Using multiple sources to improve and measure case ascertainment in surveillance studies: 20 years of the British Paediatric Surveillance Unit

BACKGROUND: The British Paediatric Surveillance Unit (BPSU) was established in 1986 to facilitate national surveillance of uncommon paediatric disorders. This study investigated the effectiveness of using multiple source reporting and capture-recapture analysis to maximize case ascertainment in studies undertaken through the BPSU. METHODS: Structured review of all surveillance studies completed through the BPSU. Quantitative and qualitative analysis of the effectiveness of multiple reporting sources and capture-recapture methods was made. RESULTS: Of 71 studies undertaken through the BPSU, 59 were included in this review and 38 used additional data sources. Established national sources were most readily adapted for use as secondary data sources, including routine health data, communicable disease and specialty-specific surveillance units, whilst the involvement of parent groups and the media was less successful. Six studies employed capture-recapture techniques to estimate the completeness of case ascertainment. CONCLUSIONS: Active surveillance through the BPSU remains a timely and reliable primary source of cases, but employing additional reporting sources is effective in enhancing case ascertainment. When the assumptions for its valid use are met, capture-recapture analysis allows the estimation of completeness of ascertainment. It is essential to define the purpose of an additional source at the outset of a study and to ensure that subsequent analysis is appropriate.     

Costs of surviving meningococcal disease in Spain: Evaluation for two cases of severe meningitis and septicaemia

Objectives

The aim of this study was to count the lifelong rehabilitation costs associated with surviving meningococcal disease with major sequelae from the perspective of the Spanish National Healthcare System (NHS) and the national government.

Methods

Two severe scenarios describing meningococcal disease were developed, one case that represented meningococcal septicaemia and another case for meningococcal meningitis. The scenarios were developed based on a literature review on severe sequelae of meningococcal disease, and discussions with paediatricians who have been responsible for the treatment of children with this disease in Spain. Second, a detailed list of all health, educational and social care resources used by survivors during their acute illness and during the rest of their lives and by family members was obtained by interviewing survivors and their families. Professionals in health and social care were also interviewed to complete the list of resources and ensure the scenario's were accurate. The costs attributed to these resources were obtained from tariff lists, catalogues and published information by the national authorities. All costs were based on a life expectancy of a survivor of 70 years and expressed in EUR 2012.

Results

In this study it was estimated that the lifelong discounted rehabilitation costs associated with the treatment of long-term sequelae due to meningococcal disease are approximately €1180,000–€1400,000. Medical care and social care were the main cost drivers for both septicaemia and meningitis. Annual costs showed to be the largest in the first year after diagnosis of the disease for both cases, due to high hospital admission and medical care costs during this period and decreased significantly over the years.

Conclusion

This study shows that the lifelong rehabilitation costs associated with the survival of meningococcal disease with severe sequelae place an important burden on the NHS budget and governmental resources in Spain.     

The Americanization of the British National Health Service: A typological approach

There have been many different claims that the British National Health Service (NHS) is becoming ‘Americanized’. Focusing on the United Kingdom, this article critically analyses the “Americanization” of the NHS in three main sections. First, we explore the basic meanings of the term. Second, we examine the development of the discourse about Americanization. Third, we focus on one of many possible meanings of Americanization, namely system change. Focusing on this most demanding dimension of Americanization, we suggest that most changes have been ‘internal changes of levels’ (where there is a shift of levels in one or more dimensions but without changing the dominant form) or ‘internal system changes’ (where only one dimension changes its dominant form) rather than a ‘system change’ (from one ideal type to another).     

National hospital data for intussusception: Data linkage and retrospective analysis to assess quality and use in vaccine safety surveillance

