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Xu S, Sy LS, Hong V, Farrington P, Glenn SC, Ryan DS, Shirley AM, Lewin BJ, Tseng HF, Vazquez-Benitez G, Glanz JM, Fireman B, McClure DL, Hurley LP, Yu O, Wernecke M, Smith N, Weintraub ES, Qian L. Mortality risk after COVID-19 vaccination: A self-controlled case series study. Vaccine 2024; 42:1731-1737. [PMID: 38388239 DOI: 10.1016/j.vaccine.2024.02.032] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 02/08/2024] [Accepted: 02/09/2024] [Indexed: 02/24/2024]
Abstract
BACKGROUND Although previous studies found no-increased mortality risk after COVID-19 vaccination, residual confounding bias might have impacted the findings. Using a modified self-controlled case series (SCCS) design, we assessed the risk of non-COVID-19 mortality, all-cause mortality, and four cardiac-related death outcomes after primary series COVID-19 vaccination. METHODS We analyzed all deaths between December 14, 2020, and August 11, 2021, among individuals from eight Vaccine Safety Datalink sites. Demographic characteristics of deaths in recipients of COVID-19 vaccines and unvaccinated individuals were reported. We conducted SCCS analyses by vaccine type and death outcomes and reported relative incidences (RI). The observation period for death spanned from the dates of emergency use authorization to the end of the study period (August 11, 2021) without censoring the observation period upon death. We pre-specified a primary risk interval of 28-day and a secondary risk interval of 14-day after each vaccination dose. Adjusting for seasonality in mortality analyses is crucial because death rates vary over time. Deaths among unvaccinated individuals were included in SCCS analyses to account for seasonality by incorporating calendar month in the models. RESULTS For Pfizer-BioNTech (BNT162b2), RIs of non-COVID-19 mortality, all-cause mortality, and four cardiac-related death outcomes were below 1 and 95 % confidence intervals (CIs) excluded 1 across both doses and both risk intervals. For Moderna (mRNA-1273), RI point estimates of all outcomes were below 1, although the 95 % CIs of two RI estimates included 1: cardiac-related (RI = 0.78, 95 % CI, 0.58-1.04) and non-COVID-19 cardiac-related mortality (RI = 0.80, 95 % CI, 0.60-1.08) 14 days after the second dose in individuals without pre-existing cancer and heart disease. For Janssen (Ad26.COV2.S), RIs of four cardiac-related death outcomes ranged from 0.94 to 0.98 for the 14-day risk interval, and 0.68 to 0.72 for the 28-day risk interval and 95 % CIs included 1. CONCLUSION Using a modified SCCS design and adjusting for temporal trends, no-increased risk was found for non-COVID-19 mortality, all-cause mortality, and four cardiac-related death outcomes among recipients of the three COVID-19 vaccines used in the US.
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Affiliation(s)
- Stanley Xu
- Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, United States; Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA, United States.
| | - Lina S Sy
- Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, United States
| | - Vennis Hong
- Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, United States
| | - Paddy Farrington
- School of Mathematics and Statistics, The Open University, Milton Keynes, UK
| | - Sungching C Glenn
- Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, United States
| | - Denison S Ryan
- Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, United States
| | - Abraelle M Shirley
- Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, United States
| | - Bruno J Lewin
- Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, United States
| | - Hung-Fu Tseng
- Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, United States
| | | | - Jason M Glanz
- Institute for Health Research, Kaiser Permanente Colorado, Denver, CO, United States; Department of Epidemiology, University of Colorado School of Public Health, Aurora, CO, United States
| | - Bruce Fireman
- Kaiser Permanente Vaccine Study Center, Kaiser Permanente Northern California, Oakland, CA, United States
| | - David L McClure
- Marshfield Clinic Research Institute, Marshfield, WI, United States
| | | | - Onchee Yu
- Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle, WA, United States
| | | | - Ning Smith
- Center for Health Research, Kaiser Permanente Northwest, Portland, OR, United States
| | - Eric S Weintraub
- Immunization Safety Office, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Lei Qian
- Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, United States
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2
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Janoff EN, Tseng HF, Nguyen JL, Alfred T, Vietri J, McDaniel A, Chilson E, Yan Q, Malhotra D, Isturiz RE, Levin MJ. Incidence and clinical outcomes of pneumonia in persons with down syndrome in the United States. Vaccine 2023; 41:4571-4578. [PMID: 37328350 DOI: 10.1016/j.vaccine.2023.05.063] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 05/04/2023] [Accepted: 05/26/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Persons with Down syndrome (DS) experience an increased risk of pneumonia. We determined the incidence and outcomes of pneumonia and relationship to underlying comorbidities in persons with and without DS in the United States. METHODS This retrospective matched cohort study used de-identified administrative claims data from Optum. Persons with DS were matched 1:4 to persons without DS on age, sex, and race/ethnicity. Pneumonia episodes were analyzed for incidence, rate ratios and 95 % confidence intervals, clinical outcomes, and comorbidities. RESULTS During 1-year follow-up among 33796 persons with and 135184 without DS, the incidence of all-cause pneumonia (pneumonia) was substantially higher among people with DS than those without DS (12427 vs. 2531 episodes/100000 person-years; 4.7-5.7 fold increase). Persons with DS and pneumonia were more likely to be hospitalized (39.4 % vs. 13.9 %) or admitted to the ICU (16.8 % vs. 4.8 %). Mortality was higher 1 year after first pneumonia (5.7 % vs. 2.4 %; P < 0.0001). Results were similar for episodes of pneumococcal pneumonia. Specific comorbidities were associated with pneumonia, particularly heart disease in children and neurologic disease in adults, which only partially mediated the effect of DS on pneumonia. CONCLUSIONS Among persons with DS, incidence of pneumonia and associated hospitalizations were increased; mortality among those with pneumonia was comparable at 30 days, but higher at 1 year. DS should be considered an independent risk condition for pneumonia.
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Affiliation(s)
- Edward N Janoff
- Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA; Denver Veterans Affairs Medical Center, Aurora, CO, USA.
| | - Hung-Fu Tseng
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - Jennifer L Nguyen
- Medical Development and Scientific/Clinical Affairs, Pfizer Vaccines, Collegeville, PA, USA
| | - Tamuno Alfred
- Statistical Research and Data Science Center, Pfizer Inc, New York, NY, USA
| | - Jeffrey Vietri
- Patient and Health Impact, Pfizer Inc, Collegeville, PA, USA
| | - Angee McDaniel
- Medical Development and Scientific/Clinical Affairs, Pfizer Vaccines, Collegeville, PA, USA
| | - Erica Chilson
- Medical Development and Scientific/Clinical Affairs, Pfizer Vaccines, Collegeville, PA, USA
| | - Qi Yan
- Medical Development and Scientific/Clinical Affairs, Pfizer Vaccines, Collegeville, PA, USA
| | - Deepa Malhotra
- Patient and Health Impact, Pfizer Inc, New York, NY, USA
| | - Raul E Isturiz
- Medical Development and Scientific/Clinical Affairs, Pfizer Vaccines, Collegeville, PA, USA
| | - Myron J Levin
- Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA; Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA
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Ackerson B, Bruxvoort K, Qian L, Sy LS, Tseng HF. Reply to Chu et al. J Infect Dis 2023; 227:466-467. [PMID: 35880546 DOI: 10.1093/infdis/jiac310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 07/20/2022] [Indexed: 02/04/2023] Open
Affiliation(s)
- Bradley Ackerson
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA
| | - Katia Bruxvoort
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Lei Qian
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA
| | - Lina S Sy
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA
| | - Hung-Fu Tseng
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA
- Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California, USA
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4
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Florea A, Sy LS, Ackerson BK, Qian L, Luo Y, Becerra-Culqui T, Lee GS, Tian Y, Zheng C, Bathala R, Tartof SY, Campora L, Ceregido MA, Kuznetsova A, Poirrier JE, Rosillon D, Valdes L, Cheuvart B, Mesaros N, Meyer N, Guignard A, Tseng HF. Investigating Tetanus, Diphtheria, Acellular Pertussis Vaccination During Pregnancy and Risk of Congenital Anomalies. Infect Dis Ther 2023; 12:411-423. [PMID: 36520325 PMCID: PMC9925651 DOI: 10.1007/s40121-022-00731-8] [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] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 11/14/2022] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION This observational retrospective matched cohort study evaluated the safety of a prenatal tetanus, diphtheria, acellular pertussis (Tdap) vaccination, Boostrix. We previously reported on the risk of maternal and neonatal outcomes; here we report on the risk of congenital anomalies in infants at birth through 6 months of age. METHODS The study included pregnant Kaiser Permanente Southern California members. Women who received the Tdap vaccine on or after the 27th week of pregnancy between January 2018 and January 2019 were matched to women who were pregnant between January 2012 and December 2014 and were not vaccinated with Tdap during pregnancy. Unadjusted and adjusted relative risks (aRRs) with 95% confidence intervals were estimated by Poisson regression. Quantitative secular trend analyses, from 2011 to 2017, were conducted on congenital anomalies with a statistically significant aRR > 1. RESULTS The analysis consisted of 16,350 and 16,088 live-born infants in the Tdap-exposed and unexposed cohorts, respectively. Of the 14 congenital anomaly body systems evaluated, 8 (eye, ear/face/neck, respiratory, upper gastrointestinal, genital, renal, musculoskeletal, integument) had statistically significant elevated aRRs, with point estimates ranging from 1.17 to 2.02. The observed elevated aRRs were consistent with their respective secular increases over time. CONCLUSION Cautious interpretation of these findings is warranted as these increases may have resulted from improved identification and diagnosis. Furthermore, the biological plausibility of an association between maternal vaccine exposure in the third trimester of pregnancy and birth defects is low. The overall study findings support the safety of maternal immunization with Boostrix during the third trimester of pregnancy. TRIAL REGISTRATION ClinicalTrials.gov identifier, NCT03463577.
