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Effectiveness of Pneumococcal Vaccine in Men
AEP Vol. 20, No. 9 September 2010: 691–724
investigated the association between ethnicity and HPV vaccine iniation using data from a national survey. METHODS: Data from the 2008 National Health Interview Survey were used to establish a cross-sectional study population of females aged 9–17 years (nZ2,116). HPV vaccine initiation was defined as self-reported receipt of at least one dose of the HPV vaccine. Our directed acyclic graph indicated that the crude estimate was sufficient for estimating the association between self-reported ethnicity and HPV vaccine initiation. We used logistic regression to estimate prevalence odds ratios (ORs) and 95% confidence intervals (CIs) for HPV vaccine initiation for each ethnicity (non-Hispanic Blacks, Hispanics, and Asians) compared to non-Hispanic Whites while accounting for the complex survey design. RESULTS: The prevalence of HPV vaccine initiation for females aged 9–17 years was 18.2%. The odds of HPV vaccine initiation was lower among all ethnic groups, particularly Asians, compared to non-Hispanic Whites (Asians: ORZ0.40, 95% CI: 0.20, 0.80; non-Hispanic black: ORZ0.79, 95% CI: 0.56, 1.13; Hispanic: ORZ0.82, 95% CI: 0.57, 1.18). CONCLUSION: Our results indicate that considerable ethnic disparities exist in HPV vaccine initiation among females aged 9–17 years in the United States. These disparities may be mediated by several factors that warrant further investigation. P57 USING MODELING TOOLS TO IDENTIFY COST EFFECTIVE INTERVENTIONS FOR WHOOPING COUGH: ACELLULAR PERTUSSIS VACCINE PROGRAMS FOR PEDIATRIC HEALTHCARE WORKERS IN CANADA AL Greer, DN Fisman, Public Health Agency of Canada and Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
PURPOSE: We sought to evaluate the health-economic attractiveness of a diphtheria – tetanus-acellular pertussis booster vaccination program for pediatric intensive care healthcare workers. METHODS: Using outputs from an agent-based model of nosocomial pertussis transmission in the neonatal intensive care (NICU) environment, we developed a Markov model to calculate the cost effectiveness of vaccinating different proportions of NICU healthcare workers ranging from the current strategy of no pertussis booster vaccination program to a vaccine program that achieved 25%, 50%, 75% or 95% coverage. RESULTS: Our results demonstrate that implementing a vaccination program that achieves between 25% and 50% coverage is cost-saving compared to no vaccine program. At all coverage levels the intervention reduced costs and increased life expectancy in most trials. The results
ABSTRACTS (ACE)
711
were most sensitive to the risk of a pertussis introduction via an infected healthcare worker. Once the risk of an introduction exceeded w0.3%, implementing an immunization program provided greater net monetary benefit than having no vaccine program. CONCLUSION: The implementation of a hospital-based and funded DTaP vaccine program administered through occupational health is cost effective in the context of pediatric healthcare facilities where many of the patients are at risk of serious morbidity and mortality should they acquire pertussis while hospitalized. Acellular pertussis vaccine is safe and effective in adults and an explicit recommendation for boosting healthcare workers is based on the importance of healthcare workers as pertussis vectors. P58 EFFECTIVENESS OF PNEUMOCOCCAL VACCINE IN MEN HF Tseng, JM Slezak, VP Quinn, S Van Den Eeden, SJ Jacobsen, Department of Research and Evaluation, Kaiser Permanente of Southern California, Pasadena, CA