ObjectivesTo assess the quality of national Hospital Episode Statistics (HES) data for intussusception, and evaluate this routinely collected database for rotavirus vaccine safety surveillance by estimating pre-vaccination trends in intussusception hospitalisation.MethodsData linkage was performed between HES and prospective intussusception data from the British Paediatric Surveillance Unit (BPSU), followed by capture–recapture analysis to verify HES data quality. Inclusion criteria were infants aged less than 12 months and admitted for intussusception to National Health Service (NHS) hospitals in England from March 2008 to March 2009. To estimate pre-vaccination incidence rates of intussusception, we performed a retrospective analysis of HES data. Infants aged less than 12 months and admitted for intussusception to NHS hospitals in England between 1995 and 2009 were included.ResultsData linkage between 254 cases of intussusception identified in HES data and 190 cases reported via the BPSU resulted in 163 cases common to both data sources. Of remaining 91 cases in HES, 37 had confirmed intussusception. HES data accuracy was 78.7% (200 confirmed/254 cases) and completeness for intussusception was 86% (163 matched/190 BPSU cases) compared to 81.5% (163 matched/200 HES cases) for BPSU. A total of 233 (95% CI: 227.4 to 238.8) intussusception cases were estimated for the infant population (2008 to 2009). For retrospective analysis, of 6462 intussusception admissions in HES data (1995 to 2009), 1594 (24.7%) were duplicate admissions. A declining trend in intussusception incidence was observed in the infant population, from 86/100,000 in 1997 to 34/100,000 in 2009 (60% reduction, P < 0.001). Cosinor modelling showed an excess of cases among infants in winter and spring (P < 0.001, n = 4957, 1995 to 2009).ConclusionNational hospital data capture the majority of admissions for intussusception and should be considered for the post-implementation surveillance of rotavirus vaccine safety in England.     

Choice of contracts in the British National Health Service: an empirical study

Following major reforms of the British National Health Service (NHS) in 1990, the roles of purchasing and providing health services were separated, with the relationship between purchasers and providers governed by contracts. Using a mixed multinomial logit analysis, we show how this policy shift led to a selection of contracts that is consistent with the predictions of a simple model, based on contract theory, in which the characteristics of the health services being purchased and of the contracting parties influence the choice of contract form. The paper thus provides evidence in support of the practical relevance of theory in understanding health care market reform.     

Highland Guatemalan women are extremely short of stature,and no lactation duration effects on body composition are observed in a cross-sectional survey

Early linear growth in Guatemala has historically been compromised, resulting in adults of short stature. We hypothesized that the rate of short stature among mothers in the Western Highlands would have tracked from their own childhood when younger than 5 years, and that maternal weight declines progressively from delivery through lactation. Maternal weight and height were collected in 542 lactating mothers of infant and toddlers, ranging in age from 15 to 48 years, with subsequent classification of mothers for short stature (relative to the 1977 World Health Organization/National Center for Health Statistics growth curves) and for underweight (body mass index [BMI], <18.5 kg/m²), overweight (BMI, 25-30 kg/m²), or obesity (BMI, ≥30 kg/m²). The mean stature for the sample of adult women was 149.3 ± 5.9 cm, with a median of 149.0 cm. Women classified of Mayan descent were significantly (P < .001) shorter (147.0 ± 5.1 cm) than others (150.5 ± 6.0 cm). In terms of height percentiles for the age-specific female reference, 410 (76%) of mothers were below the fifth percentile and only 8 (1.5%) reached the median. Respective partition for underweight, normal weight, overweight, and obesity was as follows: 5%, 50%, 36%, and 9%. Variation in BMI with respect to the age of the offspring as the indicator of the duration of lactation was not significant, by analysis of variance or correlation analysis. Insofar as short stature is a risk factor for a series of adverse health consequences, including obesity and obstructed labor at childbirth, among others, it is time to direct public health attention toward resolving the causal factors for short stature in Guatemala.     

Accounting for failure: risk-based regulation and the problems of ensuring healthcare quality in the NHS

In this paper, we examine why risk-based policy instruments have failed to improve the proportionality, effectiveness, and legitimacy of healthcare quality regulation in the National Health Service (NHS) in England. Rather than trying to prevent all possible harms, risk-based approaches promise to rationalise and manage the inevitable limits of what regulation can hope to achieve by focusing regulatory standard-setting and enforcement activity on the highest priority risks, as determined through formal assessments of their probability and consequences. As such, risk-based approaches have been enthusiastically adopted by healthcare quality regulators over the last decade. However, by drawing on historical policy analysis and in-depth interviews with 15 high-level UK informants in 2013–2015, we identify a series of practical problems in using risk-based policy instruments for defining, assessing, and ensuring compliance with healthcare quality standards. Based on our analysis, we go on to consider why, despite a succession of failures, healthcare regulators remain committed to developing and using risk-based approaches. We conclude by identifying several preconditions for successful risk-based regulation: goals must be clear and trade-offs between them amenable to agreement; regulators must be able to reliably assess the probability and consequences of adverse outcomes; regulators must have a range of enforcement tools that can be deployed in proportion to risk; and there must be political tolerance for adverse outcomes.     

