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Nguyen AT, Arnold BF, Kennedy CJ, Mishra K, Pokpongkiat NN, Seth A, Djajadi S, Holbrook K, Pan E, Kirley PD, Libby T, Hubbard AE, Reingold A, Colford JM, Benjamin-Chung J. Evaluation of a city-wide school-located influenza vaccination program in Oakland, California with respect to race and ethnicity: A matched cohort study. Vaccine 2021; 40:266-274. [PMID: 34872797 PMCID: PMC8881996 DOI: 10.1016/j.vaccine.2021.11.073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 10/12/2021] [Accepted: 11/23/2021] [Indexed: 11/23/2022]
Abstract
Background: Increasing influenza vaccination coverage in school-aged children may substantially reduce community transmission. School-located influenza vaccinations (SLIV) aim to promote vaccinations by increasing accessibility, which may be especially beneficial to race/ethnicity groups that face high barriers to preventative care. Here, we evaluate the effectiveness of a city-wide SLIV program by race/ethnicity from 2014 to 2018. Methods: We used multivariate matching to pair schools in the intervention district in Oakland, CA with schools in a comparison district in West Contra Costa County, CA. We distributed cross-sectional surveys to measure caregiver-reported student vaccination status and estimated differences in vaccination coverage levels and reasons for non-vaccination between districts stratifying by race/ethnicity. We estimated difference-in-differences (DID) of laboratory confirmed influenza hospitalization incidence between districts stratified by race/ethnicity using surveillance data. Results: Differences in influenza vaccination coverage in the intervention vs. comparison district were larger among White (2017–18: 21.0% difference [95% CI: 9.7%, 32.3%]) and Hispanic/Latino (13.4% [8.8%, 18.0%]) students than Asian/Pacific Islander (API) (8.9% [1.3%, 16.5%]), Black (5.9% [−2.2%, 14.0%]), and multiracial (6.3% [−1.8%, 14.3%)) students. Concerns about vaccine effectiveness or safety were more common among Black and multiracial caregivers. Logistical barriers were less common in the intervention vs. comparison district, with the largest difference among White students. In both districts, hospitalizations in 2017–18 were higher in Blacks (Intervention: 111.5 hospitalizations per 100,00; Comparison: 134.1 per 100,000) vs. other races/ethnicities. All-age influenza hospitalization incidence was lower in the intervention site vs. comparison site among White/API individuals in 2016–17 (DID −25.14 per 100,000 [95% CI: −40.14, −10.14]) and 2017–18 (−36.6 per 100,000 [−52.7, −20.5]) and Black older adults in 2017–18 (−282.2 per 100,000 (−508.4, −56.1]), but not in other groups. Conclusions: SLIV was associated with higher vaccination coverage and lower influenza hospitalization, but associations varied by race/ethnicity. SLIV alone may be insufficient to ensure equitable influenza outcomes.
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Affiliation(s)
- Anna T Nguyen
- Division of Epidemiology and Biostatistics, University of California, Berkeley, Berkeley, CA, United States; Department of Epidemiology and Population Health, Stanford University, Stanford, CA, United States.
| | - Benjamin F Arnold
- Francis I. Proctor Foundation, University of California, San Francisco, San Francisco, CA, United States
| | - Chris J Kennedy
- Department of Biomedical Informatics, Harvard Medical School, Boston, MA, United States
| | - Kunal Mishra
- Division of Epidemiology and Biostatistics, University of California, Berkeley, Berkeley, CA, United States
| | - Nolan N Pokpongkiat
- Division of Epidemiology and Biostatistics, University of California, Berkeley, Berkeley, CA, United States
| | - Anmol Seth
- Division of Epidemiology and Biostatistics, University of California, Berkeley, Berkeley, CA, United States
| | - Stephanie Djajadi
- Division of Epidemiology and Biostatistics, University of California, Berkeley, Berkeley, CA, United States
| | - Kate Holbrook
- Division of Communicable Disease Control and Prevention, Alameda County Public Health Department, Oakland, CA, United States; Department of Community Health Systems, School of Nursing, University of California, San Francisco, San Francisco, CA, United States
| | - Erica Pan
- Division of Communicable Disease Control and Prevention, Alameda County Public Health Department, Oakland, CA, United States; California Department of Public Health, Richmond, CA, United States; Department of Pediatrics, Division of Infectious Diseases, University of California, San Francisco, San Francisco, CA, United States
| | - Pam D Kirley
- California Emerging Infections Program, Oakland, CA, United States
| | - Tanya Libby
- California Emerging Infections Program, Oakland, CA, United States
| | - Alan E Hubbard
- Division of Epidemiology and Biostatistics, University of California, Berkeley, Berkeley, CA, United States
| | - Arthur Reingold
- Division of Epidemiology and Biostatistics, University of California, Berkeley, Berkeley, CA, United States
| | - John M Colford
- Division of Epidemiology and Biostatistics, University of California, Berkeley, Berkeley, CA, United States
| | - Jade Benjamin-Chung
- Division of Epidemiology and Biostatistics, University of California, Berkeley, Berkeley, CA, United States; Department of Epidemiology and Population Health, Stanford University, Stanford, CA, United States
