A L Reingold

University of California, Berkeley, Berkeley, California, United States

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Publications (220)2380.29 Total impact

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    ABSTRACT: Lactobacillus plays an integral part in the health of the vaginal microbiota. We compared vaginal Lactobacillus species in women with and without bacterial vaginosis (BV) from India and the US. Between July 2009 and November 2010, a cross-sectional study was conducted among 40 women attending a women's health clinic in Mysore, India, and STD clinic in San Francisco, USA. Women were diagnosed for BV by Amsel's criteria and Nugent Score. Lactobacillus 16SrDNA was sequenced to speciate the cultured isolates. Ten Indian and 10 American women without BV were compared to an equal number of women with BV. Lactobacilli were isolated from all healthy women but only 10% of Indian, and 50% of US women with BV. 16SrDNA from 164 Lactobacillus colonies were sequenced from healthy women (126 colonies) and women with BV (38 colonies). Seven cultivable Lactobacillus species were isolated from 11 Indian women, and 9 species from 15 US women. The majority of Lactobacillus colonies in Indian women were L. crispatus (25%), L. jensenii (25%), and L. reuteri (16.7%). Among US women, L. crispatus (32.0%), L. jensenii (20.0%), and L. coleohominis (12.0%) predominated. L. jensenii and L. crispatus dominated the vaginal flora of healthy Indian and US women. Indian women appeared to have a higher percentage of obligative heterofermentative species suggesting the need for a larger degree of metabolic flexibility and a more challenging vaginal environment.
    Journal of medical microbiology. 05/2014;
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    ABSTRACT: Young children are at increased risk of severe outcomes from influenza illness, including hospitalization. We conducted a case-control study to identify risk factors for influenza-associated hospitalizations among children in U.S. Emerging Infections Program sites. Cases were children 6-59 months of age hospitalized for laboratory-confirmed influenza infections during 2005-08. Age- and zip-code-matched controls were enrolled. Data on child, caregiver, and household characteristics were collected from parents and medical records. Conditional logistic regression was used to identify independent risk factors for hospitalization. We enrolled 290 (64%) of 454 eligible cases and 1,089 (49%) of 2,204 eligible controls. Risk for influenza hospitalization increased with maternal age <26 years (odds ratio [OR] 1.8, 95% confidence interval [CI] 1.1-2.9); household income below the poverty threshold (OR 2.2, CI 1.4-3.6); smoking by >50% of household members (OR 2.9, CI 1.4-6.6); lack of household influenza vaccination (OR 1.8, CI 1.2-2.5); and presence of chronic illnesses, including hematologic/oncologic (OR 11.8, CI 4.5-31.0), pulmonary (OR 2.9, CI 1.9-4.4), and neurologic (OR 3.8, CI 1.6-9.2) conditions. Full influenza immunization decreased the risk among children aged 6-23 months (OR 0.5, CI 0.3-0.9) but not among those 24-59 months of age (OR 1.5, CI 0.8-3.0; p-value for difference = 0.01). Chronic illnesses, young maternal age, poverty, household smoking, and lack of household influenza vaccination increased the risk of influenza hospitalization. These characteristics may help providers to identify young children who are at greatest risk for severe outcomes from influenza illness.
    The Pediatric Infectious Disease Journal 03/2014; · 3.57 Impact Factor
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    ABSTRACT: Background. Before introduction of 7-valent pneumococcal conjugate vaccine (PCV7), invasive pneumococcal disease (IPD) rates among blacks were twice rates in whites. We measured the effects of trends in PCV7-type and non-PCV7-type IPD rates on racial disparities in overall IPD and estimated the proportion of IPD caused by serotypes included in 13-valent pneumococcal conjugate vaccine (PCV13). Methods. We analyzed data from the Active Bacterial Core Surveillance (ABCs) System, which performs active, laboratory- and population-based surveillance for IPD for 29.2 million people in the United States during 1998-2009. For patients with unknown race, we multiply imputed race to calculate age-, race-, and serotype-specific IPD incidence rates. Results. During 1998-2009, 47,449 IPD cases were identified; race was unknown for 5,419 (11%). After multiple imputation, 31,981 (67%) patients were considered white and 13,750 (29%) black. PCV7-type IPD rates in all ages in both races decreased to <1 case per 100,000 while there were no decreases in overall IPD rates after 2002. By 2009, PCV13 serotypes caused 71% of cases among whites <5 years old compared with 58% among blacks (p<0.01). PCV13 serotypes caused 50% of IPD cases in whites ≥5 years old compared with 43% among blacks (p<0.01). Conclusions. Despite near elimination of PCV7-type IPD in both races, overall disparities in IPD rates persisted because non-PCV7-type IPD rates are higher among blacks. While PCV13 introduction may reduce racial disparities in IPD, higher valency conjugate vaccines and strategies to directly address underlying causes are needed to eliminate IPD disparities.