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Affiliation(s)
- Ana Florea
- Department of Research and Evaluation, Southern California Permanente Medical Group, Kaiser Permanente Southern California, Kaiser Permanente, 100 S Los Robles Ave, 2nd Floor, Pasadena, CA, 91101, USA.
| | - Lina S Sy
- Department of Research and Evaluation, Southern California Permanente Medical Group, Kaiser Permanente Southern California, Kaiser Permanente, 100 S Los Robles Ave, 2nd Floor, Pasadena, CA, 91101, USA
| | - Bradley K Ackerson
- Pediatrics and Pediatric Infectious Diseases, Southern California Permanente Medical Group, Harbor City, CA, USA
| | - Lei Qian
- Department of Research and Evaluation, Southern California Permanente Medical Group, Kaiser Permanente Southern California, Kaiser Permanente, 100 S Los Robles Ave, 2nd Floor, Pasadena, CA, 91101, USA
| | - Yi Luo
- Department of Research and Evaluation, Southern California Permanente Medical Group, Kaiser Permanente Southern California, Kaiser Permanente, 100 S Los Robles Ave, 2nd Floor, Pasadena, CA, 91101, USA
| | - Tracy Becerra-Culqui
- Department of Research and Evaluation, Southern California Permanente Medical Group, Kaiser Permanente Southern California, Kaiser Permanente, 100 S Los Robles Ave, 2nd Floor, Pasadena, CA, 91101, USA
- Department of Occupational Therapy, California State University, Dominguez Hills, Carson, CA, USA
| | - Gina S Lee
- Department of Research and Evaluation, Southern California Permanente Medical Group, Kaiser Permanente Southern California, Kaiser Permanente, 100 S Los Robles Ave, 2nd Floor, Pasadena, CA, 91101, USA
| | - Yun Tian
- Department of Research and Evaluation, Southern California Permanente Medical Group, Kaiser Permanente Southern California, Kaiser Permanente, 100 S Los Robles Ave, 2nd Floor, Pasadena, CA, 91101, USA
- Pharmaceutical Product Development, Thermo Fisher Scientific, Wilmington, NC, USA
| | - Chengyi Zheng
- Department of Research and Evaluation, Southern California Permanente Medical Group, Kaiser Permanente Southern California, Kaiser Permanente, 100 S Los Robles Ave, 2nd Floor, Pasadena, CA, 91101, USA
| | - Radha Bathala
- Department of Research and Evaluation, Southern California Permanente Medical Group, Kaiser Permanente Southern California, Kaiser Permanente, 100 S Los Robles Ave, 2nd Floor, Pasadena, CA, 91101, USA
| | - Sara Y Tartof
- Department of Research and Evaluation, Southern California Permanente Medical Group, Kaiser Permanente Southern California, Kaiser Permanente, 100 S Los Robles Ave, 2nd Floor, Pasadena, CA, 91101, USA
- Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA, USA
| | | | | | | | | | | | | | | | - Narcisa Mesaros
- GSK Vaccines, Wavre, Belgium
- The Janssens Pharmaceutical Companies of Johnson & Johnson, Beerse, Belgium
| | | | | | - Hung-Fu Tseng
- Department of Research and Evaluation, Southern California Permanente Medical Group, Kaiser Permanente Southern California, Kaiser Permanente, 100 S Los Robles Ave, 2nd Floor, Pasadena, CA, 91101, USA
- Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA, USA
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Xu S, Huang R, Sy LS, Hong V, Glenn SC, Ryan DS, Morrissette K, Vazquez-Benitez G, Glanz JM, Klein NP, Fireman B, McClure D, Liles EG, Weintraub ES, Tseng HF, Qian L. A safety study evaluating non-COVID-19 mortality risk following COVID-19 vaccination. Vaccine 2023; 41:844-854. [PMID: 36564276 PMCID: PMC9763207 DOI: 10.1016/j.vaccine.2022.12.036] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 12/12/2022] [Accepted: 12/15/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND The safety of COVID-19 vaccines plays an important role in addressing vaccine hesitancy. We conducted a large cohort study to evaluate the risk of non-COVID-19 mortality after COVID-19 vaccination while adjusting for confounders including individual-level demographics, clinical risk factors, health care utilization, and community-level socioeconomic risk factors. METHODS The retrospective cohort study consisted of members from seven Vaccine Safety Datalink sites from December 14, 2020 through August 31, 2021. We conducted three separate analyses for each of the three COVID-19 vaccines used in the US. Crude non-COVID-19 mortality rates were reported by vaccine type, age, sex, and race/ethnicity. The counting process model for survival analyses was used to analyze non-COVID-19 mortality where a new observation period began when the vaccination status changed upon receipt of the first dose and the second dose. We used calendar time as the basic time scale in survival analyses to implicitly adjust for season and other temporal trend factors. A propensity score approach was used to adjust for the potential imbalance in confounders between the vaccinated and comparison groups. RESULTS For each vaccine type and across age, sex, and race/ethnicity groups, crude non-COVID-19 mortality rates among COVID-19 vaccinees were lower than those among comparators. After adjusting for confounders with the propensity score approach, the adjusted hazard ratios (aHRs) were 0.46 (95% confidence interval [CI], 0.44-0.49) after dose 1 and 0.48 (95% CI, 0.46-0.50) after dose 2 of the BNT162b2 vaccine, 0.41 (95% CI, 0.39-0.44) after dose 1 and 0.38 (95% CI, 0.37-0.40) after dose 2 of the mRNA-1273 vaccine, and 0.55 (95% CI, 0.51-0.59) after receipt of Ad26.COV2.S. CONCLUSION While residual confounding bias remained after adjusting for several individual-level and community-level risk factors, no increased risk was found for non-COVID-19 mortality among recipients of three COVID-19 vaccines used in the US.
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Affiliation(s)
- Stanley Xu
- Research and Evaluation, Kaiser Permanente Southern California, 100 S Los Robles, Pasadena, CA 91101, USA.
| | - Runxin Huang
- Research and Evaluation, Kaiser Permanente Southern California, 100 S Los Robles, Pasadena, CA 91101, USA
| | - Lina S. Sy
- Research and Evaluation, Kaiser Permanente Southern California, 100 S Los Robles, Pasadena, CA 91101, USA
| | - Vennis Hong
- Research and Evaluation, Kaiser Permanente Southern California, 100 S Los Robles, Pasadena, CA 91101, USA
| | - Sungching C. Glenn
- Research and Evaluation, Kaiser Permanente Southern California, 100 S Los Robles, Pasadena, CA 91101, USA
| | - Denison S. Ryan
- Research and Evaluation, Kaiser Permanente Southern California, 100 S Los Robles, Pasadena, CA 91101, USA
| | - Kerresa Morrissette
- Research and Evaluation, Kaiser Permanente Southern California, 100 S Los Robles, Pasadena, CA 91101, USA
| | | | - Jason M. Glanz
- Institute for Health Research, Kaiser Permanente Colorado, 10065 E. Harvard Suite 300 Denver, CO 8023, USA
| | - Nicola P. Klein
- Kaiser Permanente Vaccine Study Center, Kaiser Permanente Northern California, 1 Kaiser Plaza 16th Floor, Oakland, CA 94612, USA
| | - Bruce Fireman
- Kaiser Permanente Vaccine Study Center, Kaiser Permanente Northern California, 1 Kaiser Plaza 16th Floor, Oakland, CA 94612, USA
| | - David McClure
- Marshfield Clinic Research Institute, 1000 N Oak Ave, Marshfield, WI 54449, USA
| | - Elizabeth G. Liles
- Center for Health Research, Kaiser Permanente Northwest, 3800 N. Interstate Ave, Portland, OR 97227, USA
| | - Eric S. Weintraub
- Immunization Safety Office, Centers for Disease Control and Prevention, 1600 Clifton Road NE Atlanta, GA 30333, USA
| | - Hung-Fu Tseng
- Research and Evaluation, Kaiser Permanente Southern California, 100 S Los Robles, Pasadena, CA 91101, USA
| | - Lei Qian
- Research and Evaluation, Kaiser Permanente Southern California, 100 S Los Robles, Pasadena, CA 91101, USA
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6
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Nelson JC, Ulloa-Pérez E, Yu O, Cook AJ, Jackson ML, Belongia EA, Daley MF, Harpaz R, Kharbanda EO, Klein NP, Naleway AL, Tseng HF, Weintraub ES, Duffy J, Yih WK, Jackson LA. Active Postlicensure Safety Surveillance for Recombinant Zoster Vaccine Using Electronic Health Record Data. Am J Epidemiol 2022; 192:205-216. [PMID: 36193854 PMCID: PMC9896469 DOI: 10.1093/aje/kwac170] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 07/28/2022] [Accepted: 09/30/2022] [Indexed: 02/06/2023] Open
Abstract
Recombinant zoster vaccine (RZV) (Shingrix; GlaxoSmithKline, Brentford, United Kingdom) is an adjuvanted glycoprotein vaccine that was licensed in 2017 to prevent herpes zoster (shingles) and its complications in older adults. In this prospective, postlicensure Vaccine Safety Datalink study using electronic health records, we sequentially monitored a real-world population of adults aged ≥50 years who received care in multiple US Vaccine Safety Datalink health systems to identify potentially increased risks of 10 prespecified health outcomes, including stroke, anaphylaxis, and Guillain-Barré syndrome (GBS). Among 647,833 RZV doses administered from January 2018 through December 2019, we did not detect a sustained increased risk of any monitored outcome for RZV recipients relative to either historical (2013-2017) recipients of zoster vaccine live, a live attenuated virus vaccine (Zostavax; Merck & Co., Inc., Kenilworth, New Jersey), or contemporary non-RZV vaccine recipients who had an annual well-person visit during the 2018-2019 study period. We confirmed prelicensure trial findings of increased risks of systemic and local reactions following RZV. Our study provides additional reassurance about the overall safety of RZV. Despite a large sample, uncertainty remains regarding potential associations with GBS due to the limited number of confirmed GBS cases that were observed.
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Affiliation(s)
- Jennifer C Nelson
- Correspondence to Dr. Jennifer C. Nelson, Biostatistics Division, Kaiser Permanente Washington Health Research Institute, 1730 Minor Avenue, Suite 1600, Seattle, WA 98101 (e-mail: )
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7
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Xu S, Huang R, Sy LS, Glenn SC, Ryan DS, Morrissette K, Shay DK, Vazquez-Benitez G, Glanz JM, Klein NP, McClure D, Liles EG, Weintraub ES, Tseng HF, Qian L. COVID-19 Vaccination and Non-COVID-19 Mortality Risk - Seven Integrated Health Care Organizations, United States, December 14, 2020-July 31, 2021. MMWR Morb Mortal Wkly Rep 2021; 70:1520-1524. [PMID: 34710075 PMCID: PMC8553028 DOI: 10.15585/mmwr.mm7043e2] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
By September 21, 2021, an estimated 182 million persons in the United States were fully vaccinated against COVID-19.* Clinical trials indicate that Pfizer-BioNTech (BNT162b2), Moderna (mRNA-1273), and Janssen (Johnson & Johnson; Ad.26.COV2.S) vaccines are effective and generally well tolerated (1-3). However, daily vaccination rates have declined approximately 78% since April 13, 2021†; vaccine safety concerns have contributed to vaccine hesitancy (4). A cohort study of 19,625 nursing home residents found that those who received an mRNA vaccine (Pfizer-BioNTech or Moderna) had lower all-cause mortality than did unvaccinated residents (5), but no studies comparing mortality rates within the general population of vaccinated and unvaccinated persons have been conducted. To assess mortality not associated with COVID-19 (non-COVID-19 mortality) after COVID-19 vaccination in a general population setting, a cohort study was conducted during December 2020-July 2021 among approximately 11 million persons enrolled in seven Vaccine Safety Datalink (VSD) sites.§ After standardizing mortality rates by age and sex, this study found that COVID-19 vaccine recipients had lower non-COVID-19 mortality than did unvaccinated persons. After adjusting for demographic characteristics and VSD site, this study found that adjusted relative risk (aRR) of non-COVID-19 mortality for the Pfizer-BioNTech vaccine was 0.41 (95% confidence interval [CI] = 0.38-0.44) after dose 1 and 0.34 (95% CI = 0.33-0.36) after dose 2. The aRRs of non-COVID-19 mortality for the Moderna vaccine were 0.34 (95% CI = 0.32-0.37) after dose 1 and 0.31 (95% CI = 0.30-0.33) after dose 2. The aRR after receipt of the Janssen vaccine was 0.54 (95% CI = 0.49-0.59). There is no increased risk for mortality among COVID-19 vaccine recipients. This finding reinforces the safety profile of currently approved COVID-19 vaccines in the United States.
