Samantha Kurosky

Completion and compliance of childhood vaccinations in the United States

BACKGROUND The Advisory Committee on Immunization Practices recommends routine childhood vaccination by age 2 years, yet evidence suggests that only 2% to 26% of children receive vaccine doses at age-appropriate times (compliance). The objective of this study was to estimate vaccine completion and compliance rates between birth and age 2 years using recent, nationally representative data. METHODS Using a sample of children aged 24 to 35 months from the 2012 National Immunization Survey (NIS), the present study examined completion and compliance of recommended childhood vaccines. A state-specific examination of vaccine completion and compliance was also conducted. RESULTS An unweighted sample of 11,710 children (weighted to 4.1 million) was selected. Approximately 70% of children completed all doses of six recommended vaccines by 24 months of age. Completion rates varied by antigen, ranging from 68% completing two or three doses of rotavirus vaccine to 92% completing three doses of inactivated poliovirus vaccine. Vaccine completion rates also varied at different measurement periods, with the lowest rates observed at 18 months. Approximately 26% of children received all doses of six recommended vaccines on time. Among the 74% of children who received at least one late dose, 39% had >7 months of undervaccination. Patterns of completion and compliance also varied by geographic region. CONCLUSIONS Completion of individual antigens approached Healthy People 2020 targets. However, overall completion of the recommended vaccine series and compliance with the recommended vaccination dosing schedule were low, indicating few children received vaccines at age-appropriate times. Additional clinical, policy, and educational interventions are needed to increase receipt of vaccines at optimal ages.

An analysis of factors associated with influenza, pneumoccocal, Tdap, and herpes zoster vaccine uptake in the US adult population and corresponding inter-state variability

ABSTRACT Despite longstanding recommendations for routine vaccination against influenza; pneumococcal; tetanus, diphtheria, acellular pertussis (Tdap); and herpes zoster (HZ) among the United States general adult population, vaccine uptake remains low. Understanding factors that influence adult vaccination and coverage variability beyond the national level are important steps toward developing targeted strategies for increasing vaccination coverage. A retrospective analysis was conducted using data from the Behavioral Risk Factor Surveillance System (2011–2014). Multivariable logistic regression modeling was employed to identify individual factors associated with vaccination (socio-demographics, health status, healthcare utilization, state of residence) and generate adjusted vaccination coverage and compliance estimates nationally and by state. Results indicated that multiple characteristics were consistently associated with a higher likelihood of vaccination across all four vaccines, including female sex, increased educational attainment, and annual household income. Model-adjusted vaccination coverage estimates varied widely by state, with inter-state variability for the most recent year of data as follows: influenza (aged ≥18 years) 30.2–49.5%; pneumococcal (aged ≥65 years) 64.0–74.7%; Tdap (aged ≥18 years) 18.7–46.6%; and HZ (aged ≥60 years) 21.3–42.9%. Model-adjusted compliance with age-appropriate recommendations across vaccines was low and also varied by state: influenza+Tdap (aged 18–59 years) 7.9–24.7%; influenza+Tdap+HZ (aged 60–64 years) 4.1–14.4%; and influenza+Tdap+HZ+pneumococcal (aged ≥65 years) 3.0–18.3%. In summary, after adjusting for individual characteristics associated with vaccination, substantial heterogeneity across states remained, suggesting that other local factors (e.g. state policies) may be impacting adult vaccines uptake. Further research is needed to understand such factors, focusing on differences between states with high versus low vaccination coverage.

Muscular dystrophy-related hospitalizations among male pediatric patients in the United States

Abstract Objective. While the economic burden of muscular dystrophy (MD) has been well documented, little is known of specific costs associated with Duchenne muscular dystrophy (DMD), the most prevalent form of MD. This study assessed trends in MD-related hospitalizations and costs among young males, which may reflect utilization of the DMD population in the United States. Study design. A retrospective observational study of hospitalizations of males aged 0–20 years with a primary diagnosis code for MD was conducted using data from a weighted, nationally representative database of pediatric hospitalizations in the US. Rates, characteristics and cost of MD-related hospitalizations were compared to hospitalizations not related to MD. Results. The rate of MD-related hospitalizations increased by 9% between 2000 and 2006 and then decreased by 13% in 2009. The mean length of stay for discharges related to MD was approximately 9 days during each study year. The most frequent observed diagnoses (other than MD) and procedures were for respiratory-related complications. The mean total costs for MD-related discharges increased across the study period from

