Manjunath Shankar

Incidence of Clinician-Diagnosed Lyme Disease, United States, 2005-2010.

Extrapolation from a large medical claims database suggests that 329,000 cases occur annually.

Potential intussusception risk versus benefits of rotavirus vaccination in the United States.

Background: International data show a low-level increased risk of intussusception associated with rotavirus vaccination. Although US data have not documented a risk, we assumed a risk similar to international settings and compared potential vaccine-associated intussusception cases with benefits of prevention of rotavirus gastroenteritis by a fully implemented US rotavirus vaccine program. Methods: To calculate excess intussusception cases, we used national data on vaccine coverage and baseline intussusception rates, and assumed a vaccine-associated intussusception relative risk of 5.3 (95% confidence interval [CI]: 3.0–9.3) in the first week after the first vaccine dose, the risk seen in international settings. We used postlicensure vaccine effectiveness data to calculate rotavirus disease burden averted. Results: For a US birth cohort of 4.3 million infants, vaccine-associated intussusception could cause an excess 0.2 (range: 0.1–0.3) deaths, 45 (range: 21–86) hospitalizations and 13 (range: 6–25) cases managed in short-stay or emergency department settings. Vaccination would avert 14 (95% CI: 10–19) rotavirus-associated deaths, 53,444 (95% CI: 37,622–72,882) hospitalizations and 169,949 (95% CI: 118,161–238,630) emergency department visits. Summary benefit–risk ratios for death and hospitalization are 71:1 and 1093:1, respectively. Conclusions: The burden of severe rotavirus disease averted due to vaccination compared with the vaccine-associated intussusception events offers a side-by-side analysis of the benefits and potential risks. If an intussusception risk similar to that seen internationally exists in the United States, it is substantially exceeded by the benefits of rotavirus disease burden averted by vaccination.

Initial and Long-Term Costs of Patients Hospitalized with West Nile Virus Disease

There are no published data on the economic burden for specific West Nile virus (WNV) clinical syndromes (i.e., fever, meningitis, encephalitis, and acute flaccid paralysis [AFP]). We estimated initial hospital and lost-productivity costs from 80 patients hospitalized with WNV disease in Colorado during 2003; 38 of these patients were followed for 5 years to determine long-term medical and lost-productivity costs. Initial costs were highest for patients with AFP (median

Economic and health impacts associated with a Salmonella Typhimurium drinking water outbreak-Alamosa, CO, 2008.

25,117; range

Regional Spread of Ebola Virus, West Africa, 2014

5,385-

Screening for refractive error and fitting with spectacles in rural and urban India: cost-effectiveness.

283,381) and encephalitis (median

Estimating Ebola Treatment Needs, United States.

20,105; range

Potential demand for respirators and surgical masks during a hypothetical influenza pandemic in the United States.

3,965-

Modeling in Real Time During the Ebola Response

324,167). Long-term costs were highest for patients with AFP (median

The Epidemiology of Foodborne Botulism Outbreaks: A Systematic Review

22,628; range