    Clinical Infectious Diseases 02/2014; · 9.37 Impact Factor
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    ABSTRACT: Little information is available describing the epidemiology and clinical characteristics of those <12 months hospitalized with influenza, particularly at a population level. We used population-based, laboratory-confirmed influenza hospitalization surveillance data from 2003-2012 seasons to describe the impact of influenza by age category (<3, 3 to <6 and 6 to <12 months). Logistic regression was used to explore risk factors for intensive care unit (ICU) admission. Adjusted age specific influenza-associated hospitalization rates were calculated and applied to the number of U.S. infants to estimate national numbers of hospitalizations. Influenza was associated with an annual average of 6,514 infant hospitalizations (range 1,842- 12,502). Hospitalization rates among infants <3 months were substantially higher than the rate in older infants. Most hospitalizations occurred in otherwise healthy infants (75%) among whom up to 10% were admitted to the ICU and up to 4% had respiratory failure. These proportions were 2-3 times higher in infants with high risk conditions. Infants <6 months were 40% more likely to be admitted to the ICU than older infants. Lung disease (adjusted odds ratio [aOR] 1.80; 95% confidence interval [CI] 1.22, 2.67), cardiovascular disease (aOR 4.16; 95% CI 2.65, 6.53), and neuromuscular disorder (aOR 2.99; 95% CI 1.87, 4.78) were risk factors for ICU admission among all infants. The impact of influenza on infants, particularly those very young or with high risk conditions, underscore the importance of influenza vaccination, especially among pregnant women and those in contact with young infants not eligible for vaccination.
    The Pediatric Infectious Disease Journal 02/2014; · 3.57 Impact Factor
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    ABSTRACT: We examined heavy alcohol use as a risk factor for severe influenza (intensive care admission or death) among hospitalized adults. In <65- and ≥65-year-olds, heavy alcohol use increased disease severity [relative risk (RR) 1.34; 95 % confidence interval (CI): 1.04-1.74, and RR 2.47; 95 % CI: 1.69-3.60, respectively]. Influenza vaccination and early, empiric antiviral treatment should be emphasized in this population.
    Infection 11/2013; · 2.44 Impact Factor
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    ABSTRACT: Seasonal influenza is responsible for more than 200,000 hospitalizations each year in the United States. Although hospital-onset (HO) influenza contributes to morbidity and mortality among these patients, little is known about its overall epidemiology. We describe patients with HO influenza in the United States during the 2010-2011 influenza season and compare them with community-onset (CO) cases to better understand factors associated with illness. We identified laboratory-confirmed, influenza-related hospitalizations using the Influenza Hospitalization Surveillance Network (FluSurv-NET), a network that conducts population-based surveillance in 16 states. CO cases had laboratory confirmation ≤ 3 days after hospital admission; HO cases had laboratory confirmation > 3 days after admission. We identified 172 (2.8%) HO cases among a total of 6,171 influenza-positive hospitalizations. HO and CO cases did not differ by age (P = .22), sex (P = .29), or race (P = .25). Chronic medical conditions were more common in HO cases (89%) compared with CO cases (78%) (P < .01), and a greater proportion of HO cases (42%) than CO cases (17%) were admitted to the intensive care unit (P < .01). The median length of stay after influenza diagnosis of HO cases (7.5 days) was greater than that of CO cases (3 days) (P < .01). HO cases had greater length of stay and were more likely to be admitted to the intensive care unit or die compared with CO cases. HO influenza may play a role in the clinical outcome of hospitalized patients, particularly among those with chronic medical conditions.