Effect of combination vaccines on completion and compliance of childhood vaccinations in the United States

26,785 in 2000 to

Effect of Combination Vaccines on Hepatitis B Vaccine Compliance in Children in the United States

42,751 in 2009. Conclusion. This study provides baseline and trend data describing hospitalizations of male pediatric patients with MD that may be used as baseline measurements for assessment of the impact of new strategies for managing the disease. Further assessment of the burden and the clinical, economic, and humanistic impacts of DMD is warranted.

Unresectable, Locally Advanced, Stage III Non-Small Cell Lung Cancer: Real-World Clinical Characteristics, Treatment Patterns, And Health Care Resource Utilization In Europe

ABSTRACT Vaccination at age-appropriate intervals increases protection against morbidity and mortality; however, compliance rates among children remain low partly due to a complicated vaccination schedule. Use of combination vaccines reduces the number of injections per visit; however, there is limited evidence quantifying the effect of combination vaccines on vaccination rates. To examine how combination vaccines impact childhood completion (receipt of recommended doses) and compliance (receipt of age-appropriate vaccinations) rates, this study analyzed vaccination data from the 2012 National Immunization Survey (NIS), a nationally representative cross-sectional survey of caregivers of children aged 24 to 35 months in the United States. Vaccines were categorized as combination or single antigen. Vaccine completion was measured at ages 8, 18, and 24 months. Vaccine compliance and time undervaccinated were measured at 24 months. Children who received at least 1 combination vaccine (86%) had a higher completion rate (69%) and compliance with the full vaccine series (4:3:1:3:3:1:4 series) at 24 months (24%) than those who received only single-antigen vaccines (50% and 13%, respectively). Receipt of combination vaccine was associated with an increased likelihood of completing all recommended vaccinations at 24 months (odds ratio [OR] = 2.5; P < 0.001), receiving all vaccinations at age-appropriate times (OR = 2.2; P < 0.001), and less than 7 months undervaccinated (OR = 2.4; P < 0.001). Combination vaccines were associated with improved completion and compliance and should be encouraged among children who are undervaccinated or who received single-antigen vaccines only.

Adherence with and completion of recommended hepatitis vaccination schedules among adults in the United States

Background: An increasingly crowded immunization schedule threatens the completion and compliance of hepatitis B vaccinations (HepB), the primary method of hepatitis B prevention. Combination vaccines have been proposed to alleviate this problem. Methods: Data from the 2011 National Immunization Survey Public-Use Data File were utilized (GSK study identifier: HO-11–770) to compare HepB completion and compliance rates between 3 groups of children: those who received HepB combination vaccine, those who received non-HepB combination vaccine and those who received HepB single-antigen vaccine only. Completion was defined as the accumulation of 3 HepB doses by 18 months. Compliance was defined as the receipt of vaccine doses within the Advisory Committee on Immunization Practices’ recommended age ranges. Results: Of a sample of 4,040,116 children, 39.4% received a HepB combination vaccine, 43.0% received a non-HepB combination vaccine and 17.5% received a HepB single-antigen vaccine. Overall, 91.2% of children completed all 3 recommended doses, but only 61.8% completed them at age-appropriate times. Those receiving single-antigen only (odds ratio = 0.25, 95% confidence interval: 0.17–0.35) or non-HepB combination vaccines (odds ratio = 0.50, 95% confidence interval: 0.37–0.69) were substantially less likely to complete 3 doses of HepB than those who received the HepB combination vaccine. Conclusions: Although completion rates were high, a large proportion of children did not receive HepB doses at age-appropriate times. Combination vaccine was associated with both higher completion and compliance outcomes compared with HepB single-antigen vaccine.

