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Noor A, Krilov LR. A Historical Perspective on RSV Prevention: A Journey Spanning Over Half a Century from the Setback of an Inactive Vaccine Candidate to the Success of Passive Immunization Strategy. J Pediatric Infect Dis Soc 2024:piae027. [PMID: 38577737 DOI: 10.1093/jpids/piae027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Indexed: 04/06/2024]
Abstract
The efforts to prevent RSV infection in infants span over half a century. RSV vaccine development began in the 1960s, and it confronted a significant disappointment after testing a formalin inactivated RSV (FI RSV) vaccine candidate. This inactivated RSV vaccine was not protective. A large number of the vaccinated RSV naïve children, when subsequently exposed to natural RSV infection from wild type virus in the community, developed severe lung inflammation termed enhanced respiratory disease. This resulted in a halt in RSV vaccine development. In the 1990s, attention turned to the potential for passive protection against severe RSV disease with immunoglobulin administration. This led to studies on using standard intravenous immunoglobulins in high-risk infants, followed by high-titer RSV immunoglobulin preparation and, subsequently, the development of RSV monoclonal antibodies. Over the past 25 years, palivizumab has been recognized as a safe and effective monoclonal antibody as a prevention strategy for RSV in high-risk children. Its high cost and need for monthly administration, however, has hindered its use to ~2% of the birth cohort, neglecting the vast majority of newborns, including healthy full-term infants who comprise the largest portion of RSV hospitalizations and the greatest part of the burden of RSV disease. Still these efforts, helped pave the way for the present advances in RSV prevention that hold promise for mitigating severe RSV disease for all infants.
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Affiliation(s)
- Asif Noor
- Department of Pediatrics, Division of Pediatric Infectious Diseases, NYU Grossman Long Island School of Medicine, Mineola, NY
| | - Leonard R Krilov
- Department of Pediatrics, Division of Pediatric Infectious Diseases, NYU Grossman Long Island School of Medicine, Mineola, NY
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2
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Picache D, Gluskin D, Noor A, Senken B, Fiorito T, Akerman M, Krilov LR, Leavens-Maurer J. Respiratory Syncytial Virus Infection and Apnea Risk As Criteria for Hospitalization in Full Term Healthy Infants. Cureus 2024; 16:e53845. [PMID: 38465165 PMCID: PMC10924468 DOI: 10.7759/cureus.53845] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/07/2024] [Indexed: 03/12/2024] Open
Abstract
Introduction Apnea is recognized as a serious and potentially life-threatening complication associated with Respiratory Syncope Virus (RSV). The literature reports a wide range of apnea rates for infants with comorbid factors. Prematurity and young chronological age have been historically associated with the risk of apnea in hospitalized infants. Few studies have specifically examined the risk of apnea in healthy infants presenting to the emergency department. Methods This is a retrospective review of infants diagnosed with RSV using a PCR assay. Patients were divided into "mild" and "severe" cohorts based on symptoms at presentation. This study occurred in the NYU Langone Long Island (NYULI) pediatric emergency department (ED), a midsize academic hospital in the Northeast United States. The study included infants <6 months of age, born full term without comorbid conditions such as chronic lung or cardiac conditions, seen in NYULI ED over three consecutive RSV seasons (2017-2020). The primary outcome was the risk of apneic events. Secondary outcomes included hospital admission, ICU admission, length of stay, and supplemental oxygen support. Results The risk of apnea was <2%, regardless of disease severity. There were no significant differences in demographics between mild and severe disease. Cohorts differed significantly in the number of hospitalizations (41 milds vs. 132 severe), ICU admissions (2 milds vs. 27 severe), need for oxygen support (17 milds vs. 92 severe), hospital readmissions (2 milds vs. 42 severe), and length of stay (2 days milds vs. 3 days severe). Conclusions Apnea does not pose a significant risk for healthy full-term infants with RSV disease of any severity. The decision to admit this population to the hospital should be based on clinical presentation and not solely on the perceived risk of apnea.
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Affiliation(s)
- Dyana Picache
- Pediatrics, NYU Grossman Long Island School of Medicine, Mineola, USA
| | - Diana Gluskin
- Hospital Medicine, Hackensack Meridian Ocean Medical Center, Neptune Township, USA
| | - Asif Noor
- Pediatric Infectious Diseases, NYU Grossman Long Island School of Medicine, Mineola, USA
| | - Brooke Senken
- Pediatric Emergency Medicine, Indiana University School of Medicine, Indianapolis, USA
| | - Theresa Fiorito
- Pediatric Infectious Diseases, NYU Grossman Long Island School of Medicine, Mineola, USA
| | - Meredith Akerman
- Biostatistics, NYU Grossman Long Island School of Medicine, Mineola, USA
| | - Leonard R Krilov
- Pediatric Infectious Diseases, NYU Grossman Long Island School of Medicine, Mineola, USA
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Bower M, Kothari U, Akerman M, Krilov LR, Fiorito TM. Impact of COVID-19 on HPV Vaccination Rates in New York City and Long Island. Pediatr Infect Dis J 2024; 43:84-87. [PMID: 37963272 DOI: 10.1097/inf.0000000000004149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2023]
Abstract
BACKGROUND In the United States, uptake of human papillomavirus (HPV) vaccination has been exceptionally low as compared with other vaccines. During the coronavirus disease (COVID-19) pandemic, routine vaccinations were deferred or delayed, further exacerbating HPV vaccine hesitancy. The specific effect of the pandemic on HPV vaccination rates in the United States has not been yet described. METHODS We aimed to determine the percentage of children achieving full HPV vaccination (2 doses) by age 15 years and to compare prepandemic to pandemic rates of HPV vaccination at pediatric practices across our institution. A retrospective chart review was performed to compare HPV vaccination rates in the "prepandemic" and "pandemic" periods for all children 9 through 14 years of age. Additionally, peaks in COVID-19 positivity were compared with HPV vaccination rates. RESULTS Of children 9-14 years old, 49.3% received at least 1 dose of HPV vaccine in the prepandemic period, compared with 33.5% during the pandemic ( P < 0.0001). Only 33.5% of patients received the full 2-dose series of HPV prepandemic, compared with 19.0% of patients during the pandemic ( P < 0.0001). When COVID-19 positivity rates peaked, HPV vaccination also declined. CONCLUSIONS The issue of low HPV vaccination rates was amplified due to the COVID-19 pandemic, as illustrated by the correlation between peaks in COVID-19 positivity and low rates of HPV vaccination.
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Affiliation(s)
- Maria Bower
- From the Division of Infectious Diseases, Department of Pediatrics, NYU Langone Hospital- Long Island, Mineola, NY
- Division of Pediatric Infectious Diseases, Department of Pediatrics, NYU Long Island School of Medicine, Mineola, NY
| | - Ulka Kothari
- From the Division of Infectious Diseases, Department of Pediatrics, NYU Langone Hospital- Long Island, Mineola, NY
- Division of Pediatric Infectious Diseases, Department of Pediatrics, NYU Long Island School of Medicine, Mineola, NY
| | - Meredith Akerman
- Biostatistics Core, Division of Health Services Research, NYU Long Island School of Medicine, Mineola, NY
| | - Leonard R Krilov
- From the Division of Infectious Diseases, Department of Pediatrics, NYU Langone Hospital- Long Island, Mineola, NY
- Division of Pediatric Infectious Diseases, Department of Pediatrics, NYU Long Island School of Medicine, Mineola, NY
| | - Theresa M Fiorito
- From the Division of Infectious Diseases, Department of Pediatrics, NYU Langone Hospital- Long Island, Mineola, NY
- Division of Pediatric Infectious Diseases, Department of Pediatrics, NYU Long Island School of Medicine, Mineola, NY
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4
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Affiliation(s)
- Asif Noor
- Division of Pediatric Infectious Diseases, Department of Pediatrics, NYU Long Island School of Medicine, Mineola, NY
| | - Leonard R Krilov
- Division of Pediatric Infectious Diseases, Department of Pediatrics, NYU Long Island School of Medicine, Mineola, NY
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5
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Affiliation(s)
- Asif Noor
- Division of Pediatric Infectious Diseases, Department of Pediatrics, NYU Grossman Long Island School of Medicine, Mineola, NY
| | - Leonard R Krilov
- Division of Pediatric Infectious Diseases, Department of Pediatrics, NYU Grossman Long Island School of Medicine, Mineola, NY
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Kong AM, Winer IH, Zimmerman NM, Diakun D, Bloomfield A, Gonzales T, Fergie J, Goldstein M, Krilov LR. Increasing Rates of RSV Hospitalization among Preterm Infants: A Decade of Data. Am J Perinatol 2023; 40:1529-1536. [PMID: 34704241 PMCID: PMC10556298 DOI: 10.1055/s-0041-1736581] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 09/26/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE In 2014, the American Academy of Pediatrics (AAP) changed its policy on the use of respiratory syncytial virus immunoprophylaxis (RSV-IP) so that RSV-IP was no longer recommended for use among infants without other medical conditions born >29 weeks of gestational age (wGA). This study examines 10-year trends in RSV-IP and RSV hospitalizations among term infants and preterm infants born at 29 to 34 wGA, including the 5 RSV seasons before and 5 RSV seasons after the AAP guidance change. STUDY DESIGN A retrospective observational cohort study of a convenience sample of infants less than 6 months of age during RSV season (November-March) born between July 1, 2008, and June 30, 2019, who were born at 29 to 34 wGA (preterm) or >37 wGA (term) in the IBM MarketScan Commercial and Multi-State Medicaid databases. We excluded infants with medical conditions that would independently qualify them for RSV-IP. We identified RSV-IP utilization along with RSV and all-cause bronchiolitis hospitalizations during each RSV season. A difference-in-difference model was used to determine if there was a significant change in the relative rate of RSV hospitalizations following the 2014 policy change. RESULTS There were 53,535 commercially insured and 85,099 Medicaid-insured qualifying preterm infants and 1,111,670 commercially insured and 1,492,943 Medicaid-insured qualifying term infants. Following the 2014 policy change, RSV-IP utilization decreased for all infants, while hospitalization rates tended to increase for preterm infants. Rate ratios comparing preterm to term infants also increased. The relative rate for RSV hospitalization for infants born at 29 to 34 wGA increased significantly for both commercially and Medicaid-insured infants (1.95, 95% CI: 1.67-2.27, p <0.001; 1.70, 95% CI: 1.55-1.86, p <0.001, respectively). Findings were similar for all-cause bronchiolitis hospitalizations. CONCLUSION We found that the previously identified increase in RSV hospitalization rates among infants born at 29 to 34 wGA persisted for at least 5 years following the policy change. KEY POINTS · Immunoprophylaxis rates decreased after the 2014 American Academy of Pediatrics guidelines update.. · Rate of RSV hospitalization increased among preterm infants after the 2014 AAP guidelines update.. · Increase in RSV hospitalization persisted for at least 5 years after AAP guidelines update..
