Arthur Reingold

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

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Publications (288)3131.78 Total impact

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    ABSTRACT: Background. Antibiotic-nonsusceptible invasive pneumococcal disease (IPD) decreased substantially after the US introduction of the pediatric 7-valent pneumococcal conjugate vaccine (PCV7) in 2000. However, rates of antibiotic-nonsusceptible non-PCV7-type IPD increased during 2004–2009. In 2010, the 13-valent pneumococcal conjugate vaccine (PCV13) replaced PCV7. We assessed the impact of PCV13 on antibiotic-nonsusceptible IPD rates. Methods. We defined IPD as pneumococcal isolation from a normally sterile site in a resident from 10 US surveillance sites. Antibiotic-nonsusceptible isolates were those intermediate or resistant to ≥1 antibiotic classes according to 2012 Clinical and Laboratory Standards Institute breakpoints. We examined rates of antibiotic-nonsusceptibility and estimated cases prevented between observed cases of antibiotic-nonsusceptible IPD and cases that would have occurred if PCV13 had not been introduced. Results. From 2009–2013, rates of antibiotic-nonsusceptible IPD caused by serotypes included in PCV13 but not in PCV7 decreased from 6.5 to 0.5 per 100,000 in children aged <5 years and from 4.4 to 1.4 per 100,000 in adults aged ≥65 years. During 2010–2013, we estimated that 1,636 and 1,327 cases of antibiotic-nonsusceptible IPD caused by serotypes included in PCV13 but not in PCV7, were prevented among children aged <5 years (-97% difference) and among adults aged ≥65 years (-64% difference), respectively. Although we observed small increases in antibiotic-nonsusceptible IPD caused by non-PCV13 serotypes, no non-PCV13 serotype dominated among antibiotic-nonsusceptible strains. Conclusions. Following PCV13 introduction, antibiotic-nonsusceptible IPD decreased in multiple age groups. Continued surveillance is needed to monitor trends of non-vaccine serotypes. Pneumococcal conjugate vaccines are important tools in the approach to combat antibiotic resistance.
    No preview · Article · Feb 2016 · Clinical Infectious Diseases
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    ABSTRACT: Background: Syndromic management of vaginal infections is known to have poor diagnostic accuracy. Logic regression is a machine-learning procedure which allows for the identification of combinations of variables to predict an outcome, such as the presence of a vaginal infection. Methods: We used logic regression to develop predictive models for syndromic management of vaginal infection among symptomatic, reproductive-age women in south India. We assessed the positive predictive values, negative predictive values, sensitivities and specificities of the logic regression procedure and a standard WHO algorithm against laboratory-confirmed diagnoses of two conditions: metronidazole-sensitive vaginitis [bacterial vaginosis or trichomoniasis (BV/TV)], and vulvovaginal candidiasis (VVC). Results: The logic regression procedure created algorithms which had a mean positive predictive value of 61 % and negative predictive value of 80 % for management of BV/TV, and a mean positive predictive value of 26 % and negative predictive value of 98 % for management of VVC. The results using the WHO algorithm were similarly mixed. Conclusions: The logic regression procedure identified the most predictive measures for management of vaginal infections from the candidate clinical and laboratory measures. However, the procedure provided further evidence as to the limits of syndromic management for vaginal infections using currently available clinical measures.
    Full-text · Article · Dec 2015 · BMC Medical Informatics and Decision Making
  • Pekka Nuorti · Arthur Reingold

    No preview · Article · Oct 2015 · The Lancet Respiratory Medicine
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    ABSTRACT: Active Bacterial Core surveillance (ABCs) was established in 1995 as part of the Centers for Disease Control and Prevention Emerging Infections Program (EIP) network to assess the extent of invasive bacterial infections of public health importance. ABCs is distinctive among surveillance systems because of its large, population-based, geographically diverse catchment area; active laboratory-based identification of cases to ensure complete case capture; detailed collection of epidemiologic information paired with laboratory isolates; infrastructure that allows for more in-depth investigations; and sustained commitment of public health, academic, and clinical partners to maintain the system. ABCs has directly affected public health policies and practices through the development and evaluation of vaccines and other prevention strategies, the monitoring of antimicrobial drug resistance, and the response to public health emergencies and other emerging infections.