    American journal of infection control 10/2013; · 3.01 Impact Factor
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    ABSTRACT: Background. Data on the range and severity of influenza-associated complications among children are limited. We describe the frequency and severity of complications in hospitalized children aged <18 years with seasonal influenza (2003-2009) and influenza A(H1N1)pdm09 (2009-2010). Methods. Population-based surveillance for laboratory-confirmed influenza hospitalizations was conducted among 5.3 million children in 10 states. Complications were identified by ICD-9 codes in medical records. Results. During 2003-2010, 7,293 children hospitalized with influenza were identified, of whom 6,769 (93%) had complete ICD-9 code data. Among the 6,769 children, the median length of hospitalization was 3 days (interquartile range 2-4), 975 (14%) required intensive care, 359 (5%) had respiratory failure, and 40 (1%) died. The most common complications were pneumonia (28%), asthma exacerbations (793/3616 children >2 years, 22%), and dehydration (21%). Lung abscess/empyema, tracheitis, encephalopathy, bacteremia/sepsis, acute renal failure, and myocarditis were rare (<2%) but associated with median hospitalization >6 days and 48-70% of children required intensive care. Positive bacterial cultures were identified in 2% of children (107/6769); Staphylococcus aureus and Streptococcus pneumoniae were most commonly identified. Conclusion. Complications add substantially to the burden of hospitalized children with influenza through intensive care requirements and prolonged hospitalization, highlighting the importance of primary prevention with influenza vaccination.
    The Journal of Infectious Diseases 08/2013; · 5.85 Impact Factor
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    ABSTRACT: During 2009-2010, we examined 217 cases hospitalized with laboratory-confirmed pandemic influenza in nine FluSurv-NET sites and 413 age- and community-matched controls and found a single dose of monovalent non-adjuvanted influenza A(H1N1)pdm09 vaccine was 50% (95% CI=13%-71%) effective in preventing hospitalization associated with A(H1N1)pdm09 virus infection.
    Clinical Infectious Diseases 08/2013; · 9.37 Impact Factor
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    ABSTRACT: BACKGROUND: Acute encephalitis syndrome (AES) is a constellation of symptoms that includes fever and altered mental status. Most cases are attributed to viral encephalitis (VE), occurring either in outbreaks or sporadically. We conducted hospital-based surveillance for sporadic adult-AES in rural Central India in order to describe its incidence, spatial and temporal distribution, clinical profile, etiology and predictors of mortality. METHODS: All consecutive hospital admissions during the study period were screened to identify adult-AES cases and were followed until 30-days of hospitalization. We estimated incidence by administrative sub-division of residence and described the temporal distribution of cases. We performed viral diagnostic studies on cerebrospinal fluid (CSF) samples to determine the etiology of AES. The diagnostic tests included RT-PCR (for enteroviruses, HSV 1 and 2), conventional PCR (for flaviviruses), CSF IgM capture ELISA (for Japanese encephalitis virus, dengue, West Nile virus, Varicella zoster virus, measles, and mumps). We compared demographic and clinical variables across etiologic subtypes and estimated predictors of 30-day mortality. RESULTS: A total of 183 AES cases were identified between January and October 2007, representing 2.38% of all admissions. The incidence of adult AES in the administrative subdivisions closest to the hospital was 16 per 100,000. Of the 183 cases, a non-viral etiology was confirmed in 31 (16.9%) and the remaining 152 were considered as VE suspects. Of the VE suspects, we could confirm a viral etiology in 31 cases: 17 (11.2%) enterovirus; 8 (5.2%) flavivirus; 3 (1.9%) Varicella zoster; 1 (0.6%) herpesvirus; and 2 (1.3%) mixed etiology); the etiology remained unknown in remaining 121 (79.6%) cases. 53 (36%) of the AES patients died; the case fatality proportion was similar in patients with a confirmed and unknown viral etiology (45.1 and 33.6% respectively). A requirement for assisted ventilation significantly increased mortality (HR 2.14 (95% CI 1.0-4.77)), while a high Glasgow coma score (HR 0.76 (95% CI 0.69-0.83)), and longer duration of hospitalization (HR 0.88 (95% CI 0.83-0.94)) were protective. CONCLUSION: This study is the first description of the etiology of adult-AES in India, and provides a framework for future surveillance programs in India.