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Affiliation(s)
- Amanda M. Kong
- IBM Watson Health, Life Sciences Division, Cambridge, Massachusetts
| | | | | | - David Diakun
- IBM Watson Health, Life Sciences Division, Cambridge, Massachusetts
| | - Adam Bloomfield
- Swedish Orphan Biovitrum Sobi, NA, Medical Affairs, Waltham, Massachusetts
| | - Tara Gonzales
- Swedish Orphan Biovitrum Sobi, NA, Medical Affairs, Waltham, Massachusetts
| | - Jaime Fergie
- Infectious Diseases Service, Driscoll Children's Hospital, Corpus Christi, Texas
| | - Mitchell Goldstein
- Department of Pediatrics, Loma Linda University Children's Hospital, Loma Linda, California
| | - Leonard R. Krilov
- Department of Pediatrics, NYU Langone Hospital—Long Island, and the NYU Long Island School of Medicine, Mineola, New York
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Hanna N, Clauss C, Krilov LR. Messenger RNA Vaccine in Mother's Milk-Reply. JAMA Pediatr 2023; 177:439. [PMID: 36804769 DOI: 10.1001/jamapediatrics.2022.6018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Affiliation(s)
- Nazeeh Hanna
- Division of Neonatology, Department of Pediatrics, NYU Langone Hospital-Long Island, NYU-Long Island School of Medicine, Mineola, New York
| | - Christie Clauss
- Department of Pharmacy, NYU Langone Hospital-Long Island, NYU-Long Island School of Medicine, Mineola, New York
| | - Leonard R Krilov
- Division of Infectious Diseases, Department of Pediatrics, NYU Langone Hospital-Long Island, NYU-Long Island School of Medicine, Mineola, New York
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Affiliation(s)
- Theresa M Fiorito
- Division of Infectious Diseases, Department of Pediatrics, NYU Langone Hospital-Long Island, Mineola.,Department of Pediatrics, NYU Long Island School of Medicine, Mineola, NY
| | - Leonard R Krilov
- Division of Infectious Diseases, Department of Pediatrics, NYU Langone Hospital-Long Island, Mineola.,Department of Pediatrics, NYU Long Island School of Medicine, Mineola, NY
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Begaj X, Lee H, Noor A, Fiorito T, Agarwalla V, Kambhampati O, Islam S, Krilov LR. Clinical Outcomes of Children With Extended-spectrum ß -Lactamase Urinary Tract Infection Receiving Discordant Empiric Antibiotic: A Comparative Study of Fever Duration, Length of Stay, and Readmissions. Clin Pediatr (Phila) 2022; 62:338-344. [PMID: 36199269 DOI: 10.1177/00099228221129029] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
There has been a recent increase in the incidence of urinary tract infections (UTIs) caused by extended spectrum beta-lactamase (ESBL) producing Enterobacteriaceae, which are resistant to third-generation cephalosporins. Our goal was to compare the clinical responses of patients with ESBL UTI and non-ESBL UTI who received empiric third-generation cephalosporins. A retrospective analysis was performed on data collected between June 1, 2013, and June 30, 2017, from children aged 0 days to 19 years old who presented to NYU Langone Long Island Hospital's pediatric ED and/or were admitted with a UTI caused by Enterobacteriaceae. There was no significant difference in median length of fever duration. However, ESBL patients had significantly longer hospital stays, higher 30-day readmission rate, and higher 7-day revisit rate. It is reasonable to maintain an empiric UTI antibiotic choice rather than selecting a broad-spectrum antibiotic, such as carbapenem for children at high risk of ESBL UTI.
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Affiliation(s)
- Xhesika Begaj
- NYU Long Island School of Medicine, Mineola, NY, USA
| | - Hannah Lee
- Department of Medicine and Pediatrics, UT Southwestern, Dallas, Texas
| | - Asif Noor
- Division of Pediatric Infectious Diseases, Department of Pediatrics, NYU Langone Long Island Hospital, Mineola, NY, USA
| | - Theresa Fiorito
- Division of Pediatric Infectious Diseases, Department of Pediatrics, NYU Langone Long Island Hospital, Mineola, NY, USA
| | - Vipin Agarwalla
- Department of Emergency Medicine, NYU Long Island School of Medicine, Mineola, NY, USA
| | - Ooha Kambhampati
- Division of Pediatric Infectious Diseases, Department of Pediatrics, NYU Langone Long Island Hospital, Mineola, NY, USA
| | - Shahidul Islam
- Biostatistics Core, Division of Health Services Research, NYU Long Island School of Medicine, Mineola, NY, USA
| | - Leonard R Krilov
- Division of Pediatric Infectious Diseases, Department of Pediatrics, NYU Langone Long Island Hospital, Mineola, NY, USA
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Affiliation(s)
- Leonard R Krilov
- New York University, Long Island School of Medicine, Mineola, New York
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11
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Affiliation(s)
- Theresa Fiorito
- Pediatrics, NYU Langone Health, New York, New York, USA .,NYU Long Island School of Medicine, Mineola, New York, USA
| | | | - Asif Noor
- Pediatrics, NYU Langone Health, New York, New York, USA.,NYU Long Island School of Medicine, Mineola, New York, USA
| | - Leonard R Krilov
- Pediatrics, NYU Langone Health, New York, New York, USA.,NYU Long Island School of Medicine, Mineola, New York, USA
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12
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Fiorito TM, Krilov LR. Diurnal Temperature Variation: Addressing Once-Daily Nighttime Fevers in the Era of COVID-19. Pediatr Ann 2022; 51:e202-e205. [PMID: 35575539 DOI: 10.3928/19382359-20220314-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Pediatric patients with "once-daily" fevers are often referred to pediatric infectious disease specialists for evaluation. Often, these fevers occur at nighttime in the absence of additional symptoms and come to the caregiver's attention after a viral illness. It is crucial for caregivers and providers to be able to define and measure fever accurately when trying to ascertain the true etiology of this clinical picture. Fever education is critical in providing reassurance to parents, and fever diaries should be encouraged. In a well-appearing child without any additional symptoms, at least a percentage of these fevers can be explained by normal diurnal variation of temperature. [Pediatr Ann. 2022;51(5):e202-e205.].
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Krilov LR. Infectious Disease Update: COVID-19 and Beyond. Pediatr Ann 2022; 51:e178-e179. [PMID: 35575541 DOI: 10.3928/19382359-20220314-05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Noor A, Backer M, Krilov LR. Children Lagging with COVID-19 Vaccination. Pediatr Ann 2022; 51:e180-e185. [PMID: 35575538 DOI: 10.3928/19382359-20220314-06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Children account for a growing share of coronavirus disease 2019 (COVID-19) infections in the United States. Since the widespread availability of COVID-19 vaccine in adults, there has been an upward trend of cases in children, accounting for approximately 20% of the weekly new cases. The majority (38.3%) reported in high school students age 14 to 17 years. Children are also at risk of a postinflammatory condition, known as multisystem inflammatory syndrome in children, after COVID-19. In addition, infected children could transmit the virus to vulnerable adults, contributing to ongoing pandemic. We believe that children need to be vaccinated against COVID-19 and review the available evidence. [Pediatr Ann. 2022;51(5):e180-e185.].
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Abstract
Influenza A virus (IAV) is a major cause of respiratory infections worldwide, with the most severe cases occurring in the very young and in elderly individuals [...]
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Affiliation(s)
- Norbert J. Roberts
- Division of Infectious Diseases and Immunology, Department of Medicine, New York University Grossman School of Medicine, New York, NY 10016, USA
- Division of Infectious Diseases, Department of Internal Medicine, University of Texas Medical Branch at Galveston, Galveston, TX 77555, USA
- Correspondence: ; Tel.: +1-(409)-771-3358; Fax: +1-(212)-263-3206
| | - Leonard R. Krilov
- Division of Infectious Diseases, Department of Pediatrics, New York University Long Island School of Medicine, Mineola, NY 11501, USA;
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Affiliation(s)
- Asif Noor
- Division of Pediatric Infectious Diseases, Department of Pediatrics, NYU Long Island School of Medicine, Mineola, NY
| | - Leonard R Krilov
- Division of Pediatric Infectious Diseases, Department of Pediatrics, NYU Long Island School of Medicine, Mineola, NY
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Goldstein M, Krilov LR, Fergie J, Brannman L, Wade SW, Kong AM, Ambrose CS. Unintended Consequences Following the 2014 American Academy of Pediatrics Policy Change for Palivizumab Prophylaxis among Infants Born at Less than 29 Weeks' Gestation. Am J Perinatol 2021; 38:e201-e206. [PMID: 32299107 PMCID: PMC8397527 DOI: 10.1055/s-0040-1709127] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
OBJECTIVE The aim of this study is to compare outpatient respiratory syncytial virus (RSV) immunoprophylaxis (IP) use and relative RSV hospitalization (RSVH) rates for infants <29 weeks' gestational age (wGA) versus term infants before and after the 2014 American Academy of Pediatrics (AAP) policy change. STUDY DESIGN Infants were identified in the MarketScan Commercial and Multi-State Medicaid databases. Outpatient RSV IP receipt and relative <29 wGA/term hospitalization risks in 2012 to 2014 and 2014 to 2016 were assessed using rate ratios and a difference-in-difference model. RESULTS Outpatient RSV IP receipt by infants <29 wGA and aged <3 months in the Commercial and Medicaid populations and those aged 3 to <6 months in the Medicaid population declined after 2014. Relative RSVH risks for infants <29 wGA were numerically greater after 2014, with infants aged <3 months and Medicaid infants experiencing the greatest increases. Difference-in-difference results indicated a significantly increased relative risk of RSVH for infants <29 wGA versus term (both cohorts aged 0 to <6 months) in the Medicaid-insured population (1.68, p = 0.0054). A nonsignificant increase of similar magnitude occurred in the commercially insured population (1.57, p = 0.2867). CONCLUSION The 2014 policy change was associated with a decrease in RSV IP use and an increase in RSVH risk among otherwise healthy infants <29 wGA.
