Richard K Zimmerman

University of Pittsburgh, Pittsburgh, Pennsylvania, United States

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Publications (247)853.25 Total impact

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    ABSTRACT: Objective Influenza vaccination rates among some groups of children remain below the Healthy People 2020 goal of 70%. Multistrategy interventions to increase childhood influenza vaccination have not been evaluated recently. Methods Twenty pediatric and family medicine practices were randomly assigned to receive the intervention in either year 1 or year 2. This study focuses on influenza vaccine uptake in the 10 year 1 intervention sites during intervention and the following maintenance year. The intervention included the 4 Pillars Immunization Toolkit - a practice improvement toolkit, early delivery of donated vaccine for disadvantaged children, staff education, and feedback on progress. During the maintenance year, practices were not assisted or contacted, except to complete follow-up surveys. Student's t tests assessed vaccine uptake of children aged 6 months to 18 years, and multilevel regression modeling in repeated measures determined variables related to the likelihood of vaccination. Results Influenza vaccine uptake increased 12.4 percentage points (PP; P <.01) during active intervention and uptake was sustained (+0.4 PP; P >.05) during maintenance, for an average change of 12.7 PP over all sites, increasing from 42.2% at baseline to 54.9% (P <.001) during maintenance. In regression modeling that controlled for age, race, and insurance, likelihood of vaccination was greater during intervention than baseline (odds ratio 1.47; 95% confidence interval 1.44-1.50; P <.001) and greater during maintenance than baseline (odds ratio 1.50; 95% confidence interval 1.47-1.54; P <.001). Conclusions In primary care practices, a multistrategy intervention that included the 4 Pillars Immunization Toolkit, early delivery of vaccine, and feedback was associated with significant improvements in childhood influenza vaccination rates that were maintained 1 year after active intervention.
    No preview · Article · Feb 2016 · Academic Pediatrics
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    ABSTRACT: Background: Few observational studies have evaluated the relative effectiveness of live attenuated (LAIV) and inactivated (IIV) influenza vaccines against medically attended laboratory-confirmed influenza. Methods: We analyzed US Influenza Vaccine Effectiveness Network data from participants aged 2 to 17 years during 4 seasons (2010-2011 through 2013-2014) to compare relative effectiveness of LAIV and IIV against influenza-associated illness. Vaccine receipt was confirmed via provider/electronic medical records or immunization registry. We calculated the ratio (odds) of influenza-positive to influenza-negative participants among those age-appropriately vaccinated with either LAIV or IIV for the corresponding season. We examined relative effectiveness of LAIV and IIV by using adjusted odds ratios (ORs) and 95% confidence intervals (CIs) from logistic regression. Results: Of 6819 participants aged 2 to 17 years, 2703 were age-appropriately vaccinated with LAIV (n = 637) or IIV (n = 2066). Odds of influenza were similar for LAIV and IIV recipients during 3 seasons (2010-2011 through 2012-2013). In 2013-2014, odds of influenza were significantly higher among LAIV recipients compared with IIV recipients 2 to 8 years old (OR 5.36; 95% CI, 2.37 to 12.13). Participants vaccinated with LAIV or IIV had similar odds of illness associated with influenza A/H3N2 or B. LAIV recipients had greater odds of illness due to influenza A/H1N1pdm09 in 2010-2011 and 2013-2014. Conclusions: We observed lower effectiveness of LAIV compared with IIV against influenza A/H1N1pdm09 but not A(H3N2) or B among children and adolescents, suggesting poor performance related to the LAIV A/H1N1pdm09 viral construct.