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8
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Ackerson B, Tseng HF. Reply to Johnson. J Infect Dis 2021; 224:554-555. [PMID: 33244580 DOI: 10.1093/infdis/jiaa733] [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] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 11/24/2020] [Indexed: 11/14/2022] Open
Affiliation(s)
- Bradley Ackerson
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA
| | - Hung-Fu Tseng
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA
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9
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Hause AM, Panagiotakopoulos L, Weintraub ES, Sy LS, Glenn SC, Tseng HF, McNeil MM. Adverse Outcomes in Pregnant Women Hospitalized With Respiratory Syncytial Virus Infection: A Case Series. Clin Infect Dis 2021; 72:138-140. [PMID: 32484508 DOI: 10.1093/cid/ciaa668] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 03/24/2020] [Accepted: 05/27/2020] [Indexed: 11/12/2022] Open
Abstract
We identified 10 women hospitalized with respiratory syncytial virus infection during pregnancy. Diagnoses included pneumonia/atelectasis (5), respiratory failure (2), and sepsis (2). Six had obstetrical complications during hospitalization, including 1 induced preterm birth. One required intensive care unit admission and mechanical ventilation. Four infants had complications at birth.
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Affiliation(s)
- Anne M Hause
- Immunization Safety Office, Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.,Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Lakshmi Panagiotakopoulos
- Immunization Safety Office, Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Eric S Weintraub
- Immunization Safety Office, Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Lina S Sy
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California
| | - Sungching C Glenn
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California
| | - Hung-Fu Tseng
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California
| | - Michael M McNeil
- Immunization Safety Office, Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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10
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Ackerson B, An J, Sy LS, Solano Z, Slezak J, Tseng HF. Cost of Hospitalization Associated With Respiratory Syncytial Virus Infection Versus Influenza Infection in Hospitalized Older Adults. J Infect Dis 2021; 222:962-966. [PMID: 32300806 DOI: 10.1093/infdis/jiaa183] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [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: 01/24/2020] [Accepted: 04/15/2020] [Indexed: 12/13/2022] Open
Abstract
Despite the severity of respiratory syncytial virus (RSV) disease in older adults, data on its costs are limited. We compared hospitalization costs for 2090 adults aged ≥ 60 years hospitalized with RSV or influenza by assigning direct health care costs. Hospitalization with RSV was associated with longer hospitalization and increased frequency of diagnosis-related groups for pulmonary complications, resulting in costs at least as great as those for influenza ($16 034 vs $15 163; 95% confidence interval for the difference, -$811 to $2547). Awareness of RSV disease burden in adults is needed to facilitate vaccination and treatment when they become available.
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Affiliation(s)
- Bradley Ackerson
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA
| | - Jaejin An
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA
| | - Lina S Sy
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA
| | - Zendi Solano
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA
| | - Jeff Slezak
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA
| | - Hung-Fu Tseng
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA
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Tseng HF, Qian L, Wu J, Luo Y, Sy LS, Bruxvoort K, Ackerson B. 19. Completion of Two-Dose Recombinant Zoster Vaccine Series in Adults 50 Years and Older. Open Forum Infect Dis 2020. [PMCID: PMC7776052 DOI: 10.1093/ofid/ofaa439.064] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background In 2017, the Advisory Committee on Immunization Practices preferentially recommended adjuvanted recombinant zoster vaccine (RZV) for adults ≥ 50 years as a two-dose series 2–6 months apart.1 We evaluated two-dose RZV completion and factors associated with completion. Methods The study included Kaiser Permanente Southern California members ≥ 50 years who received an RZV dose during April-November 2018 and had continuous membership 12 months before to 9 months after the 1st RZV dose (RZV1). Completion was defined as receipt of the 2nd dose ≥4 weeks to 9 months after RZV1 (allowing a 3-month grace period). Characteristics including age at RZV1, sex, race/ethnicity, Medicaid status, neighborhood level income and education, distance from home to medical office, comorbidities, history of herpes zoster, health care utilization before and after RZV1, receipt of influenza vaccine, vaccination month (supply shortage proxy), concomitant vaccine, department administering RZV1, medical center, and medically attended local or systemic reaction, pain, or gout after RZV1 were compared between completers and non-completers. Adjusted odds ratios (aOR) and 95% confidence intervals (CI) for factors associated with completion were estimated by multivariable logistic regression. Results Among 31,120 RZV1 recipients, 67.2% completed the series within 9 months. In adjusted analyses, higher completion was associated with White compared with Black or Hispanic race/ethnicity, higher neighborhood income and education, no chronic pulmonary disease, diabetes, or dementia, more outpatient visits and fewer emergency department visits before or after RZV1, no hospitalizations after RZV1, receipt of influenza vaccine, receipt of RZV1 in June-November rather than April-May 2018, no concomitant vaccine with RZV1, and receipt of RZV1 in Family Practice rather than Internal Medicine. Systemic reactions or pain after RZV1 was not associated with completion. Table 2. RZV Series Completion by Selected Characteristics During Follow-up of Members Aged ≥50 Years Who Received at Least One Dose of RZV at Kaiser Permanente Southern California in April-November 2018 ![]()
Table 2. RZV Series Completion by Selected Characteristics During Follow-up of Members Aged ≥ 50 Years Who Received at Least One Dose of RZV at KPSC in April-November 2018 ![]()
Figure 1. Factors Associated with RZV Series Completion of Members Aged ≥ 50 Years Who Received at Least One Dose of RZV at KPSC in April-November 2018 ![]()
Conclusion Completion of RZV series appears moderate in the early phase of implementation. Despite similar accessibility in a health care system, completion varied by race/ethnicity, socioeconomic status, health status, and care seeking behavior, suggesting areas to target for improvement. Disclosures Hung-Fu Tseng, MPH, PhD, GlaxoSmithKlein (Research Grant or Support) Lei Qian, PhD, GlaxoSmithKlein (Research Grant or Support) Jun Wu, MD, MS, GlaxoSmithKlein (Research Grant or Support) Yi Luo, PhD, GlaxoSmithKlein (Research Grant or Support) Lina S. Sy, MPH, GlaxoSmithKlein (Research Grant or Support) Katia Bruxvoort, PhD, MPH, GlaxoSmithKlein (Research Grant or Support) Bradley Ackerson, MD, GlasoSmithKlein (Research Grant or Support)
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Affiliation(s)
- Hung-Fu Tseng
- Kaiser Permanente Southtern California, Pasadena, California
| | - Lei Qian
- Kaiser Permanente Southern California, Pasadena, California
| | - Jun Wu
- Kaiser Permanente Southern California, Pasadena, California
| | - Yi Luo
- Kaiser Permanente Southern California, Pasadena, California
| | - Lina S Sy
- Kaiser Permanente Southern California, Pasadena, California
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Patterson BJ, Herring WL, Van Oorschot D, Curran D, Carrico J, Zhang Y, Ackerson BK, Bruxvoort K, Sy LS, Tseng HF. Incremental clinical and economic impact of recombinant zoster vaccination: real-world data in a budget impact model. J Manag Care Spec Pharm 2020; 26:1567-1575. [PMID: 33043821 PMCID: PMC10391059 DOI: 10.18553/jmcp.2020.20251] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND In 2017, the FDA approved the adjuvanted recombinant zoster vaccine (RZV) for the prevention of herpes zoster (HZ) in immunocompetent adults aged 50 years and older. RZV joined zoster vaccine live (ZVL) as U.S.-marketed vaccines against HZ. The Advisory Committee on Immunization Practices preferentially recommended use of RZV over ZVL. In order to inform population-based decision makers (PBDMs) about the incremental clinical and economic impact of RZV adoption, budget impact (BI) models may be used. Populating such models with national data can inform PBDMs about the incremental value of RZV adoption nationally; however, heterogeneity across health plans requires the inclusion of plan-specific data to ensure the relevance of modeling outcomes for plan-specific decision makers. OBJECTIVE To investigate the clinical and economic outcomes associated with the adoption of RZV in nationally representative populations with commercial and Medicare coverage and to demonstrate the effect of the heterogeneity of health plans using real-world data from a large, integrated delivery network (IDN). METHODS We used a publicly available BI model. The model accounts for national and IDN-collected population characteristics (size, age distribution) and epidemiological data (incidence of HZ and complications, HZ recurrence rate), vaccine characteristics from randomized controlled trials and observational studies (efficacy, waning, second dose compliance for RZV, adverse event rate), national costs (vaccine, direct medical for HZ, complications, and vaccine adverse events), and current and anticipated vaccine coverage. We assessed incremental clinical (HZ cases and complications) and economic (per-member-per-month [PMPM] costs) impact at 5-year to 15-year time horizons, comparing scenarios where RZV is solely implemented with one where only ZVL is utilized. RESULTS Following the adoption of RZV, the incremental HZ cases avoided over 5 and 15 years were estimated to be 1,800 and 15,000 for a commercial plan, 3,800 and 21,000 for a Medicare plan, and 8,600 and 71,000 for a specific IDN. The incremental PMPM budget impact over the same time horizons was estimated to be $0.42 and $0.31, respectively, for a commercial plan, $0.35 and $0.10 for a Medicare plan, and $0.39 and $0.25 for a specific IDN. The differences in results across plans resulted from the population age distribution, the vaccine copay (applied in the Medicare scenario only), the vaccine coverage in the plan, and other plan-specific factors affecting disease epidemiology and costs per case of HZ. CONCLUSIONS Model projections indicated that RZV adoption avoided HZ cases and related complications, with the PMPM budget impact dependent on plan-specific factors. As health gains increased over time, the incremental costs incurred were found to decrease as the shorter-term costs of adopting the new vaccine were increasingly offset by the longer-term benefits of vaccination. DISCLOSURES GlaxoSmithKline Biologicals SA funded this study (GSK study identifier: HO-17-18378) and was involved in all stages of study conduct, including analysis of the data. GlaxoSmithKline Biologicals SA also paid all costs associated with the development and publication of this manuscript. Patterson, Van Oorschot, and Curran are employees of the GSK group of companies and hold shares in the GSK group of companies. Herring, Carrico, and Zhang are employees of RTI Health Solutions, which received funding via a contractual agreement with the GSK group of companies to perform the work contributing to this research. Ackerson, Bruxvoort, Sy, and Tseng are employees of Kaiser Permanente Southern California, which was contracted by the GSK group of companies for the conduct of this study and were members of the KPSC study team. Ackerson, Bruxvoort, Sy, and Tseng report research contracts with the following pharmaceutical companies unrelated to this study: Dynavax (Ackerson, Bruxvoort, and Sy); the GSK group of companies (Ackerson, Bruxvoort, Sy, and Tseng); Novavax (Ackerson, Sy, and Tseng); and Seqirus (Ackerson, Bruxvoort, Sy, and Tseng). Tseng reports having served as a paid consultant for the GSK group of companies. The authors declare no other financial and nonfinancial relationships and activities. Findings from this study were presented at AMCP Nexus 2019; October 29-November 1, 2019; National Harbor, MD.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Lina S Sy
- Kaiser Permanente Southern California, Pasadena
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13
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Jensen NJ, Depledge DP, Ng TFF, Leung J, Quinlivan M, Radford KW, Folster J, Tseng HF, LaRussa P, Jacobsen SJ, Breuer J, Schmid DS. Analysis of the reiteration regions (R1 to R5) of varicella-zoster virus. Virology 2020; 546:38-50. [PMID: 32452416 DOI: 10.1016/j.virol.2020.03.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 01/06/2020] [Revised: 03/12/2020] [Accepted: 03/31/2020] [Indexed: 10/24/2022]
Abstract
The varicella-zoster virus (VZV) genome, comprises both unique and repeated regions. The genome also includes reiteration regions, designated R1 to R5, which are tandemly repeating sequences termed elements. These regions represent an understudied feature of the VZV genome. The R4 region is duplicated, with one copy in the internal repeat short (IRs) which we designated R4A and a second copy in the terminal repeat short (TRs) termed R4B. We developed primers to amplify and Sanger sequence these regions, including independent amplification of both R4 regions. Reiteration regions from >80 cases of PCR-confirmed shingles were sequenced and analyzed. Complete genome sequences for the remaining portions of these viruses were determined using Illumina MiSeq. We identified 28 elements not previously reported, including at least one element for each R region. Length heterogeneity was substantial in R3, R4A and R4B. Length heterogeneity between the two copies of R4 was common.
