe Laufer (a fictionalized look at the controversy over specimens collected from the Havasupai Tribe for diabetes research in 1989) on perceptions of trust, willingness to donate biospecimens, and attitudes toward harm and privacy among the medical and undergraduate students, faculty, and the public in the Intermountain West. METHODS Surveys were administered before and after a staged reading of the play by professional actors. Survey items included the short form Trust in Medical Researchers, and single-item questions about group identity, ethics of genetic testing in children, and willingness to donate biospecimens. In addition, respondents were given the option to answer open-ended questions through e-mail. RESULTS Out of the 481 who attended the play, 421 completed both the pre and post surveys, and 166 participants completed open-ended questions online approximately 1 week after the play. Across all participants, there were significant declines for trust in medical researchers and for the survey item "is it ethical for investigators to test children for adult onset diseases" (p < .001 for both) following the play. There was a significant increase in agreement to improve group identity protections (p < .001) and there were no differences on willingness to donate biospecimens to research (p = .777). Qualitative data provided extensive contextual data supporting these perspectives. DISCUSSION This is one of the first studies to document short-term impacts of a theatrical performance on both attitudes and behavioral intentions toward research ethics and clinical research participation. Future research should continue to explore the impact of theatrical performances among public and investigators on the ethical issues and complexities in clinical research.
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Affiliation(s)
| | | | | | - Bob Wong
- a University of Utah , Salt Lake City , Utah , USA
| | | | - Erin Johnson
- a University of Utah , Salt Lake City , Utah , USA
| | | | - Alena Wilson
- a University of Utah , Salt Lake City , Utah , USA
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26
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Kim L, Rha B, Abramson JS, Anderson LJ, Byington CL, Chen GL, DeVincenzo J, Edwards KM, Englund JA, Falsey AR, Griffin MR, Karron RA, Martin KG, Meissner HC, Munoz FM, Pavia AT, Piedra PA, Schaffner W, Simões EAF, Singleton R, Talbot HK, Walsh EE, Zucker JR, Gerber SI. Identifying Gaps in Respiratory Syncytial Virus Disease Epidemiology in the United States Prior to the Introduction of Vaccines. Clin Infect Dis 2018; 65:1020-1025. [PMID: 28903503 DOI: 10.1093/cid/cix432] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Accepted: 05/03/2017] [Indexed: 11/14/2022] Open
Abstract
Respiratory syncytial virus (RSV) causes lower respiratory tract illness frequently. No effective antivirals or vaccines for RSV are approved for use in the United States; however, there are at least 50 vaccines and monoclonal antibody products in development, with those targeting older adults and pregnant women (to protect young infants) in phase 2 and 3 clinical trials. Unanswered questions regarding RSV epidemiology need to be identified and addressed prior to RSV vaccine introduction to guide the measurement of impact and future recommendations. The Centers for Disease Control and Prevention (CDC) convened a technical consultation to gather input from external subject matter experts on their individual perspectives regarding evidence gaps in current RSV epidemiology in the United States, potential studies and surveillance platforms needed to fill these gaps, and prioritizing efforts. Participants articulated their individual views, and CDC staff synthesized individuals' input into this report.
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Affiliation(s)
- Lindsay Kim
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Brian Rha
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jon S Abramson
- Wake Forest School of Medicine, Winston-Salem, North Carolina
| | | | | | - Grace L Chen
- Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
| | - John DeVincenzo
- Pediatrics.,Microbiology, Immunology, and Biochemistry, University of Tennessee Center for Health Sciences.,Children's Foundation Research Institute, Lebonheur Children's Hospital, Memphis
| | - Kathryn M Edwards
- Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, Tennessee
| | | | - Ann R Falsey
- Department of Medicine, University of Rochester School of Medicine, New York
| | - Marie R Griffin
- Health Policy.,Medicine, Vanderbilt University Medical Center.,Mid-South Geriatric Research Education and Clinical Center, VA Tennessee Valley Health Care System, Nashville
| | - Ruth A Karron
- Center for Immunization Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Karen G Martin
- Council of State and Territorial Epidemiologists, Atlanta, Georgia.,Minnesota Department of Health, St Paul
| | - H Cody Meissner
- Department of Pediatrics, Tufts University School of Medicine, Boston, Massachusetts
| | - Flor M Munoz
- Departments of Pediatrics, Molecular Virology, and Microbiology, Baylor College of Medicine, Houston, Texas
| | - Andrew T Pavia
- Departments of Pediatrics and Medicine, University of Utah School of Medicine, Salt Lake City
| | - Pedro A Piedra
- Departments of Pediatrics, Molecular Virology, and Microbiology, Baylor College of Medicine, Houston, Texas
| | - William Schaffner
- Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Eric A F Simões
- Department of Pediatrics, University of Colorado School of Medicine.,Department of Epidemiology, Center for Global Health, Colorado School of Public Health, Aurora
| | - Rosalyn Singleton
- Alaska Native Tribal Health Consortium.,Arctic Investigations Program, Centers for Disease Control and Prevention, Anchorage
| | - H Keipp Talbot
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Edward E Walsh
- Department of Medicine, University of Rochester School of Medicine, New York
| | - Jane R Zucker
- New York City Department of Health and Mental Hygiene, Bureau of Immunization.,Immunization Services Division, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Susan I Gerber
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
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27
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Blaschke AJ, Korgenski EK, Wilkes J, Presson AP, Thorell EA, Pavia AT, Knackstedt ED, Reynolds C, Schunk JE, Daly JA, Byington CL. Rhinovirus in Febrile Infants and Risk of Bacterial Infection. Pediatrics 2018; 141:peds.2017-2384. [PMID: 29343585 PMCID: PMC5810600 DOI: 10.1542/peds.2017-2384] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/15/2017] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Febrile infants with viral respiratory infections have a reduced risk of bacterial infection compared with virus-negative infants. The risk of concomitant bacterial infection in febrile infants positive for human rhinovirus (HRV) by polymerase chain reaction (PCR) is unknown. METHODS Infants 1-90 days old managed using the care process model for well-appearing febrile infants and with respiratory viral testing by PCR (RVPCR) in the emergency department or inpatient setting of 22 hospitals in the Intermountain Healthcare system from 2007-2016 were identified. Relative risk (RR) of bacterial infection was calculated for infants with HRV, non-HRV viruses, or no virus detected. RESULTS Of 10 964 febrile infants identified, 4037 (37%) had RVPCR. Of these, 2212 (55%) were positive for a respiratory virus; 1392 (35%) for HRV alone. Bacterial infection was identified in 9.5%. Febrile infants with HRV detected were more likely to have bacterial infection than those with non-HRV viruses (7.8% vs 3.7%; P < .001; RR 2.12 [95% CI 1.43-3.15]). Risk of urinary tract infection was not significantly different for HRV-positive infants at any age, nor was risk of invasive bacterial infection (IBI; bacteremia and/or meningitis) meaningfully different for infants 1-28 day olds. Infants 29-90 days old with HRV had a decreased likelihood of IBI (RR 0.52 [95% CI 0.34-0.80]). CONCLUSIONS HRV is common in febrile infants. Detection did not alter risk of concomitant urinary tract infection at any age or risk of IBI in infants 1-28 days old. HRV detection may be relevant in considering risk of IBI for infants 29-90 days of age.
