March 2019
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58 Reads
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5 Citations
MMWR. Morbidity and mortality weekly report
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March 2019
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58 Reads
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5 Citations
MMWR. Morbidity and mortality weekly report
December 2016
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184 Reads
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4 Citations
Open Forum Infectious Diseases
November 2013
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34 Reads
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73 Citations
Pediatrics
Objective: Timely treatment with neuraminidase inhibitor (NAI) drugs appears to improve survival in adults hospitalized with influenza. We analyzed California surveillance data to determine whether NAI treatment improves survival in critically ill children with influenza. Methods: We analyzed data abstracted from medical records to characterize the outcomes of patients aged 0 to 17 years hospitalized in ICUs with laboratory-confirmed influenza from April 3, 2009, through September 30, 2012. Results: Seven hundred eighty-four influenza cases aged <18 years hospitalized in ICUs had information on treatment. Ninety percent (532 of 591) of cases during the 2009 H1N1 pandemic (April 3, 2009-August 31, 2010) received NAI treatment compared with 63% (121 of 193) of cases in the postpandemic period (September 1, 2010-September 30, 2012; P < .0001). Of 653 cases NAI-treated, 38 (6%) died compared with 11 (8%) of 131 untreated cases (odds ratio = 0.67, 95% confidence interval: 0.34-1.36). In a multivariate model that included receipt of mechanical ventilation and other factors associated with disease severity, the estimated risk of death was reduced in NAI-treated cases (odds ratio 0.36, 95% confidence interval: 0.16-0.83). Treatment within 48 hours of illness onset was significantly associated with survival (P = .04). Cases with NAI treatment initiated earlier in illness were less likely to die. Conclusions: Prompt treatment with NAIs may improve survival of children critically ill with influenza. Recent decreased frequency of NAI treatment of influenza may be placing untreated critically ill children at an increased risk of death.
October 2013
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47 Reads
Background: Vaccine administration errors (VAEs) are preventable events that could lead to reduced vaccine effectiveness or adverse patient health outcomes. The 2000 Institute of Medicine Report, “To Err is Human” sparked the collection of data on medication errors in the United States, but there has been no systematic effort to collect data on VAEs. Identifying important trends in VAEs could result in changes to product labeling, name, or design that prevent errors. Our objective was to develop and implement a surveillance system for VAEs. Methods: The California Department of Public Health (CDPH) partnered with the Institute for Safe Medication Practices (ISMP) to develop and implement a surveillance system called the Vaccine Error Reporting Program (VERP) (http://verp.ismp.org/) to track VAEs. It was launched on October 1, 2012. Key data elements collected include the type of error, description of error, vaccine product information, and provider information. The system also has a photo uploading feature, allowing users to provide visual examples of labeling or other problems. Reporter details are collected, although reporting is confidential. After reviewing reported errors and collecting additional information as needed, ISMP will communicate regularly with the immunization community, including manufacturers and regulators, and suggest prevention strategies. Only de-identified data are transmitted to the US Food and Drug Administration. The Centers for Disease Control and Prevention will also be offered access to de-identified data. Results: Preliminary analysis of the reports submitted to date from California immunization providers reveals a variety of administration errors including: use of wrong vaccine, inappropriate dosing, component omissions, use of expired vaccine, and vaccines being given at the incorrect age, time interval, or administration route. Reports of near misses, unclear vaccine labels and other issues were also received. Conclusion: The VERP project demonstrates that public and private partnerships are an effective way to address knowledge gaps and implement timely solutions. Our preliminary data suggest that as VERP is populated, these data will be useful in identifying systematic causes of VAEs and providing the basis for recommendations on how to reduce errors.
January 2013
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17 Reads
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1 Citation
Clinical Infectious Diseases
July 2012
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78 Reads
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274 Citations
Clinical Infectious Diseases
Background: Neuraminidase inhibitor (NAI) antiviral drugs can shorten the duration of uncomplicated influenza when administered early (<48 hours after illness onset) to otherwise healthy outpatients, but the optimal timing of effective therapy for critically ill patients is not well established. Methods: We analyzed California surveillance data to characterize the outcomes of patients in intensive care units (ICUs) treated with NAIs for influenza A(H1N1)pdm09 (pH1N1). Demographic and clinical data were abstracted from medical records, using standardized case report forms. Results: From 3 April 2009 through 10 August 2010, 1950 pH1N1 cases hospitalized in ICUs were reported. Of 1859 (95%) with information available, 1676 (90%) received NAI treatment, and 183 (10%) did not. The median age was 37 years (range, 1 week-93 years), 1473 (79%) had ≥1 comorbidity, and 492 (26%) died. The median time from symptom onset to starting NAI treatment was 4 days (range, 0-52 days). NAI treatment was associated with survival: 107 of 183 untreated case patients (58%) survived, compared with 1260 of 1676 treated case patients (75%; P ≤ .0001). There was a trend toward improved survival for those treated earliest (P < .0001). Treatment initiated within 5 days after symptom onset was associated with improved survival compared to those never treated (P < .05). Conclusions: NAI treatment of critically ill pH1N1 patients improves survival. While earlier treatment conveyed the most benefit, patients who started treatment up to 5 days after symptom onset also were more likely to survive. Further research is needed about whether starting NAI treatment >5 days after symptom onset may also convey benefit.