    Full-text · Article · Sep 2015 · Emerging Infectious Diseases
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    ABSTRACT: One objective of the Emerging Infections Program (EIP) of the US Centers for Disease Control and Prevention is to provide training opportunities in infectious disease epidemiology. To determine the extent of training performed since the program's inception in 1995, we reviewed training efforts at the 10 EIP sites. By 2015, all sites hosted trainees (most were graduate public health students and physicians) who worked on a variety of infectious disease surveillance and epidemiologic projects. Trainee projects at all sites were used for graduate student theses or practicums. Numerous projects resulted in conference presentations and publications in peer-reviewed journals. Local public health and health care partners have also benefitted from EIP presentations and training. Consideration should be given to standardizing and documenting EIP training and to sharing useful training initiatives with other state and local health departments and academic institutions.
    Full-text · Article · Sep 2015 · Emerging Infectious Diseases
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    ABSTRACT: Influenza and pneumonia combined are the leading causes of death due to infectious diseases in the United States. We describe factors associated with pneumonia among adults hospitalized with influenza. Through the Emerging Infections Program, we identified adults ≥ 18 years, who were hospitalized with laboratory-confirmed influenza during October 2005 through April 2008, and had a chest radiograph (CXR) performed. Pneumonia was defined as the presence of a CXR infiltrate and either an ICD-9-CM code or discharge summary diagnosis of pneumonia. Among 4,765 adults hospitalized with influenza, 1392 (29 %) had pneumonia. In multivariable analysis, factors associated with pneumonia included: age ≥ 75 years, adjusted odds ratio (AOR) 1.27 (95 % confidence interval 1.10-1.46), white race AOR 1.24 (1.03-1.49), nursing home residence AOR 1.37 (1.14-1.66), chronic lung disease AOR 1.37 (1.18-1.59), immunosuppression AOR 1.45 (1.19-1.78), and asthma AOR 0.76 (0.62-0.92). Patients with pneumonia were significantly more likely to require intensive care unit (ICU) admission (27 % vs. 10 %), mechanical ventilation (18 % vs. 5 %), and to die (9 % vs. 2 %). Pneumonia was present in nearly one-third of adults hospitalized with influenza and was associated with ICU admission and death. Among patients hospitalized with influenza, older patients and those with certain underlying conditions are more likely to have pneumonia. Pneumonia is common among adults hospitalized with influenza and should be evaluated and treated promptly.
    Full-text · Article · Aug 2015 · BMC Infectious Diseases
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    ABSTRACT: Treatment of a multi-drug resistant tuberculosis (MDR-TB) patient is clinically challenging, requiring a minimum of 18 months of therapy. Its occurrence in a systemic lupus erythromatosus (SLE) patient may complicate management of both MDR-TB and SLE. This is the first descriptive report of MDR-TB in an SLE patient. A 19-year old female receiving long-term prednisolone for SLE was diagnosed with MDR-TB. She was started on MDR-TB treatment regimen and prednisolone was replaced with azathioprine. After an initial response to therapy, patient experienced a flare of lupus symptoms. Imaging studies revealed avascular necrosis of right femoral head. She was then treated with intravenous methyl-prednisolone, followed by maintenance corticosteroid. Azathioprine was discontinued due to hematological toxicity and failure to control SLE. Her symptoms of lupus regressed and did not re-occur for the duration of her MDR-TB treatment. Patient was declared cured of MDR-TB after 18 months of ATT. She is currently scheduled for a total hip replacement surgery. This case highlights the challenges of simultaneously managing MDR-TB and SLE in a patient due to their over-lapping signs and symptoms, drug-drug interactions, and the need for use of immunomodulatory agents in the absence of standard guidelines and documented previous experiences. Our experience underscores the importance of appropriate selection of treatment regimens for both MDR-TB and SLE.