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Affiliation(s)
| | - E. Kent Korgenski
- Departments of Pediatrics,,Pediatric Clinical Program, Intermountain Healthcare, Salt Lake City, Utah
| | - Jacob Wilkes
- Pediatric Clinical Program, Intermountain Healthcare, Salt Lake City, Utah
| | | | - Emily A. Thorell
- Departments of Pediatrics,,Pediatric Clinical Program, Intermountain Healthcare, Salt Lake City, Utah
| | | | | | - Carolyn Reynolds
- Pediatric Clinical Program, Intermountain Healthcare, Salt Lake City, Utah
| | | | - Judy A. Daly
- Pathology, School of Medicine, University of Utah, Salt Lake City, Utah;,Patient Centered Microbiology Laboratory, Primary Children’s Hospital, Intermountain Healthcare, Salt Lake City, Utah; and
| | - Carrie L. Byington
- Departments of Pediatrics,,College of Medicine, Texas A&M Health Sciences Center, Bryan, Texas
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28
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Rathore MH, Jackson MA, Byington CL, Maldonado YA, Barnett ED, Davies HD, Edwards KM, Lynfield R, Munoz FM, Nolt D, Nyquist AC, Sawyer MH, Steinbach WJ, Tan TQ, Zaoutis TE. Infection Prevention and Control in Pediatric Ambulatory Settings. Pediatrics 2017; 140:peds.2017-2857. [PMID: 29061869 DOI: 10.1542/peds.2017-2857] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Since the American Academy of Pediatrics published its statement titled "Infection Prevention and Control in Pediatric Ambulatory Settings" in 2007, there have been significant changes that prompted this updated statement. Infection prevention and control is an integral part of pediatric practice in ambulatory medical settings as well as in hospitals. Infection prevention and control practices should begin at the time the ambulatory visit is scheduled. All health care personnel should be educated regarding the routes of transmission and techniques used to prevent the transmission of infectious agents. Policies for infection prevention and control should be written, readily available, updated every 2 years, and enforced. Many of the recommendations for infection control and prevention from the Centers for Disease Control and Prevention for hospitalized patients are also applicable in the ambulatory setting. These recommendations include requirements for pediatricians to take precautions to identify and protect employees likely to be exposed to blood or other potentially infectious materials while on the job. In addition to emphasizing the key principles of infection prevention and control in this policy, we update those that are relevant to the ambulatory care patient. These guidelines emphasize the role of hand hygiene and the implementation of diagnosis- and syndrome-specific isolation precautions, with the exemption of the use of gloves for routine diaper changes and wiping a well child's nose or tears for most patient encounters. Additional topics include respiratory hygiene and cough etiquette strategies for patients with a respiratory tract infection, including those relevant for special populations like patients with cystic fibrosis or those in short-term residential facilities; separation of infected, contagious children from uninfected children when feasible; safe handling and disposal of needles and other sharp medical devices; appropriate use of personal protective equipment, such as gloves, gowns, masks, and eye protection; and appropriate use of sterilization, disinfection, and antisepsis. Lastly, in this policy, we emphasize the importance of public health interventions, including vaccination for patients and health care personnel, and outline the responsibilities of the health care provider related to prompt public health notification for specific reportable diseases and communication with colleagues who may be providing subsequent care of an infected patient to optimize the use of isolation precautions and limit the spread of contagions.
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Affiliation(s)
- Mobeen H. Rathore
- University of Florida Center for HIV/AIDS Research, Education and Service (UF CARES) and Infectious Diseases and Immunology, Wolfson Children’s Hospital, Jacksonville, Florida; and
| | - Mary Anne Jackson
- Division of Infectious Diseases, Department of Pediatrics, University of Missouri–Kansas City School of Medicine and Children’s Mercy Kansas City, Kansas City, Missouri
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29
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Byington CL, Ampofo K, Lewis T, Mathie T, Nanayakkara D, Pavia A, Hanson K, Couturier MR, Moreau B. Arboviral Infections Following the 2016 Olympic and Paralympic Games in a Cohort of US Athletes and Support Staff. Open Forum Infect Dis 2017. [DOI: 10.1093/ofid/ofx162.152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
The 2016 Olympic and Paralympic games were held in Brazil after the peak of an explosive Zika virus (ZIKV) outbreak. The risk to US athletes and support staff of travel-associated ZIKV and other arboviral infections was unknown but concern was high.
Methods
Individuals traveling with the US Olympic Committee (USOC), including Olympic and Paralympic athletes and support staff were enrolled. Participants provided a pre- and post-travel (2–12 weeks) blood samples, and were also counseled about mosquito avoidance. Participants completed pre- and post-travel surveys detailing demographics, health history, vaccination, mosquito protection, and symptoms during and up to 2 weeks after travel to Brazil. Blood samples were tested at ARUP Laboratories, Utah, for ZIKV IgM and for Chikungunya (CHKV), Dengue (DENV), and West Nile (WNV) viruses IgM and IgG. Recent infection was defined as the presence of IgM in a post-travel blood sample and or IgG seroconversion.