July 2012
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47 Reads
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260 Citations
The Journal of Pediatrics
Objective: In 2010, California experienced the highest number of pertussis cases in >60 years, with >9000 cases, 809 hospitalizations, and 10 deaths. This report provides a descriptive epidemiologic analysis of this epidemic and describes public health mitigation strategies that were used, including expanded pertussis vaccine recommendations. Study design: Clinical and demographic information were evaluated for all pertussis cases with onset from January 1, 2010, through December 31, 2010, and reported to the California Department of Public Health. Results: Hispanic infants younger than 6 months had the highest disease rates; all deaths and most hospitalizations occurred in infants younger than 3 months. Most pediatric cases were vaccinated according to national recommendations, although 9% of those aged 6 months to 18 years were completely unvaccinated against pertussis. High disease rates also were observed in fully vaccinated preadolescents, especially 10-year-olds. Mitigation strategies included expanded tetanus, diphtheria, and acellular pertussis vaccine recommendations, public and provider education, distribution of free vaccine for postpartum women and contacts of infants, and clinical guidance on diagnosis and treatment of pertussis in young infants. Conclusions: Infants too young to be fully vaccinated against pertussis remain at highest risk of severe disease and death. Data are needed to evaluate strategies offering direct protection of this vulnerable population, such as immunization of pregnant women and of newborns. The high rate of disease among preadolescents suggests waning of immunity from the diphtheria, tetanus, and acellular pertussis series; additional studies are warranted to evaluate the efficacy and duration of protection of the diphtheria, tetanus, and acellular pertussis series and the tetanus, diphtheria, and acellular pertussis series.
June 2012
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69 Reads
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34 Citations
Oral antiviral agents to treat influenza are challenging to administer in the intensive care unit (ICU). We describe 57 critically ill patients treated with the investigational intravenous neuraminidase inhibitor drug peramivir for influenza A (H1N1)pdm09 [pH1N1]. Most received late peramivir treatment following clinical deterioration in the ICU on enterically-administered oseltamivir therapy. The median age was 40 years (range 5 months-81 years). Common clinical complications included pneumonia or acute respiratory distress syndrome requiring mechanical ventilation (54; 95%), sepsis requiring vasopressor support (34/53; 64%), acute renal failure requiring hemodialysis (19/53; 36%) and secondary bacterial infection (14; 25%). Over half (29; 51%) died. When comparing the 57 peramivir-treated cases with 1627 critically ill cases who did not receive peramivir, peramivir recipients were more likely to be diagnosed with pneumonia/acute respiratory distress syndrome (p = 0.0002) or sepsis (p = <0.0001), require mechanical ventilation (p = <0.0001) or die (p = <0.0001). The high mortality could be due to the pre-existing clinical severity of cases prior to request for peramivir, but also raises questions about peramivir safety and effectiveness in hospitalized and critically ill patients. The use of peramivir merits further study in randomized controlled trials, or by use of methods such as propensity scoring and matching, to assess clinical effectiveness and safety.
March 2012
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24 Reads
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11 Citations
The Pediatric Infectious Disease Journal
The 2009 H1N1 influenza virus emerged in April 2009 and primarily affected children and young adults. Few reports describe 2009 H1N1 influenza infection in infants. This report describes the clinical and epidemiologic features of 2009 H1N1 influenza in critically ill infants younger than 1 year of age. Laboratory-confirmed cases were reported to the California Department of Public Health as part of public health surveillance for 2009 H1N1 influenza. Data were collected using standardized report forms and medical-chart abstractions. From April 23, 2009 through May 1, 2010, 82 cases of infants hospitalized in the intensive care unit with 2009 H1N1 influenza were reported in California. Medical charts were available for 77 of the infants, whose median age was 109 days (range: 1-361 days). Twenty-seven (35%) infants had a gestational age of 36 weeks or less. More than half (46; 60%) of the infants had at least 1 reported chronic medical condition. Thirty-five (45%) infants required mechanical ventilation; 7 (9%) died. Five infants were hospitalized since birth and acquired influenza infection during their admission; 2 (40%) of these infants died. Infants who are premature or with chronic conditions seem to be at increased risk for developing severe 2009 H1N1 influenza infection. We encourage clinicians to maintain high suspicion for influenza in infants when influenza viruses are circulating. Vaccination should be encouraged among contacts of infants <6 months of age, who are too young to be immunized or treated with licensed antivirals. Infection control measures should also be implemented in hospital settings to reduce nosocomial transmission.
April 2011
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12 Reads
Co-morbid illnesses by age group in fatal cases of 2009 pandemic (H1N1) influenza A reported in California, April 2009-August 2010. (DOC)
... New data documenting the link between vaccine exemptions and measles transmission and the risks of these exemptions for the unvaccinated child or young adult, and those they expose, have focused attention on the need for stricter laws. The California outbreak demonstrated that measles in six children whose parents declined vaccination caused hundreds of secondary cases (25). While California law has not permitted personal belief exemptions since 2016, this outbreak revealed that a physician practicing far from the community had given medical exemptions for two of the cases. ...