    Clinical neurology and neurosurgery 05/2013; · 1.30 Impact Factor
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    ABSTRACT: The detection of meningococcal outbreaks relies on serogrouping and epidemiologic definitions. Advances in molecular epidemiology have improved the ability to distinguish unique Neisseria meningitidis strains, enabling the classification of isolates into clones. Around 98% of meningococcal cases in the United States are believed to be sporadic. Meningococcal isolates from 9 Active Bacterial Core surveillance sites throughout the United States from 2000 through 2005 were classified according to serogroup, multilocus sequence typing, and outer membrane protein (porA, porB, and fetA) genotyping. Clones were defined as isolates that were indistinguishable according to this characterization. Case data were aggregated to the census tract level and all non-singleton clones were assessed for non-random spatial and temporal clustering using retrospective space-time analyses with a discrete Poisson probability model. Among 1,062 geocoded cases with available isolates, 438 unique clones were identified, 78 of which had ≥2 isolates. 702 cases were attributable to non-singleton clones, accounting for 66.0% of all geocoded cases. 32 statistically significant clusters comprised of 107 cases (10.1% of all geocoded cases) were identified. Clusters had the following attributes: included 2 to 11 cases; 1 day to 33 months duration; radius of 0 to 61.7 km; and attack rate of 0.7 to 57.8 cases per 100,000 population. Serogroups represented among the clusters were: B (n = 12 clusters, 45 cases), C (n = 11 clusters, 27 cases), and Y (n = 9 clusters, 35 cases); 20 clusters (62.5%) were caused by serogroups represented in meningococcal vaccines that are commercially available in the United States. Around 10% of meningococcal disease cases in the U.S. could be assigned to a geotemporal cluster. Molecular characterization of isolates, combined with geotemporal analysis, is a useful tool for understanding the spread of virulent meningococcal clones and patterns of transmission in populations.
    PLoS ONE 01/2013; 8(12):e82048. · 3.73 Impact Factor
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    ABSTRACT: Objectives. We assessed telephone surveys as a novel surveillance method, comparing data obtained by telephone with existing national influenza surveillance systems, and evaluated the utility of telephone surveys. Methods. We used the 2007 Behavioral Risk Factor Surveillance System (BRFSS) and the 2007 National Immunization Survey-Adult (NIS-Adult) to estimate the incidence of influenza-like illness (ILI), medically attended ILI, provider-diagnosed influenza, influenza testing, and treatment of influenza with antiviral medications during the 2006-2007 influenza season. Results. With the January-May BRFSS, among persons aged 18 years and older, the cumulative incidence of seasonal ILI and provider-diagnosed influenza was 37.9 and 5.7 adults per 100 persons, respectively. Monthly medically attended ILI and provider-diagnosed influenza among adults were temporally associated with influenza activity, as documented by national surveillance. With the NIS-Adult survey data, estimated provider-diagnosed influenza, influenza testing, and antiviral treatment were 2.8%, 1.4%, and 0.6%, respectively. Conclusions. Our telephone interview-based estimates of influenza morbidity were consistent with those from national influenza surveillance systems. Telephone surveys may provide an alternative method by which population-based influenza morbidity information can be gathered. (Am J Public Health. Published online ahead of print December 13, 2012: e1-e9. doi:10.2105/AJPH.2012.300799).
    American Journal of Public Health 12/2012; · 3.93 Impact Factor
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    ABSTRACT: BACKGROUND: The efficiency of hepatitis C virus (HCV) transmission by sexual activity remains controversial. We conducted a cross-sectional study of HCV-positive persons and their partners to estimate the risk for HCV infection among monogamous heterosexual couples. METHODS: 500 anti-HCV-positive, HIV-negative index persons and their long-term heterosexual partners were studied. Couples were interviewed separately for lifetime risk factors for HCV infection, within-couple sexual practices and sharing of personal grooming items. Blood samples were tested for anti-HCV, HCV RNA, and HCV genotype and serotype. Sequencing and phylogenetic analysis determined the relatedness of virus isolates among genotype-concordant couples. RESULTS: HCV-positive index persons were mostly Non-Hispanic Whites, with median age 49 years (range 26-79) and median 15 years (range 2-52) of sexual activity with their partners. Overall, HCV prevalence among partners was 4% (n=20), and 9 couples had concordant genotype/serotype. Viral isolates in 3 couples (0.6%) were highly related, consistent with transmission of virus within the couple. Based upon 8377 person-years of follow-up, the maximum incidence rate of HCV transmission by sex was 0.07% per year (95% CI: 0.01, 0.13) or ∼1 per 190,000 sexual contacts. No specific sexual practices were related to HCV-positivity among couples. CONCLUSIONS: The results of this study provide quantifiable risk information for counseling long-term monogamous heterosexual couples in which one partner has chronic HCV infection. In addition to the extremely low estimated risk for HCV infection in sexual partners, the lack of association with specific sexual practices provides unambiguous and reassuring counseling messages. (HEPATOLOGY 2012.).