Results
A total of 950 individual subjects provided pre-travel samples and surveys. Of these, 457 (48%) also provided post-travel samples. No ZIKV infections were detected by IgM. However, 48 (11%) participants had antibody evidence of other arboviral infections; 4 (0.9% tested) with CHKV, 6 (1.3%) with DENV, and 39 (9%) with WNV. Of these, new travel-associated infection was confirmed in 32 (7%); 3 of 4 CHKV, 2 of 6 DENV, and 27 of 39 WNV. Twelve (38%) of the subjects with travel associated arbovirus infection submitted post-travel surveys; 3 (25%) respondents had symptoms of arboviral infection during or within 2 weeks after travel; 2 (16%) CHKV, and 1 (8%) WNV. Those with travel-associated arboviral infections had similar demographics, and exposure whilst in Brazil, but were less likely to use mosquito repellent than athletes without arboviral infection (7/12 (58%) vs. 130/154 (84%), OR 0.26, P = 0.04).
Conclusion
ZIKV was not detected in the USOC athletes or staff traveling to Brazil. Other arboviral infections were detected in 7% of travelers, with WNV being most common. The use of mosquito repellent was associated with decreased risk of infection. This study demonstrates multiple arboviruses in addition to ZIKV were circulating simultaneously in Brazil and has implications for pre- and post-travel counseling.
Disclosures
C. L. Byington, BioFire: Collaborator and Grant Investigator, Licensing agreement or royalty and Research grant
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Affiliation(s)
- Carrie L Byington
- Department of Pediatrics, Division of Pediatric Infectious Diseases, University of Utah School of Medicine, Salt Lake City, UT
| | - Krow Ampofo
- Department of Pediatrics, Division of Pediatric Infectious Diseases, University of Utah School of Medicine, Salt Lake City, UT
| | - Tammi Lewis
- Clinical Trials Office, University of Utah School of Medicine, Salt Lake City, UT
| | - Taylor Mathie
- University of Utah School of Medicine, Salt Lake City, Utah
| | | | - Andrew Pavia
- Department of Pediatrics, Division of Pediatric Infectious Diseases, University of Utah School of Medicine, Salt Lake City, UT
| | - Kim Hanson
- University of Utah School of Medicine, Salt Lake City, Utah
| | | | - Bill Moreau
- Sports Medicine, United States Olympic Committee, Colorado Springs, Colorado
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30
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Davies HD, Jackson MA, Rice SG, Byington CL, Maldonado YA, Barnett ED, Campbell JD, Lynfield R, Munoz FM, Nolt D, Nyquist AC, O’Leary S, Rathore MH, Sawyer MH, Steinbach WJ, Tan TQ, Zaoutis TE, LaBella CR, Brooks MA, Canty GS, Diamond A, Hennrikus W, Logan K, Moffatt KA, Nemeth B, Pengel B, Peterson A, Stricker P. Infectious Diseases Associated With Organized Sports and Outbreak Control. Pediatrics 2017; 140:peds.2017-2477. [PMID: 28947608 DOI: 10.1542/peds.2017-2477] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Participation in organized sports has a variety of health benefits but also has the potential to expose the athlete to a variety of infectious diseases, some of which may produce outbreaks. Major risk factors for infection include skin-to-skin contact with athletes who have active skin infections, environmental exposures and physical trauma, and sharing of equipment and contact with contaminated fomites. Close contact that is intrinsic to team sports and psychosocial factors associated with adolescence are additional risks. Minimizing risk requires leadership by the organized sports community (including the athlete's primary care provider) and depends on outlining key hygiene behaviors, recognition, diagnosis, and treatment of common sports-related infections, and the implementation of preventive interventions.
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Affiliation(s)
- H. Dele Davies
- Pediatric Infectious Diseases and Public Health, University of Nebraska Medical Center, Omaha, Nebraska
| | - Mary Anne Jackson
- Infectious Diseases, Children’s Mercy Kansas City and Department of Pediatrics, School of Medicine, University of Missouri-Kansas City, Kansas City, Missouri; and
| | - Stephen G. Rice
- Sports Medicine, Jersey Shore University Medical Center and Department of Pediatrics, Robert Wood Johnson Medical School, Rutgers University, Neptune, New Jersey
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31
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Byington CL, Maldonado YA, Barnett ED, Campbell JD, Davies HD, Edwards KM, Lynfield R, Munoz FM, Nolt DL, Nyquist AC, O’Leary ST, Rathore MH, Sawyer MH, Steinbach WJ, Tan TQ, Zaoutis TE. Recommendations for Prevention and Control of Influenza in Children, 2017 - 2018. Pediatrics 2017; 140:e20172550. [PMID: 28870977 DOI: 10.1542/peds.2017-2550] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
This statement updates the recommendations for routine use of the seasonal influenza vaccine and antiviral medications for the prevention and treatment of influenza in children. The American Academy of Pediatrics recommends annual seasonal influenza immunization for everyone 6 months and older, including children and adolescents. Highlights for the upcoming 2017-2018 season include the following:1. Annual universal influenza immunization is indicated with either a trivalent or quadrivalent (no preference) inactivated vaccine;2. The 2017-2018 influenza A (H1N1) vaccine strain differs from that contained in the 2016-2017 seasonal vaccines. The 2017-2018 influenza A (H3N2) vaccine strain and influenza B vaccine strains included in the trivalent and quadrivalent vaccines are the same as those contained in the 2016-2017 seasonal vaccines: a. trivalent vaccine contains an A/Michigan/45/2015 (H1N1)pdm09-like virus, an A/Hong Kong/4801/2014 (H3N2)-like virus, and a B/Brisbane/60/2008-like virus (B/Victoria lineage); and b. quadrivalent vaccine contains an additional B virus (B/Phuket/3073/2013-like virus [B/Yamagata lineage]);3. Quadrivalent live attenuated influenza vaccine (LAIV4) is not recommended for use in any setting in the United States during the 2017-2018 influenza season. This interim recommendation, originally made in 2016, followed observational data from the US Influenza Vaccine Effectiveness Network revealing that LAIV4 performed poorly against influenza A (H1N1)pdm09 viruses in recent influenza seasons;4. All children with an egg allergy of any severity can receive an influenza vaccine without any additional precautions beyond those recommended for any vaccine;5. All health care personnel should receive an annual seasonal influenza vaccine, a crucial step in preventing influenza and reducing health care-associated influenza infections, because health care personnel often care for individuals at high risk for influenza-related complications; and6. Pediatricians should attempt to promptly identify children suspected of having influenza infection for timely initiation of antiviral treatment, when indicated, to reduce morbidity and mortality. Best results are seen when treated within 48 hours of symptom onset.