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Affiliation(s)
- Mitchell Goldstein
- Division of Neonatology, Department of Pediatrics, Loma Linda University Children's Hospital, Loma Linda, California,Address for correspondence Mitchell Goldstein, MD Division of Neonatology, Department of Pediatrics, Loma Linda University Children's Hospital11175 Campus Street, Suite #11121, Loma Linda, CA 92354
| | - Leonard R. Krilov
- Division of Pediatric Infectious Disease, Children's Medical Center, NYU Winthrop, Mineola, New York
| | - Jaime Fergie
- Department of Infectious Diseases, Driscoll Children's Hospital, Corpus Christi, Texas
| | - Lance Brannman
- Biopharmaceutical Medical Department, AstraZeneca, Gaithersburg, Maryland
| | - Sally W. Wade
- Wade Outcomes Research and Consulting, Salt Lake City, Utah
| | - Amanda M. Kong
- Life Sciences Department, IBM Watson Health, Cambridge, Massachusetts
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Brand DA, Mock A, Cohn E, Krilov LR. Implementing the 2016 American Academy of Pediatrics Guideline on Brief Resolved Unexplained Events: The Parent's Perspective. Pediatr Emerg Care 2021; 37:e243-e248. [PMID: 30399064 DOI: 10.1097/pec.0000000000001659] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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] [Indexed: 11/26/2022]
Abstract
OBJECTIVES A "brief resolved unexplained event" refers to sudden alterations in an infant's breathing, color, tone, or responsiveness that prompt the parent or caregiver to seek emergency medical care. A recently published clinical practice guideline encourages discharging many of these infants home from the emergency department if they have a benign presentation. The goal is to avoid aggressive inpatient investigations of uncertain benefit. The present research explored parents' reactions to the prospect of returning home with their infant following such an event. METHODS The study used qualitative research methods to analyze semistructured, audio-recorded interviews of parents who had witnessed a brief resolved unexplained event between 2011 and 2015 and taken their infant to the emergency department of an academic teaching hospital. RESULTS A total of 22 parent interviews were conducted. The infants included 8 boys and 14 girls aged 3.6 ± 3.5 months (mean ± SD). Qualitative analysis of interview transcripts revealed a near-universal apprehension about the child's well-being, ambivalence about the best course of action after the evaluation in the emergency department, and need for reassurance about the unlikelihood of a recurrence. Parents did not, however, answer the main research question with a single voice: attitudes toward the return-home scenario ranged from unthinkable to extreme relief. Two-thirds of parents expressed at least some reservations about the idea of returning home. CONCLUSIONS Successful implementation of the 2016 guideline will require close attention to the parent's point of view. Otherwise, parental resistance is likely to compromise clinicians' best efforts.
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Affiliation(s)
| | - Ann Mock
- Department of Pediatrics, Children's Medical Center, NYU Winthrop Hospital, Mineola
| | - Elizabeth Cohn
- Center for Health Innovation, Adelphi University, Garden City, NY
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Fiorito TM, Krilov LR, Nonaillada J. Human Papillomavirus Knowledge and Communication Skills: A Role-Play Activity for Providers. MedEdPORTAL 2021; 17:11150. [PMID: 33907710 PMCID: PMC8063629 DOI: 10.15766/mep_2374-8265.11150] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 03/02/2021] [Indexed: 06/12/2023]
Abstract
INTRODUCTION Human papillomavirus (HPV) infection and related cancers are a major cause of morbidity and mortality worldwide. Routine vaccination against HPV is recommended for patients starting at age 9-12 years. Discussing this vaccine with parents of young children can be challenging for clinicians. Barriers include parental beliefs, strength and quality of clinician recommendations, physician knowledge of HPV disease and vaccines, and provider comfort levels with discussing sexuality. METHODS Our interactive workshop began with a predidactic role-play session addressing common concerns about the HPV vaccine where participants took turns playing a concerned parent or provider. We then gave a 30-minute didactic lecture and conducted a postdidactic role-play session to practice communication skills in promoting the HPV vaccine. All participants completed pre- and postintervention knowledge and skill self-assessments. RESULTS Twenty-eight pediatric residents and medical students participated. We observed significant improvement in their ability to appropriately recommend the HPV vaccine in the postdidactic role-play (all ps < .02). Learner knowledge improved from pre- to postintervention (from 34% to 100%, p < .0025, based on average score), as did self-perceived comfort and confidence levels (from 3.6 to 4.3, p < .0001, average score based on a 5-point Likert scale). DISCUSSION An interactive workshop utilizing role-play supplemented by a didactic lecture was effective in improving participants' knowledge, communication skills, comfort levels, and confidence levels regarding HPV disease and vaccines. The workshop offers a practical and interpersonal approach to improving learners' skills in discussing the HPV vaccine with parents.
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Affiliation(s)
- Theresa M. Fiorito
- Attending Physician, Department of Pediatrics, Division of Pediatric Infectious Diseases, NYU Langone Long Island Hospital; Assistant Professor, Department of Pediatrics, NYU Long Island School of Medicine
| | - Leonard R. Krilov
- Chief, Department of Pediatrics, Division of Pediatric Infectious Diseases, NYU Langone Long Island Hospital; Professor, Department of Pediatrics, NYU Long Island School of Medicine; Chair, Department of Pediatrics, NYU Langone Long Island Hospital
| | - Jeannine Nonaillada
- Associate Professor, Department of Medicine, Division of Geriatric Medicine, NYU Long Island School of Medicine; Assistant Dean, Faculty Development and Mentoring, NYU Long Island School of Medicine
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Chatterjee A, Mavunda K, Krilov LR. Current State of Respiratory Syncytial Virus Disease and Management. Infect Dis Ther 2021; 10:5-16. [PMID: 33660239 PMCID: PMC7928170 DOI: 10.1007/s40121-020-00387-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 12/09/2020] [Indexed: 01/25/2023] Open
Abstract
Respiratory syncytial virus (RSV) is a major cause of hospitalizations due to pneumonia and bronchiolitis. Substantial morbidity and socioeconomic burden are associated with RSV infection worldwide. Populations with higher susceptibility to developing severe RSV include premature infants, children with chronic lung disease of prematurity (CLDP) or congenital heart disease (CHD), elderly individuals aged > 65 years, and immunocompromised individuals. In the pediatric population, RSV can lead to long-term sequelae such as wheezing and asthma, which are associated with increased health care costs and reduced quality of life. Treatment for RSV is mainly supportive, and general preventive measures such as good hygiene and isolation are highly recommended. Although vaccine development for RSV has been a global priority, attempts to date have failed to yield a safe and effective product for clinical use. Currently, palivizumab is the only immunoprophylaxis (IP) available to prevent severe RSV in specific high-risk pediatric populations. Well-controlled, randomized clinical trials have established the efficacy of palivizumab in reducing RSV hospitalization (RSVH) in high-risk infants including moderate- to late-preterm infants. However, the American Academy of Pediatrics (AAP), in its 2014 policy, stopped recommending RSV IP use for ≥ 29 weeks' gestational age infants. Revisions to the AAP policy for RSV IP have largely narrowed the proportion of pediatric patients eligible to receive RSV IP and have been associated with an increase in RSVH and morbidity. On the other hand, after reviewing the recent evidence on RSV burden, the National Perinatal Association, in its 2018 clinical practice guidelines, recommended RSV IP use for a wider pediatric population. As the AAP recommendations drive insurance reimbursements for RSV IP, they should be revised to help further mitigate RSV disease burden.
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Affiliation(s)
- Archana Chatterjee
- Department of Pediatrics, Sanford Children's Specialty Clinic, University of South Dakota Sanford School of Medicine, Sioux Falls, SD, USA
| | - Kunjana Mavunda
- Department of Pulmonary Medicine, Kidz Medical Services, Coral Gables, FL, USA
| | - Leonard R Krilov
- Department of Pediatrics, NYU Langone Hospital-Long Island, NYU Long Island School of Medicine, Mineola, NY, USA.
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21
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Krilov LR, Forbes ML, Goldstein M, Wadhawan R, Stewart DL. Severity and Cost of RSV Hospitalization Among US Preterm Infants Following the 2014 American Academy of Pediatrics Policy Change. Infect Dis Ther 2021; 10:27-34. [PMID: 33656650 PMCID: PMC8017024 DOI: 10.1007/s40121-020-00389-0] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 12/09/2020] [Indexed: 12/02/2022] Open
Abstract
The American Academy of Pediatrics (AAP) Committee on Infectious Diseases (COID) periodically publishes recommendations for respiratory syncytial virus (RSV) immunoprophylaxis (IP) use in pediatric patients considered to be at highest risk for severe RSV infection. In 2014, for the first time, the AAP COID stopped recommending the use of RSV IP for otherwise healthy infants born at 29 weeks’ gestational age (wGA) or later, stating that RSV hospitalization (RSVH) rates in this population are similar to those of term infants. Subsequently, epidemiological studies in the US at national and regional levels provided evidence of the impact of the policy change in 29–34 wGA infants. The results of these studies demonstrated a significant decrease in IP use after 2014 that was associated with an increased rate of RSVH in 29–34 wGA infants and an increase in morbidities. RSVH-related morbidities included pediatric intensive care unit (ICU) admissions, an increased need for mechanical ventilation, and an increase in the length of stay. After the change in recommendations, the costs of RSVH also rose among 29–34 wGA infants. The severity of the illness and expenses associated with RSVH were generally higher among 29–34 wGA infants of younger chronologic age compared with older preterm infants. Overall, these studies underscore that 29–34 wGA infants continue to be a high-risk pediatric population that could benefit from the protection provided by RSV IP. On the basis of these data, in 2018, the National Perinatal Association developed guidelines that recommended RSV IP for all ≤ 32 wGA infants and 32–35 wGA infants with additional risk factors. Re-evaluation of the AAP COID policy is warranted in light of these observations.