Human papillomavirus vaccine coverage in the United States, National Health and Nutrition Examination Survey, 2007-2008

Objectives

This study aims to estimate human papillomavirus (HPV) vaccine coverage by demographic and sexual behavior characteristics 1-2 years after vaccine licensure in a nationally representative sample of females aged 9-59 years in the United States.

Methods

In 2007-2008, a total of 2775 females aged 9-59 years responded to questions on HPV vaccine receipt in the National Health and Nutrition Examination Survey (NHANES). Demographic and sexual characteristics were evaluated for select age categories in bivariate analyses after adjusting for survey design.

Results

Overall, 15.2% of females aged 11-26 years reported HPV vaccine initiation; vaccine initiation varied significantly by age. We found no significant difference in vaccine initiation by race or poverty level in either 11-18 or 19-26-year olds. Significantly more 19-26-year olds with private insurance initiated vaccine (16.3%) than those with public insurance (4.0%) (p = 0.04). Among females aged 14-18 years, vaccine initiation was higher in those who ever had sex (28.6%) compared to those who had never had sex (17.8%) (p = 0.05).

Conclusions

These results describe HPV vaccine initiation shortly after vaccine licensure. Vaccine initiation was highest in females aged 14-18 years. Efforts should be made to increase HPV vaccine coverage for the recommended age groups.     

山西省阳城县居民两周患病影响因素分析

目的了解山西省阳城县居民两周患病状况及其影响因素,为居民健康服务需求提供参考。方法 2008年国家卫生服务调查该地区5个乡镇、10个行政村、600余户,共1 814名居民第4次家庭健康询问调查资料,进行多因素logistic回归分析。结果山西省阳城县居民两周患病率14.36%,女性高于男性;前5位两周患病率以循环系统、呼吸系统、消化系统、运动系统、肿瘤等居高,分别为5.82%、2.27%、1.88%、1.72%、0.44%。影响两周患病的因素主要有居民婚姻状况、文化程度、家庭年收入及贫困等社会因素,高血压患病、注意健康体检等是影响两周患病的卫生服务因素,其OR值分别是非高血压患者和不注意体检居民的5.328和1.799倍。结论山西省阳城县家庭健康询问调查两周患病率低于全国患病水平,两周患病的因素不仅与家庭年收入等社会因素有关,而且健康体检等医疗服务等也是不可忽视的因素。     

Evaluation of the impact of 13-valent pneumococcal conjugate vaccine immunization in children by surveillance of culture-confirmed pneumococcal disease: A prospective clinical microbiological study

The study aimed to investigate the impact of 13-valent pneumococcal conjugate vaccine (PCV13) immunization on the overall pneumococcal disease in children in Taiwan by surveillance of culture-confirmed pneumococcal disease (CCPD). This study was conducted in a medical center from 2012 to 2016. Clinical isolates of Streptococcus pneumoniae were prospectively collected from pediatric patients. Serotyping, multi-locus sequence typing, and antimicrobial susceptibility testing were performed. A total of 473 patients with CCPD, including 58 with invasive pneumococcal disease (IPD), were identified. The incidence of CCPD per 10,000 admissions decreased from 71.7 in 2012 to 27.0 in 2016. The proportion of additional PCV13 serotypes significantly decreased from 52.0% in 2012 to 21.7% in 2015 but increased slightly to 26.7% because of serotype 19A in 2016 (P < 0.0001). The proportion of non-vaccine serotypes (NVTs) increased significantly from 18.4% in 2012 to 66.7% in 2016, but the increase of the incidence of CCPD caused by NVTs was not considered significant (P = 0.0885). Genotyping identified predominant clones, ST63^15A, ST83^15B, and ST166/338^23A, for major NVTs. The penicillin non-susceptibility of PCV13 serotypes was significantly higher than that of NVTs (P < 0.0001). Surveillance of CCPD appears superior to IPD alone for evaluation of the overall impact of pneumococcal immunization. Serotype replacement occurred quickly after the use of PCV13, while the incidence of NVT infection did not show a significant increase in children over the years. The gradual introduction of PCV13 into national immunization program is effective in reducing overall pneumococcal disease in children.     