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Garg S, Patel K, Pham H, Whitaker M, O'Halloran A, Milucky J, Anglin O, Kirley PD, Reingold A, Kawasaki B, Herlihy R, Yousey-Hindes K, Maslar A, Anderson EJ, Openo KP, Weigel A, Teno K, Ryan PA, Monroe ML, Reeg L, Kim S, Como-Sabetti K, Bye E, Shrum Davis S, Eisenberg N, Muse A, Barney G, Bennett NM, Felsen CB, Billing L, Shiltz J, Sutton M, Abdullah N, Talbot HK, Schaffner W, Hill M, Chatelain R, Wortham J, Taylor C, Hall A, Fry AM, Kim L, Havers FP. Clinical Trends Among U.S. Adults Hospitalized With COVID-19, March to December 2020 : A Cross-Sectional Study. Ann Intern Med 2021; 174:1409-1419. [PMID: 34370517 PMCID: PMC8381761 DOI: 10.7326/m21-1991] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic has caused substantial morbidity and mortality. OBJECTIVE To describe monthly clinical trends among adults hospitalized with COVID-19. DESIGN Pooled cross-sectional study. SETTING 99 counties in 14 states participating in the Coronavirus Disease 2019-Associated Hospitalization Surveillance Network (COVID-NET). PATIENTS U.S. adults (aged ≥18 years) hospitalized with laboratory-confirmed COVID-19 during 1 March to 31 December 2020. MEASUREMENTS Monthly hospitalizations, intensive care unit (ICU) admissions, and in-hospital death rates per 100 000 persons in the population; monthly trends in weighted percentages of interventions, including ICU admission, mechanical ventilation, and vasopressor use, among an age- and site-stratified random sample of hospitalized case patients. RESULTS Among 116 743 hospitalized adults with COVID-19, the median age was 62 years, 50.7% were male, and 40.8% were non-Hispanic White. Monthly rates of hospitalization (105.3 per 100 000 persons), ICU admission (20.2 per 100 000 persons), and death (11.7 per 100 000 persons) peaked during December 2020. Rates of all 3 outcomes were highest among adults aged 65 years or older, males, and Hispanic or non-Hispanic Black persons. Among 18 508 sampled hospitalized adults, use of remdesivir and systemic corticosteroids increased from 1.7% and 18.9%, respectively, in March to 53.8% and 74.2%, respectively, in December. Frequency of ICU admission, mechanical ventilation, and vasopressor use decreased from March (37.8%, 27.8%, and 22.7%, respectively) to December (20.5%, 12.3%, and 12.8%, respectively); use of noninvasive respiratory support increased from March to December. LIMITATION COVID-NET covers approximately 10% of the U.S. population; findings may not be generalizable to the entire country. CONCLUSION Rates of COVID-19-associated hospitalization, ICU admission, and death were highest in December 2020, corresponding with the third peak of the U.S. pandemic. The frequency of intensive interventions for management of hospitalized patients decreased over time. These data provide a longitudinal assessment of clinical trends among adults hospitalized with COVID-19 before widespread implementation of COVID-19 vaccines. PRIMARY FUNDING SOURCE Centers for Disease Control and Prevention.
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Affiliation(s)
- Shikha Garg
- Centers for Disease Control and Prevention, Atlanta, Georgia, and U.S. Public Health Service, Rockville, Maryland (S.G., J.W., A.M.F., L.K., F.P.H.)
| | - Kadam Patel
- Centers for Disease Control and Prevention and General Dynamics Information Technology, Atlanta, Georgia (K.P., O.A.)
| | - Huong Pham
- Centers for Disease Control and Prevention, Atlanta, Georgia (H.P., M.W., A.O., J.M., C.T., A.H.)
| | - Michael Whitaker
- Centers for Disease Control and Prevention, Atlanta, Georgia (H.P., M.W., A.O., J.M., C.T., A.H.)
| | - Alissa O'Halloran
- Centers for Disease Control and Prevention, Atlanta, Georgia (H.P., M.W., A.O., J.M., C.T., A.H.)
| | - Jennifer Milucky
- Centers for Disease Control and Prevention, Atlanta, Georgia (H.P., M.W., A.O., J.M., C.T., A.H.)
| | - Onika Anglin
- Centers for Disease Control and Prevention and General Dynamics Information Technology, Atlanta, Georgia (K.P., O.A.)
| | - Pam D Kirley
- California Emerging Infections Program, Oakland, California (P.D.K., A.R.)
| | - Arthur Reingold
- California Emerging Infections Program, Oakland, California (P.D.K., A.R.)
| | - Breanna Kawasaki
- Colorado Department of Public Health and Environment, Denver, Colorado (B.K., R.H.)
| | - Rachel Herlihy
- Colorado Department of Public Health and Environment, Denver, Colorado (B.K., R.H.)
| | - Kimberly Yousey-Hindes
- Connecticut Emerging Infections Program, Yale School of Public Health, New Haven, Connecticut (K.Y., A.M.)
| | - Amber Maslar
- Connecticut Emerging Infections Program, Yale School of Public Health, New Haven, Connecticut (K.Y., A.M.)
| | - Evan J Anderson
- Emory University School of Medicine and Georgia Emerging Infections Program, Georgia Department of Health, Atlanta, Georgia (E.J.A.)
| | - Kyle P Openo
- Georgia Emerging Infections Program, Georgia Department of Health, Atlanta, Georgia (K.P.O.)
| | - Andrew Weigel
- Iowa Department of Public Health, Des Moines, Iowa (A.W., K.T.)
| | - Kenzie Teno
- Iowa Department of Public Health, Des Moines, Iowa (A.W., K.T.)
| | - Patricia A Ryan
- Maryland Department of Health, Baltimore, Maryland (P.A.R., M.L.M.)
| | - Maya L Monroe
- Maryland Department of Health, Baltimore, Maryland (P.A.R., M.L.M.)
| | - Libby Reeg
- Michigan Department of Health and Human Services, Lansing, Michigan (L.R., S.K.)
| | - Sue Kim
- Michigan Department of Health and Human Services, Lansing, Michigan (L.R., S.K.)
| | | | - Erica Bye
- Minnesota Department of Health, St. Paul, Minnesota (K.C., E.B.)
| | - Sarah Shrum Davis
- New Mexico Department of Health, Santa Fe, New Mexico (S.S.D., N.E.)
| | - Nancy Eisenberg
- New Mexico Department of Health, Santa Fe, New Mexico (S.S.D., N.E.)
| | - Alison Muse
- New York State Department of Health, Albany, New York (A.M., G.B.)
| | - Grant Barney
- New York State Department of Health, Albany, New York (A.M., G.B.)
| | - Nancy M Bennett
- University of Rochester School of Medicine and Dentistry, Rochester, New York (N.M.B., C.B.F.)
| | - Christina B Felsen
- University of Rochester School of Medicine and Dentistry, Rochester, New York (N.M.B., C.B.F.)
| | | | - Jess Shiltz
- Ohio Department of Health, Columbus, Ohio (L.B., J.S.)
| | | | | | - H Keipp Talbot
- Vanderbilt University School of Medicine, Nashville, Tennessee (H.K.T., W.S.)
| | - William Schaffner
- Vanderbilt University School of Medicine, Nashville, Tennessee (H.K.T., W.S.)
| | - Mary Hill
- Salt Lake County Health Department, Salt Lake City, Utah (M.H., R.C.)
| | - Ryan Chatelain
- Salt Lake County Health Department, Salt Lake City, Utah (M.H., R.C.)