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Affiliation(s)
- Leonard R Krilov
- Department of Pediatrics, NYU Langone Hospital - Long Island and the NYU Long Island School of Medicine, Mineola, NY, USA.
| | - Michael L Forbes
- Department of Pediatrics, Akron Children's Hospital, Akron, OH, USA
| | - Mitchell Goldstein
- Department of Pediatrics, Loma Linda University Children's Hospital, Loma Linda, CA, USA
| | - Rajan Wadhawan
- Department of Pediatrics, AdventHealth for Children, Orlando, FL, USA
| | - Dan L Stewart
- Department of Pediatrics, Norton Children's Hospital and University of Louisville Hospital, Louisville, KY, USA
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22
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Abstract
Childhood cases of coronavirus disease 2019 (COVID-19) are on the rise as the pandemic continues to rage across the globe. Most children acquire infection from an adult household member. Children may stay asymptomatic, have a pre-symptomatic stage, or present with symptoms (fever, cough, and difficulty breathing being the most common). Nearly one-third of the pediatric cases (32%) in the United States occurred in children age 15 to 17 years. Children are also at risk of a postinfectious hyperinflammatory syndrome called multisystem inflammatory syndrome in children (MIS-C). The risk of vertical transmission is low (2%) in newborns of mothers with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Nucleic acid amplification testing (NAAT) is the gold standard for (SARS-CoV-2). Serology should be considered in a child with high clinical suspicion for COVID-19 when NAAT is negative and at least 2 weeks have passed since symptom onset and for assessment of MIS-C. Easy fatigability after COVID-19 infection is reported in adults; however, data in children are lacking. Implementation of early and robust containment strategies coupled with universal COVID-19 vaccination are vital to halt the spread. [Pediatr Ann. 2021;50(2):e84-e89.].
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23
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Fergie J, Goldstein M, Krilov LR, Wade SW, Kong AM, Brannman L. Update on respiratory syncytial virus hospitalizations among U.S. preterm and term infants before and after the 2014 American Academy of Pediatrics policy on immunoprophylaxis: 2011-2017. Hum Vaccin Immunother 2020; 17:1536-1545. [PMID: 33090914 PMCID: PMC8078654 DOI: 10.1080/21645515.2020.1822134] [Citation(s) in RCA: 4] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
Palivizumab is the only licensed respiratory syncytial virus (RSV) immunoprophylaxis (IP) available to prevent severe RSV disease in high-risk pediatric populations, including infants born at 29-34 weeks' gestational age (wGA). In 2014, the American Academy of Pediatrics (AAP) stopped recommending RSV IP use for otherwise healthy 29-34 wGA infants and stated that 29-34 wGA infants and term infants have similar RSV hospitalization (RSVH) rates. This study aimed to compare RSV IP use and RSVH rates in 29-34 wGA infants and term infants during the 3 RSV seasons before and after the 2014 AAP policy change. RSV IP use in otherwise healthy infants 29-30, 31-32, and 33-34 wGA was estimated from pharmacy or outpatient medical claims for palivizumab. RSVH rates in the first 6 months of life were calculated per 100 infant-seasons. RSVH rate ratios were used to compare preterm infants and term infants before and after the policy change. Across infant cohorts (29-34 wGA) and chronologic age groups (<3 months and 3-<6 months), absolute decreases in RSV IP use between the combined 2011-2014 seasons and 2014-2017 seasons ranged from 7% to 38% and from 68% to 97%, respectively. Compared with 2011-2014, the RSVH risk increased 2.09-fold (P< .001) and 1.76-fold (P< .001) in 2014-2017 for infants born at 29-34 wGA and aged <6 months with commercial and Medicaid insurance, respectively. Overall, RSV IP use declined in the RSV seasons following the 2014 RSV IP policy change, and RSVH increased among 29-34 wGA infants aged <6 months.
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Affiliation(s)
- Jaime Fergie
- Infectious Diseases Service, Driscoll Children's Hospital, Corpus Christi, TX, USA
| | - Mitchell Goldstein
- Department of Pediatrics, Loma Linda University Children's Hospital, Loma Linda, CA, USA
| | - Leonard R Krilov
- Department of Pediatrics, NYU Winthrop Hospital and the NYU Long Island School of Medicine, Mineola, NY, USA
| | - Sally W Wade
- Wade Outcomes Research and Consulting, Salt Lake City, UT, USA
| | - Amanda M Kong
- Department of Life Sciences, IBM Watson Health, Cambridge, MA, USA
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24
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Wolfe DM, Nassar GN, Divya K, Krilov LR, Noor A. Young Children Presenting With Fever and Rash in the Midst of SARS-CoV-2 Outbreak in New York. Clin Pediatr (Phila) 2020; 59:1112-1118. [PMID: 32633553 DOI: 10.1177/0009922820941631] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
| | | | - Kanneganti Divya
- NYU Winthrop Hospital Children's Medical Center, Mineola, NY, USA
| | - Leonard R Krilov
- NYU Winthrop Hospital Children's Medical Center, Mineola, NY, USA
| | - Asif Noor
- NYU Winthrop Hospital Children's Medical Center, Mineola, NY, USA
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25
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Bloomfield A, DeVincenzo JP, Ambrose CS, Krilov LR. RSV and non-RSV illness hospitalization in RSV immunoprophylaxis recipients: A systematic literature review. J Clin Virol 2020; 129:104339. [PMID: 32512375 DOI: 10.1016/j.jcv.2020.104339] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 03/05/2020] [Accepted: 03/25/2020] [Indexed: 11/26/2022]
Abstract
Respiratory syncytial virus (RSV) immunoprophylaxis (IP) has been shown to reduce RSV hospitalization rates in high-risk infants; however, it is unclear whether RSV IP is associated with increased risk of non-RSV disease, particularly non-RSV hospitalizations. We conducted a systematic literature review to understand the occurrences of non-RSV disease and/or non-RSV hospitalizations in published studies of RSV IP. Cochrane, Embase, and PubMed databases were searched and reviewed to summarize data regarding the incidence of RSV and non-RSV respiratory disease among RSV IP recipients and controls in randomized and non-randomized studies. Independent investigators screened and selected studies for inclusion. Risk-of-bias assessment was conducted to assess strength/validity of the data using the Jadad scoring system and Downs and Black quality assessment tool, where appropriate. Twenty studies were included for review (5 randomized controlled trials [RCTs]; 15 non-randomized studies). RCTs of RSV IP demonstrated reductions in RSV hospitalizations and all-cause hospitalizations, with no increase in hospitalizations for non-RSV disease. Non-randomized studies also demonstrated reduced RSV hospitalizations in RSV IP recipients but had mixed results in assessments of hospitalizations for non-RSV disease. When RSV IP recipients and controls were more similar in disease severity risk, results of non-randomized studies aligned more closely with RCTs. Observations of increased non-RSV hospitalization rates among RSV IP recipients in some non-randomized studies could be primarily explained by differences in the clinical characteristics between RSV IP recipients and controls.
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Affiliation(s)
| | - John P DeVincenzo
- Children's Foundation Research Institute at Le Bonheur Children's Hospital, Memphis, TN, USA
| | | | - Leonard R Krilov
- Children's Medical Center, NYU Winthrop Hospital and NYU Long Island School of Medicine, Mineola, NY, USA.
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26
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Anderson EJ, DeVincenzo JP, Simões EAF, Krilov LR, Forbes ML, Pannaraj PS, Espinosa CM, Welliver RC, Wolkoff LI, Yogev R, Checchia PA, Domachowske JB, Halasa N, McBride SJ, Kumar VR, McLaurin KK, Rizzo CP, Ambrose CS. SENTINEL1: Two-Season Study of Respiratory Syncytial Virus Hospitalizations among U.S. Infants Born at 29 to 35 Weeks' Gestational Age Not Receiving Immunoprophylaxis. Am J Perinatol 2020; 37:421-429. [PMID: 30991438 DOI: 10.1055/s-0039-1681014] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVE The SENTINEL1 observational study characterized confirmed respiratory syncytial virus hospitalizations (RSVH) among U.S. preterm infants born at 29 to 35 weeks' gestational age (wGA) not receiving respiratory syncytial virus (RSV) immunoprophylaxis (IP) during the 2014 to 2015 and 2015 to 2016 RSV seasons. STUDY DESIGN All laboratory-confirmed RSVH at participating sites during the 2014 to 2015 and 2015 to 2016 RSV seasons (October 1-April 30) lasting ≥24 hours among preterm infants 29 to 35 wGA and aged <12 months who did not receive RSV IP within 35 days before onset of symptoms were identified and characterized. RESULTS Results were similar across the two seasons. Among infants with community-acquired RSVH (N = 1,378), 45% were admitted to the intensive care unit (ICU) and 19% required invasive mechanical ventilation (IMV). There were two deaths. Infants aged <6 months accounted for 78% of RSVH observed, 84% of ICU admissions, and 91% requiring IMV. Among infants who were discharged from their birth hospitalization during the RSV season, 82% of RSVH occurred within 60 days of birth hospitalization discharge. CONCLUSION Among U.S. preterm infants 29 to 35 wGA not receiving RSV IP, RSVH are often severe with almost one-half requiring ICU admission and about one in five needing IMV.