    Preview · Article · Feb 2016 · PEDIATRICS
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    ABSTRACT: Introduction: Prior evidence found live attenuated influenza vaccine (LAIV) more effective than inactivated influenza vaccine (IIV) in children aged 2-8 years, leading CDC in 2014 to prefer LAIV use in this group. However, since 2013, LAIV has not proven superior, leading CDC in 2015 to rescind their LAIV preference statement. Here, the cost effectiveness of preferred LAIV use compared with IIV in children aged 2-8 years is estimated. Methods: A Markov model estimated vaccination strategy cost effectiveness in terms of cost per quality-adjusted life-year gained. Base case assumptions were equal vaccine uptake; IIV use when LAIV was not indicated (in 11.7% of the cohort); and no indirect vaccination effects. Sensitivity analyses included estimates of indirect effects from both equation- and agent-based models. Analyses were performed in 2014-2015. Results: Using prior effectiveness data in children aged 2-8 years (LAIV=83%, IIV=64%), preferred LAIV use was less costly and more effective than IIV (dominant), with results sensitive only to LAIV and IIV effectiveness variation. Using 2014-2015 U.S. effectiveness data (LAIV=0%, IIV=15%), IIV was dominant. In two-way sensitivity analyses, LAIV use was cost saving over the entire range of IIV effectiveness (0%-81%) when absolute LAIV effectiveness was >7.1% higher than IIV, but never cost saving when absolute LAIV effectiveness was <3.5% higher than IIV. Conclusions: Results support CDC's decision to no longer prefer LAIV use and provide guidance on effectiveness differences between influenza vaccines that might lead to preferential LAIV recommendation for children aged 2-8 years.
    No preview · Article · Feb 2016 · American journal of preventive medicine
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    ABSTRACT: Introduction: An effective immune response to vaccination may be related to nutritional status. This study examined the association of plasma mineral levels with hemagglutination inhibition (HI) titers produced in response to influenza vaccine in older adults. Methods: Prior to (Day 0) and 21 (range = 19-28) days after receiving the 2013-14 influenza vaccine, 109 adults ages 51-81 years, provided blood samples. Serum samples were tested for HI activity against the A/H1N1 and A/H3N2 2013-2014 vaccine virus strains. Plasma minerals were collected in zinc-free tubes and assayed by inductively coupled plasma mass spectrometry. HI titers were reported as seroprotection (≥1:40) and seroconversion (≥ 4-fold rise from Day 0 (minimum HI=1:10) to Day 21). Both HI titers and mineral values were skewed and thus log2 transformed. Magnesium (Mg), phosphorus (P), zinc (Zn), copper (Cu), iron (Fe), potassium (K) and the Cu to Zn ratio were tested. Logistic regression analyses were used to determine the associations between mineral levels and seroconversion and seroprotection of HI titers for each influenza A strain. Results: Participants' were 61% white, 28% male, 39% diabetic, and 81% overweight/obese with a mean age of 62.6 years. In logistic regression, Day 21 A/H1N1 seroprotection was associated with P and Zn at Day 21(P<0.05). Seroconversion of A/H1N1 was associated with Day 21 Cu, P, and Mg (P<0.03). Day 21 A/H3N2 seroprotection and seroconversion were associated with Day 21 P (P<0.05). Conclusions: Phosphorus was associated with seroprotection and seroconversion to influenza A after vaccination; these associations warrant additional studies with larger, more diverse population groups.
    No preview · Article · Jan 2016 · Human Vaccines & Immunotherapeutics
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    ABSTRACT: Background: The predominant strain during the 2013-2014 influenza season was 2009 pandemic influenza A(H1N1) virus (A[H1N1]pdm09). This vaccine-component has remained unchanged from 2009. Methods: The US Flu Vaccine Effectiveness Network enrolled subjects aged ≥6 months with medically attended acute respiratory illness (MAARI), including cough, with illness onset ≤7 days before enrollment. Influenza was confirmed by reverse-transcription polymerase chain reaction (RT-PCR). We determined the effectiveness of trivalent or quadrivalent inactivated influenza vaccine (IIV) among subjects ages ≥6 months and the effectiveness of quadrivalent live attenuated influenza vaccine (LAIV4) among children aged 2-17 years, using a test-negative design. The effect of prior receipt of any A(H1N1)pdm09-containing vaccine since 2009 on the effectiveness of current-season vaccine was assessed. Results: We enrolled 5999 subjects; 5637 (94%) were analyzed; 18% had RT-PCR-confirmed A(H1N1)pdm09-related MAARI. Overall, the effectiveness of vaccine against A(H1N1)pdm09-related MAARI was 54% (95% confidence interval [CI], 46%-61%). Among fully vaccinated children aged 2-17 years, the effectiveness of LAIV4 was 17% (95% CI, -39% to 51%) and the effectiveness of IIV was 60% (95% CI, 36%-74%). Subjects aged ≥9 years showed significant residual protection of any prior A(H1N1)pdm09-containing vaccine dose(s) received since 2009, as did children <9 years old considered fully vaccinated by prior season. Conclusions: During 2013-2014, IIV was significantly effective against A(H1N1)pdm09. Lack of LAIV4 effectiveness in children highlights the importance of continued annual monitoring of effectiveness of influenza vaccines in the United States.