| | - Jonathan Wortham
- Centers for Disease Control and Prevention, Atlanta, Georgia, and U.S. Public Health Service, Rockville, Maryland (S.G., J.W., A.M.F., L.K., F.P.H.)
| | - Christopher Taylor
- Centers for Disease Control and Prevention, Atlanta, Georgia (H.P., M.W., A.O., J.M., C.T., A.H.)
| | - Aron Hall
- Centers for Disease Control and Prevention, Atlanta, Georgia (H.P., M.W., A.O., J.M., C.T., A.H.)
| | - Alicia M Fry
- Centers for Disease Control and Prevention, Atlanta, Georgia, and U.S. Public Health Service, Rockville, Maryland (S.G., J.W., A.M.F., L.K., F.P.H.)
| | - Lindsay Kim
- Centers for Disease Control and Prevention, Atlanta, Georgia, and U.S. Public Health Service, Rockville, Maryland (S.G., J.W., A.M.F., L.K., F.P.H.)
| | - Fiona P Havers
- Centers for Disease Control and Prevention, Atlanta, Georgia, and U.S. Public Health Service, Rockville, Maryland (S.G., J.W., A.M.F., L.K., F.P.H.)
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Benjamin-Chung J, Arnold BF, Kennedy CJ, Mishra K, Pokpongkiat N, Nguyen A, Jilek W, Holbrook K, Pan E, Kirley PD, Libby T, Hubbard AE, Reingold A, Colford JM. Evaluation of a city-wide school-located influenza vaccination program in Oakland, California, with respect to vaccination coverage, school absences, and laboratory-confirmed influenza: A matched cohort study. PLoS Med 2020; 17:e1003238. [PMID: 32810149 PMCID: PMC7433855 DOI: 10.1371/journal.pmed.1003238] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 07/14/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND It is estimated that vaccinating 50%-70% of school-aged children for influenza can produce population-wide indirect effects. We evaluated a city-wide school-located influenza vaccination (SLIV) intervention that aimed to increase influenza vaccination coverage. The intervention was implemented in ≥95 preschools and elementary schools in northern California from 2014 to 2018. Using a matched cohort design, we estimated intervention impacts on student influenza vaccination coverage, school absenteeism, and community-wide indirect effects on laboratory-confirmed influenza hospitalizations. METHODS AND FINDINGS We used a multivariate matching algorithm to identify a nearby comparison school district with pre-intervention characteristics similar to those of the intervention school district and matched schools in each district. To measure student influenza vaccination, we conducted cross-sectional surveys of student caregivers in 22 school pairs (2017 survey, N = 6,070; 2018 survey, N = 6,507). We estimated the incidence of laboratory-confirmed influenza hospitalization from 2011 to 2018 using surveillance data from school district zip codes. We analyzed student absenteeism data from 2011 to 2018 from each district (N = 42,487,816 student-days). To account for pre-intervention differences between districts, we estimated difference-in-differences (DID) in influenza hospitalization incidence and absenteeism rates using generalized linear and log-linear models with a population offset for incidence outcomes. Prior to the SLIV intervention, the median household income was $51,849 in the intervention site and $61,596 in the comparison site. The population in each site was predominately white (41% in the intervention site, 48% in the comparison site) and/or of Hispanic or Latino ethnicity (26% in the intervention site, 33% in the comparison site). The number of students vaccinated by the SLIV intervention ranged from 7,502 to 10,106 (22%-28% of eligible students) each year. During the intervention, influenza vaccination coverage among elementary students was 53%-66% in the comparison district. Coverage was similar between the intervention and comparison districts in influenza seasons 2014-2015 and 2015-2016 and was significantly higher in the intervention site in seasons 2016-2017 (7%; 95% CI 4, 11; p < 0.001) and 2017-2018 (11%; 95% CI 7, 15; p < 0.001). During seasons when vaccination coverage was higher among intervention schools and the vaccine was moderately effective, there was evidence of statistically significant indirect effects: The DID in the incidence of influenza hospitalization per 100,000 in the intervention versus comparison site was -17 (95% CI -30, -4; p = 0.008) in 2016-2017 and -37 (95% CI -54, -19; p < 0.001) in 2017-2018 among non-elementary-school-aged individuals and -73 (95% CI -147, 1; p = 0.054) in 2016-2017 and -160 (95% CI -267, -53; p = 0.004) in 2017-2018 among adults 65 years or older. The DID in illness-related school absences per 100 school days during the influenza season was -0.63 (95% CI -1.14, -0.13; p = 0.014) in 2016-2017 and -0.80 (95% CI -1.28, -0.31; p = 0.001) in 2017-2018. Limitations of this study include the use of an observational design, which may be subject to unmeasured confounding, and caregiver-reported vaccination status, which is subject to poor recall and low response rates. CONCLUSIONS A city-wide SLIV intervention in a large, diverse urban population was associated with a decrease in the incidence of laboratory-confirmed influenza hospitalization in all age groups and a decrease in illness-specific school absence rate among students in 2016-2017 and 2017-2018, seasons when the vaccine was moderately effective, suggesting that the intervention produced indirect effects. Our findings suggest that in populations with moderately high background levels of influenza vaccination coverage, SLIV programs are associated with further increases in coverage and reduced influenza across the community.