PURPOSE: Streptococcus pneumoniae is the chief cause of pneumonia in older adults, but it remains unclear whether use of the pneumococcal polysaccharide vaccine alters the overall risk of hospitalization for pneumonia. In a large population of older adults, we assessed the effectiveness of the pneumococcal vaccine in preventing hospitalization for presumptive pneumonia and bacteremia. METHODS: In this cohort study, 39222 southern California participants in the California Men’s Health Study who were aged 45–69 recruited between January 2002 and December 2003 were followed for an average of 6.3 years. Demographic and detailed lifestyle characteristics were collected from surveys. Vaccination records were obtained from the Kaiser Immunization Tracking System. Hospitalizations for pneumonia and hospitalizations for pneumococcal bacteremia were identified on the basis of International Classification of Diseases, 9th Revision codes. RESULTS: During the follow-up, there were 484 hospitalization with primary diagnosis code as presumptive pneumonia in 134,266 vaccinated person-years (3.60 per 1,000) as compared to 174 hospitalization events in 108,807 unvaccinated person-years (1.60 per 1,000). For bacteremia there were 81 events in 135627 vaccinated person-years (0.60 per 1,000) as compared to 21 events in 108,830 unvaccinated person-years (0.19 per 1,000). In an attempt to control for confounding by indication, we found no evidence for an association between pneumococcal vaccination and reduced risk of hospitalization for presumptive pneumonia (adjusted hazards ratio (HR) Z 1.11, 95% confidence interval (CI): 0.93–1.32) or bacteremia (adjusted HRZ 1.08, 95% CI: 0.70–1.67). An inverse association was also not found in men of different age and risk groups.
712
ABSTRACTS (ACE)
CONCLUSIONS: Among a cohort of men age 45 years or older, receipt of pneumococcal vaccine was not associated with subsequent reduced risk of hospitalization for presumptive pneumonia. Due to small number of bacteremia events, the association between pneumococcal vaccination and bacteremia needs further clarification.
P59 MORTALITY TRENDS AMONG HIV OUTPATIENTS AT THE UNIVERSITY OF LOUISVILLE: COMPARISON WITH THE HIV OUTPATIENT STUDY (HOPS) AND THE COMPREHENSIVE CARE CENTER (CCC) D Appiah, FD Groves, AK Huang, Department of Epidemiology, University of Louisville, Louisville, KY
PURPOSE: To evaluate the quality of HIV therapy at the HIV outpatient (WINGS) Clinic, which provides service for HIV infected patients in the metropolitan Louisville area and southeastern Indiana. We further compared our survival data with the current available published data from the HIV Outpatient Study (HOPS) and Nashville’s Comprehensive Care Center (CCC) and also to ascertain any disparities in survival according to race and gender within our patient population. METHODS: A retrospective cohort study was conducted to analyze the survival of HIV positive patients who are 18 years and older and received treatment between January 1, 2004 and June 30, 2008, and followed until December 31, 2008 in the WINGS clinic. Data was obtained from outpatient electronic medical records. Cox proportional hazards regression was used to estimate the hazard ratios for mortality by race and gender. RESULTS: There were 1450 patients who meet the criteria for inclusion in this study. Among the entire cohort, 73% were males and 51 % were white (not Hispanic) producing 5960 person years of observation with 154 deaths. There was no difference in mortality trends between race and gender. The Cox proportional hazard regression found age at HIV diagnosis as predictor of mortality (aHR Z 1.03 CI: 1.01– 1.04, PZ0.003). CONCLUSION: Mortality rate for the study period was comparable with the HOPS cohort and lower than that seen in the CCC’s population.