    Hepatology 11/2012; · 12.00 Impact Factor
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    ABSTRACT: Background. Certain chronic diseases increase risk for invasive pneumococcal disease (IPD) and are indications for receipt of 23-valent pneumococcal polysaccharide vaccine (PPV23). Since the pediatric introduction of 7-valent pneumococcal conjugate vaccine (PCV7) in 2000, incidence of IPD among adults has declined. The relative magnitude of these indirect effects among persons with and without PPV23 indications is unknown.Methods. We evaluated IPD incidence among adults with and without PPV23 indications using population- and laboratory-based data collected during 1998-2009 and estimates of the denominator populations with PPV23 indications from the National Health Interview Survey. We compared rates before and after PCV7 use by age, race, PPV23 indication and serotype.Results. The proportion of adult IPD cases with PPV23 indications increased from 51% before to 61% after PCV7 introduction (p<0.0001). PCV7-serotype IPD declined among all race, age and PPV23 indication strata, ranging from 82-97%. Overall IPD rates declined in most strata, by up to 65%. However, incidence remained highest among adults with PPV23 indications compared to those without (34.9 vs. 8.8 cases per 100,000 population, respectively). Apart from age ≥65 years, diabetes is now the most common indication for PPV23 (20% of all cases vs. 10% of cases in 1998-99).Conclusions. Although IPD rates have declined among adults, adults with underlying conditions remain at increased risk of IPD and comprise a larger proportion of adult IPD cases in 2009 compared to 2000. A continued increase in the prevalence of diabetes among U.S. adults could lead to increased burden of pneumococcal disease.
    Clinical Infectious Diseases 11/2012; · 9.37 Impact Factor
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    ABSTRACT: OBJECTIVES: Introduction of the Haemophilus influenzae type b (Hib) conjugate vaccine has resulted in a dramatic reduction of Hib disease in the U.S. and an increase in the relative importance of infections caused by nontypeable strains. The current project describes the characteristics and clinical outcomes of pediatric and adult patients with invasive H. influenzae (HI) and, through multivariable analysis, identifies risk factors for in-hospital mortality. METHODS: HI cases were identified during 1999-2008 through active surveillance as part of Active Bacterial Core surveillance (ABCs). Multivariable analysis was performed with logistic regression to identify factors predictive of in-hospital death. RESULTS: 4839 cases of HI were identified from 1999-2008. Children accounted for 17.1% of cases and adults 82.9%. Underlying conditions were present in 20.7% of children and 74.8% of adults. In-hospital mortality was highest in cases ≥65 years (21.9%) and <3 months (16.2%). The risk of in-hospital death in children <1 year was higher among those who were prematurely-born (<28 weeks, OR 7.1, 95% CI 3.2-15.6; 28-36 weeks OR 2.1, 95% CI 0.9-4.8) and, among children aged 1-17 years, higher in those with healthcare-associated onset and dialysis (OR 5.66, 95% CI 1.84-17.39; OR 18.11, 95% CI 2.77-118.65). In adults, age ≥40 was associated with death in nontypeable, but not encapsulated, infections. Infections with nontypeable strains increased the risk of death in cases ≥65 years (OR 1.81, 95% CI 1.31-2.52). Healthcare-associated HI, bacteremia without identifiable focus, bacteremic pneumonia, associated cirrhosis, cerebrovascular accident, dialysis, heart failure, and non-hematologic malignancy also increased the risk of death in adults. CONCLUSION: Prematurity in infants, advanced age and certain chronic diseases in adults were associated with an increased risk of in-hospital death. Nontypeable HI was associated with higher mortality in the elderly.