    Preview · Article · Jan 2016 · The Journal of Infectious Diseases
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    ABSTRACT: Background: Few studies have examined the effectiveness of full vs. partial vaccination with inactivated trivalent influenza vaccines (IIV3) as defined by the U.S. CDC Advisory Committee on Immunization Practices (ACIP). Methods: Respiratory swabs were collected from outpatients aged 6 months to 8 years with acute cough for ≤7 days in clinics in 5 states during the 2011-2012 and 2012-2013 influenza seasons. Influenza was confirmed by real-time reverse transcription polymerase chain reaction assay. Receipt of current season IIV3 and up to 4 prior vaccinations was documented from medical records and immunization registries. Using a test-negative design, vaccine effectiveness (VE) was estimated adjusting for age, race/ethnicity, medical conditions, study site, and month of enrollment. Results: We did not observe higher VE for children fully vs. partially vaccinated with IIV3, as defined by U.S. ACIP, though our sample of partially vaccinated children was relatively small. However, among children aged 2-8 years in both seasons and against A(H3N2) and B influenza illness separately, VE point estimates were consistently higher for children who had received 2 doses in the same prior season compared to those without (VE range of 58-80% vs. 33-44%, respectively). Across seasons, the odds of A(H3N2) illness despite IIV3 vaccination were 2.4-fold (95% CI = 1.4-4.3) higher among children who had not received 2 doses in the same prior season. We also noted residual protection among unvaccinated children who were vaccinated the previous season (VE range = 36-40% across outcomes). Conclusion: Vaccination with IIV3 may provide preventive benefit in subsequent seasons, including possible residual protection if vaccination is missed. Two vaccine doses in the same season may be more effective than alternative priming strategies.
    No preview · Article · Dec 2015 · The Pediatric Infectious Disease Journal
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    ABSTRACT: Background: Influenza causes significant morbidity and mortality with considerable economic costs, including lost work productivity. Influenza vaccines may reduce the economic burden through primary prevention of influenza and reduction in illness severity. Methods: We examined illness severity and work productivity loss among working adults with medically-attended acute respiratory illnesses, and compared outcomes for patients with and without laboratory-confirmed influenza, and by influenza vaccination status among patients with influenza during the 2012-2013 influenza season. Results: Illnesses laboratory-confirmed as influenza (i.e. Cases) were subjectively assessed as more severe than illnesses not caused by influenza (i.e. Non-Cases) based on multiple measures, including current health status at study enrollment (<7 days from illness onset), and current activity and sleep quality status relative to usual. Influenza Cases reported missing 45% more work hours (20.5 vs. 15.0, P<.001) than Non-Cases, and subjectively assessed their work productivity as impeded to a greater degree (6.0 vs. 5.4, P<.001). Current health status and current activity relative to usual were subjectively assessed as modestly, but significantly, better for vaccinated influenza Cases compared with unvaccinated Cases; however, no significant modifications of sleep quality, missed work hours, or work productivity loss were noted for vaccinated subjects. Conclusions: . Influenza illnesses were more severe and resulted in more missed work hours and productivity loss than illnesses not confirmed as influenza. Modest reductions in illness severity for vaccinated influenza cases were observed. These findings highlight the burden of influenza illnesses and illustrate the importance of laboratory-confirmation of influenza outcomes in evaluations of vaccine effectiveness.