P60 PERIODICITY OF EPIDEMICS OF INVASIVE DISEASE DUE TO INFECTION WITH STREPTOCOCCUS PNEUMONIAE IN THE UNITED STATES CA Eckrode, MC Rangel, SL Morrell, H Danawi, College of Health Sciences, Walden University, Minneapolis, MN
PURPOSE: This study set out to determine whether invasive infection by S. pneumoniae in the United States occurs
AEP Vol. 20, No. 9 September 2010: 691–724
in an epidemic pattern of a predictable recurrent nature and definable frequency, in addition to the predicted seasonal increase in incidence in the United States during the period from 1979–2006, in the aggregate, and when stratified by age, gender, or geographic region. METHODS: A retrospective cohort design study was conducted using a population-based cohort of hospitalized patients in the United States with a discharge diagnosis of Invasive Pneumococcal Disease (IPD), taken from the National Hospital Discharge Summary (NHDS) database for the period of 1979–2006. The question of epidemic recurrence at definable frequency was addressed by frequency domain time-series analysis. RESULTS: Results from the time series analysis revealed findings that failed to support the existence of periodic epidemics of IPD in addition to the expected annual increases in incidence. These results hold for the analysis in the aggregate, and for data stratified by gender, age (in ranges), and by geographic region. CONCLUSION: Use of frequency domain time series analysis should have revealed any hidden patterns or periodic components in an epidemic pattern. Instead, the results of this study showed an absence of IPD periodic epidemics of a definable frequency outside of the predicted seasonal increase in incidence in the United States for the period from 1979–2006. P61 THE EPIDEMIOLOGY OF HERPES SIMPLEX VIRUS TYPE-2 INFECTION AMONG PREGNANT WOMEN IN RURAL MYSORE TALUK, INDIA P Madhivanan1,2, A Bochner2, K Krupp1, A Arun1, AL Reingold2, 1Public Health Research Institute of India, Mysore, India, 2San Francisco Department of Public Health, San Francisco, CA
PURPOSE: To assess the prevalence of and risk factors for herpes simplex virus type 2 (HSV-2) infections among pregnant women attending mobile antenatal health camps in rural villages in Mysore Taluk, in the south Indian state of Karnataka. METHODS: Between February and September 2009, 487 pregnant women attended mobile medical health camps for antenatal care and HIV testing. Each participant was interviewed to collect epidemiological information after undergoing an informed consent process. ELISA test kits (Herpes Select IgG, Focus Technologies, Cypress, CA) were used according to manufacturer’s instructions for detection of HSV-2 antibodies. RESULTS: HSV-2 prevalence was 6.7% (95% confidence interval [CI] 4.6–9.3), while only one woman tested positive for HIV (CI 0-1.1). The average age of women was 21 years and participants had been married for an average of 34 months. Women whose spouses traveled away from home
investigated the association between ethnicity and HPV vaccine iniation using data from a national survey. METHODS: Data from the 2008 National Health Interview Survey were used to establish a cross-sectional study population of females aged 9–17 years (nZ2,116). HPV vaccine initiation was defined as self-reported receipt of at least one dose of the HPV vaccine. Our directed acyclic graph indicated that the crude estimate was sufficient for estimating the association between self-reported ethnicity and HPV vaccine initiation. We used logistic regression to estimate prevalence odds ratios (ORs) and 95% confidence intervals (CIs) for HPV vaccine initiation for each ethnicity (non-Hispanic Blacks, Hispanics, and Asians) compared to non-Hispanic Whites while accounting for the complex survey design. RESULTS: The prevalence of HPV vaccine initiation for females aged 9–17 years was 18.2%. The odds of HPV vaccine initiation was lower among all ethnic groups, particularly Asians, compared to non-Hispanic Whites (Asians: ORZ0.40, 95% CI: 0.20, 0.80; non-Hispanic black: ORZ0.79, 95% CI: 0.56, 1.13; Hispanic: ORZ0.82, 95% CI: 0.57, 1.18). CONCLUSION: Our results indicate that considerable ethnic disparities exist in HPV vaccine initiation among females aged 9–17 years in the United States. These disparities may be mediated by several factors that warrant further investigation. P57 USING MODELING TOOLS TO IDENTIFY COST EFFECTIVE INTERVENTIONS FOR WHOOPING COUGH: ACELLULAR PERTUSSIS VACCINE PROGRAMS FOR PEDIATRIC HEALTHCARE WORKERS IN CANADA AL Greer, DN Fisman, Public Health Agency of Canada and Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