    The Journal of infection 08/2012; · 4.13 Impact Factor
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    ABSTRACT: Abstract Pandemic response takes place in distributed, uncertain, and high-tempo environments. These conditions require public health agencies to rapidly generate and roll out publicly accountable responses in the face of incomplete and ambiguous evidence. To perform under these conditions, public health organizations have devised several tools to support decision making and response. This article examines two such tools that debuted during the 2009 H1N1 outbreak—the 2005 International Health Regulations and influenza pandemic planning. Relying on an international network of researchers who gained access to lead public health agencies in advance of the 2009 pandemic, this study draws on several forms of data—primary documentation, interviews, and an extended workshop with key officials—that were collected as the pandemic unfolded. With this unique dataset, we analyze the performance of the International Health Regulations and pandemic influenza plans from a “sensemaking” perspective. We find that insufficient attention to both the complexities and time horizons involved with adequate sensemaking limited the ability of both tools to fully meet their goals. To improve organizational performance during global pandemics, the sensemaking perspective calls attention to the importance of informal venues of information-sharing and to the need for decisionmakers to continually update planning assumptions.
    Risk, Hazards & Crisis in Public Policy. 06/2012; 3(2).
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    ABSTRACT: Because of widespread distribution of the influenza A (H1N1) 2009 monovalent vaccine (pH1N1 vaccine) and the prior association between Guillain-Barré syndrome (GBS) and the 1976 H1N1 influenza vaccine, enhanced surveillance was implemented to estimate the magnitude of any increased GBS risk following administration of pH1N1 vaccine. The authors conducted active, population-based surveillance for incident cases of GBS among 45 million persons residing at 10 Emerging Infections Program sites during October 2009-May 2010; GBS was defined according to published criteria. The authors determined medical and vaccine history for GBS cases through medical record review and patient interviews. The authors used vaccine coverage data to estimate person-time exposed and unexposed to pH1N1 vaccine and calculated age- and sex-adjusted rate ratios comparing GBS incidence in these groups, as well as age- and sex-adjusted numbers of excess GBS cases. The authors received 411 reports of confirmed or probable GBS. The rate of GBS immediately following pH1N1 vaccination was 57% higher than in person-time unexposed to vaccine (adjusted rate ratio = 1.57, 95% confidence interval: 1.02, 2.21), corresponding to 0.74 excess GBS cases per million pH1N1 vaccine doses (95% confidence interval: 0.04, 1.56). This excess risk was much smaller than that observed during the 1976 vaccine campaign and was comparable to some previous seasonal influenza vaccine risk assessments.
    American journal of epidemiology 05/2012; 175(11):1110-9. · 5.59 Impact Factor
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    ABSTRACT: Case-control studies evaluating post-licensure effectiveness of conjugate vaccines can be laborious and costly. We applied an indirect cohort method to evaluate the effectiveness of seven-valent pneumococcal conjugate vaccine (PCV7) against invasive pneumococcal disease (IPD) and compared the results to the effectiveness measured using a standard case-control study conducted during the same time period. IPD cases among children 2-59 months old were identified through the Active Bacterial Core surveillance system during 2001-2009. We used logistic regression to calculate the odds ratio of vaccination (versus no vaccination) among cases (PCV7-type IPD cases) and non-cases (non-PCV7-type IPD cases), controlling for the presence of underlying conditions. Vaccine effectiveness (VE) was calculated as one minus the adjusted odds ratio. Among 4225 IPD cases reported during 2001-2009, 2680 (63%) had serotype information and vaccine history. Effectiveness of ≥ 1 dose of PCV7 against PCV7-types was 88% (95% confidence interval (CI) 78-94%) among children with comorbid conditions and 97% (95% CI 92-98%) among healthy children. Among healthy children, VE was higher in 2001-2003 (97%, 95% CI 95-98%) compared to 2004-2009 (81%, 95% CI 64-90%). The annual estimates of VE in 2004-2009 showed great variability and wide confidence intervals due to the small number of PCV7-type cases. An indirect cohort design using IPD surveillance data confirms the findings of the case-control study and, therefore, appears suitable for estimating PCV7 effectiveness. This method would be most useful shortly after vaccine introduction, and less useful in a setting of very high vaccine coverage and fewer vaccine-type cases.
    Vaccine 04/2012; 30(27):4067-72. · 3.77 Impact Factor
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    ABSTRACT: In response to pandemic (H1N1) 2009, data were collected on work status and industry of employment of 3,365 adults hospitalized with laboratory-confirmed influenza during the 2009-10 influenza season in the United States. The proportion of workers hospitalized for influenza was lower than their proportion in the general population, reflecting underlying protective characteristics of workers compared with nonworkers. The most commonly represented sectors were transportation and warehousing; administrative and support and waste management and remediation services; health care; and accommodation and food service.