    Preview · Article · Aug 2015 · BMC Research Notes
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    ABSTRACT: The aim of this study was to assess risk factors associated with low levels of HIV testing among MSM recruited through respondent driven sampling (RDS) in Brazil. Of 3,617 participants, 48.4% had never tested previously for HIV. A logistic model indicated that younger age, lower socioeconomic class, education, poor HIV/AIDS knowledge, no history of cruising, and having been tested during the study were characteristics independently associated with low levels of previous HIV testing. The HIV testing rate among MSM in Brazil is still low in spite of the availability of a large number services providing universal and free access to HIV/AIDS diagnosis and treatment. To respond to low utilization, the authors propose a higher priority for testing for key populations such as MSM, expanded education, expanding testing sites and a welcoming and nonjudgmental environment in health services.
    Full-text · Article · Jun 2015 · PLoS ONE
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    ABSTRACT: A healthy vaginal environment is predominated by certain Lactobacillus species, which lead to the prevention of infections of the reproductive tract. This study examined the characteristics of cultivable Lactobacillus species between healthy women and women with bacterial vaginosis (BV). Between November 2011 and Sept 2013, 139 women attending a women's clinic in Mysore, India were diagnosed for BV in a cross-sectional study. BV was diagnosed using Amsel's criteria: homogeneous vaginal discharge, vaginal pH > 4.5, production of amines, and presence of 'clue' cells. Those with three or more of the characteristics were considered to have BV. Vaginal swabs were then cultured in Rogosa agar, de Man-Rogosa-Sharpe broth. Gram-positive lactobacilli generating 600- 800bp amplicon by16 sRNA were further characterized by sequencing. Cultivable vaginal samples were obtained from 132 (94.9%) women. According to Amsel criteria, 83(62.1%) women were healthy and 49(37.1%) women had BV. Eleven different Lactobacillus species were isolated from 47 women. The common lactobacilli species found in this sample included L. crispatus (39.6%), L. gasseri (45.8%), and L. jensenii (14.6%). Lactobacilli were isolated from 39 healthy and 8 women with BV. L. gasseri was cultured from 18.8% of healthy and 6.1% of women with BV. The presence of L. reuteri was significantly associated with normal vaginal microbiota (p-value = 0.026). These results further our understanding of vaginal lactobacilli colonisation and richness in this particular population. Our findings showed lactobacilli species present in healthy vagina of women in India do not differ from those reported from other countries.
    Full-text · Article · Apr 2015 · Journal of Medical Microbiology
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    ABSTRACT: Background: Some studies suggest that influenza vaccination might be protective against severe influenza outcomes in vaccinated persons who become infected. We used data from a large surveillance network to further investigate the effect of influenza vaccination on influenza severity in adults aged ≥50 years who were hospitalized with laboratory-confirmed influenza. Methods: We analyzed influenza vaccination and influenza severity using Influenza Hospitalization Surveillance Network (FluSurv-NET) data for the 2012-2013 influenza season. Intensive care unit (ICU) admission, death, diagnosis of pneumonia, and hospital and ICU lengths of stay served as measures of disease severity. Data were analyzed by multivariable logistic regression, parametric survival models, and propensity score matching (PSM). Results: Overall, no differences in severity were observed in the multivariable logistic regression model. Using PSM, adults aged 50-64 years (but not other age groups) who were vaccinated against influenza had a shorter length of ICU stay than those who were unvaccinated (hazard ratio for discharge, 1.84; 95% confidence interval, 1.12-3.01). Conclusions: Our findings show a modest effect of influenza vaccination on disease severity. Analysis of data from seasons with different predominant strains and higher estimates of vaccine effectiveness are needed.