March 2019
MMWR. Morbidity and mortality weekly report
... Die höchste Inzidenz gab es bei Kindern unter 5 Jahren, was auf nichtoptimale Regelimpfungen der vergangenen Jahre deutet. Insgesamt traten 8 % (n = 6441) der Fälle bei Kleinkindern im Alter von weniger als einem Jahr auf, für die Masern besonders gefährlich sind, weil die Infektion zu schweren Komplikationen führen kann, hierunter zur seltenen, aber immer tödlich verlaufenden subakuten sklerosierenden Panenzephalitis (SSPE; [12] [13]. ...
December 2016
Open Forum Infectious Diseases
... Pertussis (PT) booster immunization during the late second or third trimester of pregnancy is an important public health strategy to reduce the morbidity and mortality from whooping cough in neonates. Since 2010, the pertussis vaccine has been recommended for all pregnant people between 27-and 36-weeks of gestation in order to provide protective antibodies to the fetus for protection against pertussis, in the critical early months of the infant's life when they are most at risk for serious disease (61,62). In the U.S., this is typically administered through the combined Tdap vaccine, which also provides protection against tetanus, diphtheria, in addition to pertussis (63). ...
September 2010
JAMA The Journal of the American Medical Association
... [161][162][163][164][165][166]169 In a retrospective study of 784 PICU admissions from 2009 to 2012, the estimated risk of death was reduced in 653 NAI-treated individuals (OR: 0.36; 95% CI: 0.16-0.83). 170 In a retrospective analysis of data from the US Influenza Hospitalization Surveillance Network, administration of antiviral agents #2 days after illness onset was associated with shorter lengths of stay in children admitted to the ICU (adjusted hazard ratio: 1.46; P 5 .007) and in children with underlying medical conditions not admitted to the ICU (adjusted hazard ratio: 1.37; P 5 .02). ...
November 2013
Pediatrics
... According to expert guidelines, antiviral therapy should be initiated within 48 h for patients experiencing more severe illness or those at higher risk of complications (15). The current standard of care involves promptly initiating neuraminidase inhibitors (e.g., oseltamivir) for influenza treatment, which effectively alleviates symptoms, reduces complications, minimizes healthcare resource utilization, and lowers mortality rates in hospitalized patients (16)(17)(18)(19)(20)(21). ...
July 2012
Clinical Infectious Diseases
... Though suspected cases were reported throughout year, which shows sensitive surveillance system, but peak of suspected cases & lab confirmed pertussis cases were found In Dec 2022 to Aug 2023, which is contrary to other research where outbreaks were found in July to Sep months (12,13). We found that children <1 years of age were most affected followed by children of 10 to 15 years age group which is like data of European Centre for Disease Prevention and Control agency (14) & other study (15). Though most cases were found among Hindu community, this is likely to be due to Hindu's being the predominant population group in the affected areas. ...
July 2012
The Journal of Pediatrics
... study reported the use of laninamivir in 112 pregnant women at different doses (40 mg and 20 mg doses) and showed no increased risk of adverse pregnancy or fetal outcomes compared to the general population[71]. During the 2009 H1N1 pandemic, the U.S. Food and Drug Administration issued an Emergency Use Authorization (EUA) for intravenous(IV) peramivir and allowed use of IV zanamivir through an Emergency Investigational New Drug (eIND) application for single patient use in hospitalized patients with influenza A(H1N1)pdm09 for whom enterically administered oseltamivir would not be tolerated or when there was no clinical improvement with oseltamivir treatment[72][73][74][75][76].A small number of pregnant women received IV peramivir or IV zanamivir. Due to small sample sizes and lack of an untreated comparison group, no conclusions were possible on the clinical benefit or safety of these intravenous NAIs for pregnant women or non-pregnant persons. ...
June 2012
... The risk of severe disease progression and the long-term impairment of the lungs is particularly high in infants with chronic underlying conditions [1,5]. Prematurity is a known risk-factor for influenza-related hospital admission [6,7]. Persistent viral presence in the lungs can contribute to the development of chronic lung disease (CLD) [8][9][10]. ...
March 2012
The Pediatric Infectious Disease Journal
... [7][8][9][10][11][12][13][14][15] However, the peak of excess mortality occurred in the young adult group rather than the elderly during the 1918 Spanish flu pandemic and the 2009 H1N1 pandemic. 16,17 This can be potentially explained by the immunological memory protection resulting from previous exposure to similar strains among the elderly, as well as the effects of immune imprinting and excessive immune responses among young adults. 18 These theories suggest that immune memory complicates our understanding of the incidence and prognosis of infections when aging. ...
April 2011
... Obesity is an independent risk factor for complications arising from severe influenza infection [130]. Thus, Moorthy et al. studied whether obesity is associated with higher pulmonary NET formation that aggravates the outcome of influenza pneumonia [131]. ...
February 2011
Clinical Infectious Diseases