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Affiliation(s)
- Evan J Anderson
- Departments of Pediatrics and Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - John P DeVincenzo
- Departments of Pediatrics and Microbiology, Immunology, and Biochemistry, University of Tennessee School of Medicine, Memphis, Tennessee
| | - Eric A F Simões
- Section of Pediatric Infectious Disease, University of Colorado School of Medicine, Colorado School of Public Health, Children's Hospital Colorado, Aurora, Colorado
| | - Leonard R Krilov
- Division of Pediatric Infectious Disease, Children's Medical Center, NYU-Winthrop Hospital, Mineola, New York
| | - Michael L Forbes
- Pediatric Critical Care Medicine, Akron Children's Hospital, Akron, Ohio
| | - Pia S Pannaraj
- Division of Infectious Diseases, Children's Hospital Los Angeles, Los Angeles, California, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Claudia M Espinosa
- Pediatric Infectious Diseases, University of Louisville, Louisville, Kentucky
| | - Robert C Welliver
- Pediatric Infectious Diseases, Children's Hospital at OU Medical Center, Oklahoma City, Oklahoma
| | - Leslie I Wolkoff
- Division of Neonatology, Connecticut Children's Medical Center, Hartford, Connecticut
| | - Ram Yogev
- Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Paul A Checchia
- Cardiac Intensive Care, Texas Children's Hospital, Houston, Texas
| | - Joseph B Domachowske
- Pediatrics: Infectious Disease, SUNY Upstate Medical University, Syracuse, New York
| | - Natasha Halasa
- Pediatric Infectious Diseases, Vanderbilt University Medical Center, Nashville, Tennessee
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27
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Noyola E, Noor A, Sweeney N, Chan J, Ramesh R, Calixte R, Krilov LR. Prevalence of Bandemia in Respiratory Viral Infections: A Pediatric Emergency Room Experience. Front Pediatr 2020; 8:576676. [PMID: 33489997 PMCID: PMC7816918 DOI: 10.3389/fped.2020.576676] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 11/16/2020] [Indexed: 11/13/2022] Open
Abstract
Objective: The aim of this study was to examine the prevalence of bandemia in confirmed respiratory viral infections in febrile infants and children presenting to the emergency department. Methods: An observational retrospective study from January 1, 2016, through December 31, 2016, was conducted in patients between the ages of ≥ 1 month and ≤ 5 years presenting to the emergency room with fever and who had a complete blood cell count performed. Patients were separated into seven groups based on the type of respiratory viral infection. Inclusion criteria strictly counted children with viral infections and absence of clinical and laboratory evidence of a bacterial coinfection. Results: A total of 419 patients had a documented viral infection. A significant proportion of these children were found to have bandemia; children with adenovirus (17%), respiratory syncytial virus (RSV) (14.9%), human metapneumovirus (hMPV) (13%), and parainfluenza virus (7.9%) had the highest prevalence when the cutoff for bandemia was set at 10%. The prevalence increased to 35.3, 30.9, 40.3, and 15.8% for adenovirus, RSV, hMPV, and parainfluenza virus, respectively, when this cutoff was lowered further to 5%. Conclusion: Band neutrophils are detected frequently in confirmed respiratory viral infections particularly during early stages.
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Affiliation(s)
- Estela Noyola
- Department of Pediatrics, NYU Long Island School of Medicine, Mineola, NY, United States
| | - Asif Noor
- Department of Pediatrics, NYU Long Island School of Medicine, Mineola, NY, United States
| | - Nicole Sweeney
- Department of Pediatrics, NYU Long Island School of Medicine, Mineola, NY, United States
| | - Joshua Chan
- Department of Pediatrics, NYU Long Island School of Medicine, Mineola, NY, United States
| | - Rahul Ramesh
- Department of Pediatrics, NYU Long Island School of Medicine, Mineola, NY, United States
| | - Rose Calixte
- Department of Pediatrics, NYU Long Island School of Medicine, Mineola, NY, United States.,Department of Community Health and Social Medicine, The City University of New York (CUNY) School of Medicine, New York, NY, United States
| | - Leonard R Krilov
- Department of Pediatrics, NYU Long Island School of Medicine, Mineola, NY, United States
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28
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Krilov LR, Fergie J, Goldstein M, Brannman L. Impact of the 2014 American Academy of Pediatrics Immunoprophylaxis Policy on the Rate, Severity, and Cost of Respiratory Syncytial Virus Hospitalizations among Preterm Infants. Am J Perinatol 2020; 37:174-183. [PMID: 31430818 DOI: 10.1055/s-0039-1694008] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [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: 10/26/2022]
Abstract
OBJECTIVE This study examined the rate, severity, and cost of respiratory syncytial virus (RSV) hospitalizations among preterm infants 29 to 34 weeks gestational age (wGA) versus term infants before and after a 2014 change in the American Academy of Pediatrics policy for RSV immunoprophylaxis. STUDY DESIGN Preterm (29-34 wGA) and term infants born from July 2011 to March 2017 and aged < 6 months were identified in a U.S. commercial administrative claims database. RSV hospitalization (RSVH) rate ratios, severity, and costs were evaluated for the 2011 to 2014 and 2014 to 2017 RSV seasons. Postpolicy changes in RSVH risks for preterm versus term infants were assessed with difference-in-difference (DID) modeling to control for patient characteristics and temporal trends. RESULTS In the DID analysis, prematurity-associated RSVH risk was 55% greater in 2014 to 2017 versus 2011 to 2014 (relative risk = 1.55, 95% confidence interval: 1.10-2.17, p = 0.011). RSVH severity increased among preterm infants after 2014 and was highest among those aged < 3 months. Differences in mean RSVH costs for preterm infants in 2014 to 2017 versus 2011 to 2014 were not statistically significant. CONCLUSION RSVH risk for preterm versus term infants increased after the policy change, confirming previous national analyses. RSVHs after the policy change were more severe, particularly among younger preterm infants.
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Affiliation(s)
- Leonard R Krilov
- Division of Pediatric Infectious Disease, Children's Medical Center, NYU Winthrop Hospital, Mineola, New York
| | - Jaime Fergie
- Department of Pediatric Infectious Disease, Driscoll Children's Hospital, Corpus Christi, Texas
| | - Mitchell Goldstein
- Division of Neonatal Medicine, Loma Linda University Children's Hospital, Loma Linda, California
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29
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Fiorito TM, Noor A, Silletti R, Krilov LR. Neonatal Conjunctivitis Caused by Neisseria cinerea: A Case of Mistaken Identity. J Pediatric Infect Dis Soc 2019; 8:478-480. [PMID: 30462276 DOI: 10.1093/jpids/piy116] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Accepted: 10/23/2018] [Indexed: 11/12/2022]
Abstract
We report a case of a 3-day-old boy with Neisseria cinerea conjunctivitis, originally misidentified as Neisseria gonorrhoeae conjunctivitis. Neonates are at increased risk for disseminated gonococcal infection, and physicians should be cognizant of N cinerea and its potential to be mistaken for N gonorrhoeae.
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Affiliation(s)
- Theresa M Fiorito
- Division of Pediatric Infectious Diseases, Department of Pediatrics, NYU Winthrop Hospital, Mineola, New York
| | - Asif Noor
- Division of Pediatric Infectious Diseases, Department of Pediatrics, NYU Winthrop Hospital, Mineola, New York
| | - Rodger Silletti
- Department of Microbiology, NYU Winthrop Hospital, Mineola, New York
| | - Leonard R Krilov
- Division of Pediatric Infectious Diseases, Department of Pediatrics, NYU Winthrop Hospital, Mineola, New York.,Department of Pediatrics, State University of New York at Stony Brook School of Medicine
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30
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Affiliation(s)
- Asif Noor
- Department of Pediatrics, Children's Medical Center, NYU Winthrop Hospital, Mineola, NY
| | - Theresa Fiorito
- Department of Pediatrics, Children's Medical Center, NYU Winthrop Hospital, Mineola, NY
| | - Leonard R Krilov
- Department of Pediatrics, Children's Medical Center, NYU Winthrop Hospital, Mineola, NY.,Department of Pediatrics, State University of New York, Stony Brook School of Medicine, Stony Brook, NY
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31
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Merritt JL, Quinonez RA, Bonkowsky JL, Franklin WH, Gremse DA, Herman BE, Jenny C, Katz ES, Krilov LR, Norlin C, Sapién RE, Tieder JS. A Framework for Evaluation of the Higher-Risk Infant After a Brief Resolved Unexplained Event. Pediatrics 2019; 144:peds.2018-4101. [PMID: 31350360 DOI: 10.1542/peds.2018-4101] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/24/2019] [Indexed: 11/24/2022] Open
Abstract
In 2016, the American Academy of Pediatrics published a clinical practice guideline that more specifically defined apparent life-threatening events as brief resolved unexplained events (BRUEs) and provided evidence-based recommendations for the evaluation of infants who meet lower-risk criteria for a subsequent event or serious underlying disorder. The clinical practice guideline did not provide recommendations for infants meeting higher-risk criteria, an important and common population of patients. Therefore, we propose a tiered approach for clinical evaluation and management of higher-risk infants who have experienced a BRUE. Because of a vast array of potential causes, the initial evaluation prioritizes the diagnosis of time-sensitive conditions for which delayed diagnosis or treatment could impact outcomes, such as child maltreatment, feeding problems, cardiac arrhythmias, infections, and congenital abnormalities. The secondary evaluation addresses problems that are less sensitive to delayed diagnosis or treatment, such as dysphagia, intermittent partial airway obstruction, and epilepsy. The authors recommend a tailored, family-centered, multidisciplinary approach to evaluation and management of all higher-risk infants with a BRUE, whether accomplished during hospital admission or through coordinated outpatient care. The proposed framework was developed by using available evidence and expert consensus.