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Affiliation(s)
- Nancy J Jensen
- Division of Viral Diseases, National Center for Immunizations and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Daniel P Depledge
- Division of Infection and Immunity, University College London, London, United Kingdom; Department of Microbiology, New York University School of Medicine, New York, NY, USA
| | - Terry Fei Fan Ng
- Division of Viral Diseases, National Center for Immunizations and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Jessica Leung
- Division of Viral Diseases, National Center for Immunizations and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Mark Quinlivan
- Division of Viral Diseases, National Center for Immunizations and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Kay W Radford
- Division of Viral Diseases, National Center for Immunizations and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Jennifer Folster
- Division of Viral Diseases, National Center for Immunizations and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Hung-Fu Tseng
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - Philip LaRussa
- Department of Pediatrics, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Steven J Jacobsen
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - Judith Breuer
- Division of Infection and Immunity, University College London, London, United Kingdom
| | - D Scott Schmid
- Division of Viral Diseases, National Center for Immunizations and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA.
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Hechter RC, Qian L, Yan S, Luo Y, Krishnarajah G, Tseng HF. Impact of the change of copay policy in Medicare Part D on zoster vaccine uptake among Medicare beneficiaries in a managed care organization. BMC Health Serv Res 2017; 17:503. [PMID: 28732518 PMCID: PMC5521141 DOI: 10.1186/s12913-017-2441-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [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: 03/08/2017] [Accepted: 07/10/2017] [Indexed: 11/10/2022] Open
Abstract
Background Kaiser Permanente Southern California (KPSC) adopted the Medicare Part D Tier-6 with zero patient copay for zoster vaccination in 2012. We assessed the impact of the implementation on zoster vaccination rate (GSK study identifier: HO-13-14,182). Methods Zoster vaccination rate was examined among an open cohort of ≥65-year-old Medicare Part D beneficiaries during 01/01/2008–06/30/2014, compared to ≥65-year-old commercial health plan members and 60–64-year-old members. The demographics, vaccination records, and insurance and benefit type were confirmed through KPSC electronic medical record databases. Person-time based vaccination rate was calculated for each observation interval (calendar month or year). The changes in annual rates in one year pre- (2011) and post- (2012) Tier-6 implementation were compared in a difference-in-difference analysis. Linear spline Poisson regression models were fitted to compare the secular trend of monthly rates during pre and post Tier-6 implementation (01/2012). Results Zoster vaccination rate increased in Medicare Part D beneficiaries after the implementation of zero copay. The increase in annual vaccination rate from 2011 to 2012 was marginally higher in Medicare Part D beneficiaries but not statistically significant (difference in rate ratio [RR] = 0.04, p > 0.05) compared to commercial health plan members. Among non-Hispanic white members, the difference of RR was 0.09 (p = 0.020) between Medicare Part D beneficiaries and ≥65-year-old commercial plan members, and it was 0.08 (p = 0.034) compared to 60–64-year-old commercial plan members. In secular trend analysis, we did not observe significant increase in overall and race stratified zoster vaccination rate attributable to the implementation of the Tier-6. Conclusions The impact of Tier-6 on zoster vaccination was not substantial in elderly Medicare Part D beneficiaries in this population where a lower than average copay ($20 to $40) was applied prior to the Tier-6 implementation. Further research is necessary to explore the numerical relationship between vaccination and amount of copay. Trial registration GSK study identifier: HO-13-14,182. Electronic supplementary material The online version of this article (doi:10.1186/s12913-017-2441-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Rulin C Hechter
- Department of Research & Evaluation, Kaiser Permanente Southern California, 100 South Los Robles Avenue, 2nd Floor, Pasadena, CA, 91101, USA
| | - Lei Qian
- Department of Research & Evaluation, Kaiser Permanente Southern California, 100 South Los Robles Avenue, 2nd Floor, Pasadena, CA, 91101, USA
| | - Songkai Yan
- US Health Outcomes & Epidemiology - Vaccines, GSK, 5 Crescent Drive, Philadelphia, PA, 19112, USA.,CSL Behring, 1020 First Avenue, King of Prussia, PA, 19406, USA
| | - Yi Luo
- Department of Research & Evaluation, Kaiser Permanente Southern California, 100 South Los Robles Avenue, 2nd Floor, Pasadena, CA, 91101, USA
| | - Girishanthy Krishnarajah
- US Health Outcomes & Epidemiology - Vaccines, GSK, 5 Crescent Drive, Philadelphia, PA, 19112, USA.,CSL Behring, 1020 First Avenue, King of Prussia, PA, 19406, USA
| | - Hung-Fu Tseng
- Department of Research & Evaluation, Kaiser Permanente Southern California, 100 South Los Robles Avenue, 2nd Floor, Pasadena, CA, 91101, USA.
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Hsia SCV, Chen LH, Tseng HF. Receipt of thyroid hormone deficiency treatment and risk of herpes zoster. Int J Infect Dis 2017; 59:90-95. [PMID: 28450196 DOI: 10.1016/j.ijid.2017.04.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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: 03/15/2017] [Revised: 04/11/2017] [Accepted: 04/13/2017] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE Thyroid hormone (TH) has been suggested to control herpes virus gene expression and replication in neurons via epigenetics through its nuclear receptors. It has previously been shown that patients with hypothyroidism are predisposed to herpes zoster (HZ), suggesting that the TH deficiency may be a risk factor for varicella zoster virus (VZV) reactivation. The aim of this study was to test the hypothesis that TH treatment will ameliorate the complication of HZ. METHODS This study investigated the hypothesis by enquiring into a comprehensive medical database at Kaiser Permanente Southern California (KPSC) to verify whether patients taking TH medication experience a reduction in HZ occurrence. RESULTS It was shown by Kaplan-Meier analysis that hypothyroidism patients taking TH medicines had a lower risk of HZ. The fully adjusted analysis indicated that patients receiving medication for the treatment of TH deficiency exhibited a reduced risk of HZ (hazard ratio 0.60, 95% confidence interval 0.51-0.71). This lower risk of HZ was significant in all age groups except the 18-39 years cohort. In addition, female patients taking TH treatment exhibited a lower risk than their male counterparts. CONCLUSIONS Together these findings support the hypothesis that a constant level of TH will provide a degree of protection from contracting HZ. More studies are underway to evaluate the laboratory data for an analysis of hormonal effects on individuals.
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Affiliation(s)
- Shao-Chung V Hsia
- Department of Pharmaceutical Sciences, School of Pharmacy and Health Professions, University of Maryland, Eastern Shore, Princess Anne, MD 21853, USA.
| | - Lie Hong Chen
- Department of Research and Evaluation, Kaiser Permanente Research, 100 S. Los Robles Ave, 2nd Floor, Pasadena, CA 91101, USA
| | - Hung-Fu Tseng
- Department of Research and Evaluation, Kaiser Permanente Research, 100 S. Los Robles Ave, 2nd Floor, Pasadena, CA 91101, USA.
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16
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Ackerson B, Hechter R, Sidell M, Sy LS, Slezak J, Chao C, Patel N, Tseng HF, Jacobsen S. Human papillomavirus vaccine series completion in boys before and after recommendation for routine immunization. Vaccine 2017; 35:897-902. [DOI: 10.1016/j.vaccine.2017.01.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Revised: 12/23/2016] [Accepted: 01/03/2017] [Indexed: 02/03/2023]
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Tseng HF, Sy LS, Ackerson BK, Hechter RC, Tartof SY, Haag M, Slezak JM, Luo Y, Fischetti CA, Takhar HS, Miao Y, Cunnington M, Solano Z, Jacobsen SJ. Safety of Quadrivalent Meningococcal Conjugate Vaccine in 11- to 21-Year-Olds. Pediatrics 2017; 139:peds.2016-2084. [PMID: 28025240 DOI: 10.1542/peds.2016-2084] [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] [Accepted: 10/03/2016] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Meningococcal conjugate vaccination is recommended in the United States. This study evaluates the safety of quadrivalent meningococcal conjugate vaccine in a cohort aged 11 to 21 years. METHODS This cohort study with self-controlled case-series analysis was conducted at Kaiser Permanente Southern California. Individuals receiving MenACWY-CRM, a quadrivalent meningococcal conjugate vaccine, during September 30, 2011 to June 30, 2013, were included. Twenty-six prespecified events of interest (EOIs), including neurologic, rheumatologic, hematologic, endocrine, renal, pediatric, and pediatric infectious disease EOIs, were identified through electronic health records 1 year after vaccination. Of these, 16 were reviewed by case review committees. Specific risk and comparison windows after vaccination were predefined for each EOI. The relative incidence (RI) and 95% confidence intervals (CIs) were estimated through conditional Poisson regression models, adjusted for seasonality. RESULTS This study included 48 899 vaccinated individuals. No cases were observed in the risk window for 14 of 26 EOIs. The RI for Bell's palsy, a case review committee-reviewed EOI, was statistically significant (adjusted RI: 2.9, 95% CI: 1.1-7.5). Stratified analyses demonstrated an increased risk for Bell's palsy in subjects receiving concomitant vaccines (RI = 5.0, 95% CI = 1.4-17.8), and no increased risk for those without concomitant vaccine (RI = 1.1, 95% CI = 0.2-5.5). CONCLUSIONS We observed a temporal association between occurrence of Bell's palsy and receipt of MenACWY-CRM concomitantly with other vaccines. The association needs further investigation as it could be due to chance, concomitant vaccination, or underlying medical history predisposing to Bell's palsy.