    Emerging Infectious Diseases 04/2012; 18(4):556-62. · 6.79 Impact Factor
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    ABSTRACT: The Strategic Group of Advisory Experts (SAGE) on immunization is an independent advisory committee with a mandate to advise the World Health Organization (WHO) on the development of vaccine and immunization related policies. SAGE working groups are established on a time-limited basis to review and provide evidence-based recommendations, together with their implications, for open deliberation and decision-making by SAGE. In making its recommendations, SAGE takes into consideration: the epidemiologic and clinical characteristics of the disease; vaccine and immunization characteristics; economic analysis; health system considerations; the existence of and interaction with other intervention and control strategies; costing and social impacts; and legal and ethical concerns. Since 1998, WHO has produced evidence-based vaccine position papers for use primarily by national public health officials and immunization programme managers. Since April 2006 all new or updated position papers have been based on SAGE recommendations. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach has been adopted by WHO and, since 2008, GRADE tables that rate the quality of evidence have been produced in support of key recommendations. SAGE previously expressed concern that GRADE was not ideally suited to many immunization-specific issues such as the vaccine population level effect and the inclusion of surveillance system data, particularly for vaccine safety. Extensive productive interactions with various advisory groups including the US Advisory Committee on Immunization Practices, the European Centres for Disease Control, the German Standing Committee on Vaccination (STIKO), WHO's Global Advisory Committee on Vaccine Safety and the GRADE working group resulted in key enhancements to accommodate vaccine-relevant evidence. This facilitated integration and acceptability of the GRADE approach in the development of immunization related SAGE and WHO recommendations. Ongoing utilisation should result in further fine-tuning of the approach to ensure that recommendations are based on the full range of appropriate evidence.
    Vaccine 03/2012; · 3.77 Impact Factor

Publication Stats

12k Citations
2,380.29 Total Impact Points


  • 1988–2014
    • University of California, Berkeley
      • • Division of Epidemiology
      • • School of Public Health
      Berkeley, California, United States
  • 2013
    • AIIMS Bhopal All India Institute of Medical Sciences
      Bhopal, Madhya Pradesh, India
  • 2012
    • University of Berkley
      Berkley, Michigan, United States
    • Institut National de Santé Publique du Québec (INSPQ)
      Québec, Quebec, Canada
  • 2011
    • Florida International University
      • Robert Stempel College of Public Health and Social Work
      Miami, Florida, United States
    • Santa Casa Medicine School, São Paulo
      • Departamento de Medicina Social
      São Paulo, Estado de Sao Paulo, Brazil
  • 2010–2011
    • Public Health research Institute, India
      Davis, California, United States
    • University of Newcastle
      Newcastle, New South Wales, Australia
  • 1998–2011
    • University of California, San Francisco
      • • Division of Hospital Medicine
      • • Division of General Internal Medicine
      San Francisco, CA, United States
  • 1982–2010
    • Centers for Disease Control and Prevention
      • • Division of Bacterial Diseases
      • • Division of HIV/AIDS Prevention, Intervention and Support
      Druid Hills, GA, United States
  • 2009
    • San Francisco Department of Public Health
      San Francisco, California, United States
    • McGill University
      • Department of Epidemiology, Biostatistics and Occupational Health
      Montréal, Quebec, Canada
  • 2007
    • McGill University Health Centre
      Montréal, Quebec, Canada
    • Asha Hospitals
      Bhaganagar, Andhra Pradesh, India
  • 2002–2006
    • National Institute of Allergy and Infectious Diseases
      Maryland, United States
  • 2005
    • Minnesota Department of Health
      Saint Paul, Minnesota, United States
    • Yale-New Haven Hospital
      New Haven, Connecticut, United States
    • Ministry of Health, Uganda
      Kampala, Central Region, Uganda
    • Mahatma Gandhi Institute of Medical Sciences
      • Department of Medicine
      Wardha, State of Maharashtra, India
  • 2000
    • Centro Nacional De Investigaciones En Salud Materno Infantil (Cenismi)
      Santo Domingo Pueblo, New Mexico, United States
  • 1991
    • Kaiser Permanente
      Oakland, California, United States
  • 1984
    • U.S. Department of Health and Human Services
      Washington, Washington, D.C., United States