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32
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O'Leary ST, Maldonado YA, Byington CL. Update From the Advisory Committee on Immunization Practices. J Pediatric Infect Dis Soc 2017; 6:215-218. [PMID: 28903515 DOI: 10.1093/jpids/pix040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Accepted: 04/28/2017] [Indexed: 11/14/2022]
Abstract
The Advisory Committee on Immunization Practices (ACIP), a group of medical and public health experts, meets 3 times per year to develop recommendations for vaccine use in the United States. The group has 15 voting members, and each member's term is 4 years. ACIP members and Centers for Disease Control and Prevention (CDC) staff discuss the epidemiology of vaccine-preventable diseases and vaccine research, effectiveness, safety data, and clinical trial results. Representatives from the American Academy of Pediatrics (C. L. B. and Y. A. M.) and the Pediatric Infectious Diseases Society (S. T. O.) are present as liaisons to the ACIP. The ACIP met February 22 and 23, 2017, to discuss proposed recommendations regarding vaccination for unprotected infants born to hepatitis B surface antigen (HBsAg)-positive mothers; topics included cost analysis, influenza surveillance, influenza vaccine effectiveness, herpes zoster vaccine, and considerations for meningococcal serogroup B booster doses in groups at increased risk. Updates on mumps epidemiology, Dengue virus vaccines, Zika virus vaccines, adult immunization, and yellow fever vaccine were also provided.
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33
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Stockmann C, Byington CL, Pavia AT, Ampofo K, Wilkes J, Korgenski EK, Hersh AL. Limited and Variable Use of Antivirals for Children Hospitalized With Influenza. JAMA Pediatr 2017; 171:299-301. [PMID: 28114638 DOI: 10.1001/jamapediatrics.2016.3484] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Chris Stockmann
- Division of Pediatric Infectious Diseases, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City†Deceased
| | - Carrie L Byington
- Division of Pediatric Infectious Diseases, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City
| | - Andrew T Pavia
- Division of Pediatric Infectious Diseases, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City
| | - Krow Ampofo
- Division of Pediatric Infectious Diseases, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City
| | - Jacob Wilkes
- Pediatric Clinical Program, Intermountain Healthcare, Salt Lake City, Utah
| | - E Kent Korgenski
- Pediatric Clinical Program, Intermountain Healthcare, Salt Lake City, Utah
| | - Adam L Hersh
- Division of Pediatric Infectious Diseases, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City
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34
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Bernstein HH, Bocchini JA, Byington CL, Maldonado YA, Barnett ED, Campbell JD, Davies HD, Lynfield R, Munoz FM, Nolt D, Nyquist AC, O’Leary S, Rathore MH, Sawyer MH, Steinbach WJ, Tan TQ, Zaoutis TE. Practical Approaches to Optimize Adolescent Immunization. Pediatrics 2017; 139:peds.2016-4187. [PMID: 28167515 DOI: 10.1542/peds.2016-4187] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
With the expansion of the adolescent immunization schedule during the past decade, immunization rates notably vary by vaccine and by state. Addressing barriers to improving adolescent vaccination rates is a priority. Every visit can be viewed as an opportunity to update and complete an adolescent's immunizations. It is essential to continue to focus and refine the appropriate techniques in approaching the adolescent patient and parent in the office setting. Health care providers must continuously strive to educate their patients and develop skills that can help parents and adolescents overcome vaccine hesitancy. Research on strategies to achieve higher vaccination rates is ongoing, and it is important to increase the knowledge and implementation of these strategies. This clinical report focuses on increasing adherence to the universally recommended vaccines in the annual adolescent immunization schedule of the American Academy of Pediatrics, the American Academy of Family Physicians, the Centers for Disease Control and Prevention, and the American Congress of Obstetricians and Gynecologists. This will be accomplished by (1) examining strategies that heighten confidence in immunizations and address patient and parental concerns to promote adolescent immunization and (2) exploring how best to approach the adolescent and family to improve immunization rates.
