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Vaccinating to Prevent Antibiotic Use: Potential Impact of a Group A Streptococcus Vaccine on Acute Respiratory Infections
- Joseph Lewnard, Laura King, Katherine Fleming-Dutra, Ruth Link-Gelles, Chris Van Beneden
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- Journal:
- Infection Control & Hospital Epidemiology / Volume 41 / Issue S1 / October 2020
- Published online by Cambridge University Press:
- 02 November 2020, p. s428
- Print publication:
- October 2020
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Background: Group A Streptococcus (GAS) causes acute upper respiratory tract infections that are frequently treated with antibiotics. GAS vaccines in development may prevent both disease and outpatient antibiotic prescribing. We estimated (1) the incidences of GAS-attributable pharyngitis, sinusitis, and acute otitis media (AOM) infections in the United States; (2) the proportion of these infections resulting in antibiotic prescriptions; and (3) the incidence of infection and antibiotic prescribing potentially preventable by vaccination against GAS. Methods: We estimated annual rates of US outpatient visits and antibiotic prescriptions for pharyngitis, sinusitis, and AOM using physician office and emergency department visit data in the National Ambulatory Care Survey and National Hospital Ambulatory Medical Care Survey from 2012 to 2015. We supplemented this with visits to other outpatient settings (eg, urgent care) from the 2016 IBM MarketScan Commercial Database. We estimated the proportion of episodes attributable to GAS and to GAS emm types targeted by a 30-valent vaccine in development using data from previously conducted etiology studies. We estimated the incidence of disease and antibiotic prescribing preventable by a vaccine meeting the WHO 80% efficacy target for preventing noninvasive GAS disease, with doses administered during infancy and at age 4 years. We estimated the proportion of outpatient antibiotic prescribing preventable by vaccination by dividing estimates by total antibiotic dispensations, estimated from the IQVIA TM dataset. Results: Among individuals aged 0–64 years, GAS causes 27.3 (95% CI, 24.6–30.6) ambulatory care visits and 16.4 (95% CI, 14.5–18.6) outpatient antibiotic prescriptions per 1,000 population annually for pharyngitis, sinusitis, and AOM combined, representing 2.1% (95% CI, 1.8%–2.4%) of all outpatient antibiotic prescriptions. Among children aged 3–9 years, GAS-attributable incidence includes 124.4 (95% CI, 109.0–142.1) visits and 77.1 (95% CI, 65.7–90.6) antibiotic prescriptions per 1,000 population annually, representing 8.6% (95% CI, 7.3%–10.1%) of antibiotic prescriptions in this age group. Individual-level direct protection from a 30-valent vaccine meeting the WHO target could prevent 26.0% (95% CI, 24.0%–28.1%) of pharyngitis visits; 17.3% (95% CI, 15.5%–19.5%) of pharyngitis, sinusitis, and AOM visits; and 5.5% (95% CI, 4.7%–6.4%) of outpatient antibiotic prescriptions among children aged 3–9 years. If vaccination eliminated the need for antibiotic treatment of pharyngitis (for which GAS is the only etiology warranting antibiotic treatment), the total effects of vaccination could include the prevention of up to 17.2% (95% CI, 15.0%–19.6%) and 6.8% (95% CI, 6.3%–7.3%) of antibiotic prescriptions among persons 3–9 years and 0–64 years of age, respectively. Conclusions: In addition to preventing infections and healthcare visits, an efficacious GAS vaccine could prevent a substantial volume of outpatient antibiotic prescribing in the United States.
Funding: This work was supported by the Centers for Disease Control and Prevention. The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.
Disclosures: Laura M. King is a contractor employed by Northrop Grumman Corporation to fulfill research needs at the Centers for Disease Control and Prevention as part of a contract covering many positions and tasks. All other authors declare no conflicts.
Just Call Me Dad: Health and Social Benefits to Fathers and their Children
- Joseph Fleming, Andrew King, Tara Hunt
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- Journal:
- Children Australia / Volume 39 / Issue 1 / March 2014
- Published online by Cambridge University Press:
- 11 February 2014, pp. 34-41
- Print publication:
- March 2014
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In the past 20 years, social change and expectations for both maternal and paternal responsibilities have highlighted the need for services for families to better understand the role of a father in family relationships. In Australia, as well as internationally, there have been many contested understandings about what constitutes ‘good fathering’ in research, social media and in the political sphere. More specifically, there has also been an emerging trend to understand the challenging task of recruiting and maintaining men's involvement in child and family services programmes, particularly those fathers who are deemed a risk to children and mothers, violent or have been separated from their children. That many child and family/welfare services have exercised dedicated effort to work with fathers is still a relatively recent phenomenon, and has only emerged following criticism that services have been too geared towards working only with mothers. Despite this increasing interest, there is still ongoing need for more research to be undertaken in Australia. An important area of focus is the views of professionals about their perception and engagement of fathers, particularly the views of fathers who are described as being absent from family-based services. The purpose of this article is to report briefly on a study undertaken to examine how child and family welfare workers engage fathers in their work. First, this paper will describe some of the social and health benefits to fathers and their children, focusing on the key role of attachment through play. Research into effective service delivery involving fathers will then be presented, concluding with key practice factors necessary for fathers to be involved in family life.
Contributors
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- By Joëlle Adrien, M. Y. Agargun, Negar Ahmadi, Imran M. Ahmed, J. Todd Arnedt, Joseph Barbera, Simon Beaulieu-Bonneau, Marie E. Beitinger, Francesco Benedetti, Glenn Berall, Kirk J. Brower, Gregory M. Brown, Kumaraswamy Budur, Daniel P. Cardinali, Deirdre A. Conroy, Sara Dallaspezia, José Manuel de la Fuente, Paolo De Luca, Diana De Ronchi, Antonio Drago, Matthew R. Ebben, Irshaad Ebrahim, Pingfu Feng, Peter B. Fenwick, Lina Fine, Jonathan Adrian Ewing Fleming, Paul A. Fredrickson, Stephany Fulda, Lucile Garma, Roger Godbout, Reut Gruber, J. Allan Hobson, Andrea Iaboni, Anna Ivanenko, Mayumi Kimura, Milton Kramer, Christoph J. Lauer, Remy Luthringer, Luis Fernando Martínez, Sara Matteson-Rusby, Robert W. McCarley, Charles J. Meliska, Harvey Moldofsky, Charles M. Morin, Sricharan Moturi, Marie-Christine Ouellet, James F. Pagel, S. R. Pandi-Perumal, Barbara L. Parry, Timo Partonen, Wilfred R. Pigeon, Thomas Pollmächer, Nathalie Pross, Elliott Richelson, Naomi L. Rogers, Stefan Rupprecht-Mrozek, Philip Saleh, Andreas Schuld, Alessandro Serretti, Colin M. Shapiro, Christopher Michael Sinton, Marcel G. Smits, D. Warren Spence, Jürgen Staedt, Corinne Staner, Luc Staner, Axel Steiger, Deborah Suchecki, Michael J. Thorpy, Inna Voloh, Bradley G. Whitwell, Robert A. Zucker
- Edited by S. R. Pandi-Perumal, Milton Kramer, University of Illinois, Chicago
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- Book:
- Sleep and Mental Illness
- Published online:
- 05 July 2011
- Print publication:
- 01 April 2010, pp ix-xiii
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