High Risk Conditions and Vaccination Gaps in Invasive Pneumococcal Disease Cases in Tennessee,
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1 High Risk Conditions and Vaccination Gaps in Invasive Pneumococcal Disease Cases in Tennessee, Kinley Reed Candidate for Master of Public Health September 12, 2017
2 Outline Brief Introduction of Field Experience Minor Project: SNiPP Data Entry Major Project: High Risk Conditions and Vaccination Gaps in IPD Core Competencies Questions
3 Field Experience: Emerging Infections Program
4 Emerging Infections Program Established in 1995 by the CDC Response to the growing population, an increase in poverty, and the heightened international travels Network of state health departments, public health and clinical laboratories, academic establishments, state and federal agencies, and healthcare providers
5 Emerging Infections Program
6 Emerging Infections Program
7 TN Emerging Infections Program Active Bacterial Core Surveillance (ABCs) FoodNet Healthcare-Associated Infections (HAI) Flu-Surv Net HPV-IMPACT TickNet
8 Active Bacterial Core Surveillance (ABCs) Focuses on the epidemiology and surveillance of invasive bacterial diseases Group A Streptococcus (GAS), Group B Streptococcus (GBS), Haemophilus influenza, Neisseria meningitides, Streptococcus pneumoniae, and Methicillin-Resistant Staphylococcus aureus (MRSA)
9 Learning Objectives Learn to navigate database software used for population-based surveillance and research Gain experience extracting pertinent medical information from patient records and CRFs Expand knowledge of statistical analyses and additional epidemiological techniques
10 Measurable Outcomes Shadowed personnel in population-based surveillance, epidemiology, and diseaseprevention careers Assisted in data entry for SNiPP project Aided in data cleaning and audit for Pneumococcal Carriage Study Attended weekly surveillance meetings and discussions at TDH
11 Measureable Outcomes Assisted in the transfer of data to new software databases (REDCap) Participated in monthly EIP meetings to discuss various public health issues Designed and implemented an observational study to evaluate high risk conditions in populations with IPD, and to determine vaccination gaps within those identified populations
12 Outline Brief Introduction of Field Experience Minor Project: SNiPP Data Entry Major Project: High Risk Conditions and Vaccination Gaps in IPD Core Competencies Questions
13 Minor Project: SNiPP SNiPP: Surveillance for Non-invasive Pneumococcal pneumonia Most common form of pneumococcal disease in adults Over 900,000 diagnosed each year in U.S. Account for 36% of community-acquired pneumonia
14
15 Urine Antigen Test (UAT)
16 Objectives To properly transfer patient medical information from hard copy of the case report form (CRF) to the electronic form entry Results from data entry are used to provide population-based estimates that are easily transmitted to the CDC for future studies
17 Methods Healthcare facilities report all possible UAT cases to EIP Surveillance Officer gets results from hospitals/labs All UAT (+/- cases) cases are processed through REDCap
18 REDCap Software solution to develop and manage online surveys and databases Established by Vanderbilt Over 2,000 institutional partners use REDCap TN EIP transfers all data to REDCap
19 Methods: Data Entry
20 Results Submitted over 1,000 negative UAT cases into REDCap Approximately over 7,400 negative UAT cases in the REDCap Patient Tracker
21 Discussion Pneumococcal pneumonia is very common Important to enter both positive and negative UAT cases to ensure proper population-based estimates EIP analyzes the proportions of pneumonia hospitalizations in hospitals that perform the UATs and those that do not
22 Outline Brief Introduction of Field Experience Minor Project: SNiPP Data Entry Major Project: High Risk Conditions and Vaccination Gaps in IPD Core Competencies Questions
23 Major Project: High Risk Conditions and Vaccination Gaps in Invasive Pneumococcal Disease in Tennessee,
24 History: Streptococcus pneumoniae Gram + bacteria, also known as pneumococcus First isolated by Pasteur in 1881 by a rabies + patient As of 2011, over 92 serotypes identified
25 Background: Streptococcus pneumoniae Normal inhabitants of the respiratory track Certain serotypes cause serious illness (6A, 14, 19F, and 23F) Cause invasive illnesses and/or noninvasive illnesses Major clinical illnesses: Pneumonia Sinusitis Otis media Bacteremia Meningitis
26 Invasive Pneumococcal Disease (IPD) Morbidity Mortality 62% of invasive disease worldwide Over 12,000 bacteremia cases/year in U.S. 50% of meningitis cases in U.S. 22,000 deaths/year in U.S.