    No preview · Article · Nov 2015 · Clinical Infectious Diseases

  • No preview · Conference Paper · Oct 2015
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    ABSTRACT: We estimated the burden of outpatient influenza and cases prevented by vaccination during the 2011/2012 and 2012/2013 influenza seasons using data from the United States Influenza Vaccine Effectiveness (US Flu VE) Network. We defined source populations of persons who could seek care for acute respiratory illness (ARI) at each of the five US Flu VE Network sites. We identified all members of the source population who were tested for influenza during US Flu VE influenza surveillance. Each influenza-positive subject received a sampling weight based on the proportion of source population members who were tested for influenza, stratified by site, age, and other factors. We used the sampling weights to estimate the cumulative incidence of medically attended influenza in the source populations. We estimated cases averted by vaccination using estimates of cumulative incidence, vaccine coverage, and vaccine effectiveness. Cumulative incidence of medically attended influenza ranged from 0.8% to 2.8% across sites during 2011/2012 and from 2.6% to 6.5% during the 2012/2013 season. Stratified by age, incidence ranged from 1.2% among adults 50 years of age and older in 2011/2012 to 10.9% among children 6 months to 8 years of age in 2012/2013. Cases averted by vaccination ranged from 4 to 41 per 1000 vaccinees, depending on the study site and year. The incidence of medically attended influenza varies greatly by year and even by geographic region within the same year. The number of cases averted by vaccination varies greatly based on overall incidence and on vaccine coverage. Copyright © 2015. Published by Elsevier Ltd.
    No preview · Article · Aug 2015 · Vaccine
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    ABSTRACT: A multifaceted intervention to raise influenza vaccination rates was tested among children with asthma. In a pre/post study design, 18 primary care practices implemented the 4 Pillars Immunization Toolkit along with other strategies. The primary outcome was the difference in influenza vaccination rates at each practice among children with asthma between the baseline year (before the intervention) and at the end of year 2 (after the intervention), both overall and by race (White vs. non-White). Influenza vaccination rates increased significantly in 13 of 18 practices. The percentage of vaccinated non-White children increased from 46% to 61% (p < .01), and the percentage of vaccinated White children increased from 58% to 65% (p < .001). Likelihood of vaccination was significantly lower for non-White children before the intervention (odds ratio = 0.66; 95% confidence interval = 0.59-0.73; p < .001), but this difference was eliminated after the intervention (odds ratio = 0.95; 95% confidence interval = 0.85-1.05; p = .289). A multi-strategy, evidence-based intervention significantly increased influenza vaccination uptake and reduced racial disparities among children with asthma. Copyright © 2015 National Association of Pediatric Nurse Practitioners. All rights reserved.
    No preview · Article · Aug 2015 · Journal of Pediatric Health Care
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    ABSTRACT: In addition to its well-known effects on bone metabolism, vitamin D is an immunomodulating hormone. Serum vitamin D levels in males 18-25 years were measured at baseline, and HPV antibody titers were measured one month following the third quadrivalent HPV vaccine dose. Vitamin D levels were >30 ng/ml (normal) in 60 males and <30 ng/ml (low) in 113 males. Reverse cumulative distribution curves and scatter plots showed higher antibody titers with low vitamin D for all vaccine strains (P<0.05). In linear regression analyses, antibody titers for all HPV strains were significantly higher among those with lower vitamin D levels and among younger participants (P<0.05). These relationships add to the body of knowledge of the complex role of vitamin D in immunoregulation.