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Affiliation(s)
- J Lawrence Merritt
- Department of Pediatrics, University of Washington and Seattle Children's Hospital, Seattle, Washington;
| | - Ricardo A Quinonez
- Section of Pediatric Hospital Medicine, Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | - Joshua L Bonkowsky
- Department of Pediatrics, School of Medicine, University of Utah, Salt Lake City, Utah.,Brain and Spine Center, Primary Children's Hospital, Salt Lake City, Utah
| | - Wayne H Franklin
- Department of Pediatrics, Stritch School of Medicine, Loyola University, Maywood, Illinois
| | - David A Gremse
- Department of Pediatrics, University of South Alabama, Mobile, Alabama
| | - Bruce E Herman
- Department of Pediatrics, School of Medicine, University of Utah, Salt Lake City, Utah
| | - Carole Jenny
- Department of Pediatrics, University of Washington and Seattle Children's Hospital, Seattle, Washington
| | - Eliot S Katz
- Department of Medicine, Harvard Medical School, Harvard University, Boston, Massachusetts
| | - Leonard R Krilov
- Department of Pediatrics, New York University Winthrop, Mineola, New York; and
| | - Chuck Norlin
- Department of Pediatrics, School of Medicine, University of Utah, Salt Lake City, Utah
| | - Robert E Sapién
- Department of Emergency Medicine, Health Sciences Center, University of New Mexico, Albuquerque, New Mexico
| | - Joel S Tieder
- Department of Pediatrics, University of Washington and Seattle Children's Hospital, Seattle, Washington
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32
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Krilov LR. Respiratory Syncytial Virus Immunoprophylaxis: Issues in Short-term and Longer-term Impact. Pediatrics 2019; 144:peds.2019-0153. [PMID: 31239288 DOI: 10.1542/peds.2019-0153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/23/2019] [Indexed: 11/24/2022] Open
Affiliation(s)
- Leonard R Krilov
- Children's Medical Center, NYU Winthrop Hospital, Mineola, New York and NYU Long Island School of Medicine, Mineola, New York
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33
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Goldstein M, Krilov LR, Fergie J, McLaurin KK, Wade SW, Diakun D, Lenhart GM, Bloomfield A, Kong AM. Respiratory Syncytial Virus Hospitalizations among U.S. Preterm Infants Compared with Term Infants Before and After the 2014 American Academy of Pediatrics Guidance on Immunoprophylaxis: 2012-2016. Am J Perinatol 2018; 35:1433-1442. [PMID: 29920638 PMCID: PMC6260117 DOI: 10.1055/s-0038-1660466] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
OBJECTIVE The objective of this study was to compare risk for respiratory syncytial virus (RSV) hospitalizations (RSVH) for preterm infants 29 to 34 weeks gestational age (wGA) versus term infants before and after 2014 guidance changes for immunoprophylaxis (IP), using data from the 2012 to 2016 RSV seasons. STUDY DESIGN Using commercial and Medicaid claims databases, infants born between July 1, 2011 and June 30, 2016 were categorized as preterm or term. RSVH during the RSV season (November-March) were identified for infants aged <6 months and rate ratios (RRs) for hospitalization comparing preterm and term infants were calculated. Difference-in-difference models were fit to evaluate the changes in hospitalization risks in preterm versus term infants from 2012 to 2014 seasons to 2014 to 2016 seasons. RESULTS In all seasons, preterm infants had higher RSVH rates than term infants. Seasonal RRs prior to the guidance change for preterm wGA categories versus term infants ranged from 1.6 to 3.4. After the guidance change, the seasonal RRs ranged from 2.6 to 5.6. In 2014 to 2016, the risk associated with prematurity of 29 to 34 wGA versus term was significantly higher than in 2012 to 2014 (P<0.0001 for commercial and Medicaid samples). CONCLUSION In infants aged <6 months, the risk for RSVH for infants 29 to 34 wGA compared with term infants increased significantly after the RSV IP recommendations became more restrictive.
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Affiliation(s)
- Mitchell Goldstein
- Division of Neonatal Medicine, Loma Linda University Children's Hospital, Loma Linda, California,Address for correspondence Mitchell Goldstein, MD Loma Linda University Children's Hospital11175 Campus Street, Loma Linda, CA 92354
| | - Leonard R. Krilov
- Pediatric Infectious Diseases, Children's Medical Center, NYU Winthrop, Mineola, New York
| | - Jaime Fergie
- Department of Pediatric Infectious Disease, Driscoll Children's Hospital, Corpus Christi, Texas
| | | | - Sally W. Wade
- Wade Outcomes Research and Consulting, Salt Lake City, Utah
| | - David Diakun
- Truven Health Analytics, an IBM Company, Cambridge, Massachusetts
| | | | | | - Amanda M. Kong
- Truven Health Analytics, an IBM Company, Cambridge, Massachusetts
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Affiliation(s)
- Alexandra Vinci
- Children's Medical Center, NYU Winthrop Hospital, Mineola, NY
| | - Paul J Lee
- Children's Medical Center, NYU Winthrop Hospital, Mineola, NY.,State University of New York, Stony Brook School of Medicine, Stony Brook, NY
| | - Leonard R Krilov
- Children's Medical Center, NYU Winthrop Hospital, Mineola, NY.,State University of New York, Stony Brook School of Medicine, Stony Brook, NY
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Goldstein M, Krilov LR, Fergie J, Brannman L, Ambrose CS, Wade S, Kong A. 740. Impact of the 2014 American Academy of Pediatrics Guidance on Respiratory Syncytial Virus Hospitalization Rates for Preterm Infants <29 Weeks Gestational Age at Birth: 2012–2016. Open Forum Infect Dis 2018. [PMCID: PMC6255659 DOI: 10.1093/ofid/ofy210.747] [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: 11/12/2022] Open
Abstract
Abstract
Background
In 2014, the American Academy of Pediatrics stopped recommending RSV immunoprophylaxis (RSV IP) for otherwise healthy infants 29–34 weeks gestational age (wGA), while continuing to recommend RSV IP for infants born at <29 wGA. The decline in RSV IP and associated increase in RSV hospitalizations (RSVH) among infants 29–34 wGA have been described previously, but potential effects of the 2014 guidance change on preterm infants <29 wGA are unknown. This study compared 2012–2014 and 2014–2016 outpatient RSV IP use as well as RSVH rates relative to term infants among otherwise healthy <29 wGA infants.
Methods
Infants born from July 1, 2011 to June 30, 2016 were followed from birth hospitalization discharge through their first year of life in the MarketScan Commercial (COM) and Multistate Medicaid (MED) databases. DRG and ICD codes identified term and <29 wGA infants at birth. RSV IP receipt was derived from pharmacy and outpatient medical claims (inpatient RSV IP data were unavailable). RSVH were derived from inpatient medical claims. RSVH IP use and RSVH were assessed across three chronologic age (CA) groups: <3 months, 3–<6 months, and 6–<12 months. RSVH rate ratios for 2012–2014 and 2014–2016 were calculated for <29 wGA infants using healthy term infants 0–<12 months of age as a reference category.
Results
Outpatient RSV IP receipt fell after 2014 for <29 wGA infants across all CA categories, with the greatest decline observed among infants <3 months CA (Table 1). Greater RSVH rates for <29 wGA infants relative to term infants were observed after 2014 (Figures 1 and 2), with infants <3 months CA experiencing the greatest percentage increases in relative RSVH risks.
Conclusion
Outpatient RSV IP decreased and RSVH relative to term infants increased among otherwise healthy <29 wGA infants following the 2014 policy change, even though RSV IP continued to be recommended. The effects were greatest for infants <3 months CA and those insured by Medicaid.
Funded by AstraZeneca
Disclosures
M. Goldstein, AstraZeneca/MedImmune: Consultant, Research grant and Research support. L. R. Krilov, AstraZeneca/MedImmune: Consultant, Research grant and Research support. J. Fergie, AstraZeneca/MedImmune: Consultant and Speaker’s Bureau, Research grant and Research support. L. Brannman, AstraZeneca: Employee, Salary and Stocks. C. S. Ambrose, AstraZeneca: Employee, Salary and Stocks. S. Wade, Wade Outcomes Research and Consulting contracted by Truven: Consultant, Consulting fee. A. Kong, Truven Health Analytics, an IBM Company: Employee, Salary.
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Affiliation(s)
| | | | - Jaime Fergie
- Driscoll Children’s Hospital, Corpus Christi, Texas
| | | | | | - Sally Wade
- Wade Outcomes Research and Consulting, Salt Lake City, Utah
| | - Amanda Kong
- Truven Health Analytics, an IBM Company, Cambridge, Massachusetts
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Goldstein M, Krilov LR, Fergie J, Ambrose CS, Wade S, Kong A, Brannman L. 735. Severity and Healthcare Costs of Respiratory Syncytial Virus Hospitalizations in US Preterm Infants Born at 29–34 Weeks Gestation: 2014–2016. Open Forum Infect Dis 2018. [PMCID: PMC6253181 DOI: 10.1093/ofid/ofy210.742] [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: 12/02/2022] Open
Abstract
Background In 2014, the American Academy of Pediatrics recommended against the use of respiratory syncytial virus (RSV) immunoprophylaxis in infants 29–34 weeks gestational age (wGA) at birth without chronic lung disease/bronchopulmonary dysplasia (CLD/BPD) or congenital heart disease (CHD). To inform discussions of the clinical and economic value of RSV immunoprophylaxis in these infants, we compared RSV hospitalization (RSVH) severity and costs incurred by infants hospitalized from 2014–2016 at <6 months chronologic age (CA) for two groups: 29–34 wGA infants without CLD/BPD or CHD and term infants (≥37 wGA) without major health problems. Methods Births were identified in the MarketScan Commercial (COM) and Multistate Medicaid (MED) databases. Term and 29–34 wGA infants without CLD/BPD or CHD were selected using DRG and ICD-9/10-CM diagnosis codes. RSVH occurring from Julu 1, 2014 to June 30, 2016 while infants were <6 months CA (the period of highest RSVH incidence) were identified by ICD-9/10-CM diagnosis codes. Severity measures were length of stay (LOS) in days, intensive care unit (ICU) admissions, and healthcare costs (paid amounts on reimbursed hospital claims in 2016 US$). Comparisons between term and 29–34 wGA infants were made with t-tests and chi-squared tests. Results There were 1,114 RSVH in the COM data and 3,167 RSVH in the MED data during the study period. Mean LOS was longer for 29–34 wGA infants than term infants for each age category (P < 0.05) and tended to be longer for MED infants vs. COM infants (Figure 1). Thirty-eight percent of COM 29–34 wGA infants and 52% of MED 29–34 wGA infants hospitalized for RSV at <3 months CA were admitted to the ICU (Figure 2). RSVH costs for 29–34 wGA infants were greater than term RSVH costs for each age category (P < 0.05) and were greatest among 29–34 wGA infants hospitalized at <3 months CA: $41,104 for 29–34 wGA COM infants and $24,049 for 29–34 wGA MED infants (Figure 3). Conclusion RSVH severity and costs were significantly higher for 29–34 wGA infants without CLD/BPD or CHD relative to term infants. Infants hospitalized at <3 months CA experienced the most severe hospitalizations and incurred the highest costs. This study was funded by AstraZeneca. ![]()
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Disclosures M. Goldstein, AstraZeneca/MedImmune: Consultant, Research grant and Research support. L. R. Krilov, AstraZeneca/MedImmune: Consultant, Research grant and Research support. J. Fergie, AstraZeneca/MedImmune: Consultant and Speaker’s Bureau, Research grant and Research support. C. S. Ambrose, AstraZeneca: Employee, Salary and Stocks. S. Wade, Wade Outcomes Research and Consulting: Employee, Salary. A. Kong, Truven Health Analytics, an IBM Company: Employee, Salary. L. Brannman, AstraZeneca: Employee, Salary and Stocks.