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Affiliation(s)
- Hung-Fu Tseng
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California;
| | - Lina S Sy
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California
| | - Bradley K Ackerson
- Pediatrics and Pediatric Infectious Diseases, Southern California Permanente Medical Group, Harbor City, California
| | - Rulin C Hechter
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California
| | - Sara Y Tartof
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California
| | - Mendel Haag
- Seqirus Netherlands B.V., Amsterdam, Netherlands
| | - Jeffrey M Slezak
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California
| | - Yi Luo
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California
| | - Christine A Fischetti
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California
| | - Harp S Takhar
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California
| | - Yan Miao
- GlaxoSmithKline B.V., Amsterdam, Netherlands; and
| | | | - Zendi Solano
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California
| | - Steven J Jacobsen
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California
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18
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Cheetham TC, Marcy SM, Tseng HF, Sy LS, Liu ILA, Bixler F, Baxter R, Donahue JG, Naleway AL, Jacobsen SJ. Risk of Herpes Zoster and Disseminated Varicella Zoster in Patients Taking Immunosuppressant Drugs at the Time of Zoster Vaccination. Mayo Clin Proc 2015; 90:865-73. [PMID: 26051268 DOI: 10.1016/j.mayocp.2015.04.021] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [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: 01/30/2015] [Accepted: 04/29/2015] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To determine the risks associated with zoster vaccine when administered to patients taking immunosuppressant medications. PATIENTS AND METHODS Patients enrolled in 1 of 7 managed care organizations affiliated with the Vaccine Safety Datalink between January 1, 2006, and December 31, 2009, were eligible. The exposure of interest was zoster vaccination in patients with current or remote immunosuppressant drug use. The primary outcomes were disseminated varicella zoster virus (VZV) and herpes zoster in the 42 days after vaccination. Automated data were collected on immunosuppressant drugs and baseline medical conditions. A logistic regression model using inverse probability treatment weights was used to estimate the odds of developing VZV or herpes zoster. RESULTS A total of 14,554 individuals had an immunosuppressant medication dispensed around the time of vaccination, including 4826 with current use and 9728 with remote use. Most patients were taking low-dose corticosteroids. No cases of disseminated VZV were found in the current or remote users. The risk of herpes zoster was elevated in the 42 days after vaccination in current vs remote users (adjusted odds ratio, 2.99; 95% CI, 1.58-5.70). CONCLUSION We found that patients taking immunosuppressant medications at the time of vaccination had a modest increased risk of herpes zoster in the 42 days after vaccination. The development of herpes zoster within 42 days after vaccination suggests that this is more likely due to reactivation of latent zoster virus than dissemination of the vaccine-derived varicella virus. These findings support the current zoster vaccination guidelines.
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Affiliation(s)
- T Craig Cheetham
- Research and Evaluation, Kaiser Permanente Southern California, Pasadena.
| | - S Michael Marcy
- Research and Evaluation, Kaiser Permanente Southern California, Pasadena
| | - Hung-Fu Tseng
- Research and Evaluation, Kaiser Permanente Southern California, Pasadena
| | - Lina S Sy
- Research and Evaluation, Kaiser Permanente Southern California, Pasadena
| | - In-Lu Amy Liu
- Research and Evaluation, Kaiser Permanente Southern California, Pasadena
| | - Felicia Bixler
- Research and Evaluation, Kaiser Permanente Southern California, Pasadena
| | - Roger Baxter
- Division of Research, Kaiser Permanente Northern California, Oakland
| | | | | | - Steven J Jacobsen
- Research and Evaluation, Kaiser Permanente Southern California, Pasadena
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19
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Tseng HF, Liu A, Sy L, Marcy SM, Fireman B, Weintraub E, Baggs J, Weinmann S, Baxter R, Nordin J, Daley MF, Jackson L, Jacobsen SJ. Safety of zoster vaccine in adults from a large managed-care cohort: a Vaccine Safety Datalink study. J Intern Med 2012; 271:510-20. [PMID: 22026504 DOI: 10.1111/j.1365-2796.2011.02474.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [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] [Indexed: 10/16/2022]
Abstract
OBJECTIVES The aim of this study was to examine a large cohort of adults who received the zoster vaccine for evidence of an increased risk of prespecified adverse events requiring medical attention. DESIGN Two self-comparison approaches, including a case-centred approach and a self-controlled case series (SCCS) analysis were used. SETTING Eight managed-care organizations participating in the Vaccine Safety Datalink project in the United States. SUBJECTS A total of 193 083 adults aged 50 and older receiving a zoster vaccine from 1 January 2007 to 31 December 2008 were included. MAIN OUTCOME MEASURES Prespecified adverse events were identified by aggregated International Classification of Diseases, Ninth Revision (ICD-9) codes in automated health plan datasets. RESULTS The risk of allergic reaction was significantly increased within 1-7 days of vaccination [relative risk = 2.13, 95% confidence interval (CI): 1.87-2.40 by case-centred method and relative rate = 2.32, 95% CI: 1.85-2.91 by SCCS]. No increased risk was found for the following adverse event groupings: cerebrovascular events; cardiovascular events; meningitis; encephalitis; and encephalopathy; and Ramsay-Hunt syndrome and Bell's palsy. CONCLUSIONS The results of this study support the findings from the prelicensure clinical trials, providing reassurance that the zoster vaccine is generally safe and well-tolerated with a small increased risk of allergic reactions in 1-7 days after vaccination.
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Affiliation(s)
- H F Tseng
- Kaiser Permanente, Southern California, Pasadena, CA 91101, USA
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Yang CH, Chuang LY, Chen YJ, Tseng HF, Chang HW. Computational Analysis of Simulated SNP Interactions Between 26 Growth Factor-Related Genes in a Breast Cancer Association Study. OMICS: A Journal of Integrative Biology 2011; 15:399-407. [DOI: 10.1089/omi.2010.0028] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Cheng-Hong Yang
- Department of Electronic Engineering, National Kaohsiung University of Applied Sciences, Kaohsiung, Taiwan, Republic of China
| | - Li-Yeh Chuang
- I-Shou University, Department of Chemical Engineering, Kaohsiung, Taiwan, Republic of China
| | - Yu-Jung Chen
- Department of Electronic Engineering, National Kaohsiung University of Applied Sciences, Kaohsiung, Taiwan, Republic of China
| | - Hung-Fu Tseng
- Department of Research and Evaluation, Southern California Permanente Medical Group, Pasadena, California
| | - Hsueh-Wei Chang
- Department of Biomedical Science and Environmental Biology, Kaohsiung Medical University, Kaohsiung, Taiwan, Republic of China
- Graduate Institute of Natural Products, College of Pharmacy, Kaohsiung Medical University, Kaohsiung, Taiwan, Republic of China
- Cancer Center, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan, Republic of China
- Center of Excellence for Environmental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan, Republic of China
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Lin GT, Tseng HF, Yang CH, Hou MF, Chuang LY, Tai HT, Tai MH, Cheng YH, Wen CH, Liu CS, Huang CJ, Wang CL, Chang HW. Combinational polymorphisms of seven CXCL12-related genes are protective against breast cancer in Taiwan. OMICS 2010; 13:165-72. [PMID: 19196101 DOI: 10.1089/omi.2008.0050] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Many single nucleotide polymorphisms (SNPs) have been found to be associated with breast cancer, but their SNP interactions are seldom addressed. In this study, we focused on the joint effect for SNP combinations of seven CXCL12-related genes involved in major cancer-related pathways. SNP genotyping was determined by PCR-restriction fragment length polymorphism (RFLP) in this study (case = 220, control = 334). Different numbers of combinational SNPs with genotypes called the SNP barcodes from different chromosomes were used to evaluate their joint effect on breast cancer risk. Except for vascular endothelial growth factor (VEGF) rs3025039-CT, none of these SNPs were found to individually contribute to breast cancer risk. However, for two combined SNPs, the proportion of subjects with breast cancer was significantly low in the SNP barcode with CC-GG genotypes in rs2228014-1801157 (CXCR4-CXCL12) compared to those with non-CC-GG genotypes. Similarly, the SNP barcode of rs12812942-rs2228014-rs3025039 (CD4-CXCR4-VEGF) and rs12812942-rs3136685-rs2228014-rs1801157 (CD4- CCR7-CXCR4-CXCL12) with specific genotype patterns (AT-CC-CC and AT-AG-CC-GG) among three and four combinational SNPs were significantly low in breast cancer occurrence. More SNP combinations larger than five SNPs were also addressed, and these showed similar effects. After controlling for age, and comparing their corresponding non-SNP barcodes, the estimated odds ratios for breast cancer ranged between 0.20 and 0.71 for specific SNP barcodes with two to seven SNPs. In conclusion, we have associated the potential combined CXCL12-related SNPs with genotypes that were protective against breast cancer, and that may contribute to identification of a low-risk population for the development of breast cancer.
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Affiliation(s)
- Gau-Tyan Lin
- Department of Orthopedic Surgery, Kaohsiung Medical University, Chung-Ho Memorial Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
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Chao C, Haque R, Caan BJ, Poon KYT, Tseng HF, Quinn VP. Red Wine Consumption Not Associated With Reduced Risk of Colorectal Cancer. Nutr Cancer 2010; 62:849-55. [DOI: 10.1080/01635581.2010.492091] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Lai CH, Tseng HF. Nationwide population-based epidemiological study of myasthenia gravis in taiwan. Neuroepidemiology 2010; 35:66-71. [PMID: 20523074 DOI: 10.1159/000311012] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2009] [Accepted: 03/18/2010] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The purpose of this study is to investigate the epidemiology and medical expenses of myasthenia gravis (MG) in Taiwan. METHODS Cases of MG were identified from the National Health Insurance Research Database with corresponding codes of the International Classification of Diseases, ninth revision (ICD-9), from January 2000 to December 2007. Age- and sex-specific incidences were estimated by dividing the incidence number by population data obtained from the Department of Statistics, Ministry of the Interior. RESULTS During the study period, 5,211 cases were identified. The incidence ratio of males to females was 0.68. The average annual incidence rate was 2.1/100,000. MG occurred in all age groups with a higher incidence in older individuals and the lowest incidence in the 10- to 14-year-olds for both sexes. Among the 5,211 cases, 615 (12%) had a neoplasm of the thymus. The prevalence increased steadily during the study period from 8.4/100,000 in 2000 to 14.0/ 100,000 in 2007. CONCLUSIONS This is the first population-based epidemiological study of MG in Taiwan. The incidence rate and prevalence were higher than in most published studies, especially in old age groups.
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Affiliation(s)
- Chien-Hsu Lai
- Department of Neurology, Changhua Christian Hospital, Changhua, Taiwan, ROC
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Abstract
Background Taiwan has the highest incidence of end-stage renal disease (ESRD) in the world. The epidemiologic features of ESRD, however, have not been investigated. In this case–control study, we evaluated the risk of ESRD associated with a number of putative risk factors. Methods We studied 200 patients among whom ESRD had been newly diagnosed between 1 January 2005 and 31 December 2005; 200 controls were selected from among relatives of patients treated in the general surgery unit. Using a structured questionnaire, we collected information related to socioeconomic factors, history of disease, regular blood or urine screening, lifestyle, environmental exposure, consumption of vitamin supplements, and regular drug use at 5 years before disease onset. Results Our primary multivariate risk models indicated that low socioeconomic status was a strong predictor of ESRD (education: odds ratio [OR], 2.78; 95% confidence interval [CI], 1.49–5.19; income: OR, 2.86, 95% CI, 1.48–5.52), even after adjusting for other risk factors. Other significant predictors for ESRD were a history of hypertension (OR, 3.63–3.90), history of diabetes (OR, 3.85–5.50), and regular intake of folk remedies or over-the-counter Chinese herbs (OR, 10.84–12.51). Regular intake of a multivitamin supplement 5 years before diagnosis was associated with a decreased risk of ESRD (OR, 0.12–0.14). Conclusions Our findings indicate that low socioeconomic status, history of hypertension, diabetes, and regular use of folk remedies or over-the-counter Chinese herbs were significant risk factors for ESRD, while regular intake of a multivitamin supplement was associated with a decreased risk of ESRD.