27 Pneumococcal disease kills more people in the United States each year than all other vaccinepreventable diseases combined. -CDC, 2014
28 IPD Risk Factors Race Age Immunosuppressant illnesses The CDC lists the following as most prevalent underlying conditions: HIV Diabetes Liver/Heart Disease Smoking Asthma
29
30 Vaccinations
31 Vaccination Recommendations PCV 13 (Prevnar 13) Children 2 years of age and younger Adults 65+ Adults 19+ with certain illnesses (HIV and kidney disease) PPSV23(Pneumovax 23) Adults 65+ Children under 2 years of age and Adults 19+ with certain illnesses (diabetes and heart disease)
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34 Objectives: 1) To evaluate ABC s data from REDCap and Access to identify the high-risk conditions of patients with IPD 2) To provide awareness of vaccination gaps within the IPD population
35 Methods: Data Collection An IPD case is defined as a positive culture of Streptococcus pneumoniae in an adult (aged 19 years old) with one or more highrisk conditions within the Tennessee catchment areas
36 Case Report Form
37 Methods: Data Analysis IPD data extracted from Access IPD data extracted from REDCap Total number of IPD cases=2,693 (years ) All data complied into one excel worksheet
38 Phase 1: IPD Study Population Demographics
39 Age Age 18% 11% 36% 35%
40 Race 0% Race 0% 2% 2% 27% 69% White Black American Indian Asian Native Hawaiian/Pacific Unknown
41 Ethnic Origin Ethnic Origin 1% 24% 75% Hispanic/Latino Not Hispanic/Latino Unknown
42 Hospital and ICU % Hospital and ICU % For Each Age Group % % % 35.20% 48.36% 28.88% % 80.00% 43.02% 60.00% 40.00% 87.55% 99.48% 54.66% 91.72% 20.00% 0.00% Hosptial ICU
43 Prevalent IPD Underlying Conditions 40.00% 35.00% 30.00% 25.00% 20.00% 15.00% 10.00% 5.00% 0.00% IPD Underlying Conditions 36.84% 28.78% 25.99% 18.98% 16.34% ASCVD Diabetes COPD Smoker Othill
44 Phase 2: Most Prevalent IPD Underlying Conditions (by age)
45 IPD Underlying Conditions 60.00% 50.00% 40.00% 30.00% 20.00% 10.00% 0.00% ASCVD Diabetes COPD Smoker Othill % 12.65% 7.96% 41.84% 17.14% % 25.18% 30.09% 51.10% 19.23% % 33.37% 38.88% 30.09% 19.49% % 27.15% 26.82% 4.64% 19.54%
46 Phase 3: IPD Vaccination Gaps
47 Vaccination Percentages for Each Age Group 11% 40% 18% %
48 Axis Title Vaccination Percentages for Age Group % % % % % % 0.000% ASCVD Diabetes COPD Smoker Othill Yes % % % 9.756% % No 25.00% 32.26% 20.51% % % Unknown 50.00% 53.23% 53.85% 58.54% 52.38%
49 Vaccination Percentages for Age group 60.00% Yes No Unknown 50.00% 40.00% 30.00% 20.00% 10.00% 0.00% ASCVD Diabetes COPD Smoker Othill Yes 27.55% 18.26% 23.61% 16.36% 16.85% No 27.55% 32.37% 27.08% % % Unknown 44.90% 49.38% 49.31% 53.99% 48.37%
50 Vaccination Percentages for Age Group % 50.00% 40.00% 30.00% 20.00% 10.00% 0.00% ASCVD Diabetes COPD Smoker Othill Yes 31.80% 31.43% 31.61% 25.00% 16.85% No 15.06% 16.51% 17.44% % % Unknown 53.14% 52.06% 50.95% 52.11% 57.07% Yes No Unknown
51 Vaccination Percentages for Age Group % 70.00% 60.00% 50.00% 40.00% 30.00% 20.00% 10.00% 0.00% ASCVD Diabetes COPD Smoker Othill Yes 40.66% 40.24% 35.80% 21.43% 32.20% No 15.38% 18.29% 16.05% 7.143% % Unknown 43.96% 41.46% 48.15% 71.43% 42.37% Yes No Unknown
52 Vaccine Types for All Age Groups 14.00% 12.00% 10.00% 8.00% 6.00% 4.00% 2.00% 0.00% PCV7/PCV13 PPSV23
53 PCV7/13 PPSV23 Unknown PCV7/13 PPSV23 Unknown PCV7/13 PPSV23 Unknown PCV7/13 PPSV23 Unknown 2011 Percentages for Underlying Conditions within Vaccine Types by Age % % % % % % 80.00% 60.00% 40.00% 20.00% 0.00% ASCVD Diabetes COPD Smoker Othill
54 PCV7/13 PPSV23 Unknown PCV7/13 PPSV23 Unknown PCV7/13 PPSV23 Unknown PCV7/13 PPSV23 Unknown 2012 Percentages for Underlying Conditions within Vaccine Types by Age % % % % % % 80.00% 60.00% 40.00% 20.00% 0.00% ASCVD Diabetes COPD Smoker Othill
55 PCV7/13 PPSV23 Unknown PCV7/13 PPSV23 Unknown PCV7/13 PPSV23 Unknown PCV7/13 PPSV23 Unknown 2013 Percentages for Underlying Conditions within Vaccine Types by Age % % % % % 80.00% 60.00% 40.00% 20.00% 0.00% ASCVD Diabetes COPD Smoker Othill
56 PCV7/13 PPSV23 Unknown PCV7/13 PPSV23 Unknown PCV7/13 PPSV23 Unknown PCV7/13 PPSV23 Unknown 2014 Percentages for Underlying Conditions within Vaccine Types by Age % % % % % % 80.00% 60.00% 40.00% 20.00% 0.00% ASCVD Diabetes COPD Smoker Othill