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Affiliation(s)
- Jade Benjamin-Chung
- Division of Epidemiology and Biostatistics, University of California, Berkeley, Berkeley, California, United States of America
| | - Benjamin F. Arnold
- Division of Epidemiology and Biostatistics, University of California, Berkeley, Berkeley, California, United States of America
- Francis I. Proctor Foundation, University of California, San Francisco, San Francisco, California, United States of America
| | - Chris J. Kennedy
- Division of Epidemiology and Biostatistics, University of California, Berkeley, Berkeley, California, United States of America
| | - Kunal Mishra
- Division of Epidemiology and Biostatistics, University of California, Berkeley, Berkeley, California, United States of America
| | - Nolan Pokpongkiat
- Division of Epidemiology and Biostatistics, University of California, Berkeley, Berkeley, California, United States of America
| | - Anna Nguyen
- Division of Epidemiology and Biostatistics, University of California, Berkeley, Berkeley, California, United States of America
| | - Wendy Jilek
- Division of Epidemiology and Biostatistics, University of California, Berkeley, Berkeley, California, United States of America
| | - Kate Holbrook
- Division of Communicable Disease Control and Prevention, Alameda County Public Health Department, Oakland, California, United States of America
| | - Erica Pan
- Division of Communicable Disease Control and Prevention, Alameda County Public Health Department, Oakland, California, United States of America
- Department of Pediatrics, Division of Infectious Diseases, University of California, San Francisco, San Francisco, California, United States of America
| | - Pam D. Kirley
- California Emerging Infections Program, Oakland, California, United States of America
| | - Tanya Libby
- California Emerging Infections Program, Oakland, California, United States of America
| | - Alan E. Hubbard
- Division of Epidemiology and Biostatistics, University of California, Berkeley, Berkeley, California, United States of America
| | - Arthur Reingold
- Division of Epidemiology and Biostatistics, University of California, Berkeley, Berkeley, California, United States of America
| | - John M. Colford
- Division of Epidemiology and Biostatistics, University of California, Berkeley, Berkeley, California, United States of America
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Garg S, Kim L, Whitaker M, O’Halloran A, Cummings C, Holstein R, Prill M, Chai SJ, Kirley PD, Alden NB, Kawasaki B, Yousey-Hindes K, Niccolai L, Anderson EJ, Openo KP, Weigel A, Monroe ML, Ryan P, Henderson J, Kim S, Como-Sabetti K, Lynfield R, Sosin D, Torres S, Muse A, Bennett NM, Billing L, Sutton M, West N, Schaffner W, Talbot HK, Aquino C, George A, Budd A, Brammer L, Langley G, Hall AJ, Fry A. Hospitalization Rates and Characteristics of Patients Hospitalized with Laboratory-Confirmed Coronavirus Disease 2019 - COVID-NET, 14 States, March 1-30, 2020. MMWR Morb Mortal Wkly Rep 2020; 69:458-464. [PMID: 32298251 PMCID: PMC7755063 DOI: 10.15585/mmwr.mm6915e3] [Citation(s) in RCA: 1633] [Impact Index Per Article: 408.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Since SARS-CoV-2, the novel coronavirus that causes coronavirus disease 2019 (COVID-19), was first detected in December 2019 (1), approximately 1.3 million cases have been reported worldwide (2), including approximately 330,000 in the United States (3). To conduct population-based surveillance for laboratory-confirmed COVID-19-associated hospitalizations in the United States, the COVID-19-Associated Hospitalization Surveillance Network (COVID-NET) was created using the existing infrastructure of the Influenza Hospitalization Surveillance Network (FluSurv-NET) (4) and the Respiratory Syncytial Virus Hospitalization Surveillance Network (RSV-NET). This report presents age-stratified COVID-19-associated hospitalization rates for patients admitted during March 1-28, 2020, and clinical data on patients admitted during March 1-30, 2020, the first month of U.S. surveillance. Among 1,482 patients hospitalized with COVID-19, 74.5% were aged ≥50 years, and 54.4% were male. The hospitalization rate among patients identified through COVID-NET during this 4-week period was 4.6 per 100,000 population. Rates were highest (13.8) among adults aged ≥65 years. Among 178 (12%) adult patients with data on underlying conditions as of March 30, 2020, 89.3% had one or more underlying conditions; the most common were hypertension (49.7%), obesity (48.3%), chronic lung disease (34.6%), diabetes mellitus (28.3%), and cardiovascular disease (27.8%). These findings suggest that older adults have elevated rates of COVID-19-associated hospitalization and the majority of persons hospitalized with COVID-19 have underlying medical conditions. These findings underscore the importance of preventive measures (e.g., social distancing, respiratory hygiene, and wearing face coverings in public settings where social distancing measures are difficult to maintain)† to protect older adults and persons with underlying medical conditions, as well as the general public. In addition, older adults and persons with serious underlying medical conditions should avoid contact with persons who are ill and immediately contact their health care provider(s) if they have symptoms consistent with COVID-19 (https://www.cdc.gov/coronavirus/2019-ncov/symptoms-testing/symptoms.html) (5). Ongoing monitoring of hospitalization rates, clinical characteristics, and outcomes of hospitalized patients will be important to better understand the evolving epidemiology of COVID-19 in the United States and the clinical spectrum of disease, and to help guide planning and prioritization of health care system resources.
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5
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Chow EJ, Rolfes MA, O’Halloran A, Alden NB, Anderson EJ, Bennett NM, Billing L, Dufort E, Kirley PD, George A, Irizarry L, Kim S, Lynfield R, Ryan P, Schaffner W, Talbot HK, Thomas A, Yousey-Hindes K, Reed C, Garg S. Respiratory and Nonrespiratory Diagnoses Associated With Influenza in Hospitalized Adults. JAMA Netw Open 2020; 3:e201323. [PMID: 32196103 PMCID: PMC7084169 DOI: 10.1001/jamanetworkopen.2020.1323] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
IMPORTANCE Seasonal influenza virus infection is a major cause of morbidity and mortality and may be associated with respiratory and nonrespiratory diagnoses. OBJECTIVE To examine the respiratory and nonrespiratory diagnoses reported for adults hospitalized with laboratory-confirmed influenza between 2010 and 2018 in the United States. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study used data from the US Influenza Hospitalization Surveillance Network (FluSurv-NET) from October 1 through April 30 of the 2010-2011 through 2017-2018 influenza seasons. FluSurv-NET is a population-based, multicenter surveillance network with a catchment area that represents approximately 9% of the US population. Patients are identified by practitioner-ordered influenza testing. Adults (aged ≥18 years) hospitalized with laboratory-confirmed influenza were included in the study. EXPOSURES FluSurv-NET defines laboratory-confirmed influenza as a positive influenza test result by rapid antigen assay, reverse transcription-polymerase chain reaction, direct or indirect fluorescent staining, or viral culture. MAIN OUTCOMES AND MEASURES Acute respiratory or nonrespiratory diagnoses were defined using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) and International Statistical Classification of Diseases and Related Health Problems, 10th Revision (ICD-10) discharge diagnosis codes. The analysis included calculation of the frequency of acute respiratory and nonrespiratory diagnoses with a descriptive analysis of patient demographic characteristics, underlying medical conditions, and in-hospital outcomes by respiratory and nonrespiratory diagnoses. RESULTS Of 89 999 adult patients hospitalized with laboratory-confirmed influenza, 76 649 (median age, 69 years; interquartile range, 55-82 years; 55% female) had full medical record abstraction and at least 1 ICD code for an acute diagnosis. In this study, 94.9% of patients had a respiratory diagnosis and 46.5% had a nonrespiratory diagnosis, including 5.1% with only nonrespiratory diagnoses. Pneumonia (36.3%), sepsis (23.3%), and acute kidney injury (20.2%) were the most common acute diagnoses. Fewer patients with only nonrespiratory diagnoses received antiviral therapy for influenza compared with those with respiratory diagnoses (81.4% vs 88.9%; P < .001). CONCLUSIONS AND RELEVANCE Nonrespiratory diagnoses occurred frequently among adults hospitalized with influenza, further contributing to the burden of infection in the United States. The findings suggest that during the influenza season, practitioners should consider influenza in their differential diagnosis for patients who present to the hospital with less frequently recognized manifestations and initiate early antiviral treatment for patients with suspected or confirmed infection.