    Full-text · Article · Mar 2015 · The Journal of Infectious Diseases
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    ABSTRACT: In 2000, seven-valent pneumococcal conjugate vaccine (PCV7) was introduced in the USA and resulted in dramatic reductions in invasive pneumococcal disease (IPD) and moderate increases in non-PCV7 type IPD. In 2010, PCV13 replaced PCV7 in the US immunisation schedule. We aimed to assess the effect of use of PCV13 in children on IPD in children and adults in the USA. We used laboratory-based and population-based data on incidence of IPD from the Active Bacterial Core surveillance (part of the Centers for Disease Control and Prevention's Emerging Infections Program) in a time-series model to compare rates of IPD before and after the introduction of PCV13. Cases of IPD between July 1, 2004, and June 30, 2013, were classified as being caused by the PCV13 serotypes against which PCV7 has no effect (PCV13 minus PCV7). In a time-series model, we used an expected outcomes approach to compare the reported incidence of IPD to that which would have been expected if PCV13 had not replaced PCV7. Compared with incidence expected among children younger than 5 years if PCV7 alone had been continued, incidence of IPD overall declined by 64% (95% interval estimate [95% IE] 59-68) and IPD caused by PCV13 minus PCV7 serotypes declined by 93% (91-94), by July, 2012, to June, 2013. Among adults, incidence of IPD overall also declined by 12-32% and IPD caused by PCV13 minus PCV7 type IPD declined by 58-72%, depending on age. We estimated that over 30 000 cases of IPD and 3000 deaths were averted in the first 3 years after the introduction of PCV13. PCV13 reduced IPD across all age groups when used routinely in children in the USA. These findings provide reassurance that, similar to PCV7, PCVs with additional serotypes can also prevent transmission to unvaccinated populations. Centers for Disease Control and Prevention. Copyright © 2015 Elsevier Ltd. All rights reserved.
    No preview · Article · Feb 2015 · The Lancet Infectious Diseases
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    ABSTRACT: The incidence of meningococcal disease is currently at historic lows in the United States; however, incidence remains highest among infants aged <1 year. With routine use of Haemophilus influenzae type b and pneumococcal vaccines in infants and children in the United States, Neisseria meningitidis remains an important cause of bacterial meningitis in young children. Data were collected from active, population- and laboratory-based surveillance for N meningitidis conducted through Active Bacterial Core surveillance during 2006 through 2012. Expanded data collection forms were completed for infant cases identified in the surveillance area during 2006 through 2010. An estimated 113 cases of culture-confirmed meningococcal disease occurred annually among infants aged <1 year in the United States from 2006 through 2012, for an overall incidence of 2.74 per 100 000 infants. Among these cases, an estimated 6 deaths occurred. Serogroup B was responsible for 64%, serogroup C for 12%, and serogroup Y for 16% of infant cases. Based on the expanded data collection forms, a high proportion of infant cases (36/58, 62%) had a smoker in the household and the socioeconomic status of the census tracts where infant meningococcal cases resided was lower compared with the other Active Bacterial Core surveillance areas and the United States as a whole. The burden of meningococcal disease remains highest in young infants and serogroup B predominates. Vaccines that provide long-term protection early in life have the potential to reduce the burden of meningococcal disease, especially if they provide protection against serogroup B meningococcal disease. Copyright © 2015 by the American Academy of Pediatrics.
    No preview · Article · Jan 2015 · Pediatrics
  • Arthur Reingold

    No preview · Conference Paper · Oct 2014
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    ABSTRACT: Background: Incidence of invasive pneumococcal disease (IPD) dramatically declined among children and adults after 7-valent pneumococcal conjugate vaccine (PCV7) introduction for children in 2000. In February 2010, 13-valent pneumococcal conjugate vaccine (PCV13) replaced PCV7. We evaluated PCV13 impact on IPD rates among children and adults. Methods: IPD cases (isolation of pneumococcus from sterile sites) were identified through 10 Active Bacterial Core surveillance (ABCs) sites during July 2006–June 2013. Isolates were serotyped at reference laboratories. To distinguish the incremental effect of PCV13, we focused on the 5 serotypes (PCV5 types) not affected by PCV7. We used pre-PCV13 observed cases in time-series models to forecast post-PCV13 incidence in the absence of PCV13. PCV13 impact was the difference between forecasted and observed incidence. Results: ABCs identified 3,355 and 21,747 IPD cases among children and adults, respectively; 90% of isolates had serotyping results. Incidence of PCV5-type IPD declined in all age groups after PCV13 introduction with the largest decline among children <5 years (Table). Reductions in PCV5-type IPD were driven by serotypes 19A and 7F. No significant increase was seen in non-PCV13 serotypes, except among 50–64 year olds in 2012–2013 (percent change, 26; 95% interval estimate (IE): 13–44). Table. Changes in incidence of PCV5-type IPD, by age Percent Change Compared to Incidence Expected in Absence of PCV13 (95% IE) Age group (years) 2010–2011 2011–2012 2012–2013 <5 -66 (-70, -61) -88 (-89, -86) -93 (-94, -91) 5–17 -35 (-45, -21) -59 (-66, -48) -75 (-80, -67) 18–49 -33 (-38, -26) -64 (-68, -60) -72 (-75, -69) 50–64 -23 (-28, -18) -54 (-57, -50) -62 (-65, -59) 65+ -23 (-31, -13) -46 (-52, -39) -58 (-64, -52) Conclusion: Dramatic reductions in PCV5-type IPD were evident among children and adults after 3 years of PCV13 use. Continued surveillance is needed to monitor for serotype replacement.