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Affiliation(s)
- Henry H. Bernstein
- Department of Pediatrics, Cohen Children's Medical Center of New York, New Hyde Park, New York; and
| | - Joseph A. Bocchini
- Department of Pediatrics, Louisiana State University Health Sciences Center, Shreveport, Louisiana
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35
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Korgenski EK, Ampofo K, Lopansri BK, Byington CL, Wilkes J, Gesteland P, Pavia A. Provider Compliance with Rapid Influenza Detection Testing Guidelines During the 2016–17 Influenza A Season. Open Forum Infect Dis 2017. [DOI: 10.1093/ofid/ofx163.1488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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36
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Sanderson SK, Stockmann C, Pavia A, Byington CL, Blaschke AJ, Thorell E, Hersh AL, Korgenski EK, Daly JA, Ampofo K. Laboratory-Confirmed Human Coronavirus Infections Among Children: Does Type Matter? Open Forum Infect Dis 2016. [PMCID: PMC7117591 DOI: 10.1093/ofid/ofw172.24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Susan K. Sanderson
- Department of Pediatrics, Division of Pediatric Infectious Diseases, University of Utah School of Medicine, Salt Lake City, Utah
| | - Chris Stockmann
- Department of Pediatrics, Division of Pediatric Infectious Diseases, University of Utah School of Medicine, Salt Lake City, Utah
| | - Andrew Pavia
- Department of Pediatrics, Division of Pediatric Infectious Diseases, University of Utah School of Medicine, Salt Lake City, Utah
| | | | - Anne J. Blaschke
- Department of Pediatrics, Division of Pediatric Infectious Diseases, University of Utah School of Medicine, Salt Lake City, Utah
| | - Emily Thorell
- Department of Pediatrics, Division of Pediatric Infectious Diseases, University of Utah School of Medicine, Salt Lake City, Utah
| | - Adam L. Hersh
- University of Utah School of Medicine, Salt Lake City, Utah
| | - E. Kent Korgenski
- Department of Pediatrics, Pediatric Clinical Program, University of Utah School of Medicine and Intermountain Healthcare, Salt Lake City, Utah
| | - Judy A. Daly
- Clinical Microbiology, Primary Children's Hospital, Salt Lake City, Utah
| | - Krow Ampofo
- Department of Pediatrics, Division of Pediatric Infectious Diseases, University of Utah School of Medicine, Salt Lake City, Utah
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37
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Davis CR, Stockmann C, Pavia AT, Byington CL, Blaschke AJ, Hersh AL, Thorell EA, Korgenski K, Daly J, Ampofo K. Incidence, Morbidity, and Costs of Human Metapneumovirus Infection in Hospitalized Children. J Pediatric Infect Dis Soc 2016; 5:303-11. [PMID: 26407261 PMCID: PMC5125451 DOI: 10.1093/jpids/piv027] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Accepted: 04/14/2015] [Indexed: 11/13/2022]
Abstract
BACKGROUND Human metapneumovirus (HMPV) causes acute respiratory tract infections in infants and children. We sought to measure the clinical and economic burden of HMPV infection in hospitalized children. METHODS We conducted a retrospective cohort study from 2007 to 2013 at Primary Children's Hospital in Salt Lake City, Utah. Children <18 years of age with laboratory-confirmed HMPV infection were included. Demographic, clinical, and financial data were abstracted from the electronic medical record. RESULTS During the study period, 815 children were hospitalized with laboratory-confirmed HMPV infection: 16% <6 months, 50% 6-23 months, 23% 2-4 years, and 11% 5-17 years of age. A complex chronic condition was identified in 453 (56%) children hospitalized with HMPV infection; this proportion increased with increasing age (P < .001). There was marked variation in annual HMPV hospitalization rates, ranging from 9 of 100 000 person-years in 2012-2013 to 79 of 100 000 in 2009-2010. Hospitalization rates were highest among children <2 years (200 of 100 000 person-years) and lowest among children 5-17 years of age (5 of 100 000). Of hospitalized children, 18% were treated in the intensive care unit and 6% required mechanical ventilation. The median length of stay was 2.8 days (interquartile range [IQR], 1.8-4.6) and did not vary by age. The median total hospital cost per patient was $5513 (IQR, $3850-$9946) with significantly higher costs for patients with chronic medical conditions (P < .001). CONCLUSIONS Human metapneumovirus infection results in a large number of hospitalizations with substantial morbidity, resource utilization, and costs. The development of a safe and effective vaccine could reduce the clinical and economic burden of HMPV.
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Affiliation(s)
- Carly R. Davis
- Department of Pediatrics, University of Utah Health Sciences Center, Salt Lake City
| | - Chris Stockmann
- Department of Pediatrics, University of Utah Health Sciences Center, Salt Lake City
| | - Andrew T. Pavia
- Department of Pediatrics, University of Utah Health Sciences Center, Salt Lake City
| | - Carrie L. Byington
- Department of Pediatrics, University of Utah Health Sciences Center, Salt Lake City
| | - Anne J. Blaschke
- Department of Pediatrics, University of Utah Health Sciences Center, Salt Lake City
| | - Adam L. Hersh
- Department of Pediatrics, University of Utah Health Sciences Center, Salt Lake City
| | - Emily A. Thorell
- Department of Pediatrics, University of Utah Health Sciences Center, Salt Lake City
| | - Kent Korgenski
- Department of Pediatrics, University of Utah Health Sciences Center, Salt Lake City,Intermountain Healthcare, Salt Lake City, Utah
| | - Judy Daly
- Intermountain Healthcare, Salt Lake City, Utah
| | - Krow Ampofo
- Department of Pediatrics, University of Utah Health Sciences Center, Salt Lake City
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38
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Abstract
This clinical report offers guidance to health care providers and hospitals on options to consider regarding parental presence at the bedside while caring for a child with suspected or proven Ebola virus disease (Ebola) or other highly consequential infection. Options are presented to help meet the needs of the patient and the family while also posing the least risk to providers and health care organizations. The optimal way to minimize risk is to limit contact between the person under investigation or treatment and family members/caregivers whenever possible while working to meet the emotional support needs of both patient and family. At times, caregiver presence may be deemed to be in the best interest of the patient, and in such situations, a strong effort should be made to limit potential risks of exposure to the caregiver, health care providers, and the community. The decision to allow parental/caregiver presence should be made in consultation with a team including an infectious diseases expert and state and/or local public health authorities and should involve consideration of many factors, depending on the stage of investigation and management, including (1) a careful history, physical examination, and investigations to elucidate the likelihood of the diagnosis of Ebola or other highly consequential infection; (2) ability of the facility to offer appropriate isolation for the person under investigation and family members and to manage Ebola; (3) ability to recognize and exclude people at increased risk of worse outcomes (eg, pregnant women); and (4) ability of parent/caregiver to follow instructions, including appropriate donning and doffing of personal protective equipment.