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Affiliation(s)
- Eric J. Chow
- Epidemic Intelligence Service, Center for Surveillance, Epidemiology and Laboratory Services, Centers for Disease Control and Prevention, Atlanta, Georgia
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Melissa A. Rolfes
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Alissa O’Halloran
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Nisha B. Alden
- Communicable Disease Branch, Colorado Department of Public Health and Environment, Denver
| | - Evan J. Anderson
- Departments of Medicine and Pediatrics, Emory University School of Medicine, Atlanta, Georgia
- Emerging Infections Program, Atlanta, Georgia
- Veterans Affairs Medical Center, Atlanta, Georgia
| | - Nancy M. Bennett
- Department of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Laurie Billing
- Bureau of Infectious Diseases, Ohio Department of Health, Columbus
| | | | | | - Andrea George
- Salt Lake County Health Department, Salt Lake City, Utah
| | | | - Sue Kim
- Communicable Disease Division, Michigan Department of Health and Human Services, Lansing
| | | | | | - William Schaffner
- Division of Infectious Disease, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - H. Keipp Talbot
- Division of Infectious Disease, Vanderbilt University School of Medicine, Nashville, Tennessee
| | | | | | - Carrie Reed
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Shikha Garg
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
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Link-Gelles R, Toews KA, Schaffner W, Edwards KM, Wright C, Beall B, Barnes B, Jewell B, Harrison LH, Kirley PD, Lorentzson L, Aragon D, Petit S, Bareta J, Spina NL, Cieslak PR, Van Beneden C. Characteristics of Intracranial Group A Streptococcal Infections in US Children, 1997-2014. J Pediatric Infect Dis Soc 2020; 9:30-35. [PMID: 30462264 PMCID: PMC8931553 DOI: 10.1093/jpids/piy108] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Accepted: 10/24/2018] [Indexed: 11/12/2022]
Abstract
BACKGROUND Few data on intracranial group A Streptococcus (GAS) infection in children are available. Here, we describe the demographic, clinical, and diagnostic characteristics of 91 children with intracranial GAS infection. METHODS Cases of intracranial GAS infection in persons ≤18 years of age reported between 1997 and 2014 were identified by the Centers for Disease Control and Prevention's population- and laboratory-based Active Bacterial Core surveillance (ABCs) system. Medical charts were abstracted using a active, standardized case report form. All available isolates were emm typed. US census data were used to calculate rates. RESULTS ABCs identified 2596 children with invasive GAS infection over an 18-year period; 91 (3.5%) had an intracranial infection. Intracranial infections were most frequent during the winter months and among children aged <1 year. The average annual incidence was 0.07 cases per 100000 children. For 83 patients for whom information for further classification was available, the principal clinical presentations included meningitis (35 [42%]), intracranial infection after otitis media, mastoiditis, or sinusitis (34 [41%]), and ventriculoperitoneal shunt infection (14 [17%]). Seven (8%) of these infections progressed to streptococcal toxic shock syndrome. The overall case fatality rate was 15%. GAS emm types 1 (31% of available isolates) and 12 (13% of available isolates) were most common. CONCLUSIONS Pediatric intracranial (GAS) infections are uncommon but often severe. Risk factors for intracranial GAS infection include the presence of a ventriculoperitoneal shunt and contiguous infections in the middle ear or sinuses.
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Affiliation(s)
- Ruth Link-Gelles
- Respiratory Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Karrie-Ann Toews
- Respiratory Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - William Schaffner
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Kathryn M. Edwards
- Division of Pediatric Infectious Diseases, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Carolyn Wright
- Respiratory Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Bernard Beall
- Respiratory Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Brenda Barnes
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee
| | | | - Lee H. Harrison
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | | | | | - Deborah Aragon
- Colorado Department of Public Health and Environment, Denver
| | - Susan Petit
- Connecticut Department of Public Health, Hartford
| | | | | | | | - Chris Van Beneden
- Respiratory Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia
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7
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Garg S, O’Halloran A, O’Halloran A, Cummings CN, Cummings CN, Holstein R, Kniss K, Anderson EJ, Anderson EJ, Bennett NM, Bennett NM, Billing LM, Billing LM, Herlihy R, Hill M, Irizarry L, Irizarry L, Kim S, Kim S, Kirley PD, Lynfield R, Lynfield R, Monroe M, Monroe M, Spina N, Talbot K, Talbot K, Thomas A, Thomas A, Yousey-Hindes K, Budd A, Brammer L, Reed C, Reed C. LB19. Patterns of Influenza A Hospitalizations by Subtype and Age in the United States, FluSurv-NET, 2018–2019. Open Forum Infect Dis 2019. [PMCID: PMC6810298 DOI: 10.1093/ofid/ofz415.2502] [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: 11/13/2022] Open
Abstract
Background The 2018–19 influenza season was characterized by prolonged co-circulation of Influenza A H3N2 (H3) and H1N1pdm09 (H1) viruses. We used data from the Influenza Hospitalization Surveillance Network (FluSurv-NET) to describe age-related differences in the distribution of influenza A subtypes. Methods We included all cases residing within a FluSurv-NET catchment area and hospitalized with laboratory-confirmed influenza during October 1, 2018–April 30, 2019. We multiply imputed influenza A subtype for 63% of cases with unknown subtype and based imputation on factors that could be associated with missing subtype including surveillance site, 10-year age groups and month of hospital admission. We calculated influenza hospitalization rates and 95% confidence intervals (95% CI) by type and subtype per 100,000 population. We compared the proportion of cases with H1 by year of age in FluSurv-NET to the distribution obtained from US public health laboratories participating in virologic surveillance and providing specimen-level influenza Results. Results Based on available data, 18,669 hospitalizations were reported; 41% received influenza vaccination ≥2 weeks prior to hospitalization and 90% received antivirals. Cumulative hospitalization rates per 100,000 population were as follows: H1 32.5 (95% CI 31.7–33.3), H3 29.3 (95% CI 28.5–30.1) and B 2.5 (95% CI 2.3–2.7). Based on weekly rates, H1 hospitalizations peaked during February (week 8) and H3 hospitalizations during March (week 11) (Figure A). FluSurv-NET data showed distinct patterns of subtype distribution by age, with H1 predominating among cases 0–9 and 24–70 years, and H3 predominating among cases 10–23 and ≥71 years. Data on the proportion of H1 results by age correlated well between FluSurv-NET and US virologic surveillance (Figure B). Conclusion Influenza A H1 and H3 virus circulation patterns varied by age group during the 2018–2019 season. The proportion of cases with H1 relative to H3 was low among those born between 1996 and 2009 and those born before 1948. These findings may indicate protection against H1 viruses in age groups with exposure to H1N1pdm09 during the 2009 pandemic or to older antigenically similar H1N1 viruses as young children. ![]()
Disclosures Evan J. Anderson, MD, AbbVie (Consultant), GSK (Grant/Research Support), Merck (Grant/Research Support), Micron (Grant/Research Support), PaxVax (Grant/Research Support), Pfizer (Consultant, Grant/Research Support), sanofi pasteur (Grant/Research Support), Keipp Talbot, MD, MPH, Sequirus (Other Financial or Material Support, On Data Safety Monitoring Board).