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Affiliation(s)
- Su-Ying Tsai
- Department of Health Management, I-Shou University, Yanchao Township, Kaohsiung County, Taiwan (R.O.C.).
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Yen CY, Chen CH, Chang CH, Tseng HF, Liu SY, Chuang LY, Wen CH, Chang HW. Matrix metalloproteinases (MMP) 1 and MMP10 but not MMP12 are potential oral cancer markers. Biomarkers 2009; 14:244-9. [DOI: 10.1080/13547500902829375] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Tan HF, Yeh CY, Chang HW, Chang CK, Tseng HF. Private doctors' practices, knowledge, and attitude to reporting of communicable diseases: a national survey in Taiwan. BMC Infect Dis 2009; 9:11. [PMID: 19178741 PMCID: PMC2642829 DOI: 10.1186/1471-2334-9-11] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2008] [Accepted: 01/29/2009] [Indexed: 11/10/2022] Open
Abstract
Background Epidemiological surveillance of infectious diseases through the mandatory-reporting system is crucial in the planning and evaluation of disease control and prevention program. This study investigated the reporting behavior, knowledge, and attitude to reporting communicable disease in private doctors in Taiwan. The differences between the reporting and non-reporting doctors were also explored. Methods A total of 1250 clinics were randomly sampled nationwide by a 2-stage process. Data were collected from 1093 private doctors (87.4% response rate) using a self-administered structured questionnaire. Four hundred and six (37.2%) doctors reported having diagnosed reportable communicable diseases. Among them, 340 (83.5%) have the experiences of reporting. Results The most common reasons for not reporting were "do not want to violate the patient's privacy", "reporting procedure is troublesome", and "not sure whether the diagnosed disease is reportable". Significantly higher proportions of the non-reporting doctors considered the reporting system inconvenient or were not familiar with the system. The highest percentage (65.2%) of the non-reporting doctors considered that a simplified reporting procedure, among all measures, would increase their willingness to report. In addition, a significantly higher proportion of the non-reporting doctors would increase their willingness to report if there has been a good reward for reporting or a penalty for not reporting. Conclusion The most effective way to improve reporting rate may be to modify doctor's attitude to disease reporting. The development of a convenient and widely-accepted reporting system and the establishment of a reward/penalty system may be essential in improving disease reporting compliance in private doctors.
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Affiliation(s)
- Hsiu-Fen Tan
- Department of Healthcare Administration, Chang Jung Christian University, Tainan, Taiwan.
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Lai CH, Tseng HF. Population-Based Epidemiological Study of Neurological Diseases in Taiwan: I. Creutzfeldt-Jakob Disease and Multiple Sclerosis. Neuroepidemiology 2009; 33:247-53. [DOI: 10.1159/000229779] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2009] [Accepted: 05/14/2009] [Indexed: 11/19/2022] Open
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Liu TH, Wu CL, Chiang CW, Lo YW, Tseng HF, Chang CK. No effect of short-term arginine supplementation on nitric oxide production, metabolism and performance in intermittent exercise in athletes. J Nutr Biochem 2008; 20:462-8. [PMID: 18708287 DOI: 10.1016/j.jnutbio.2008.05.005] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2008] [Revised: 04/24/2008] [Accepted: 05/06/2008] [Indexed: 10/21/2022]
Abstract
Arginine supplementation has been shown to alleviate endothelial dysfunction and improve exercise performance through increasing nitric oxide production in patients with cardiopulmonary diseases. In addition, arginine supplementation could decrease accumulations of lactate and ammonia, metabolites involved in development of muscular fatigue. The aim of this study was to investigate the effect of short-term arginine supplementation on performance in intermittent anaerobic exercise and the underlying mechanism in well-trained male athletes. Ten elite male college judo athletes participated with a randomized crossover, placebo-controlled design. The subjects consumed 6 g/day arginine (ARG trial) or placebo (CON trial) for 3 days then performed an intermittent anaerobic exercise test on a cycle ergometer. Blood samples were collected before supplementation, before and during exercise and 0, 3, 6, 10, 30 and 60 min after exercise. ARG trial had significantly higher arginine concentrations than CON trial at the same time point before, during and after exercise. In both trials, nitrate and nitrite concentration was significantly higher during and 6 min after exercise comparing to the basal concentration. The increase in nitrate and nitrite concentration during exercise in both trials was parallel to the increase in plasma citrulline concentrations. There was no significant difference between the 2 trials in plasma nitrate and nitrite, lactate and ammonia concentrations and peak and average power in the exercise. The results of this study suggested that short-term arginine supplementation had no effect on nitric oxide production, lactate and ammonia metabolism and performance in intermittent anaerobic exercise in well-trained male athletes.
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Affiliation(s)
- Tsung-Han Liu
- Department of Physical Education, Taiwan Sport University, 404 Taichung, Taiwan
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Yen CY, Liu SY, Chen CH, Tseng HF, Chuang LY, Yang CH, Lin YC, Wen CH, Chiang WF, Ho CH, Chen HC, Wang ST, Lin CW, Chang HW. Combinational polymorphisms of four DNA repair genes XRCC1, XRCC2, XRCC3, and XRCC4 and their association with oral cancer in Taiwan. J Oral Pathol Med 2008; 37:271-7. [PMID: 18410587 DOI: 10.1111/j.1600-0714.2007.00608.x] [Citation(s) in RCA: 94] [Impact Index Per Article: 5.9] [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 Many single nucleotide polymorphisms (SNPs) have been found to be associated with oral cancer but the biological interactions through SNPs are seldom addressed. In this study, we focused on the joint effect for SNP combinations of four DNA repair genes, X-ray repair cross-complementing groups (XRCCs) 1-4, involved in major cancer-related pathways. METHODS Single nucleotide polymorphism genotyping was determined using by polymerase chain reaction-restriction fragment length polymorphism in this study (case = 103, control = 98). Different numbers of combinational SNPs with genotypes called the pseudo-haplotypes from these chromosome-wide genes were used to evaluate their joint effect on oral cancer risk. RESULTS Except for XRCC2 rs2040639-AG, none of these SNPs was found to individually contribute to oral cancer risk. However, for two combined SNPs, the proportion of subjects with oral cancer was significantly higher in the pseudo-haplotype with AG-CC genotypes in rs2040639-rs861539 (XRCC2-XRCC3) compared with those with non-AG-CC genotypes. Similarly, the pseudo-haplotype of rs2040639-rs861539-rs2075685 (XRCC2-XRCC3-XRCC4) and rs2040639-rs861539-rs2075685-rs1799782 (XRCCs 1-4) with specific genotype pattern (AG-CC-TG and CT-AG-CC-TG) among three and four combinational SNPs were significantly associated with oral cancer. After controlling for age, gender, smoking, drinking, and betel nut chewing, the estimated odds ratio of oral cancer were 2.45, 5.03, and 10.10 for two, three and four specific SNP combinations, respectively, comparing these specific pseudo-haplotypes to their corresponding non-pseudo-haplotypes. CONCLUSION We have identified the potential combined XRCCs 1-4 SNPs with genotypes that were associated with oral cancer risk and may have an impact on identification of a high-risk population.
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Affiliation(s)
- Ching-Yu Yen
- Department of Oral and Maxillofacial Surgery, Chi-Mei Medical Center, Tainan, and School of Dentistry, Taipei Medical University, Taipei, Taiwan
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Lin GT, Tseng HF, Chang CK, Chuang LY, Liu CS, Yang CH, Tu CJ, Wang EC, Tan HF, Chang CC, Wen CH, Chen HC, Chang HW. SNP combinations in chromosome-wide genes are associated with bone mineral density in Taiwanese women. CHINESE J PHYSIOL 2008; 51:32-41. [PMID: 18551993] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023] Open
Abstract
Osteoporosis is a major public health problem, mainly quantified by low BMD. Eleven polymorphisms were investigated in this study; TNFalpha-857 (rs1799724), TGFbeta1-509 (rs1800469), osteocalcin (rs1800247), TNFalpha-308 (rs1800629), PTH BstB I (rs6254), PTH Dra II (rs6256), IL-1ra (VNTR), HSP70 hom (rs2227956), HSP 70-2 (rs1061581), CTR (rs1801197), and BMP-4 (rs17563). The relationship between the combined polymorphisms in different genomic regions and BMD variation was investigated. Among the female subjects, the proportion of subjects with low BMD in low BMI group (< or = 18.50) was significantly higher than that of the middle (18.51-22.99) and high (> or = 23.00) BMI groups (P < 0.05). In post-menopausal women, there was a significant association between low BMD and genotypes ranging from 2 to approximately 7 SNPs. For two combined SNPs, the portion of subjects with low BMD was significantly higher in those with CC-AA genotypes in rs1799724-rs1800629, compared to those with non-CC-AA genotypes in post-menopausal women and the combination of all women. Similarly, part of the combined SNPs with rs1799724-rs1800629-rs6254-rs6256-IL-1ra-rs2227956-rs1801197 was significantly associated with reduced BMD. After controlling for age and BMI, post-menopausal women with certain specific SNP combination had a 3.54- to 4.68-fold increased risk for low BMD, comparing to other SNP combinations. In conclusion, our data suggest that several gene polymorphisms may be cooperatively involved in the development of osteoporosis.
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Affiliation(s)
- Gau-Tyan Lin
- Department of Orthopaedic Surgery, Chung-Ho Memorial Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan, Republic of China
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Lai CH, Tseng HF. Epidemiology and Medical Expenses of Motor Neuron Diseases in Taiwan. Neuroepidemiology 2008; 31:159-66. [DOI: 10.1159/000154928] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2008] [Accepted: 06/02/2008] [Indexed: 11/19/2022] Open
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Affiliation(s)
- Kuei-Min Chen
- Department of Nursing, Fooyin University, Kaohsiung, Taiwan.
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Chang CK, Tan HF, Tseng HF, Lin CC. Analysis of factors associated with varicella-zoster virus susceptibility among children 0–12 years old in Taiwan. Med Mal Infect 2007; 37:222-8. [PMID: 17368781 DOI: 10.1016/j.medmal.2006.10.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [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: 07/25/2006] [Accepted: 10/02/2006] [Indexed: 02/02/2023]
Abstract
OBJECTIVES Varicella is a highly infectious disease caused by varicella-zoster virus (VZV). The aim of this study was to explore the geographical difference of VZV antibody seroprevalence among children in private vaccination areas in Taiwan, controlling for potential factors relating to varicella susceptibility. PATIENTS AND METHOD A cross-sectional survey of the seroprevalence of VZV antibodies among children 0-12 years of age was conducted in Taiwan between August and December 2003. Sera of children visiting the outpatient unit of the participating hospitals around the island were collected. Six hundred and fifty-six parents among those of the 931 children studied agreed to answer the self-administered questionnaire regarding the possible factors associated with varicella susceptibility. IgG antibodies to VZV were measured using an enzyme-linked immunosorbent assay kit, Enzygnost anti VZV/IgG. RESULTS The susceptibility was the highest at age 1 year, and then decreased as the age increased. Children living in southern and eastern Taiwan showed higher susceptibility to varicella than those living in northern area (odds ratio (OR) = 2.71 and 2.10, respectively). Prior history of varicella infection, varicella vaccination, and contact with cases remained to be associated with the susceptibility after multivariate analysis. CONCLUSIONS Children who lived in tropical and rural regions and those who had no history of varicella infection, varicella vaccination, and contact with cases, might be more susceptible to varicella. Island-wide VZV seroprevalence surveillance is required to examine whether the geographical difference of susceptibility in Taiwan will become less significant or disappear after the mass varicella vaccination program initiated in 2004.