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39
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Byington CL, Munoz FM. Palivizumab Prophylaxis for Healthy Preterm Infants: More Data Supporting American Academy of Pediatrics Guidelines. Pediatrics 2016; 138:peds.2016-1494. [PMID: 27432851 PMCID: PMC4960734 DOI: 10.1542/peds.2016-1494] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/05/2016] [Indexed: 11/24/2022] Open
Affiliation(s)
| | - Flor M. Munoz
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas
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40
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Stockmann C, Ampofo K, Pavia AT, Blaschke AJ, Mason EO, Presson AP, Forney LJ, Byington CL. Clinical and Epidemiological Evidence of the Red Queen Hypothesis in Pneumococcal Serotype Dynamics. Clin Infect Dis 2016; 63:619-626. [PMID: 27282711 DOI: 10.1093/cid/ciw357] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Accepted: 05/20/2016] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND The Red Queen hypothesis is an evolutionary theory that describes the reciprocal coevolution of competing species. We sought to study whether introduction of the 7- and 13-valent pneumococcal conjugate vaccines (PCV7 and PCV13, respectively) altered pneumococcal serotype dynamics among children with invasive pneumococcal disease (IPD) as predicted by the Red Queen hypothesis. METHODS This study examined pneumococcal isolates (n = 641) obtained from children <18 years of age hospitalized with IPD from 1997 to 2014 in Utah. A review of the literature also identified several additional studies conducted in the United States and Europe that were used to test the external generalizability of our Utah findings. Simpson's index was used to quantify pneumococcal serotype diversity. RESULTS In Utah, the introduction of PCV7 and PCV13 was associated with rapid increases in serotype diversity (P < .001). Serotypes rarely present before vaccine introduction emerged as common causes of IPD. Diversity then decreased (P < .001) as competition selected for the fittest serotypes and new evolutionary equilibriums were established. This pattern was also observed more broadly in the United States, the United Kingdom, Norway, and Spain. CONCLUSIONS This vaccine-driven example of human/bacterial coevolution appears to confirm the Red Queen hypothesis, which reveals a limitation of serotype-specific vaccines and offers insights that may facilitate alternative strategies for the elimination of IPD.
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Affiliation(s)
- Chris Stockmann
- Department of Pediatrics, University of Utah, Salt Lake City
| | - Krow Ampofo
- Department of Pediatrics, University of Utah, Salt Lake City
| | - Andrew T Pavia
- Department of Pediatrics, University of Utah, Salt Lake City
| | - Anne J Blaschke
- Department of Pediatrics, University of Utah, Salt Lake City
| | | | - Angela P Presson
- Study Design and Biostatistics Center, University of Utah, Salt Lake City
| | - Larry J Forney
- Department of Biological Sciences, University of Idaho, Moscow
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41
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Shakib JH, Korgenski K, Presson AP, Sheng X, Varner MW, Pavia AT, Byington CL. Influenza in Infants Born to Women Vaccinated During Pregnancy. Pediatrics 2016; 137:peds.2015-2360. [PMID: 27244843 PMCID: PMC4894254 DOI: 10.1542/peds.2015-2360] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/03/2016] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Infants <6 months old with influenza are at risk for adverse outcomes. Our objective was to compare influenza outcomes in infants <6 months old born to women who did and did not report influenza vaccine during pregnancy. METHODS The study included all women who delivered from 12/2005 to 3/2014 at Intermountain facilities and their infants. Influenza outcomes included infant influenza-like illness (ILI), laboratory-confirmed influenza, and influenza hospitalizations. RESULTS The cohort included 245 386 women and 249 387 infants. Overall, 23 383 (10%) pregnant women reported influenza immunization. This number increased from 2.2% before the H1N1 pandemic to 21% postpandemic (P < .001). A total of 866 infants <6 months old had ≥1 ILI encounter: 32 (1.34/1000) infants born to women reporting immunization and 834 (3.70/1000) born to women who did not report immunization (relative risk [RR] 0.36; 95% confidence interval [CI], 0.26-0.52; P < .001). A total of 658 infants had laboratory-confirmed influenza: 20 (0.84/1000) born to women reporting immunization and 638 (2.83/1000) born to unimmunized women (RR 0.30; 95% CI, 0.19-0.46; P < .001). A total of 151 infants with laboratory-confirmed influenza were hospitalized: 3 (0.13/1000) born to women reporting immunization and 148 (0.66/1000) born to unimmunized women (RR 0.19; 95% CI, 0.06-0.60; P = .005). CONCLUSIONS Self-reported influenza immunization during pregnancy was low but increased after the H1N1 pandemic. Infants born to women reporting influenza immunization during pregnancy had risk reductions of 64% for ILI, 70% for laboratory-confirmed influenza, and 81% for influenza hospitalizations in their first 6 months. Maternal influenza immunization during pregnancy is a public health priority.
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Affiliation(s)
| | | | | | | | - Michael W. Varner
- Obstetrics and Gynecology, University of Utah, Salt Lake City, Utah; and
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Flygare S, Simmon K, Miller C, Qiao Y, Kennedy B, Di Sera T, Graf EH, Tardif KD, Kapusta A, Rynearson S, Stockmann C, Queen K, Tong S, Voelkerding KV, Blaschke A, Byington CL, Jain S, Pavia A, Ampofo K, Eilbeck K, Marth G, Yandell M, Schlaberg R. Taxonomer: an interactive metagenomics analysis portal for universal pathogen detection and host mRNA expression profiling. Genome Biol 2016; 17:111. [PMID: 27224977 PMCID: PMC4880956 DOI: 10.1186/s13059-016-0969-1] [Citation(s) in RCA: 110] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Accepted: 04/27/2016] [Indexed: 02/07/2023] Open
Abstract
Background High-throughput sequencing enables unbiased profiling of microbial communities, universal pathogen detection, and host response to infectious diseases. However, computation times and algorithmic inaccuracies have hindered adoption. Results We present Taxonomer, an ultrafast, web-tool for comprehensive metagenomics data analysis and interactive results visualization. Taxonomer is unique in providing integrated nucleotide and protein-based classification and simultaneous host messenger RNA (mRNA) transcript profiling. Using real-world case-studies, we show that Taxonomer detects previously unrecognized infections and reveals antiviral host mRNA expression profiles. To facilitate data-sharing across geographic distances in outbreak settings, Taxonomer is publicly available through a web-based user interface. Conclusions Taxonomer enables rapid, accurate, and interactive analyses of metagenomics data on personal computers and mobile devices. Electronic supplementary material The online version of this article (doi:10.1186/s13059-016-0969-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Steven Flygare
- Department of Human Genetics, University of Utah, Salt Lake City, UT, USA
| | - Keith Simmon