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Affiliation(s)
| | | | - Jaime Fergie
- Driscoll Children’s Hospital, Corpus Christi, Texas
| | | | - Sally Wade
- Wade Outcomes Research and Consulting, Salt Lake City, Utah
| | - Amanda Kong
- Truven Health Analytics, an IBM Company, Cambridge, Massachusetts
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Krilov LR, Fergie J, Goldstein M, Rizzo C, Brannman L, McPheeters J, Korrer S, Burton T, Sharpsten L. 743. Severity and Costs of Respiratory Syncytial Virus and Bronchiolitis Hospitalization in Commercially Insured Preterm and Term Infants Before and After the 2014 American Academy of Pediatrics Guidance Change on Immunoprophylaxis. Open Forum Infect Dis 2018. [PMCID: PMC6254027 DOI: 10.1093/ofid/ofy210.750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background Methods Results Conclusion Disclosures
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Affiliation(s)
| | - Jaime Fergie
- Driscoll Children’s Hospital, Corpus Christi, Texas
| | | | | | | | | | | | - Tanya Burton
- Health Economics and Outcomes Research (HEOR), Optum, Eden Prairie, Minnesota
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Abstract
INTRODUCTION Respiratory syncytial virus (RSV) is the leading cause of lower respiratory tract infection in infants and elderly and to date, there is no safe or effective vaccine against RSV. AREAS COVERED This review provides a roadmap to RSV vaccine development. It is a journey spanning over more than half a century from the initial disappointment with inactivated formalin vaccine to the current advancements in vaccine technology. We highlight the important aspects of RSV structural biology and protective immune response. We include discussion of newer fusion glycoprotein immune targets and current vaccine candidates. We used Pub Med and Medline resources for literature search. EXPERT OPINION A resurgence of information on the burden related to RSV infection coupled with the newer understanding of the molecular mechanism of RSV infection has reignited a tremendous activity in RSV vaccine discovery. The vaccine pipeline is diverse and target populations are varied, thus making the goal of a safe and effective RSV vaccine in the future within reach.
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Affiliation(s)
- Asif Noor
- a Department of Pediatrics, Children's Medical Center , NYU Winthrop Hospital , Mineola , NY , USA
| | - Leonard R Krilov
- a Department of Pediatrics, Children's Medical Center , NYU Winthrop Hospital , Mineola , NY , USA.,b Department of Pediatrics, Stony Brook School of Medicine , State University of New York , Stony Brook , NY , USA
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Abstract
Clostridium difficile is an important cause of health care associated infections. The epidemiology of C. difficile infection (CDI) in children has changed over the past few decades. There is now a higher incidence in hospitalized children, and there has been an emergence of community-onset infection. A hypervirulent strain, North American pulse type 1, has also developed. Neonates and young infants have high rates of colonization but rarely have symptoms. The well-known risk factor for CDI in children age 2 years or older is antibiotic use. Inflammatory bowel disease and cancer are associated with increased incidence and severity of CDI. Nucleic acid amplification tests are now widely used for diagnosis given their rapid turnover and higher sensitivity and specificity. The treatment for an initial episode and first recurrence is oral metronidazole. Oral vancomycin is reserved for second recurrence or severe cases. A new treatment option, fecal bowel transplant, has been reported to be safe and effective in adults, and studies are now being conducted in children. [Pediatr Ann. 2018;47(9):e359-e365.].
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Noor A, Krilov LR, D'Agati V, Chandra M. Acute infection-related glomerulonephritis with disseminated gonococcal infection in a 13-year-old girl. BMJ Case Rep 2018; 2018:bcr-2018-225371. [PMID: 30021740 DOI: 10.1136/bcr-2018-225371] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Infection-related glomerulonephritis results from glomerular immune complex deposition due to a variety of potential pathogens. Poststreptococcal glomerulonephritis is the best known example. We present a case of acute infection-related glomerulonephritis associated with disseminated gonococcal infection in a sexually active 13-year-old girl, the first report of such an association in the absence of endocarditis. The patient presented with features of acute disseminated gonococcal infection including fever, hypotension, tenosynovitis, polyarthralgias and petechiae. She developed hypocomplementemic glomerulonephritis synchronous with the acute infection. The renal biopsy revealed a diffuse endocapillary proliferative and exudative glomerulonephritis with subepithelial electron-dense humps and granular glomerular capillary wall staining for C3 and IgG, typical of acute postinfectious glomerulonephritis. After treatment and resolution of the gonococcal infection, the serum creatinine, complement levels and urine sediment normalised. The only residual renal damage 16 months later was low-grade proteinuria.
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Affiliation(s)
- Asif Noor
- Department of Pediatrics, NYU Winthrop Hospital, Mineola, New York, USA
| | - Leonard R Krilov
- Department of Pediatrics, NYU Winthrop Hospital, Mineola, New York, USA
| | - Vivette D'Agati
- Department of Pathology, Columbia University Medical Center, New York City, New York, USA
| | - Manju Chandra
- Department of Pediatrics, NYU Winthrop Hospital, Mineola, New York, USA
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42
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Olchanski N, Hansen RN, Pope E, D'Cruz B, Fergie J, Goldstein M, Krilov LR, McLaurin KK, Nabrit-Stephens B, Oster G, Schaecher K, Shaya FT, Neumann PJ, Sullivan SD. Palivizumab Prophylaxis for Respiratory Syncytial Virus: Examining the Evidence Around Value. Open Forum Infect Dis 2018. [PMID: 29516023 PMCID: PMC5833316 DOI: 10.1093/ofid/ofy031] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [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] [Indexed: 01/11/2023] Open
Abstract
Respiratory syncytial virus (RSV) infection is the most common cause of lower respiratory tract infection and the leading cause of hospitalization among young children, incurring high annual costs among US children under the age of 5 years. Palivizumab has been found to be effective in reducing hospitalization and preventing serious lower respiratory tract infections in high-risk infants. This paper presents a systematic review of the cost-effectiveness studies of palivizumab and describes the main highlights of a round table discussion with clinical, payer, economic, research method, and other experts. The objectives of the discussion were to (1) review the current state of clinical, epidemiology, and economic data related to severe RSV disease; (2) review new cost-effectiveness estimates of RSV immunoprophylaxis in US preterm infants, including a review of the field’s areas of agreement and disagreement; and (3) identify needs for further research.
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Affiliation(s)
- Natalia Olchanski
- Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies at Tufts Medical Center, Boston, Massachusetts
| | - Ryan N Hansen
- University of Washington School of Pharmacy, Seattle, Washington
| | - Elle Pope
- Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies at Tufts Medical Center, Boston, Massachusetts
| | - Brittany D'Cruz
- Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies at Tufts Medical Center, Boston, Massachusetts
| | - Jaime Fergie
- Infectious Diseases, Driscoll Children's Hospital, Corpus Christi, Texas
| | - Mitchell Goldstein
- Division of Neonatology-Perinatal Medicine, Loma Linda University, Loma Linda, California
| | - Leonard R Krilov
- Pediatric Infectious Disease, NYU Winthrop Hospital, Mineola, New York
| | - Kimmie K McLaurin
- Health Economics and Outcomes Research, AstraZeneca, Gaithersburg, Maryland
| | | | | | | | - Fadia T Shaya
- University of Maryland School of Pharmacy, Baltimore, Maryland
| | - Peter J Neumann
- Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies at Tufts Medical Center, Boston, Massachusetts
| | - Sean D Sullivan
- University of Washington School of Pharmacy, Seattle, Washington
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Kong AM, Krilov LR, Fergie J, Goldstein M, Diakun D, Wade SW, Pavilack M, McLaurin KK. The 2014-2015 National Impact of the 2014 American Academy of Pediatrics Guidance for Respiratory Syncytial Virus Immunoprophylaxis on Preterm Infants Born in the United States. Am J Perinatol 2018; 35:192-200. [PMID: 28881376 PMCID: PMC6193366 DOI: 10.1055/s-0037-1606352] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE This article aims to compare respiratory syncytial virus (RSV) immunoprophylaxis (IP) use and RSV hospitalization rates (RSVH) in preterm and full-term infants without chronic lung disease of prematurity or congenital heart disease before and after the recommendation against RSV IP use in preterm infants born at 29 to 34 weeks' gestational age (wGA). STUDY DESIGN Infants in commercial and Medicaid claims databases were followed from birth through first year to assess RSV IP and RSVH, as a function of infant's age and wGA. RSV IP was based on pharmacy or outpatient medical claims for palivizumab. RSVH was based on inpatient medical claims with a diagnosis of RSV. RESULTS Commercial and Medicaid infants 29 to 34 wGA represented 2.9 to 3.5% of all births. RSV IP use in infants 29 to 34 wGA decreased 62 to 95% (p < 0.01) in the 2014-2015 season relative to the 2013-2014 season. Compared with the 2013-2014 season, RSVH increased by 2.7-fold (p = 0.02) and 1.4-fold (p = 0.03) for infants aged <3 months and 29 to 34 wGA in the 2014-2015 season with commercial and Medicaid insurance, respectively. In the 2014-2015 season, RSVH for infants 29 to 34 wGA were two to seven times higher than full-term infants without high-risk conditions. CONCLUSION Following the 2014 RSV IP guidance change, RSV IP use declined and RSVH increased among infants born at 29 to 34 wGA and aged <3 months.