    No preview · Article · Jul 2015 · Human Vaccines & Immunotherapeutics
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    ABSTRACT: To determine the effects of symptoms and presence of confirmed influenza on intention to receive an influenza vaccine, specifically in patients recovering from a medically-attended acute (≤ 7 days' duration) respiratory illness (ARI). During the 2013-14 influenza season individuals seeking outpatient care for an ARI that included cough were tested for influenza using reverse transcription polymerase chain reaction assays (PCR) and completed surveys. Children (6 months-18 years) and adults (≥ 18 years) were grouped by their combined current season's influenza vaccination status (vaccinated/not vaccinated) and their vaccination intentions for next season (intend/do not intend). Overall, 41% (323/786) were unvaccinated at enrollment; of those, nearly half (151/323) intended to be vaccinated next season. When adjusting for demographic, health, and other factors, unvaccinated individuals who intended to be vaccinated next season were approximately 1.5 times more likely to have PCR-confirmed influenza compared with vaccinated individuals who intended to be vaccinated next season. The combined experience of not being vaccinated against influenza and seeking medical attention for an ARI seemed to influence approximately one-half of unvaccinated participants to consider influenza vaccination for next season.
    No preview · Article · Jul 2015 · American journal of health behavior
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    ABSTRACT: During the 2013-14 influenza season, we analyzed data from 6,004 outpatients aged ≥6 months with acute respiratory illness (ARI). Among the 2,786 ARI patients at higher risk for influenza complications, 835 (30%) presented to care ≤2 days from symptom onset; among those, 126 (15%) were prescribed an antiviral medication. Published by Oxford University Press on behalf of the Infectious Diseases Society of America 2015. This work is written by (a) US Government employee(s) and is in the public domain in the US.
    No preview · Article · Feb 2015 · Clinical Infectious Diseases
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    ABSTRACT: In the United States, annual vaccination against seasonal influenza is recommended for all persons aged ≥6 months. Each season since 2004-05, CDC has estimated the effectiveness of seasonal influenza vaccine in preventing medically attended acute respiratory illness (ARI) associated with laboratory-confirmed influenza. This season, early estimates of influenza vaccine effectiveness are possible because of widespread, early circulation of influenza viruses. By January 3, 2015, 46 states were experiencing widespread flu activity, with predominance of influenza A (H3N2) viruses. This report presents an initial estimate of seasonal influenza vaccine effectiveness at preventing laboratory-confirmed influenza virus infection associated with medically attended ARI based on data from 2,321 children and adults enrolled in the U.S. Influenza Vaccine Effectiveness Network (Flu VE) during November 10, 2014-January 2, 2015. During this period, overall vaccine effectiveness (VE) (adjusted for study site, age, sex, race/ethnicity, self-rated health, and days from illness onset to enrollment) against laboratory-confirmed influenza associated with medically attended ARI was 23% (95% confidence interval [CI] = 8%-36%). Most influenza infections were due to A (H3N2) viruses. This interim VE estimate is relatively low compared with previous seasons when circulating viruses and vaccine viruses were well-matched and likely reflects the fact that more than two-thirds of circulating A (H3N2) viruses are antigenically and genetically different (drifted) from the A (H3N2) vaccine component of 2014-15 Northern Hemisphere seasonal influenza vaccines. These early, low VE estimates underscore the need for ongoing influenza prevention and treatment measures. CDC continues to recommend influenza vaccination because the vaccine can still prevent some infections with the currently circulating A (H3N2) viruses as well as other viruses that might circulate later in the season, including influenza B viruses. Even when VE is reduced, vaccination still prevents some illness and serious influenza-related complications, including thousands of hospitalizations and deaths. Persons aged ≥6 months who have not yet been vaccinated this season should be vaccinated, including persons who might already have been ill with influenza this season.