PURPOSE: We sought to evaluate the health-economic attractiveness of a diphtheria – tetanus-acellular pertussis booster vaccination program for pediatric intensive care healthcare workers. METHODS: Using outputs from an agent-based model of nosocomial pertussis transmission in the neonatal intensive care (NICU) environment, we developed a Markov model to calculate the cost effectiveness of vaccinating different proportions of NICU healthcare workers ranging from the current strategy of no pertussis booster vaccination program to a vaccine program that achieved 25%, 50%, 75% or 95% coverage. RESULTS: Our results demonstrate that implementing a vaccination program that achieves between 25% and 50% coverage is cost-saving compared to no vaccine program. At all coverage levels the intervention reduced costs and increased life expectancy in most trials. The results
ABSTRACTS (ACE)
711
were most sensitive to the risk of a pertussis introduction via an infected healthcare worker. Once the risk of an introduction exceeded w0.3%, implementing an immunization program provided greater net monetary benefit than having no vaccine program. CONCLUSION: The implementation of a hospital-based and funded DTaP vaccine program administered through occupational health is cost effective in the context of pediatric healthcare facilities where many of the patients are at risk of serious morbidity and mortality should they acquire pertussis while hospitalized. Acellular pertussis vaccine is safe and effective in adults and an explicit recommendation for boosting healthcare workers is based on the importance of healthcare workers as pertussis vectors. P58 EFFECTIVENESS OF PNEUMOCOCCAL VACCINE IN MEN HF Tseng, JM Slezak, VP Quinn, S Van Den Eeden, SJ Jacobsen, Department of Research and Evaluation, Kaiser Permanente of Southern California, Pasadena, CA
PURPOSE: Streptococcus pneumoniae is the chief cause of pneumonia in older adults, but it remains unclear whether use of the pneumococcal polysaccharide vaccine alters the overall risk of hospitalization for pneumonia. In a large population of older adults, we assessed the effectiveness of the pneumococcal vaccine in preventing hospitalization for presumptive pneumonia and bacteremia. METHODS: In this cohort study, 39222 southern California participants in the California Men’s Health Study who were aged 45–69 recruited between January 2002 and December 2003 were followed for an average of 6.3 years. Demographic and detailed lifestyle characteristics were collected from surveys. Vaccination records were obtained from the Kaiser Immunization Tracking System. Hospitalizations for pneumonia and hospitalizations for pneumococcal bacteremia were identified on the basis of International Classification of Diseases, 9th Revision codes. RESULTS: During the follow-up, there were 484 hospitalization with primary diagnosis code as presumptive pneumonia in 134,266 vaccinated person-years (3.60 per 1,000) as compared to 174 hospitalization events in 108,807 unvaccinated person-years (1.60 per 1,000). For bacteremia there were 81 events in 135627 vaccinated person-years (0.60 per 1,000) as compared to 21 events in 108,830 unvaccinated person-years (0.19 per 1,000). In an attempt to control for confounding by indication, we found no evidence for an association between pneumococcal vaccination and reduced risk of hospitalization for presumptive pneumonia (adjusted hazards ratio (HR) Z 1.11, 95% confidence interval (CI): 0.93–1.32) or bacteremia (adjusted HRZ 1.08, 95% CI: 0.70–1.67). An inverse association was also not found in men of different age and risk groups.
712
ABSTRACTS (ACE)
CONCLUSIONS: Among a cohort of men age 45 years or older, receipt of pneumococcal vaccine was not associated with subsequent reduced risk of hospitalization for presumptive pneumonia. Due to small number of bacteremia events, the association between pneumococcal vaccination and bacteremia needs further clarification.