Treatment patterns and outcomes of patients with metastatic ER+/HER-2- breast cancer: A multicountry retrospective medical record review

• Poor prognosis associated with unresectable stage III NSCLC and the limited effectiveness of standard care indicate a continued need for effective treatment options. Research on real-world treatment, outcomes, and health care resource burden associated with unresectable stage III NSCLC may provide needed data for assessing unmet treatment needs and current information for evaluating the impact of future novel therapies for treating NSCLC. PCN242

Recent Trends in Costs, Length of Stay, and Mortality Associated with Infant Pertussis Hospitalizations in the United States:

INTRODUCTION Adult vaccination coverage rates in the US are well below national targets, leaving many adults at increased risk. Additionally, typical vaccination coverage calculations do not adequately approximate population immunity as they do not consider whether multidose vaccines were administered within the recommended schedules. As timely administration of each dose optimizes overall vaccine effectiveness, we sought to document adherence to and completion of the hepatitis A (HepA), hepatitis B (HepB), and combined hepatitis A and hepatitis B (HepA-HepB) multidose vaccine schedule in an insured adult population in the US. METHODS We conducted a retrospective database study of administrative claims from 2008 to 2015 (analyzed in 2017). Completion of 2 (HepA) and 3 doses (HepB and HepA-HepB), and adherence to the 2- and 3-dose recommended schedules were measured among individuals aged 19 years and older at first dose. The proportion of patients who completed 2 and 3 doses and were adherent to the recommended schedule were estimated using Kaplan-Meier methods. RESULTS For HepA, 27.14% of initiating adults were adherent to the recommended schedule, and 32.05% had received a second dose by 42 months. Approximately one-third of adults who initiated the HepB or HepA-HepB series completed all 3 doses within 2 years of the minimum spacing (31.17% and 32.27%, respectively). Generally, completion and adherence were highest in individuals aged 60-64 years at the time of initiation. CONCLUSIONS Hepatitis vaccine adherence and completion in adults is suboptimal. As a result, the majority of adults initiating each series may not be receiving the full protective benefit of these multidose vaccines.

Hepatitis A and Hepatitis B Recombinant Vaccine Adherence In The United States

&NA; With the emergence of novel therapies for metastatic ER+/HER‐2− breast cancer, substantial changes in treatment options are impending. This study analyzed medical records of a sample of 901 patients with metastatic ER+/HER‐2− breast cancer across 7 countries to describe current real‐world treatment patterns and factors associated with disease progression and survival. Receipt of endocrine therapy was associated with longer time to progression and overall survival compared to chemotherapy in the first‐ and second‐line settings. Median time to disease progression was less than a year regardless of therapy type (endocrine or chemotherapy) after both first‐ and second‐line treatment, indicating a need for new treatment strategies that delay progression without affecting quality of life among these patients. Purpose: To describe treatment patterns and clinical outcomes among postmenopausal women with metastatic ER+/HER‐2− breast cancer treated with ≥ 2 lines of endocrine therapy or chemotherapy in the metastatic setting. Patients and Methods: Retrospective medical record review was conducted in Canada, the United Kingdom, Belgium, the Netherlands, Germany, Spain, and France. Baseline characteristics were assessed at the date of metastatic diagnosis. Time to progression (TTP) and overall survival (OS) were estimated by Kaplan‐Meier analyses. Multivariable models were used to evaluate factors associated with disease progression. Results: Among 901 patients, the mean (standard deviation) age at metastatic diagnosis was 62.7 (9.7) years; 67.26% were initially diagnosed with metastatic disease, 66.37% had visceral disease, and 25.86% had bone metastasis only. Two‐thirds of patients received endocrine therapy for first‐line treatment. Fifty‐nine percent received endocrine therapy, and 37.18% received chemotherapy for second‐line treatment. The most common reason for stopping treatment was disease progression. Median (95% confidence interval [CI]) TTP on first‐line endocrine treatment was 11.3 (10.7‐12.2) months and 7.0 (6.3‐7.9) months on chemotherapy. Median (95% CI) TTP on second‐line endocrine therapy was 8.1 (7.5‐9.1) months and 6.1 (5.4‐6.8) months on chemotherapy. Median (95% CI) OS was 68.6 (52.2‐83.7) months after first‐line endocrine therapy and 39.7 (34.5‐48.7) months after chemotherapy. Conclusion: Patients prescribed endocrine therapy had longer TTP and OS than patients prescribed chemotherapy in the first‐ and second‐line settings. Disease progression was less than a year regardless of treatment type and line of therapy, indicating a need for treatments that delay progression without affecting quality of life among these patients.