- Department of Biomedical Informatics, University of Utah, Salt Lake City, UT, USA
| | - Chase Miller
- Department of Human Genetics, University of Utah, Salt Lake City, UT, USA
| | - Yi Qiao
- Department of Human Genetics, University of Utah, Salt Lake City, UT, USA
| | - Brett Kennedy
- Department of Human Genetics, University of Utah, Salt Lake City, UT, USA
| | - Tonya Di Sera
- Department of Human Genetics, University of Utah, Salt Lake City, UT, USA
| | - Erin H Graf
- Department of Pathology, University of Utah, Salt Lake City, UT, USA
| | - Keith D Tardif
- ARUP Institute for Clinical and Experimental Pathology, Salt Lake City, UT, USA
| | - Aurélie Kapusta
- Department of Human Genetics, University of Utah, Salt Lake City, UT, USA
| | - Shawn Rynearson
- Department of Human Genetics, University of Utah, Salt Lake City, UT, USA
| | - Chris Stockmann
- Department of Pediatrics, University of Utah, Salt Lake City, UT, USA
| | - Krista Queen
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Suxiang Tong
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Karl V Voelkerding
- Department of Pathology, University of Utah, Salt Lake City, UT, USA.,ARUP Institute for Clinical and Experimental Pathology, Salt Lake City, UT, USA
| | - Anne Blaschke
- Department of Pediatrics, University of Utah, Salt Lake City, UT, USA
| | - Carrie L Byington
- Department of Pediatrics, University of Utah, Salt Lake City, UT, USA
| | - Seema Jain
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Andrew Pavia
- Department of Pediatrics, University of Utah, Salt Lake City, UT, USA
| | - Krow Ampofo
- Department of Pediatrics, University of Utah, Salt Lake City, UT, USA
| | - Karen Eilbeck
- Department of Biomedical Informatics, University of Utah, Salt Lake City, UT, USA.,USTAR Center for Genetic Discovery, Salt Lake City, UT, USA
| | - Gabor Marth
- Department of Human Genetics, University of Utah, Salt Lake City, UT, USA.,USTAR Center for Genetic Discovery, Salt Lake City, UT, USA
| | - Mark Yandell
- Department of Human Genetics, University of Utah, Salt Lake City, UT, USA. .,USTAR Center for Genetic Discovery, Salt Lake City, UT, USA.
| | - Robert Schlaberg
- Department of Pathology, University of Utah, Salt Lake City, UT, USA. .,ARUP Institute for Clinical and Experimental Pathology, Salt Lake City, UT, USA.
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43
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Curfman AL, Glissmeyer EW, Ahmad FA, Korgenski EK, Blaschke AJ, Byington CL, Miller AS. Initial Presentation of Neonatal Herpes Simplex Virus Infection. J Pediatr 2016; 172:121-126.e1. [PMID: 26960921 DOI: 10.1016/j.jpeds.2016.02.015] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Revised: 01/25/2016] [Accepted: 02/04/2016] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To inform the decision to test and empirically treat for herpes simplex virus (HSV) by describing the initial clinical presentation and laboratory findings of infants with a confirmed diagnosis of neonatal HSV. STUDY DESIGN This is a retrospective case series performed at 2 pediatric tertiary care centers. Infants who developed symptoms prior to 42 days of age with laboratory confirmed HSV from 2002 through 2012 were included. We excluded infants <34 weeks gestation, those who developed illness before discharge from their birth hospital, and those who developed symptoms after 42 days of age. RESULTS We identified 49 infants with HSV meeting these criteria. Most infants (43/49, 88%) came to medical attention at ≤28 days. Of 49 infants, 22 (45%) had disseminated, 16 (33%) central nervous system, and 10 (20%) skin, eye, mouth HSV disease. Eight infants (16%) had nonspecific presentations without the classic signs of seizure, vesicular rash, or critical illness (intensive care admission). All infants with nonspecific presentation were ≤14 days, had cerebrospinal fluid pleocytosis, or both. CONCLUSIONS The majority of infants with HSV (84%) presented with seizure, vesicular rash, or critical illness. A subset of patients (16%) lacked classic signs at hospitalization; most manifested signs suggestive of HSV within 24 hours. Further studies are needed to validate the risk factors identified in this study including age <14 days and cerebrospinal fluid pleocytosis at presentation.
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Affiliation(s)
- Alison L Curfman
- Department of Pediatrics, Washington University in St. Louis, St. Louis, MO.
| | - Eric W Glissmeyer
- Department of Pediatrics, University of Utah, Salt Lake City, UT; Institute for Health Care Delivery Research, Intermountain Healthcare, Salt Lake City, UT
| | - Fahd A Ahmad
- Department of Pediatrics, Washington University in St. Louis, St. Louis, MO
| | - E Kent Korgenski
- Department of Pediatrics, University of Utah, Salt Lake City, UT; Pediatric Clinical Program, Intermountain Healthcare, Salt Lake City, UT
| | - Anne J Blaschke
- Department of Pediatrics, University of Utah, Salt Lake City, UT
| | | | - Aaron S Miller
- Department of Pediatrics, St. Louis University School of Medicine, St. Louis, MO
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45
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Byington CL, Keenan H, Phillips JD, Childs R, Wachs E, Berzins MA, Clark K, Torres MK, Abramson J, Lee V, Clark EB. A Matrix Mentoring Model That Effectively Supports Clinical and Translational Scientists and Increases Inclusion in Biomedical Research: Lessons From the University of Utah. Acad Med 2016; 91:497-502. [PMID: 26650676 PMCID: PMC4811725 DOI: 10.1097/acm.0000000000001021] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
Physician-scientists and scientists in all the health professions are vital members of the U.S. biomedical workforce, but their numbers at academic health centers are declining. Mentorship has been identified as a key component in retention of faculty members at academic health centers. Effective mentoring may promote the retention of clinician-scientists in the biomedical workforce. The authors describe a holistic institutional mentoring program to support junior faculty members engaged in clinical and translational science at the University of Utah. The clinical and translational scholars (CATS) program leverages the resources of the institution, including the Center for Clinical and Translational Science, to augment departmental resources to support junior faculty investigators and uses a multilevel mentoring matrix that includes self, senior, scientific, peer, and staff mentorship. Begun in the Department of Pediatrics, the program was expanded in 2013 to include all departments in the school of medicine and the health sciences. During the two-year program, scholars learn management essentials and have leadership training designed to develop principal investigators. Of the 86 program participants since fiscal year 2008, 92% have received extramural awards, 99% remain in academic medicine, and 95% remain at the University of Utah. The CATS program has also been associated with increased inclusion of women and underrepresented minorities in the institutional research enterprise. The CATS program manifests institutional collaboration and coordination of resources, which have benefited faculty members and the institution. The model can be applied to other academic health centers to support and sustain the biomedical workforce.