P59 MORTALITY TRENDS AMONG HIV OUTPATIENTS AT THE UNIVERSITY OF LOUISVILLE: COMPARISON WITH THE HIV OUTPATIENT STUDY (HOPS) AND THE COMPREHENSIVE CARE CENTER (CCC) D Appiah, FD Groves, AK Huang, Department of Epidemiology, University of Louisville, Louisville, KY
PURPOSE: To evaluate the quality of HIV therapy at the HIV outpatient (WINGS) Clinic, which provides service for HIV infected patients in the metropolitan Louisville area and southeastern Indiana. We further compared our survival data with the current available published data from the HIV Outpatient Study (HOPS) and Nashville’s Comprehensive Care Center (CCC) and also to ascertain any disparities in survival according to race and gender within our patient population. METHODS: A retrospective cohort study was conducted to analyze the survival of HIV positive patients who are 18 years and older and received treatment between January 1, 2004 and June 30, 2008, and followed until December 31, 2008 in the WINGS clinic. Data was obtained from outpatient electronic medical records. Cox proportional hazards regression was used to estimate the hazard ratios for mortality by race and gender. RESULTS: There were 1450 patients who meet the criteria for inclusion in this study. Among the entire cohort, 73% were males and 51 % were white (not Hispanic) producing 5960 person years of observation with 154 deaths. There was no difference in mortality trends between race and gender. The Cox proportional hazard regression found age at HIV diagnosis as predictor of mortality (aHR Z 1.03 CI: 1.01– 1.04, PZ0.003). CONCLUSION: Mortality rate for the study period was comparable with the HOPS cohort and lower than that seen in the CCC’s population.
P60 PERIODICITY OF EPIDEMICS OF INVASIVE DISEASE DUE TO INFECTION WITH STREPTOCOCCUS PNEUMONIAE IN THE UNITED STATES CA Eckrode, MC Rangel, SL Morrell, H Danawi, College of Health Sciences, Walden University, Minneapolis, MN
PURPOSE: This study set out to determine whether invasive infection by S. pneumoniae in the United States occurs
AEP Vol. 20, No. 9 September 2010: 691–724
in an epidemic pattern of a predictable recurrent nature and definable frequency, in addition to the predicted seasonal increase in incidence in the United States during the period from 1979–2006, in the aggregate, and when stratified by age, gender, or geographic region. METHODS: A retrospective cohort design study was conducted using a population-based cohort of hospitalized patients in the United States with a discharge diagnosis of Invasive Pneumococcal Disease (IPD), taken from the National Hospital Discharge Summary (NHDS) database for the period of 1979–2006. The question of epidemic recurrence at definable frequency was addressed by frequency domain time-series analysis. RESULTS: Results from the time series analysis revealed findings that failed to support the existence of periodic epidemics of IPD in addition to the expected annual increases in incidence. These results hold for the analysis in the aggregate, and for data stratified by gender, age (in ranges), and by geographic region. CONCLUSION: Use of frequency domain time series analysis should have revealed any hidden patterns or periodic components in an epidemic pattern. Instead, the results of this study showed an absence of IPD periodic epidemics of a definable frequency outside of the predicted seasonal increase in incidence in the United States for the period from 1979–2006. P61 THE EPIDEMIOLOGY OF HERPES SIMPLEX VIRUS TYPE-2 INFECTION AMONG PREGNANT WOMEN IN RURAL MYSORE TALUK, INDIA P Madhivanan1,2, A Bochner2, K Krupp1, A Arun1, AL Reingold2, 1Public Health Research Institute of India, Mysore, India, 2San Francisco Department of Public Health, San Francisco, CA
PURPOSE: To assess the prevalence of and risk factors for herpes simplex virus type 2 (HSV-2) infections among pregnant women attending mobile antenatal health camps in rural villages in Mysore Taluk, in the south Indian state of Karnataka. METHODS: Between February and September 2009, 487 pregnant women attended mobile medical health camps for antenatal care and HIV testing. Each participant was interviewed to collect epidemiological information after undergoing an informed consent process. ELISA test kits (Herpes Select IgG, Focus Technologies, Cypress, CA) were used according to manufacturer’s instructions for detection of HSV-2 antibodies. RESULTS: HSV-2 prevalence was 6.7% (95% confidence interval [CI] 4.6–9.3), while only one woman tested positive for HIV (CI 0-1.1). The average age of women was 21 years and participants had been married for an average of 34 months. Women whose spouses traveled away from home