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Fiore A.E.,Centers for Disease Control and Prevention | Epperson S.,Centers for Disease Control and Prevention | Perrotta D.,Council of State and Territorial Epidemiologists | Perrotta D.,Texas A&M University | Neuzil K.,University of Washington
Pediatrics | Year: 2012

BACKGROUND: Despite long-standing recommendations to vaccinate children who have underlying chronic medical conditions or who are contacts of high-risk persons, vaccination coverage among school-age children remains low. Community studies have indicated that school-age children have the highest incidence of influenza and are an important source of amplifying and sustaining community transmission that affects all age groups. METHODS: A consultation to discuss the advantages and disadvantages of a universal recommendation for annual influenza vaccination of all children age ≥6 months was held in Atlanta, Georgia, in September 2007. Consultants provided summaries of current data on vaccine effectiveness, safety, supply, successful program implementation, and economics studies and discussed challenges associated with continuing a risk- and contact-based vaccination strategy compared with a universal vaccination recommendation. RESULTS: Consultants noted that school-age children had a substantial illness burden caused by influenza, that vaccine was safe and effective for children aged 6 months through 18 years, and that evidence suggested that vaccinating school-age children would provide benefits to both the vaccinated children and their unvaccinated household and community contacts. However, implementation of an annual recommendation for all school-age children would pose major challenges to parents, medical providers and health care systems. Alternative vaccination venues were needed, and of these school-located vaccination programs might offer the most promise as an alternative vaccination site for school-age children. CONCLUSIONS: Expansion of recommendations to include all school-age children will require additional development of an infrastructure to support implementation and methods to adequately evaluate impact. Copyright © 2012 by the American Academy of Pediatrics. Source

Stricof R.,Council of State and Territorial Epidemiologists | Stricof R.,New York State Department of Health
Clinical Governance | Year: 2012

Purpose: This paper aims to describe experience to date with mandatory public reporting of healthcare-associated infection rates from a perspective inside one of the first and most advanced of the state programs, to help frame the research agenda of an interdisciplinary university faculty collaborative. Design/ methodology/ approach: The paper is a narrative review of personal experience. Findings: Key factors enabling program achievements include starting with a sufficient pilot phase, including strong provisions for audit and validation, a balance of viewpoints among advisors to the program, adoption of internationally respected data systems, and ability to sponsor improvement projects in reporting hospitals. Identified pitfalls and needs for more progress also must be addressed. Practical implications: Public health departments are in uncharted territory with this new area of activity, faced with fundamental knowledge gaps that potentially hamper chances of success. Perspectives explored in this part of the Universities Council Symposium help frame a research agenda and guide evolution of less advanced programs. Originality/value: This review helps frame the research agenda of an interdisciplinary university faculty collaborative and guides evolution of less advanced programs. © 2012 Emerald Group Publishing Limited. Source

Haley V.B.,New York State Department of Health | DiRienzo A.G.,Albany State University | Lutterloh E.C.,New York State Department of Health | Lutterloh E.C.,Albany State University | Stricof R.L.,Council of State and Territorial Epidemiologists
Infection Control and Hospital Epidemiology | Year: 2014

objective. To assess the effect of multiple sources of bias on state- and hospital-specific National Healthcare Safety Network (NHSN) laboratory-identified Clostridium difficile infection (CDI) rates. design. Sensitivity analysis. setting. A total of 124 New York hospitals in 2010. methods. New York NHSN CDI events from audited hospitals were matched to New York hospital discharge billing records to obtain additional information on patient age, length of stay, and previous hospital discharges. "Corrected" hospital-onset (HO) CDI rates were calculated after (1) correcting inaccurate case reporting found during audits, (2) incorporating knowledge of laboratory results from outside hospitals, (3) excluding days when patients were not at risk from the denominator of the rates, and (4) adjusting for patient age. Data sets were simulated with each of these sources of bias reintroduced individually and combined. The simulated rates were compared with the corrected rates. Performance (ie, better, worse, or average compared with the state average) was categorized, and misclassification compared with the corrected data set was measured. results. Counting days patients were not at risk in the denominator reduced the stateHOrate by 45% and resulted in 8%misclassification. Age adjustment and reporting errors also shifted rates (7% and 6% misclassification, respectively). conclusions. Changing the NHSN protocol to require reporting of age-stratified patient-days and adjusting for patient-days at risk would improve comparability of rates across hospitals. Further research is needed to validate the risk-adjustment model before these data should be used as hospital performance measures. © 2013 by The Society for Healthcare Epidemiology of America. All rights reserved. Source

Sugerman D.E.,Epidemic Intelligence Service | Barskey A.E.,Centers for Disease Control and Prevention | Delea M.G.,Council of State and Territorial Epidemiologists | Ortega-Sanchez I.R.,Centers for Disease Control and Prevention | And 5 more authors.
Pediatrics | Year: 2010

OBJECTIVE: In January 2008, an intentionally unvaccinated 7-year-old boy who was unknowingly infected with measles returned from Switzerland, resulting in the largest outbreak in San Diego, California, since 1991. We investigated the outbreak with the objective of understanding the effect of intentional undervaccination on measles transmission and its potential threat to measles elimination. METHODS: We mapped vaccination-refusal rates according to school and school district, analyzed measles-transmission patterns, used discussion groups and network surveys to examine beliefs of parents who decline vaccination, and evaluated containment costs. RESULTS: The importation resulted in 839 exposed persons, 11 additional cases (all in unvaccinated children), andthe hospitalization of an infant too young to be vaccinated. Two-dose vaccination coverage of 95%, absence of vaccine failure, and a vigorous outbreak response halted spread beyond the third generation, at a net public-sector cost of $10 376 per case. Although 75% of the cases were of persons who were intentionally unvaccinated, 48 children too young to be vaccinated were quarantined, at an average family cost of $775 per child. Substantial rates of intentional undervaccination occurred in public charter and private schools, as well as public schools in upper-soeioeconomic areas. Vaccine refusal clustered geographically and the overall rate seemed to be rising. In discussion groups and survey responses, the majority of parents who declined vaccination for their children were concerned with vaccine adverse events. CONCLUSIONS: Despite high community vaccination coverage, measles outbreaks can occur among clusters of intentionally undervaccinated children, at major cost to public health agencies, medical systems, and families. Rising rates of intentional undervaccination can undermine measles elimination. Source

Jones T.F.,Communicable and Environmental Disease Services | Rosenberg L.,Council of State and Territorial Epidemiologists | Kubota K.,Association of Public Health Laboratories | Ingram L.A.,Communicable and Environmental Disease Services
Foodborne Pathogens and Disease | Year: 2013

Over 1,100 foodborne disease outbreaks cause over 23,000 illnesses in the United States annually, but the rates of outbreaks reported and successful investigation vary dramatically among states. We used data from the Centers for Disease Control and Prevention's outbreak reporting database, Association of Public Health Laboratories' PulseNet laboratory subtyping network survey and Salmonella laboratory survey, national public health surveillance data, and national surveys to examine potential causes of this variability. The mean rate of reporting of Salmonella outbreaks was higher in states requiring submission of all isolates to the state public health laboratory, compared to those that do not (5.9 vs. 4.1 per 10 million population, p=0.0062). Rates of overall outbreak reporting or successful identification of an etiology or food vehicle did not correlate at the state level with population, rates of sporadic disease reporting, health department organizational structure, or self-reported laboratory or epidemiologic capacity. Foodborne disease outbreak surveillance systems are complex, and improving them will require a multi-faceted approach to identifying and overcoming barriers. © Mary Ann Liebert, Inc. Source

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