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Affiliation(s)
- Amanda M. Kong
- Watson Health Value Based Care, Truven Health Analytics, an IBM Company, Cambridge, Massachusetts
| | - Leonard R. Krilov
- Pediatric Infectious Diseases, Children's Medical Center, NYU Winthrop, Mineola, New York
| | - Jaime Fergie
- Department of Pediatric Infectious Disease, Driscoll Children's Hospital, Corpus Christi, Texas,Address for correspondence Jaime Fergie, MD Driscoll Children's Hospital3533 S Alameda Street, Corpus Christi, TX 78411
| | - Mitchell Goldstein
- Division of Neonatal Medicine, Loma Linda University Children's Hospital, Linda Loma, California
| | - David Diakun
- Watson Health Value Based Care, Truven Health Analytics, an IBM Company, Cambridge, Massachusetts
| | - Sally W. Wade
- Wade Outcomes Research and Consulting, Salt Lake City, Utah
| | - Melissa Pavilack
- Health Economics and Outcomes Research, AstraZeneca, Gaithersburg, Maryland
| | - Kimmie K. McLaurin
- Health Economics and Outcomes Research, AstraZeneca, Gaithersburg, Maryland
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Kong AM, Krilov LR, Fergie J, Goldstein M, Diakun D, Wade SW, Pavilack M, McLaurin KK. The 2014-2015 National Impact of the 2014 American Academy of Pediatrics Guidance for Respiratory Syncytial Virus Immunoprophylaxis on Preterm Infants Born in the United States. Am J Perinatol 2017. [PMID: 28881376 DOI: 10.1055/s‐0037‐1606352] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/29/2022]
Abstract
OBJECTIVE This article aims to compare respiratory syncytial virus (RSV) immunoprophylaxis (IP) use and RSV hospitalization rates (RSVH) in preterm and full-term infants without chronic lung disease of prematurity or congenital heart disease before and after the recommendation against RSV IP use in preterm infants born at 29 to 34 weeks' gestational age (wGA). STUDY DESIGN Infants in commercial and Medicaid claims databases were followed from birth through first year to assess RSV IP and RSVH, as a function of infant's age and wGA. RSV IP was based on pharmacy or outpatient medical claims for palivizumab. RSVH was based on inpatient medical claims with a diagnosis of RSV. RESULTS Commercial and Medicaid infants 29 to 34 wGA represented 2.9 to 3.5% of all births. RSV IP use in infants 29 to 34 wGA decreased 62 to 95% (p < 0.01) in the 2014-2015 season relative to the 2013-2014 season. Compared with the 2013-2014 season, RSVH increased by 2.7-fold (p = 0.02) and 1.4-fold (p = 0.03) for infants aged <3 months and 29 to 34 wGA in the 2014-2015 season with commercial and Medicaid insurance, respectively. In the 2014-2015 season, RSVH for infants 29 to 34 wGA were two to seven times higher than full-term infants without high-risk conditions. CONCLUSION Following the 2014 RSV IP guidance change, RSV IP use declined and RSVH increased among infants born at 29 to 34 wGA and aged <3 months.
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Affiliation(s)
- Amanda M Kong
- Watson Health Value Based Care, Truven Health Analytics, an IBM Company, Cambridge, Massachusetts
| | - Leonard R Krilov
- Pediatric Infectious Diseases, Children's Medical Center, NYU Winthrop, Mineola, New York
| | - Jaime Fergie
- Department of Pediatric Infectious Disease, Driscoll Children's Hospital, Corpus Christi, Texas
| | - Mitchell Goldstein
- Division of Neonatal Medicine, Loma Linda University Children's Hospital, Linda Loma, California
| | - David Diakun
- Watson Health Value Based Care, Truven Health Analytics, an IBM Company, Cambridge, Massachusetts
| | - Sally W Wade
- Wade Outcomes Research and Consulting, Salt Lake City, Utah
| | - Melissa Pavilack
- Health Economics and Outcomes Research, AstraZeneca, Gaithersburg, Maryland
| | - Kimmie K McLaurin
- Health Economics and Outcomes Research, AstraZeneca, Gaithersburg, Maryland
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46
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Anderson EJ, Simões EA, Forbes ML, Checchia PA, Domachowske JB, Krilov LR, Halasa NB, Devincenzo JP, Rizzo C, McLaurin KK, Ambrose CS. Respiratory Syncytial Virus (RSV) Hospitalizations of US Preterm Infants Born at 29–35 Weeks Gestational Age: Proportions by Chronologic Age and Birth Month. Open Forum Infect Dis 2017. [DOI: 10.1093/ofid/ofx163.1483] [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: 11/15/2022] Open
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47
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Anderson EJ, Krilov LR, DeVincenzo JP, Checchia PA, Halasa N, Simões EAF, Domachowske JB, Forbes ML, Pannaraj PS, McBride SJ, McLaurin KK, Kumar VR, Ambrose CS. SENTINEL1: An Observational Study of Respiratory Syncytial Virus Hospitalizations among U.S. Infants Born at 29 to 35 Weeks' Gestational Age Not Receiving Immunoprophylaxis. Am J Perinatol 2017; 34:51-61. [PMID: 27233106 DOI: 10.1055/s-0036-1584147] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [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: 10/21/2022]
Abstract
Objective SENTINEL1 characterized U.S. preterm infants 29 to 35 weeks' gestational age (wGA) < 12 months old hospitalized for laboratory-confirmed respiratory syncytial virus (RSV) disease and not receiving RSV immunoprophylaxis during the 2014 to 2015 RSV season. Study Design This is a noninterventional, observational, cohort study. Results A total of 702 infants were hospitalized with community-acquired RSV disease, of whom an estimated 42% were admitted to the intensive care unit (ICU) and 20% required invasive mechanical ventilation (IMV). Earlier gestational age and younger chronologic age were associated with an increased frequency of RSV-confirmed hospitalization (RSVH), ICU admission, and IMV. Among infants 29 to 32 wGA and < 3 months of age, 68% required ICU admission and 44% required IMV. One death occurred of an infant 29 wGA. Among the 212 infants enrolled for in-depth analysis of health care resource utilization, mean and median RSVH charges were $55,551 and $27,461, respectively, which varied by intensity of care required. Outpatient visits were common, with 63% and 62% of infants requiring visits before and within 1 month following the RSVH, respectively. Conclusion Preterm infants 29 to 35 wGA are at high risk for severe RSV disease, which imposes a substantial health burden, particularly in the first months of life.
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Affiliation(s)
- Evan J Anderson
- Departments of Pediatrics and Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Leonard R Krilov
- Department of Pediatrics, Winthrop University Hospital, Mineola, New York
| | - John P DeVincenzo
- Department of Pediatrics, CFRI at Le Bonheur Children's Hospital, University of Tennessee Center for Health Sciences, Memphis, Tennessee
| | - Paul A Checchia
- Department of Pediatrics, Texas Children's Hospital, Houston, Texas
| | - Natasha Halasa
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Eric A F Simões
- Department of Pediatrics, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado
| | | | - Michael L Forbes
- Department of Pediatrics, Akron Children's Hospital, Akron, Ohio
| | - Pia S Pannaraj
- Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, California
| | - Scott J McBride
- Department of Statistics, United BioSource Corporation, Ann Arbor, Michigan
| | - Kimmie K McLaurin
- Department of U.S. Medical Affairs, AstraZeneca, Gaithersburg, Maryland
| | - Veena R Kumar
- Department of U.S. Medical Affairs, AstraZeneca, Gaithersburg, Maryland
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Anderson EJ, Devincenzo JP, Checchia PA, Forbes ML, Halasa N, Krilov LR, Pannaraj PS, Simões EA, Domachowske JB, Espinosa CM, Welliver RC, Wolkoff LI, McBride SJ, McLaurin KK, Kumar VR, Ambrose CS. SENTINEL1: An Ongoing Multicenter Observational Study of Respiratory Syncytial Virus Hospitalizations Among United States Infants Born at 29–35 Weeks' Gestational Age Not Receiving Immunoprophylaxis in 2014–2016. Open Forum Infect Dis 2016. [DOI: 10.1093/ofid/ofw172.982] [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)
- Evan J. Anderson
- Pediatrics and Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - John P. Devincenzo
- Department of Pediatrics, University of Tennessee Center for Health Sciences and the CFRI at Le Bonheur Children's Hospital, Memphis, Tennessee
| | - Paul A. Checchia
- Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas
| | | | - Natasha Halasa
- School of Medicine, Vanderbilt University, Nashville, Tennessee
- Vanderbilt University Medical Center, Nashville, Tennessee
| | - Leonard R. Krilov
- Department of Pediatrics, Winthrop University Hospital, Mineola, New York
| | - Pia S. Pannaraj
- Department of Pediatrics and Molecular Immunology and Microbiology, Children's Hospital Los Angeles, Los Angeles, California
| | - Eric A. Simões
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado
| | - Joseph B. Domachowske
- Pediatrics, Microbiology and Immunology, SUNY Upstate Medical University, Syracuse, New York
| | | | - Robert C. Welliver
- Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | | | - Scott J. McBride
- Department of Statistics, United BioSource Corporation, Ann Arbor, Michigan
| | - Kimmie K. McLaurin
- Department of Health Economics and Outcomes Research, AstraZeneca, Gaithersburg, Maryland
| | - Veena R. Kumar
- Department of US Medical Affairs, AstraZeneca, Gaithersburg, Maryland
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Noor A, Krilov LR, Rebaza A, Quintos L. Successful Reduction in Medication Use in Respiratory Syncytial Virus (RSV) Bronchiolitis by Repeated Plan-Do-Study-Act (PDSA) Cycles. Open Forum Infect Dis 2016. [DOI: 10.1093/ofid/ofw172.1466] [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)
- Asif Noor
- Pediatrics, Winthrop University Hospital, Mineola, New York
| | | | - Andre Rebaza
- Department of Pediatrics, Winthrop University Hospital, Mineola, New York
| | - Lyn Quintos
- Pediatrics, Winthrop University Hospital, Mineola, New York
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50
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Affiliation(s)
- Asif Noor
- Department of Pediatrics, Children's Medical Center, Winthrop University Hospital, Mineola, NY
| | - Leonard R Krilov
- Department of Pediatrics, Children's Medical Center, Winthrop University Hospital, Mineola, NY.,Department of Pediatrics, State University of New York, Stony Brook School of Medicine, Stony Brook, NY
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