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Affiliation(s)
- C K Chang
- Department of Sport Management and Sport Science Research Center, National Taiwan College of Physical Education, 16, Sec. 1, Shuan-Shih Road, Taichung 404, Taiwan, ROC
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Tan HF, Chang CK, Tseng HF, Lin W. Evaluation of the National Notifiable Disease Surveillance System in Taiwan: An example of varicella reporting. Vaccine 2007; 25:2630-3. [PMID: 17270318 DOI: 10.1016/j.vaccine.2006.12.016] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [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: 07/31/2006] [Revised: 11/22/2006] [Accepted: 12/10/2006] [Indexed: 11/17/2022]
Abstract
Despite the mandatory reporting by laws, the incompleteness of notifiable infectious disease reporting is well-documented in many countries for various diseases. The purpose of this study is to investigate the completeness of varicella reporting in Taiwan. Annual reports of National Notifiable Disease Surveillance System in Taiwan were compared to the annual outpatient claims of National Health Insurance (NHI) in the years of 2000, 2001, and 2002. Age and area-specific reporting rates of varicella were calculated by dividing the respective reported cases by the number of incidence cases. The reporting rate was the highest in aged 0 year in all years, followed by the 20-29- and 30-39-year groups. The reporting rate in each age group increased gradually during the study period. Other than Taipei City, the reporting rates in all regions were below 9% during this period. This study suggested that varicella reporting rate is very low in Taiwan. In addition, the reporting rates were inconsistent in 2000-2002, making the estimation of prevalence and vaccine efficacy using data from the National Notifiable Disease Surveillance System almost impossible. This study indicated that the physicians in Taiwan should improve their knowledge and attitude toward notifiable infectious diseases.
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Affiliation(s)
- Hsiu-Fen Tan
- Department of Healthcare Administration, Chang-Jung Christian University, Taiwan
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Wang JJ, Tseng HF, Chen KM. Development and testing of screening indicators for psychological abuse of older people. Arch Psychiatr Nurs 2007; 21:40-7. [PMID: 17258108 DOI: 10.1016/j.apnu.2006.09.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2006] [Revised: 08/24/2006] [Accepted: 09/10/2006] [Indexed: 11/18/2022]
Abstract
Abuse of older people is a serious and growing social problem. Although physical abuse is the easiest to identify, covert acts of psychological abuse are of concern to elders' health care providers. The assessment of psychological abuse in elders is an important, but difficult, aspect of concern for these older adults. This article describes the development and testing of a screening instrument for elders' psychological abuse. The Elders' Psychological Abuse Scale (EPAS) was developed from many abuse indicators that have been identified in past research and from inputs from a focus group discussion. The content validity index of .92 was established through expert panel evaluation. Psychometric findings provided support for the efficacy of the 32-indicator EPAS in screening for the presence of psychological abuse in elders. Significant inverse relationships between the EPAS, the Short Portable Mental State Questionnaire (r = -.32, P < .001), and Barthel's Index (r = -.36, P < .001) provided confirmation of criterion-related validity. A high test-retest agreement percentage and the finding that 26 of 32 kappa values exceeded 0.6 confirmed the reliability of the EPAS. We concluded that the EPAS appears to be a promising tool, providing reliable and valid screening data to help determine psychological abuse among elders in long-term care facilities and domestic settings, as well as facilitating researchers' better understanding of the phenomenon of elders' abuse.
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Affiliation(s)
- Jing-Jy Wang
- Department of Nursing, National Cheng Kung University, Taiwan, ROC.
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Kuo CL, Turton MA, Lee-Hsieh J, Tseng HF, Hsu CL. Measuring peer caring behaviors of nursing students: Scale development. Int J Nurs Stud 2007; 44:105-14. [PMID: 17027986 DOI: 10.1016/j.ijnurstu.2006.07.025] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [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: 08/28/2004] [Revised: 07/20/2006] [Accepted: 07/20/2006] [Indexed: 11/30/2022]
Abstract
BACKGROUND Caring is one of the most important domains of nursing research, peer caring among student nurses, and its potential effects on nurse caring behaviors remains largely unexplored. Few tools in the literature target peer caring interactions, and which were either irrelevant to our research purpose or culturally inappropriate for nursing student population in Taiwan. OBJECTIVES The purpose of this study was to develop a culturally sensitive instrument to measure peer caring behavior from the student perspective and to offer a descriptive answer to "what is peer caring in Taiwan." DESIGN The study uses both qualitative and quantitative methods in developing the "Peer Caring Measurement (PCM)" questionnaire. SETTINGS Students from a 5-year associate degree nursing program in a university of technology in southern Taiwan were recruited into this study. PARTICIPANTS Thirteen first- through fourth-year student volunteers between the ages of 16 and 20 were interviewed to explore caring behavior in student peer-to-peer interactions. Two classes from each of the first, second, third, and fourth year students, a total of 360 students were randomly selected to assess the internal consistency of "PCM", and 47 first-year students were conveniently selected to examine the stability of the tool. METHODS Interviews were conducted in an unstructured manner. Qualitative data were analyzed by a constant comparative method. The questionnaire survey was used to assess the validity and reliability of "PCM". RESULTS A 17-item "PCM" was developed; the content validity, construct validity, and reliability of the tool were ensured by expert review, factor analysis, and internal consistency. Three factors, labeled assistant caring, academic caring, and affective caring, accounted for 63.197% of the variance. CONCLUSIONS The "PCM" addressed the multidimensional construct of peer caring. It was validated in a Chinese language version and can be used in college settings to evaluate student interactions and their peer caring behaviors.
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Affiliation(s)
- Chien-Lin Kuo
- Department of Nursing, Junior College, Fooyin University, Kaohsiung, Taiwan
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Tseng HF, Chang CK, Tan HF, Yang SE, Chang HW. Seroepidemiology study of rubella antibodies among pregnant women from seven Asian countries: Evaluation of the rubella vaccination program in Taiwan. Vaccine 2006; 24:5772-7. [PMID: 16759764 DOI: 10.1016/j.vaccine.2006.04.047] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [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: 08/18/2005] [Revised: 11/24/2005] [Accepted: 04/25/2006] [Indexed: 11/22/2022]
Abstract
During 2003-2004, approximately 13% of birth in Taiwan was given by foreign-born females. The aims of this study were to compare the seroprevalence of rubella antibodies between Taiwan-born and foreign-born pregnant women and evaluate the effect of rubella vaccination program in Taiwan. We reviewed the rubella antibody test results of 5007 women during routine pregnancy check-ups at Fooyin University Hospital during 1999-2002. In Taiwan-born women, rubella antibody was undetectable in 29.2%, 7.3%, and 8.3% of the cohorts born before 1971, between 1971 and 1976, and after 1976, respectively. In the cohorts born between 1971 and 1976 and after 1976, pregnant women born in China, Vietnam, Indonesia, and Philippines had significant higher chances of being susceptible. Our results suggested that the voluntary adult vaccination program was not as effective as the school or wipe-out programs. Both Taiwanese women born before 1971 and foreign-born women were more likely to be susceptible to rubella. The introduction of 'catch-up' immunization program and enforcement of the checking of immunization record and/or blood test before pregnancy for these women are necessary in preventing CRS.
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Affiliation(s)
- Hung-Fu Tseng
- Institute of Medical Research, Chang-Jung Christian University, 396, Sec. l, Chang Jung Rd., Kway Jen, Tainan 711, Taiwan.
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Tan HF, Tseng HF. Cost-Effectiveness Analysis of Universal Haemophilus Influenzae Type B (HIB) Vaccination Program in Taiwan. Am J Epidemiol 2006. [DOI: 10.1093/aje/163.suppl_11.s133-a] [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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Tseng HF, Tan HF, Chang CK. Use of National Health Insurance database to evaluate the impact of public varicella vaccination program on burden of varicella in Taiwan. Vaccine 2006; 24:5341-8. [PMID: 16713038 DOI: 10.1016/j.vaccine.2006.04.025] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [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: 11/05/2005] [Revised: 03/31/2006] [Accepted: 04/14/2006] [Indexed: 11/21/2022]
Abstract
The aims of this study were to investigate the epidemiology of varicella and evaluate the effect of varicella vaccination on the burden of varicella in Taiwan. The outpatient and hospitalization claims made to the National Health Insurance (NHI) in public and private vaccination areas were compared during 2000-2002. In 2002, the outpatient visit rates for 1- to 5-year-old children in public vaccination areas were 66-78% lower than their counterparts in private vaccination areas. The reduction in outpatient visit rate was the greatest among preschool children. The reductions also occurred in every age group including infants and adults. This study showed significant evidence of vaccine impact with a marked decline in clinical cases in the short term.
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Affiliation(s)
- Hung-Fu Tseng
- Institute of Medical Research, Chang-Jung Christian University, 396, Sec. l, Chang Jung Rd, Kway Jen, Tainan 711, Taiwan, ROC.
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Chang CK, Huang HY, Tseng HF, Hsuuw YD, Tso TK. Interaction of vitamin E and exercise training on oxidative stress and antioxidant enzyme activities in rat skeletal muscles. J Nutr Biochem 2006; 18:39-45. [PMID: 16644199 DOI: 10.1016/j.jnutbio.2006.02.007] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [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: 12/01/2005] [Revised: 01/18/2006] [Accepted: 02/14/2006] [Indexed: 10/24/2022]
Abstract
It has been shown that free radicals are increased during intensive exercise. We hypothesized that vitamin E (vit E) deficiency, which will increase oxidative stress, would augment the training-induced adaptation of antioxidant enzymes. This study investigated the interaction effect of vit E and exercise training on oxidative stress markers and activities of antioxidant enzymes in red quadriceps and white gastrocnemius of rats in a 2x2 design. Thirty-two male rats were divided into trained vit E-adequate, trained vit E-deficient, untrained vit E-adequate, and untrained vit E-deficient groups. The two trained groups swam 6 h/day, 6 days/week for 8 weeks. The two vit E-deficient groups consumed vit E-free diet for 8 weeks. Vitamin E-training interaction effect was significant on thiobarbituric acid reactive substances (TBARSs), glutathione peroxidase (GPX), and superoxide dismutase (SOD) in both muscles. The trained vit E-deficient group showed the highest TBARS and GPX activity and the lowest SOD activity in both muscles. A significant vit E effect on glutathione reductase and catalase was present in both muscles. Glutathione reductase and catalase activities were significantly lower in the two vit E-adequate groups combined than in the two vit E-deficient groups combined in both muscles. This study shows that vit E status and exercise training have interactive effect on oxidative stress and GPX and SOD activities in rat skeletal muscles. Vitamin E deprivation augmented the exercise-induced elevation in GPX activity while inhibiting exercise-induced SOD activity, possibly through elevated oxidative stress.