    No preview · Article · Jan 2015 · MMWR. Morbidity and mortality weekly report

  • No preview · Article · Jan 2015 · MMWR. Morbidity and mortality weekly report
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    ABSTRACT: Influenza vaccination is administered throughout the influenza disease season, even as late as March. Given such timing, what is the value of vaccinating the population earlier than currently being practiced? We used real data on when individuals were vaccinated in Allegheny County, Pennsylvania, and the following 2 models to determine the value of vaccinating individuals earlier (by the end of September, October, and November): Framework for Reconstructing Epidemiological Dynamics (FRED), an agent-based model (ABM), and FluEcon, our influenza economic model that translates cases from the ABM to outcomes and costs [health care and lost productivity costs and quality-adjusted life-years (QALYs)]. We varied the reproductive number (R0) from 1.2 to 1.6. Applying the current timing of vaccinations averted 223,761 influenza cases, $16.3 million in direct health care costs, $50.0 million in productivity losses, and 804 in QALYs, compared with no vaccination (February peak, R0 1.2). When the population does not have preexisting immunity and the influenza season peaks in February (R0 1.2-1.6), moving individuals who currently received the vaccine after September to the end of September could avert an additional 9634-17,794 influenza cases, $0.6-$1.4 million in direct costs, $2.1-$4.0 million in productivity losses, and 35-64 QALYs. Moving the vaccination of just children to September (R0 1.2-1.6) averted 11,366-1660 influenza cases, $0.6-$0.03 million in direct costs, $2.3-$0.2 million in productivity losses, and 42-8 QALYs. Moving the season peak to December increased these benefits, whereas increasing preexisting immunity reduced these benefits. Even though many people are vaccinated well after September/October, they likely are still vaccinated early enough to provide substantial cost-savings.
    No preview · Article · Jan 2015 · Medical Care
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    ABSTRACT: Background. Despite vaccination, residents of long-term-care facilities (LTCFs) remain at high risk of influenza-related morbidity and mortality. More-effective vaccine options for this population are needed. Methods. We conducted a single-blinded, randomized, controlled trial comparing high-dose (HD) to standard-dose (SD) inactivated influenza vaccine (IIV) in 205 frail, elderly residents of LTCFs during the 2011-2012 and 2012-2013 influenza seasons. Hemagglutination inhibition (HI) antibody titers were measured at baseline and 30 and 180 days following vaccination. Results. A total of 187 subjects (91%) completed the study. The mean age was 86.7 years. Geometric mean titers (GMTs) were significantly higher (P < .05) at day 30 for HD recipients, compared with SD recipients, for all comparisons except influenza A(H1N1) during 2012-2013 (the HD formulation was noninferior to the SD formulation for influenza A[H1N1] during 2012-2013). GMTs for HD and SD recipients during 2011-2012 were as follows: influenza A(H1N1), 78 (95% confidence interval [CI], 45-136) and 27 (95% CI, 17-44), respectively; influenza A(H3N2), 26 (95% CI, 17-40) and 10 (95% CI, 7-15), respectively; and influenza B, 26 (95% CI, 19-35) and 14 (95% CI, 11-18), respectively. During 2012-2013, GMTs for HD and SD recipients were as follows: influenza A(H1N1), 46 (95% CI, 33-63) and 50 (95% CI, 37-67); influenza A(H3N2), 23 (95% CI, 18-31) and 14 (95% CI, 11-18), respectively; and influenza B, 26 (95% CI, 21-32) and 17 (95% CI, 14-22), respectively. GMTs were significantly higher at day 180 for HD recipients, compared with SD recipients, for influenza A(H3N2) in both years (P < .001). Conclusions. Among frail, elderly residents of LTCFs, HD influenza vaccine produced superior responses for all strains except influenza A(H1N1) in 2012-2013. Clinical Trials Registration. NCT01654224.
    No preview · Article · Dec 2014 · The Journal of Infectious Diseases
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    ABSTRACT: Rapid, accurate, and cost-effective methods to identify the cause of respiratory tract infections are needed to maximize clinical benefit. Outpatients with acute respiratory illness were tested for influenza using a singleplex reverse transcriptase polymerase chain reaction (SRT-PCR) method. A multiplex RT-PCR (MRT-PCR) method tested for influenza and 17 other viruses and was compared with SRT-PCR using chi-square tests. Among 935 patients, 335 (36%) tested positive for influenza A and influenza B using SRT-PCR. Using MRT-PCR, 320 (34.2%) tested positive for influenza A and influenza B. This study supports MRT-PCR as a comparable method for detecting influenza among patients seeking outpatient care for acute respiratory illnesses.