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Affiliation(s)
| | | | | | | | | | | | | | - Evan J Anderson
- Emory University, Atlanta VA Medical Center, Atlanta, Georgia
| | - Evan J Anderson
- Emory University, Atlanta VA Medical Center, Atlanta, Georgia
| | - Nancy M Bennett
- University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Nancy M Bennett
- University of Rochester School of Medicine and Dentistry, Rochester, New York
| | | | | | - Rachel Herlihy
- Colorado Department of Public Health and Environment, Denver, Colorado
| | - Mary Hill
- Salt Lake County Health Department, Salt Lake City, Utah
| | | | | | - Sue Kim
- Michigan Department of Health and Human Services, Lansing, Michigan
| | - Sue Kim
- Michigan Department of Health and Human Services, Lansing, Michigan
| | - Pam D Kirley
- California Emerging Infections Program, Oakland, California
| | - Ruth Lynfield
- Minnesota Department of Health, Minneapolis, Minnesota
| | - Ruth Lynfield
- Minnesota Department of Health, Minneapolis, Minnesota
| | - Maya Monroe
- Maryland Department of Health and Mental Hygiene, Baltimore, Maryland
| | - Maya Monroe
- Maryland Department of Health and Mental Hygiene, Baltimore, Maryland
| | - Nancy Spina
- New York State Department of Health, Albany, New York
| | - Keipp Talbot
- Vanderbilt University Medical Center, Nashville, Tennessee
| | - Keipp Talbot
- Vanderbilt University Medical Center, Nashville, Tennessee
| | - Ann Thomas
- Oregon Public Health Division, Portland, Oregon
| | - Ann Thomas
- Oregon Public Health Division, Portland, Oregon
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8
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Chandrasekhar R, Sloan C, Mitchel E, Ndi D, Alden N, Thomas A, Bennett NM, Kirley PD, Hill M, Anderson EJ, Lynfield R, Yousey-Hindes K, Bargsten M, Zansky SM, Lung K, Schroeder M, Monroe M, Eckel S, Markus TM, Cummings CN, Garg S, Schaffner W, Lindegren ML. Social determinants of influenza hospitalization in the United States. Influenza Other Respir Viruses 2017; 11:479-488. [PMID: 28872776 PMCID: PMC5720587 DOI: 10.1111/irv.12483] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [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] [Accepted: 08/16/2017] [Indexed: 11/30/2022] Open
Abstract
Background Influenza hospitalizations result in substantial morbidity and mortality each year. Little is known about the association between influenza hospitalization and census tract‐based socioeconomic determinants beyond the effect of individual factors. Objective To evaluate whether census tract‐based determinants such as poverty and household crowding would contribute significantly to the risk of influenza hospitalization above and beyond individual‐level determinants. Methods We analyzed 33 515 laboratory‐confirmed influenza‐associated hospitalizations that occurred during the 2009‐2010 through 2013‐2014 influenza seasons using a population‐based surveillance system at 14 sites across the United States. Results Using a multilevel regression model, we found that individual factors were associated with influenza hospitalization with the highest adjusted odds ratio (AOR) of 9.20 (95% CI 8.72‐9.70) for those ≥65 vs 5‐17 years old. African Americans had an AOR of 1.67 (95% CI 1.60‐1.73) compared to Whites, and Hispanics had an AOR of 1.21 (95% CI 1.16‐1.26) compared to non‐Hispanics. Among census tract‐based determinants, those living in a tract with ≥20% vs <5% of persons living below poverty had an AOR of 1.31 (95% CI 1.16‐1.47), those living in a tract with ≥5% vs <5% of persons living in crowded conditions had an AOR of 1.17 (95% CI 1.11‐1.23), and those living in a tract with ≥40% vs <5% female heads of household had an AOR of 1.32 (95% CI 1.25‐1.40). Conclusion Census tract‐based determinants account for 11% of the variability in influenza hospitalization.