57 PCV7/13 PPSV23 Unknown PCV7/13 PPSV23 Unknown PCV7/13 PPSV23 Unknown PCV7/13 PPSV23 Unknown 2015 Percentages for Underlying Conditions within Vaccine Types by Age % % % % 50.00% 0.00% ASCVD Diabetes COPD Smoker Othill
58 PCV7/13 PPSV23 Unknown PCV7/13 PPSV23 Unknown PCV7/13 PPSV23 Unknown PCV7/13 PPSV23 Unknown 2016 Percentages for Underlying Conditions within Vaccine Types by Age 90.00% 80.00% 70.00% 60.00% 50.00% 40.00% 30.00% 20.00% 10.00% 0.00% ASCVD Diabetes COPD Smoker Othill
59 Dual Vaccine Recommendation Evaluated the percentages of the vaccinated population that received dual vaccines less than 1.7% of the age group, 65-84, and less than 2.2% of the age group, 19-49, received the recommended dual vaccines
60 Data Summary Phase 1 Largest Populations Age: Race: Caucasian Ethnic Origin: Not Hispanic Hospital/ICU group: Most prevalent underlying conditions: ASCVD, Diabetes, COPD, Smoker, Other illnesses
61 Data Summary: Phase : Smoker 50-64: Smoker 65-84: COPD 85+: ASCVD
62 Data Summary: Phase 3: Vaccination Percentages for each age group: 19-49: 11% 50-64: 18% 65-84: 31% 85+: 40% Vaccine Types for all age groups: PPSV 23 Low percentage of dual vaccinations in all age groups
63 Conclusion: Analyses was conducted to shed light on IPD highrisk conditions and vaccination gaps among those with IPD Most prevalent highrisk condition is smoking Younger age groups are going unvaccinated Majority of patients mark unknown vaccination status Low percentages of dual vaccines
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66 Limitations Small study population Incomplete CRFs Unknown Vaccination Statuses Lack of communication between patients and healthcare providers (i.e. medical terminology)
67 Future Studies A larger study population Comparison of IPD data within all ten EIP states Vaccination gaps among pregnant women with IPD high-risk conditions Measure the risk of reoccurrence of IPD in same study population Measure the risk of IPD in Hepatitis C patients
68 Outline Brief Introduction of Field Experience Minor Project: SNiPP Data Entry Major Project: High Risk Conditions and Vaccination Gaps in IPD Core Competencies Questions
69 Core Competencies Biostatistics: Use of descriptive statistics and statistical analyses Environmental Health: Acknowledgement of the link between disease and the environment Epidemiology: Use and understanding of surveillance methods and terms
70 Core Competencies Health Administration: Use of HIPAA regulations and understanding of the U.S. healthcare system Social and Behavioral Science: Acknowledgment of the link between demographics with certain diseases and health disparities
71 Acknowledgements Dr. Ellyn Mulcahy Dr. Natalie Cernicchario Dr. Jodi McGill Barta Stevenson Dr. William Schaffner Dr. Tiffanie Markus Dr. Keip Talbot Danielle Ndi Dr. John Dunn EIP Staff
72 Questions?
73 References Baxter, R., Lee, A., Aukes, L., Snow, V., Fireman, B., Atkinson, B., Klein, N. (2016) Risk of Underlying Chronic Medical Condtions for Invasive Pneumococcal Disease in Adults. Vaccine., 34(36), ( ). Centers for Disease Control and Prevention. (1994). Addressing Emerging Infectious Disease Threats: a prevention strategy for the United States. Executive Summary. MMWR Recomm Rep, Centers for Disease Control and Prevention. (2015). Pneumococcal Disease: About Pneumococcal. Retrieved May 1, 2017, from Centers for Disease Control and Prevention (2010). Updates Recommendations for Prevention of Invasive Pneumococcal Disease Among Adults Using the 23-Valent Pneumococcal Polysaccharide Vaccine (PPSV23). Retreived June 25, 2017, from mmwrhtml/mm5934a3.htm. Centers for Disease Control and Prevention (2014). Manual for the Surveillance of Vaccine- Preventable Diseases. Retrieved June 20, 2017 from Henriques-Normark, Birgitta, and Elaine I. Tuomanen. "The Pneumococcus: Epidemiology, Microbiology, and Pathogenesis." Cold Spring Harbor Perspectives in Medicine. Cold Spring Harbor Laboratory Press, July Web. 08 Aug Tennessee Department of Health (2017). Emerging Infections Programs, (1-4). Retrieved May 1, 2017, from
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