    No preview · Conference Paper · Oct 2014
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    ABSTRACT: Prevention of Antimicrobial-Resistant Infections Among Children Aged <5 Years with the 13-valent Pneumococcal Conjugate Vaccine Selected U.S. Areas, 20052013 S. Tomczyk, J. Jorgensen, R. Lynfield, W. Schaffner, D. Aragon, L. Harrison, M. Nichols, S. Petit, A. Thomas, A. Reingold, MM. Farley, S. Zansky, B. Beall, L. McGee, L. Kim Background: Following introduction of the 7-valent pneumococcal conjugate vaccine (PCV7) in 2000, antimicrobial-resistant (AR) invasive pneumococcal disease (IPD) decreased in the U.S. In 2010, a 13-valent PCV (PCV13) replaced PCV7. We evaluated the impact of PCV13 on AR IPD and progress towards the Healthy People (HP) 2020 goal to reduce AR IPD to 6.0 cases per 100,000 among children <5 years in the U.S. Methods: IPD cases (isolation of pneumococcus from sterile sites) were identified from 10 Active Bacterial Core surveillance (ABCs) sites during 20052013 in children <5 years. Isolates were serotyped, and antimicrobial susceptibility testing was performed at reference laboratories. AR was defined as a bacterial isolate exhibiting intermediate or resistant patterns to ≥1 antimicrobial class (i.e. penicillins, macrolides, cephalosporins, and tetracyclines) according to the Clinical and Laboratory Standards Institute's minimum inhibitory concentration breakpoints. Multidrug resistance (MR) was defined as resistance to ≥3 antimicrobial classes. We calculated overall incidence rates during 20052013 of AR and MR IPD. We also stratified overall AR by PCV5-type (i.e. the 5 serotypes not protected by PCV7) and non-vaccine type IPD (i.e. not included in PCV7 or PCV13). Results: We identified 745 resistant cases pre-PCV13 (20052009) and 378 resistant cases post-PCV13 (20102013). Overall incidence of AR IPD decreased from 9.3 to 3.5 per 100,000 in 2009 and 2013, respectively (percent change, -62) (Figure 1). Similarly, PCV5-type AR and MR IPD decreased by 93% and 86% from 2009 to 2013, respectively. Non-vaccine type AR IPD increased from 2.5 to 3.1 per 100,000 (Figure). Conclusion: Substantial decreases in overall, PCV5-type, and MR IPD occurred after PCV13 introduction in children <5 years. The HP 2020 goal was met in 2011, 9 years earlier than the target year. The use of appropriate antimicrobials remains important in addition to sustained high use of PCV13. Figure.