    Full-text · Article · Dec 2014 · Advances in Virology
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    ABSTRACT: Background: During the 2012-2013 influenza season, there was cocirculation of influenza A(H3N2) and 2 influenza B lineage viruses in the United States. Methods: Patients with acute cough illness for ≤7 days were prospectively enrolled and had swab samples obtained at outpatient clinics in 5 states. Influenza vaccination dates were confirmed by medical records. The vaccine effectiveness (VE) was estimated as [100% × (1 - adjusted odds ratio)] for vaccination in cases versus test-negative controls. Results: Influenza was detected in 2307 of 6452 patients (36%); 1292 (56%) had influenza A(H3N2), 582 (25%) had influenza B/Yamagata, and 303 (13%) had influenza B/Victoria. VE was 49% (95% confidence interval [CI], 43%-55%) overall, 39% (95% CI, 29%-47%) against influenza A(H3N2), 66% (95% CI, 58%-73%) against influenza B/Yamagata (vaccine lineage), and 51% (95% CI, 36%-63%) against influenza B/Victoria. VE against influenza A(H3N2) was highest among persons aged 50-64 years (52%; 95% CI, 33%-65%) and persons aged 6 months-8 years (51%; 95% CI, 32%-64%) and lowest among persons aged ≥65 years (11%; 95% CI, -41% to 43%). In younger age groups, there was evidence of residual protection from receipt of the 2011-2012 vaccine 1 year earlier. Conclusions: The 2012-2013 vaccines were moderately effective in most age groups. Cross-lineage protection and residual effects from prior vaccination were observed and warrant further investigation.
    Full-text · Article · Nov 2014 · The Journal of Infectious Diseases
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    ABSTRACT: College-age men were recruited using Facebook™ advertisements (ads), as well as traditional recruitment methods, for a randomized controlled trial to compare immunological responses to human papillomavirus vaccine administered in two dosing schedules. This study compares enrollees who were recruited through traditional recruitment methods versus social networking sites (SNSs), including Facebook. Potential participants were recruited using flyers posted on and off campus(es), and distributed at health fairs, classes, sporting, and other campus events; e-mails to students and student organizations; and print advertisements in student newspapers and on city buses. Facebook ads were displayed to users with specific age, geographic, and interest characteristics; ads were monitored daily to make adjustments to improve response. A total of 220 males, aged 18 to 25 years enrolled between October 2010 and May 2011. The majority of participants (51%) reported print advertisements as the method by which they first heard about the study, followed by personal contact (29%) and Facebook or other SNSs (20%). The likelihood of a SNS being the source by which the participant first heard about the study compared with traditional methods was increased if the participant reported (a) being homosexual or bisexual or (b) posting daily updates on SNSs. Facebook and other SNSs are a viable recruitment strategy for reaching potential clinical trial participants among groups who typically use social media to stay connected with their friends and hard-to-reach groups such as young men who self-identify as homosexual or bisexual.
    No preview · Article · Nov 2014 · American journal of men's health

Publication Stats

4k Citations
853.25 Total Impact Points


  • 1995-2016
    • University of Pittsburgh
      • • Department of Family Medicine
      • • Department of Medicine
      • • Department of Pediatrics
      Pittsburgh, Pennsylvania, United States
  • 2009
    • Centers for Disease Control and Prevention
      • National Center for Immunization and Respiratory Diseases
      Atlanta, MI, United States
  • 2003-2007
    • Medical University of Ohio at Toledo
      Toledo, Ohio, United States
    • TAS Energy
      Houston, Texas, United States
    • University of Louisville
      • School of Public Health and Information Sciences
      Louisville, KY, United States
  • 1991-1993
    • University of Minnesota Duluth
      Duluth, Minnesota, United States