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Affiliation(s)
- Chen-Kang Chang
- Sport Science Research Center, National Taiwan College of Physical Education, Taichung 404, Taiwan
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41
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Yang SE, Pan MJ, Tseng HF, Liau MY. The efficacy of mouse-brain inactivated Nakayama strain Japanese encephalitis vaccine—Results from 30 years experience in Taiwan. Vaccine 2006; 24:2669-73. [PMID: 16314007 DOI: 10.1016/j.vaccine.2005.10.054] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [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: 04/18/2005] [Revised: 08/14/2005] [Accepted: 10/27/2005] [Indexed: 10/25/2022]
Abstract
An intensive mandatory vaccination program has been underway, combating Japanese encephalitis (JE) since 1968 in Taiwan. Long-term collection of immunization records has been developed from 1967 to 2000 in this study to retrospectively assess the efficacy of the mouse-brain inactivated Nakayama JE vaccine. The vaccine efficacy (VE) of completing at least two doses of the JE vaccine was 96.98%. Among 1 to 14-year-old children, the efficacy of completing 1, 2, and 3 doses of immunization was 85.59%, 91.07% and 98.51%, respectively. Furthermore, the long-term efficacy for a single dose vaccinated at least 25 years was 86.79%, and for 2 and 3 doses it was 88.10% and 95.54%, respectively. In contrast to previous studies that recommended at least two doses of JE vaccination to acquire necessary protection, the empirical results in this study indicated that even immunization with one single dose provides sufficient protection to the population. However, a single dose of JE vaccine might still be beneficial for some JE epidemic or endemic developing countries with limited resources for infectious disease control.
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Affiliation(s)
- Shu-Er Yang
- Graduate Institute of Veterinary Medicine, National Taiwan University, Taipei 106, Taiwan
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Hsieh LC, Chien SL, Huang MS, Tseng HF, Chang CK. Anti-inflammatory and anticatabolic effects of short-term beta-hydroxy-beta-methylbutyrate supplementation on chronic obstructive pulmonary disease patients in intensive care unit. Asia Pac J Clin Nutr 2006; 15:544-50. [PMID: 17077073] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Elevated inflammatory markers and muscle wasting were common in chronic obstructive pulmonary disease (COPD) patients. The purpose of this study was to investigate the effect of 7-day beta-hydroxy-beta-methylbutyrate (HMB) supplementation on inflammation, protein metabolism, and pulmonary function in COPD patients in an intensive care unit. Thirty-four COPD patients who required mechanical ventilators were randomly assigned to HMB (n=18) or control (n=16) groups. The HMB group received HMB 3 g/d for 7 days. White blood cell count, C-reactive protein, and creatinine were significantly lower, while cholesterol and total protein were significantly higher after HMB supplementation. The body weight remained unchanged in both groups. Ten subjects (55.6%) in the HMB group and 4 subjects (25.0%) in the control group had improved pulmonary function, indicated by their ventilator modes. This short-term study suggests that HMB supplementation may have anti-inflammatory and anticatabolic effect and improve pulmonary function in COPD patients in an intensive care unit setting.
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Affiliation(s)
- Lan-Chi Hsieh
- Department of Dietetics, Kaohsiung Municipal United Hospital, Kaohsiung, Taiwan, ROC
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43
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Tang PL, Yuan WL, Tseng HF. Clinical follow-up study on diabetes patients participating in a health management plan. J Nurs Res 2005; 13:253-62. [PMID: 16372236] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2023] Open
Abstract
The "Health Management Plan"(HMP) for caring diabetic patient was begun by the National Health Insurance (NHI) in Taiwan in order to maximize the effectiveness of limited medical resources. This study describes the clinical experience of the nurse-directed diabetic HMP program and analyzes factors associated with the outcome. One hundred and thirty-six patients, all of whom had participated in the diabetic HMP program at least 5 times, were enrolled in the study. The effect of the HMP was evaluated by comparing hemoglobin A1C status before and after %) maintained their hemoglobin A1C status over the course of HMP participation. Diabetic patients with regular exercise habits showed a 2.8-fold increased chance of outcome improvement compared with those who did not exercise regularly. The chance of outcome improvement in patients with complications was found to be one-third that of patients who had no complications (Odds ratio: 0.3, 95% CI: 0.1-1.0). This study found that specially trained nurses, following agreed upon protocols and algorithms and collaborating with medical team members, can effectively concentrate on providing comprehensive and effective diabetes care.
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Affiliation(s)
- Pei-Ling Tang
- Institute of Medical Research, Chang-Jung Christian University
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Tseng HF, Tan HF, Chang CK. Varicella epidemiology and cost-effectiveness analysis of universal varicella vaccination program in Taiwan. Southeast Asian J Trop Med Public Health 2005; 36:1450-8. [PMID: 16610647] [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] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
Varicella zoster virus is highly contagious and affects people worldwide. In this study, we collected local epidemiological data and evaluated the cost-effectiveness of varicella vaccination program in Taiwan. To examine the economical consequences of universal vaccination, a model of the incidence and the associated costs in a hypothetical cohort was created each year for 30 years. The incidence increased sharply after the infancy and peaked in children aged 5 years. The hospitalization rate among cases was the highest in infants, followed by adults 30 to 44 years old. The benefit-cost analysis showed that one dollar invested in the program would cost extra 46 cents in direct medical expense, but would save extra 45 cents considering the societal expenses. Substantial economical benefits can occur due to the averted unproductive days for parents. Sensitive surveillance of both varicella and zoster is essential in countries that have implemented or are about to implement varicella vaccination.
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Affiliation(s)
- H F Tseng
- Institute of Medical Research, Chang-Jung University, Taiwan.
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Abstract
CONTEXT An experimental Health Care Improvement Program (HCIP) was initiated by the Bureau of National Health Insurance in 1997 to improve the accessibility of health care in several rural, mountainous districts. PURPOSE This longitudinal study evaluated service availability, utilization patterns, and effectiveness of services under the HCIP in the A-Li Mountain District. METHODS Outpatient claims made by residents in the A-Li Mountain District were extracted from the database of the National Health Insurance program. Changes in utilization pattern and volume were analyzed. Satisfaction levels were assessed by 2-stage face-to-face interviews with local residents. FINDINGS After the HCIP, the average population served by each doctor decreased 75%, and total outpatient visits increased 15.4%. The total number of in-district outpatient visits increased 83.6%. The proportion of in-district outpatient visits to all visits increased from 22.1% to 35.1%. The total in-district outpatient visit fee claimed increased 100.2%, and the total out-of-district outpatient visit fee claimed increased only 7.2%. About 60.4% of the residents were not satisfied with overall health care services before the HCIP. The proportion decreased to 32.4% after the HCIP. CONCLUSIONS The HCIP improved accessibility, enriched local medical care resources, changed the utilization pattern of some residents, and increased residents' satisfaction level. A well-managed program with stabilized financial resources is more likely to succeed if it also respects cultural differences and responds to community needs.
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Affiliation(s)
- Hsiu-Fen Tan
- Department of Health Care Administration, Chung Jung Christian University, Taiwan, Republic of China.
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Tseng HF, Tan HF, Chang CK, Wang LY, Yang SE, Liau MY, Pan MJ, Chen CY, Huang SP. A seroepidemiology study of varicella among children aged 0-12 years in Taiwan. Southeast Asian J Trop Med Public Health 2005; 36:1201-7. [PMID: 16438146] [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] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
The epidemiology pattern of varicella appears to vary among regions with different climates, population densities, and degrees of development. This study investigated the age-specific varicella zoster virus (VZV) seroprevalence in children aged 0 to 12 years in Taiwan and compared these seroprevalences between free and private vaccination areas. Residual sera were collected from 13 hospitals with 1,401 valid samples. Immunoglobulin G antibodies to VZV were measured by enzyme-linked immunosorbent assay. Parents of 656 children answered questions about the varicella incidence and varicella vaccination history of their children. In the 8-12 year-olds, the seroprevance ranged between 88.0-93.8% in northern, central, and eastern, while it was only 76.1% in southern Taiwan. The seroprevalence of children 0-5 years old were significantly different between free and private vaccination areas. Seropositive children who reported no history of varicella or receiving varicella vaccine accounted for 26.1-59.3% of the total positive cases. Our findings suggest the possible effects of climate, geographical conditions, and lifestyle on the seroepidemiology of VZV in Taiwan. The efforts of implementing a varicella vaccination program in Taiwan should focus on reaching high levels of coverage.
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Affiliation(s)
- H F Tseng
- Institute of Medical Research, Chang-Jung University, Taiwan.
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Lee-Hsieh J, Kuo CL, Tseng HF, Turton MA. Development of an instrument to measure caring behaviors in nursing students in Taiwan. Int J Nurs Stud 2005; 42:579-88. [PMID: 15921989 DOI: 10.1016/j.ijnurstu.2004.09.018] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [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: 03/22/2004] [Revised: 08/02/2004] [Accepted: 09/23/2004] [Indexed: 11/22/2022]
Abstract
The purpose of this study was to develop a culturally sensitive instrument to measure caring behaviors in nursing students in Taiwan from the patient perspective. The study, involving expert assessment of content validity and face validity, a first test (n = 196), and a second test (n = 192) in medical-surgical patients, and the generation of descriptive statistics, resulted in a 28-item questionnaire, the caring behavior measurement (CBM). The findings suggest the CBM is a valid and reliable assessment tool of caring behaviors in students and practicing professional nurses, as well as offering a descriptive answer to "what is caring in nursing in Taiwan".
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Affiliation(s)
- Jane Lee-Hsieh
- Department of Nursing, Junior College, Fooyin University, Kaohsiung, Taiwan.
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48
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Tan HF, Tseng HF. 137: Factors Associated with Susceptibility to Varicella Among Children Under 12 Years Old in Taiwan. Am J Epidemiol 2005. [DOI: 10.1093/aje/161.supplement_1.s35] [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] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- H F Tan
- Chung-Jung University, Taiwan, Tainan 711
| | - H F Tseng
- Chung-Jung University, Taiwan, Tainan 711
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49
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Tseng HF, Tan HF, Chiu SY. 138: Evaluation of Varicella Vaccination Program in Taiwan. Am J Epidemiol 2005. [DOI: 10.1093/aje/161.supplement_1.s35a] [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] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- H F Tseng
- Fooyin University, Taiwan, Kaohsiung 831
| | - H F Tan
- Fooyin University, Taiwan, Kaohsiung 831
| | - S Y Chiu
- Fooyin University, Taiwan, Kaohsiung 831
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Abstract
This study evaluated the effectiveness of the Caring Code, a tool for teaching caring to nursing students during clinical practice. An experimental, longitudinal design was used. A sample of 480 students from a 5-year junior nursing college program in Taiwan was randomly divided into experimental and control groups. Each member of the experimental group carried a copy of the Caring Code, the content of which was explained by the clinical instructors at the beginning of clinical practice, and about which reminders were provided weekly. A questionnaire was distributed to the patients during the nursing students' 1-year clinical practice, once prior to the implementation of the Caring Code and twice afterwards, to obtain quantitative data on the caring behaviors of the two student groups. Instructors and nursing students were interviewed for their experiences and perceptions of using the Caring Code. The Caring Code had a statistically significant positive effect on student caring behavior.
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