    No preview · Conference Paper · Oct 2014

  • No preview · Article · Oct 2014 · Open Forum Infectious Diseases
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    ABSTRACT: Since the introduction of the Haemophilus influenzae serotype b vaccine, H influenzae epidemiology has shifted. In the United States, the largest burden of disease is now in adults aged ≥65 years. However, few data exist on risk factors for disease severity and outcome in this age group. A retrospective case-series review of invasive H influenzae infections in patients aged ≥65 years was conducted for hospitalized cases reported to Active Bacterial Core surveillance in 2011. There were 299 hospitalized cases included in the analysis. The majority of cases were caused by nontypeable H influenzae, and the overall case fatality ratio (CFR) was 19.5%. Three or more underlying conditions were present in 63% of cases; 94% of cases had at least 1. Patients with chronic heart conditions (congestive heart failure, coronary artery disease, and/or atrial fibrillation) (odds ratio [OR], 3.27; 95% confidence interval [CI], 1.65-6.46), patients from private residences (OR, 8.75; 95% CI, 2.13-35.95), and patients who were not resuscitate status (OR, 2.72; 95% CI, 1.31-5.66) were more likely to be admitted to the intensive care unit (ICU). Intensive care unit admission (OR, 3.75; 95% CI, 1.71-8.22) and do not resuscitate status (OR, 12.94; 95% CI, 4.84-34.55) were significantly associated with death. Within this age group, burden of disease and CFR both increased significantly as age increased. Using ICU admission as a proxy for disease severity, our findings suggest several conditions increased risk of disease severity and patients with severe disease were more likely to die. Further research is needed to determine the most effective approach to prevent H influenzae disease and mortality in older adults.
    Full-text · Article · Sep 2014 · Open Forum Infectious Diseases
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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.
    Full-text · Article · May 2014 · Journal of Medical Microbiology
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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.
    Full-text · Article · Mar 2014 · The Pediatric Infectious Disease Journal
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    ABSTRACT: Background: Before the introduction of 7-valent pneumococcal conjugate vaccine (PCV7), invasive pneumococcal disease (IPD) rates among blacks were twice the 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 the 13-valent pneumococcal conjugate vaccine (PCV13). Methods: We analyzed data from the Active Bacterial Core surveillance system, which performs active, laboratory- and population-based surveillance for IPD for 29.2 million people in the United States, for the period 1998-2009. For patients with unknown race, we multiplied 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 5419 (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, whereas there were no decreases in overall IPD rates after 2002. By 2009, PCV13 serotypes caused 71% of cases among whites aged <5 years compared with 58% among blacks (P < .01). PCV13 serotypes caused 50% of IPD cases in whites aged ≥5 years compared with 43% among blacks (P < .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. Whereas 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.
    Preview · Article · Feb 2014 · Clinical Infectious Diseases

Publication Stats

19k Citations
3,131.78 Total Impact Points


  • 1988-2015
    • University of California, Berkeley
      • • School of Public Health
      • • Division of Epidemiology
      • • Department of Environmental Health Sciences
      Berkeley, California, United States
  • 2014
    • Battelle Memorial Institute
      Columbus, Ohio, United States
  • 1984-2012
    • Centers for Disease Control and Prevention
      • • Division of HIV/AIDS Prevention, Intervention and Support
      • • Influenza Division
      • • Division of Bacterial Diseases
      • • National Center for Emerging and Zoonotic Infectious Diseases
      Атланта, Michigan, United States
    • U.S. Department of Health and Human Services
      Washington, Washington, D.C., United States
  • 2010
    • San Francisco Department of Public Health
      San Francisco, California, United States
  • 2007
    • McGill University Health Centre
      Montréal, Quebec, Canada
  • 1998-2006
    • University of California, San Francisco
      • • Department of Epidemiology and Biostatistics
      • • Division of Hospital Medicine
      San Francisco, California, United States
  • 2005
    • Emory University
      Atlanta, Georgia, United States
    • Vanderbilt University
      Нашвилл, Michigan, United States
    • Mahatma Gandhi Institute of Medical Sciences
      • Department of Medicine
      Wardha, State of Maharashtra, India
  • 2004
    • University of Pittsburgh
      Pittsburgh, Pennsylvania, United States
  • 2001
    • University of Illinois at Chicago
      • Division of Epidemiology and Biostatistics
      Chicago, Illinois, United States
  • 1999
    • Johns Hopkins University
      Baltimore, Maryland, United States
  • 1996
    • Yale University
      New Haven, Connecticut, United States
    • Oakland University
      Рочестер, Michigan, United States
  • 1985
    • Zoo Atlanta
      Atlanta, Georgia, United States
  • 1983
    • Leiden University
      Leyden, South Holland, Netherlands