Jaime Fergie

Financing vaccination of children and adolescents: National Vaccine Advisory Committee recommendations

Increases in the number and cost of vaccines routinely recommended for children and adolescents have raised concerns about the ability of the current systems for vaccine financing and delivery to ensure that all children and adolescents have access to all routinely recommended vaccinations without financial barriers. The National Vaccine Advisory Committee (NVAC) was chartered in 1988 to advise and to make recommendations to the director of the National Vaccine Program and the Assistant Secretary for Health at the US Department of Health and Human Services on matters related to the prevention of infectious diseases through vaccination. In October 2006, NVAC established a Vaccine Financing Working Group to explore approaches for child and adolescent vaccine financing. The Vaccine Financing Working Group was charged with establishing a process for obtaining stakeholder input regarding challenges to creating optimal approaches to vaccine financing in both the public and private sectors. The goal of this process was to develop recommendations to ensure that all children and adolescents have access to all routinely recommended vaccinations without financial barriers.

The 2014–2015 National Impact of the 2014 American Academy of Pediatrics Guidance for Respiratory Syncytial Virus Immunoprophylaxis on Preterm Infants Born in the United States

Objective This article aims to compare respiratory syncytial virus (RSV) immunoprophylaxis (IP) use and RSV hospitalization rates (RSVH) in preterm and full‐term infants without chronic lung disease of prematurity or congenital heart disease before and after the recommendation against RSV IP use in preterm infants born at 29 to 34 weeks gestational age (wGA). Study Design Infants in commercial and Medicaid claims databases were followed from birth through first year to assess RSV IP and RSVH, as a function of infants age and wGA. RSV IP was based on pharmacy or outpatient medical claims for palivizumab. RSVH was based on inpatient medical claims with a diagnosis of RSV. Results Commercial and Medicaid infants 29 to 34 wGA represented 2.9 to 3.5% of all births. RSV IP use in infants 29 to 34 wGA decreased 62 to 95% (p < 0.01) in the 2014‐2015 season relative to the 2013‐2014 season. Compared with the 2013‐2014 season, RSVH increased by 2.7‐fold (p = 0.02) and 1.4‐fold (p = 0.03) for infants aged <3 months and 29 to 34 wGA in the 2014‐2015 season with commercial and Medicaid insurance, respectively. In the 2014‐2015 season, RSVH for infants 29 to 34 wGA were two to seven times higher than full‐term infants without high‐risk conditions. Conclusion Following the 2014 RSV IP guidance change, RSV IP use declined and RSVH increased among infants born at 29 to 34 wGA and aged <3 months.

Myositis in a Child with Murine Typhus

A 12-year-old boy presented with fever, lower extremity pain and weakness. Examination revealed paraparesis, thigh and calf tenderness. Labs showed high creatinine phosphokinase and Rickettsia typhi titers. This case illustrates endemic typhus should be considered in the differential diagnosis of myositis especially in areas with high prevalence of the disease. To our knowledge, this is the first reported case of myositis and paraparesis associated with a case of murine typhus.

Palivizumab Prophylaxis for Respiratory Syncytial Virus: Examining the Evidence Around Value

Abstract Respiratory syncytial virus (RSV) infection is the most common cause of lower respiratory tract infection and the leading cause of hospitalization among young children, incurring high annual costs among US children under the age of 5 years. Palivizumab has been found to be effective in reducing hospitalization and preventing serious lower respiratory tract infections in high-risk infants. This paper presents a systematic review of the cost-effectiveness studies of palivizumab and describes the main highlights of a round table discussion with clinical, payer, economic, research method, and other experts. The objectives of the discussion were to (1) review the current state of clinical, epidemiology, and economic data related to severe RSV disease; (2) review new cost-effectiveness estimates of RSV immunoprophylaxis in US preterm infants, including a review of the field’s areas of agreement and disagreement; and (3) identify needs for further research.

Two Infants with Presumed Congenital Zika Syndrome, Brownsville, Texas, USA, 2016–2017

Since 2007, Zika virus has spread through the Pacific Islands and the Americas. Beginning in 2016, women in Brownsville, Texas, USA, were identified as possibly being exposed to Zika virus during pregnancy. We identified 18 pregnant women during 2016–2017 who had supportive serologic or molecular test results indicating Zika virus or flavivirus infection. Two infants were evaluated for congenital Zika syndrome after identification of prenatal microcephaly. Despite standard of care testing of mothers and neonates, comparative results were unreliable for mothers and infants, which highlights the need for clinical and epidemiologic evidence for an accurate diagnosis. A high index of suspicion for congenital Zika syndrome for at-risk populations is useful because of current limitations of testing.

