Katherine L. O'Brien

Integrated Monitoring of a New Group B Streptococcal Disease Prevention Program and Other Perinatal Infections

Objective: To determine levels of prenatal screening for several infections, intrapartum recognition of risk factors, and prophylaxis against mother-to-child transmission of group B streptococcus. Methods: Review of stratified random sample of hospital records for deliveries in Connecticut during 1996. SUDAAN analysis was used to adjust for the complex survey design, and weighting adjusted for the probability of being sampled and nonresponse. Results: Of 992 records requested, 868 (88%) were abstracted and analyzed. Thirty-six percent of women had prenatal screening for group B streptococcus and 26% had been tested for human immunodeficiency virus (HIV), while 97–99% of women had been screened prenatally for hepatitis B surface antigen, rubella, and syphilis. Of those women tested, 17% were detected as group B streptococcus carriers, and 78% of these received intrapartum antibiotic prophylaxis. Among women who were not screened for group B streptococcus prenatally, 22% met risk-based criteria for prophylaxis, but only 45% of these received intrapartum prophylaxis. Among unscreened women with a risk factor, those with shorter hospital stays prior to delivery, admitted on evening or night shifts, or who delivered on the weekend were significantly less likely to receive intrapartum prophylaxis. Conclusion: In 1996, the majority of women who delivered in Connecticut were not tested prenatally for group B streptococcus and the majority of those not tested in whom there was an indication for prophylaxis were not treated. Compliance with group B streptococcus prevention recommendations can be improved through increased prenatal testing and/or better recognition of risk-based criteria for intrapartum prophylaxis.

Delivering pneumococcal vaccine to a high risk population: the Navajo experience.

High rates of preventable diseases such as pneumococcal disease occur among the Navajodespite their universal health insurance through the Indian Health Service. The objective of thisstudy was to determine the proportion of Navajo adults vaccinated with pneumococcalpolysaccharide vaccine and to examine key features of vaccination programs of the NavajoIndian Health Service. For this cross-sectional study, medical charts of Navajo patients withvaccine indications were randomly selected and reviewed to determine who had been vaccinatedas of January 1, 1999. Among 480 Navajo > 65 years old, 73% were vaccinated (95%confidence interval [CI]: 69%-77%). Among 111 Navajo 18-64 years old with vaccineindications, 54% were vaccinated (95%CI: 45%-63%). Vaccination programs utilized extensivepublic health nursing, home visits, standing orders, and “express lane” clinics. In spite ofexcellent delivery systems and universal healthcare, the proportion of Navajo persons vaccinatedwas still below the goals for Healthy People 2010 of having 90% of persons >65 years oldvaccinated and 60% of high-risk persons 18-64 years old vaccinated.

Pneumococcal Conjugate Vaccines and Hospitalization of Children for Pneumonia: A Time-Series Analysis, South Africa, 2006-2014/vaccins Antipneumococciques Conjugues et Hospitalisation Des Enfants Atteints De Pneumonie: Analyse D'une Serie Chronologique En Afrique Du Sud Entre 2006 et 2014/las Vacunas Antineumococicas Conjugadas Y la Hospitalizacion De Ninos Por Neumonia: Un Analisis De Series Temporales, Sudafrica, 2006-2014

Abstract Objective To assess the impact of immunization with pneumococcal conjugate vaccines on all-cause pneumonia hospitalizations among children in Soweto, South Africa. Methods We used data collected at the Chris Hani Baragwanath Hospital in Soweto between 2006 and 2014 – i.e. before and after April 2009, when a pneumococcal conjugate vaccine was first included in South Africa’s routine immunization programme. Using a Bayesian generalized seasonal autoregressive moving-average model and the data collected in 2006–2008, we estimated the numbers of children that would have been hospitalized for pneumonia between 2010 and 2014 if no pneumococcal conjugate vaccines had been used. These estimates were then compared with the corresponding numbers of hospitalizations observed. Findings Between 2006 and 2014, 26 778 children younger than five years – including 3388 known to be infected with human immunodeficiency virus (HIV) – were admitted to the study hospital for pneumonia. We estimated that, for the children known to be infected with HIV and for the other children, pneumococcal conjugate vaccines reduced the numbers of hospitalizations for pneumonia in 2014 by 33% (50% credible interval, CrI: 6 to 52) and 39% (50% CrI: 24 to 50), respectively. In the study hospital in 2012–2014, as a result of immunizations with these vaccines, there were an estimated 3100 fewer pneumonia hospitalizations of children younger than five years. Conclusion In our study hospital, following the introduction of pneumococcal conjugate vaccines into the national immunization programme, there were significant reductions in pneumonia hospitalizations among children.