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Affiliation(s)
- Carrie L. Byington
- C.L. Byington is professor, Department of Pediatrics, University of Utah School of Medicine, and associate vice president, Health Sciences Faculty, University of Utah Health Sciences Center, Salt Lake City, Utah
| | - Heather Keenan
- H. Keenan is professor, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah
| | - John D. Phillips
- J.D. Phillips is research professor, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah
| | - Rebecca Childs
- R. Childs is manager, Office of Academic Affairs and Faculty Development for the Health Sciences, University of Utah Health Sciences Center, Salt Lake City, Utah
| | - Erin Wachs
- E. Wachs is pediatric research manager, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah
| | - Mary Anne Berzins
- M.A. Berzins is assistant vice president, Human Resources and Management, University of Utah, Salt Lake City, Utah
| | - Kim Clark
- K. Clark is program coordinator, University of Utah Health Sciences Center, Salt Lake City, Utah
| | - Maria K. Torres
- M.K. Torres is program coordinator, University of Utah Health Sciences Center, Salt Lake City, Utah
| | - Jan Abramson
- J. Abramson is program manager, Vice President’s Clinical and Translational Research Scholars Program, University of Utah Health Sciences Center, Salt Lake City, Utah
| | - Vivian Lee
- V. Lee is senior vice president for the health sciences, University of Utah Health Sciences Center, Salt Lake City, Utah
| | - Edward B. Clark
- E.B. Clark is chair, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah
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Affiliation(s)
- Kathryn M Edwards
- American Academy of Pediatrics Committee on Infectious Diseases, USA
| | - Yvonne Maldonado
- American Academy of Pediatrics Committee on Infectious Diseases, USA
| | - Carrie L Byington
- American Academy of Pediatrics Committee on Infectious Diseases, USA
| | - Tom Jefferson
- Centre for Evidence Based Medicine, Oxford OX2 6GG, UK
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47
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Byington CL, Maldonado Y. Rotavirus Vaccines-OK to Mix and Match. Pediatrics 2016; 137:e20153618. [PMID: 26823542 PMCID: PMC4732364 DOI: 10.1542/peds.2015-3618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/16/2015] [Indexed: 01/19/2023] Open
Affiliation(s)
| | - Yvonne Maldonado
- Stanford University, Department of Pediatrics, Palo Alto, California
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Kendall BA, Dascomb KK, Mehta RR, Stockmann C, Mason EO, Ampofo K, Pavia AT, Byington CL. Early Streptococcus pneumoniae serotype changes in Utah adults after the introduction of PCV13 in children. Vaccine 2015; 34:474-478. [PMID: 26706276 DOI: 10.1016/j.vaccine.2015.12.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Revised: 11/14/2015] [Accepted: 12/02/2015] [Indexed: 01/23/2023]
Abstract
INTRODUCTION Pneumococcal conjugate vaccines (PCV) have indirect effects due to decreased Streptococcus pneumoniae colonization in vaccine recipients. We sought to determine whether the introduction of PCV13 in children led to changes in the epidemiology and clinical manifestations of invasive pneumococcal disease (IPD) in adults. METHODS We described demographics, comorbidities, clinical manifestations, and serotypes of IPD in Utah adults before (November 2009-February 2010) and after (March 2010-March 2012) the introduction of PCV13 in children. We also compare serotypes causing IPD in Utah adults and children. RESULTS After the introduction of PCV13 in the childhood vaccine program, the proportion of IPD due to PCV13 exclusive serotypes decreased significantly in Utah adults (64-40%, p=0.009), primarily due to a decline in serotype 7F (36-15%, p=0.008). There were non-significant increases in IPD due to Pneumococcal polysaccharide 23 (PPV23) unique serotypes and non-vaccine serotypes, most notably serotype 22F. Changes in the proportions of vaccine and non-vaccine serotypes were similar in adults and children. Meningitis was more commonly due to non-vaccine serotypes relative to non-meningitis cases (47% vs. 18%, p=0.007). When stratified by sex, decreases in PCV13 serotype IPD were only noted in men (76-33%, p=0.001). CONCLUSIONS Serotype epidemiology of IPD in adults closely follows that of children in the PCV13 era. Continued surveillance is needed to confirm whether replacement serotypes will lead to increases in pneumococcal meningitis and whether there are sex differences in the indirect effects of PCV vaccination in children.
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Affiliation(s)
- Brian A Kendall
- Departments of Medicine and Pathology, University of Utah, Salt Lake City, UT, USA.
| | - Kristin K Dascomb
- Departments of Medicine and Pathology, University of Utah, Salt Lake City, UT, USA; Department of Infectious Diseases, Intermountain Healthcare, Murray, UT, USA
| | - Rajesh R Mehta
- Department of Infectious Diseases, Intermountain Healthcare, Murray, UT, USA
| | - Chris Stockmann
- Department of pediatrics, University of Utah, Salt Lake City, UT, USA
| | - Edward O Mason
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - Krow Ampofo
- Department of pediatrics, University of Utah, Salt Lake City, UT, USA
| | - Andrew T Pavia
- Department of pediatrics, University of Utah, Salt Lake City, UT, USA
| | - Carrie L Byington
- Department of pediatrics, University of Utah, Salt Lake City, UT, USA
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Miller A, Curfman A, Ahmad F, Glissmeyer E, Byington CL, Blaschke AJ, Korgenski K. Initial Presentation of Herpes Simplex Virus Infection in Infants Aged 0-60 Days. Open Forum Infect Dis 2015. [DOI: 10.1093/ofid/ofv133.349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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50
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Korgenski EK, Stockmann C, Gesteland P, Pavia A, Thorell E, Stenehjem E, Hersh AL, Olson J, Byington CL. A Syndromic Evidence-Based Antibiotic Prescribing Tool to Improve Empiric Therapy for 1-90 Day Febrile Infants. Open Forum Infect Dis 2015. [DOI: 10.1093/ofid/ofv131.94] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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