Respiratory Syncytial Virus Hospitalizations among U.S. Preterm Infants Compared with Term Infants Before and After the 2014 American Academy of Pediatrics Guidance on Immunoprophylaxis: 2012–2016

Objective The objective of this study was to compare risk for respiratory syncytial virus (RSV) hospitalizations (RSVH) for preterm infants 29 to 34 weeks gestational age (wGA) versus term infants before and after 2014 guidance changes for immunoprophylaxis (IP), using data from the 2012 to 2016 RSV seasons. Study Design Using commercial and Medicaid claims databases, infants born between July 1, 2011 and June 30, 2016 were categorized as preterm or term. RSVH during the RSV season (November‐March) were identified for infants aged <6 months and rate ratios (RRs) for hospitalization comparing preterm and term infants were calculated. Difference‐in‐difference models were fit to evaluate the changes in hospitalization risks in preterm versus term infants from 2012 to 2014 seasons to 2014 to 2016 seasons. Results In all seasons, preterm infants had higher RSVH rates than term infants. Seasonal RRs prior to the guidance change for preterm wGA categories versus term infants ranged from 1.6 to 3.4. After the guidance change, the seasonal RRs ranged from 2.6 to 5.6. In 2014 to 2016, the risk associated with prematurity of 29 to 34 wGA versus term was significantly higher than in 2012 to 2014 (P<0.0001 for commercial and Medicaid samples). Conclusion In infants aged <6 months, the risk for RSVH for infants 29 to 34 wGA compared with term infants increased significantly after the RSV IP recommendations became more restrictive.

National Bronchiolitis Hospitalization Rates Among Preterm and Full Term Infants: 2010–2015

Abstract Background The 2014 American Academy of Pediatrics (AAP) policy statement on respiratory syncytial virus immunoprophylaxis (RSV IP) recommended against its use in infants 29–34 weeks gestational age (wGA) without chronic lung disease or bronchopulmonary dysplasia (CLD/BPD) or congenital heart disease (CHD). This study examined the impact of these changes by evaluating RSV IP use and bronchiolitis hospitalization rates among full-term (FT) and preterm (PT) infants 29–34 wGA in the 2014–15 RSV season relative to previous seasons. Methods Infants born 7/1/2009 to 6/30/2015 were identified in the MarketScan Multistate Medicaid (MED) and Commercial (COM) databases; DRG and ICD-9-CM codes were used to select FT and PT infants without CLD/BPD or CHD. Outpatient RSV IP use was identified by drug and administration codes. Bronchiolitis hospitalizations were identified by diagnosis codes (466.11 and 466.19) during the RSV season (Nov–Mar) and summarized by chronologic age (CA). Hospitalization rates were calculated per 100 infant-seasons, and statistical significance was tested using generalized linear regression models with Poisson error, log link, and log offset for exposure time. Results 1.1 mil MED and 1.0 mil COM births were identified; 5.2% MED and 4.8% COM infants were born at 29–34 wGA. RSV IP use decreased among MED and COM infants 29–34 wGA (P < .01) in 2014–15 compared with 2013–14. Bronchiolitis hospitalization rates increased for MED and COM infants 29–34 wGA in 2014–15 compared with 2013–14 (rate ratios <3 months CA: MED 1.45, P = .009 and COM 2.1, P = .004; 3–6 months CA: MED 1.35, P = .023 and COM 1.7, P = .053), whereas the rates for FT infants remained the same (rate ratios 0.94–1.08, P > .05). Absolute increases were greatest for infants 29–30 wGA and <3 months CA (MED +10.0 and COM +8.3 per 100 infant-seasons). Similar trends were observed when 2014–15 was compared with the combined 2010–14 RSV seasons. Conclusion In the 2014–15 RSV season, there was an increase in bronchiolitis hospitalization rates among PT infants born at 29–34 wGA when <3 months and 3–6 months CA, but no increase among FT infants. Trends were consistent in the MED and COM populations and are associated with the change to AAP policy. Funding AstraZeneca Disclosures L. R. Krilov, AstraZeneca/MedImmune: Consultant, Research grant and Research support; J. Fergie, MedImmune: Speaker’s Bureau, Research grant and Research support; M. Goldstein, AstraZeneca/MedImmune: Consultant, Research grant and Research support; K. K. McLaurin, AstraZeneca: Employee, Salary; S. Wade, Truven Health Analytics: Consultant, Consulting fee; D. Diakun, Truven Health Analytics: Employee, Salary; A. Kong, Truven Health Analytics: Employee, Salary

Septic arthritis and hemarthroses caused by Haemophilus influenzae serotype A in children

Invasive disease caused by Haemophilus influenzae serotype A (Hia) is rare in children. Clinical syndromes caused by Hia include meningitis, sepsis and respiratory tract infections. Septic arthritis is rare in children with invasive Hia infection and hemarthrosis has not been described in the published literature. We report a case of septic arthritis and hemarthrosis caused by Hia infection in a 2.5 year-old-boy and review invasive Hia infection in children.