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Affiliation(s)
| | | | - Edward Mitchel
- Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Danielle Ndi
- Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Nisha Alden
- Colorado Department of Public Health and Environment, Denver, CO, USA
| | - Ann Thomas
- Oregon Department of Public Health, Portland, OR, USA
| | - Nancy M Bennett
- University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Pam D Kirley
- California Emerging Infections Program, Oakland, CA, USA
| | - Mary Hill
- Salt Lake County Health Department, Salt Lake City, CO, USA
| | - Evan J Anderson
- Georgia Emerging Infections Program, Atlanta VAMC, Emory University, Atlanta, GA, USA
| | | | - Kimberly Yousey-Hindes
- Connecticut Emerging Infections Program, Yale School of Public Health, New Haven, CT, USA
| | | | | | - Krista Lung
- Ohio Department of Health, Columbus, OH, USA
| | - Monica Schroeder
- Council of State and Territorial Epidemiologists, Atlanta, GA, USA
| | - Maya Monroe
- Maryland Department of Health and Mental Hygiene, Baltimore, MD, USA
| | - Seth Eckel
- Michigan Department of Health and Human Services, Lansing, MI, USA
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9
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McGowan C, Arriola C, Cummings CN, Kirley PD, Miller L, Meek JI, Anderson EJ, Monroe M, Bohm S, McMahon M, Bargsten M, Zansky S, Bennett N, Lung K, Thomas A, Schaffner W, Price A, Chaves SDS, Reed C, Garg S. Causes of In-hospital and Post discharge Mortality Among Patients Hospitalized with Laboratory-Confirmed Influenza, Influenza Hospitalization Surveillance Network, 2014–2015. Open Forum Infect Dis 2017. [PMCID: PMC5632265 DOI: 10.1093/ofid/ofx162.061] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background Influenza results in an estimated 12,000–56,000 deaths annually in the USA. While in-hospital deaths are well characterized, less is known about deaths that occur after discharge among those hospitalized with influenza. Methods We identified patients hospitalized with laboratory-confirmed influenza who died during hospitalization or within 30 days after discharge during the 2014–2015 influenza season for 11 Influenza Hospitalization Surveillance Network sites. We matched cases to the National Center for Health Statistics Electronic Death Registration System and abstracted cause and location of death from death certificates. We compared clinical characteristics between those who died during hospitalization and those who died after hospital discharge using χ2 tests. Results Among 795 patients with laboratory-confirmed influenza who died, 370 (47%) died during hospitalization, and 425 (53%) died within 30 days after discharge. Eighteen (2%) were 0–17 years and 652 (82%) were ≥65 years. Common causes of death listed in any position on the death certificate included influenza (35%), other respiratory causes (50%), cardiovascular disease (37%), and sepsis (15%). Among those who died after discharge, 207 (49%) died within 7 days, 86 (20%) within 8–14 days, and 132 (31%) within 15–30 days post discharge. Patients who died after discharge were more likely to be ≥65 years (88 vs. 74%) or admitted from a nursing home (48 vs. 36%), but were less likely to be admitted to an intensive care unit (30 vs. 68%) or receive a pneumonia diagnosis (46 vs. 62%) than patients who died during hospitalization (all P < 0.001). There were no significant differences in sex, race, underlying conditions, vaccination rates, or time from symptom onset to hospitalization. Patients who died in hospital were more likely to have influenza listed as a cause of death (55 vs. 21%, P < 0.01). Conclusion Over half of deaths among patients hospitalized with laboratory-confirmed influenza occurred after discharge. Patients who died after discharge were older and less likely to have influenza listed as a cause of death. Deaths that occur after an influenza-related hospitalization represent an important and under-characterized contribution to the burden of seasonal influenza. Disclosures E. J. Anderson, AbbVie: Consultant, Consulting fee; NovaVax: Research Contractor, Research support; Regeneron: Research Contractor, Research grant; MedImmune: Research Contractor, Research grant and Research support. W. Schaffner, Pfizer: Scientific Advisor, Consulting fee; Merck: Scientific Advisor, Consulting fee; Novavax: Consultant, Consulting fee; Dynavax: Consultant, Consulting fee; Sanofi-pasteur: Consultant, Consulting fee; GSK: Consultant, Consulting fee; Seqirus: Consultant, Consulting fee
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Affiliation(s)
- Craig McGowan
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Carmen Arriola
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Pam D Kirley
- California Emerging Infections Program, Oakland, California
| | - Lisa Miller
- Colorado Department of Public Health and Environment, Denver, Colorado
| | - James I Meek
- Connecticut Emerging Infections Program, Yale School of Public Health, New Haven, Connecticut
| | - Evan J Anderson
- Pediatrics and Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Maya Monroe
- Maryland Department of Health and Mental Hygiene, Baltimore, MD
| | - Susan Bohm
- Michigan Department of Health and Human Services, Lansing, Michigan
| | | | | | - Shelley Zansky
- Emerging Infections Program, New York State Department of Health, Albany, New York
| | - Nancy Bennett
- University of Rochester Medical Center, Rochester, New York
| | - Krista Lung
- Bureau of Infectious Diseases, Ohio Department of Health, Columbus, Ohio
| | - Ann Thomas
- Oregon Public Health Division, Portland, Oregon
| | | | - Andrea Price
- Salt Lake County Health Department, Salt Lake City, Utah
| | | | - Carrie Reed
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Shikha Garg
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia
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10
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Kline K, Hadler JL, Yousey‐Hindes K, Niccolai L, Kirley PD, Miller L, Anderson EJ, Monroe ML, Bohm SR, Lynfield R, Bargsten M, Zansky SM, Lung K, Thomas AR, Brady D, Schaffner W, Reed G, Garg S. Impact of pregnancy on observed sex disparities among adults hospitalized with laboratory-confirmed influenza, FluSurv-NET, 2010-2012. Influenza Other Respir Viruses 2017; 11:404-411. [PMID: 28703414 PMCID: PMC5596517 DOI: 10.1111/irv.12465] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/27/2017] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Previous FluSurv-NET studies found that adult females had a higher incidence of influenza-associated hospitalizations than males. To identify groups of women at higher risk than men, we analyzed data from 14 FluSurv-NET sites that conducted population-based surveillance for laboratory-confirmed influenza-associated hospitalizations among residents of 78 US counties. METHODS We analyzed 6292 laboratory-confirmed, geocodable (96%) adult cases collected by FluSurv-NET during the 2010-12 influenza seasons. We used 2010 US Census and 2008-2012 American Community Survey data to calculate overall age-adjusted and age group-specific female:male incidence rate ratios (IRR) by race/ethnicity and census tract-level poverty. We used national 2010 pregnancy rates to estimate denominators for pregnant women aged 18-49. We calculated male:female IRRs excluding them and IRRs for pregnant:non-pregnant women. RESULTS Overall, 55% of laboratory-confirmed influenza cases were female. Female:male IRRs were highest for females aged 18-49 of high neighborhood poverty (IRR 1.50, 95% CI 1.30-1.74) and of Hispanic ethnicity (IRR 1.70, 95% CI 1.34-2.17). These differences disappeared after excluding pregnant women. Overall, 26% of 1083 hospitalized females aged 18-49 were pregnant. Pregnant adult females were more likely to have influenza-associated hospitalizations than their non-pregnant counterparts (relative risk [RR] 5.86, 95% CI 5.12-6.71), but vaccination levels were similar (25.5% vs 27.8%). CONCLUSIONS Overall rates of influenza-associated hospitalization were not significantly different for men and women after excluding pregnant women. Among women aged 18-49, pregnancy increased the risk of influenza-associated hospitalization sixfold but did not increase the likelihood of vaccination. Improving vaccination rates in pregnant women should be an influenza vaccination priority.
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Affiliation(s)
- Kelly Kline
- Connecticut Emerging Infections ProgramYale School of Public HealthNew HavenCTUSA
| | - James L. Hadler
- Connecticut Emerging Infections ProgramYale School of Public HealthNew HavenCTUSA
| | | | - Linda Niccolai
- Connecticut Emerging Infections ProgramYale School of Public HealthNew HavenCTUSA
| | | | - Lisa Miller
- Colorado Department of Public Health and EnvironmentDenverCOUSA
| | - Evan J. Anderson
- Emory University School of MedicineAtlantaGAUSA
- Atlanta Veterans Affairs Medical CenterAtlantaGAUSA
| | - Maya L. Monroe
- Maryland Department of Health and Mental HygieneBaltimoreMDUSA
| | - Susan R. Bohm
- Michigan Department of Health and Human ServicesLansingMIUSA
| | | | | | | | | | | | - Diane Brady
- Rhode Island Department of HealthProvidenceRIUSA
| | | | - Gregg Reed
- Utah Department of HealthSalt Lake CityUTUSA
| | - Shikha Garg
- Influenza DivisionNational Center for Immunization and Respiratory DiseasesCDCAtlantaGAUSA
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11
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Appiah GD, Chaves SS, Kirley PD, Miller L, Meek J, Anderson E, Oni O, Ryan P, Eckel S, Lynfield R, Bargsten M, Zansky SM, Bennett N, Lung K, McDonald-Hamm C, Thomas A, Brady D, Lindegren ML, Schaffner W, Hill M, Garg S, Fry AM, Campbell AP. Increased Antiviral Treatment Among Hospitalized Children and Adults With Laboratory-Confirmed Influenza, 2010-2015. Clin Infect Dis 2016; 64:364-367. [PMID: 28013261 DOI: 10.1093/cid/ciw745] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
(See the Editorial Commentary by Martin on pages 368-9.)Using population-based surveillance data, we analyzed antiviral treatment among hospitalized patients with laboratory-confirmed influenza. Treatment increased after the influenza A(H1N1) 2009 pandemic from 72% in 2010-2011 to 89% in 2014-2015 (P < .001). Overall, treatment was higher in adults (86%) than in children (72%); only 56% of cases received antivirals on the day of admission.
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Affiliation(s)
- Grace D Appiah
- Epidemic Intelligence Service and Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia; .,California Emerging Infections Program, Oakland
| | - Sandra S Chaves
- Epidemic Intelligence Service and Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Lisa Miller
- Colorado Department of Public Health and Environment, Denver
| | - James Meek
- Connecticut Emerging Infections Program, Yale School of Public Health, New Haven
| | - Evan Anderson
- Departments of Pediatrics and Medicine, Emory University School of Medicine, and Atlanta Veterans Affairs Medical Center, Atlanta, Georgia
| | | | - Patricia Ryan
- Maryland Department of Health and Mental Hygiene, Baltimore
| | - Seth Eckel
- Michigan Department of Health and Human Services, Lansing
| | | | | | - Shelley M Zansky
- New York State Department of Health, Albany; University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Nancy Bennett
- Epidemic Intelligence Service and Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | | | - Ann Thomas
- Oregon Department of Public Health, Portland
| | - Diane Brady
- Rhode Island Department of Health, Providence
| | - Mary L Lindegren
- Vanderbilt University School of Medicine, Nashville, Tennessee; and
| | | | - Mary Hill
- Utah Department of Health, Salt Lake City
| | - Shikha Garg
- Epidemic Intelligence Service and Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Alicia M Fry
- Epidemic Intelligence Service and Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Angela P Campbell
- Epidemic Intelligence Service and Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia;
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12
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Su S, Chaves SS, Perez A, D'Mello T, Kirley PD, Yousey-Hindes K, Farley MM, Harris M, Sharangpani R, Lynfield R, Morin C, Hancock EB, Zansky S, Hollick GE, Fowler B, McDonald-Hamm C, Thomas A, Horan V, Lindegren ML, Schaffner W, Price A, Bandyopadhyay A, Fry AM. Comparing clinical characteristics between hospitalized adults with laboratory-confirmed influenza A and B virus infection. Clin Infect Dis 2014; 59:252-5. [PMID: 24748521 DOI: 10.1093/cid/ciu269] [Citation(s) in RCA: 93] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
We challenge the notion that influenza B is milder than influenza A by finding similar clinical characteristics between hospitalized adult influenza-cases. Among patients treated with oseltamivir, length of stay and mortality did not differ by type of virus infection.
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Affiliation(s)
- Su Su
- Influenza Division, Centers for Disease Control and Prevention Atlanta Research and Education Foundation, Atlanta, Georgia
| | - Sandra S Chaves
- Influenza Division, Centers for Disease Control and Prevention
| | - Alejandro Perez
- Influenza Division, Centers for Disease Control and Prevention
| | - Tiffany D'Mello
- Influenza Division, Centers for Disease Control and Prevention Atlanta Research and Education Foundation, Atlanta, Georgia
| | | | | | - Monica M Farley
- School of Medicine, Emory University, and Atlanta Veterans Affairs Medical Center, Atlanta, GA
| | | | | | | | | | | | - Shelley Zansky
- Emerging Infections Program, New York State Department of Health, Albany
| | - Gary E Hollick
- Department of Medicine, University of Rochester School of Medicine and Dentistry, New York
| | | | | | | | | | | | | | - Andrea Price
- Salt Lake County Health Department, Salt Lake City, Utah
| | | | - Alicia M Fry
- Influenza Division, Centers for Disease Control and Prevention
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