Regional assemblage and the spatial reorganisation of health and care: the case of devolution in Greater Manchester,England

In this paper, we examine how space is integral to the practices and politics of restructuring health and care systems and services and specifically how ideas of assemblage can help understand the remaking of a region. We illustrate our arguments by focusing on health and social care devolution in Greater Manchester, England. Emphasising the open‐ended political construction of the region, we consider the work of assembling different actors, organisations, policies and resources into a new territorial formation that provisionally holds together without becoming a fixed totality. We highlight how the governing of health and care is shaped through the interplay of local, regional and national actors and organisations coexisting, jostling and forging uneasy alliances. Our goal is to show that national agendas continued to be firmly embedded within the regional project, not least the politics of austerity. Yet through keeping the region together as if it was an integrated whole and by drawing upon new global policy networks, regional actors strategically reworked national agendas in attempts to leverage and compete for new resources and powers. We set out a research agenda that foregrounds how the political reorganisation of health and care is negotiated and contested across multiple spatial dimensions simultaneously.     

Burden of pertussis among young infants in Malaysia: A hospital-based surveillance study

BackgroundThe case fatality rate and the risk of complications due to pertussis is very high in infants. Asia has the second highest childhood pertussis burden. The study aimed to assess the prevalence, clinical complications, and mortality rates of pertussis disease requiring hospitalization among young infants in Malaysia.MethodsThe study was a one-year, hospital-based, multi-site surveillance of infants less than six months of age with symptoms consistent with pertussis and a cross-sectional analysis of their mothers for recent pertussis infection. Information was obtained from medical records and interviews with the parents. Pertussis diagnosis was confirmed for all infants through serum anti-PT titration test or PCR test.Results441 possible cases of pertussis were included in this study. Of these, 12.7 % had laboratory confirmation of pertussis. Infants with confirmed pertussis had significantly higher rates of cyanosis (37.5 % vs 8.6 %; p < 0.0001) and apnea (12.5 % vs 3.9 %; p = 0.027) than test-negative infants. Most infants from both groups were in recovery/recovered at discharge. Those with confirmed pertussis had higher case fatality rate than test-negative cases (5.4 % vs 1.0 %; p = 0.094), but the difference did not reach significance. The majority of confirmed pertussis cases (89.3 %) occurred in infants too young to be fully vaccinated or under-vaccinated for their age. Both test-negative and confirmed pertussis resulted in work-day losses and incurred costs for both parents.ConclusionsA high pertussis disease burden persists in infants less than six months of age, especially among those un- and under-vaccinated. Maternal and complete, on-time infant vaccination is important to reduce disease burden.     

Vitamin E,vitamin A,and zinc status are not related to serologic response to influenza vaccine in older adults: an observational prospective cohort study

It has been hypothesized that micronutrient levels play a role in the immune response to vaccination; however, population-level research on the association between micronutrient levels and immune response to influenza vaccination is needed. In this study, we hypothesized that decreasing levels of nutrients would be associated with decreased hemagglutination inhibition (HAI) responses to influenza vaccination. Therefore, the purpose of this study was to determine whether serum vitamin A, vitamin E, or zinc levels are associated with influenza vaccine response determined by HAI titer in adults 65 years or older. Participants in this study included 205 community-dwelling adults 65 years or older who resided in Marshfield, WI, USA, from fall 2008 through spring 2009. Participants received trivalent influenza vaccine and donated blood samples before and 21 to 28 days after vaccination. Prevaccination levels of serum retinol, α-tocopherol, and zinc as well as prevaccination and postvaccination HAI titer levels were measured. No participants were vitamin A or vitamin E deficient; 20% had low serum zinc levels (<70 μg/dL). Continuous variables and categorical quartiles coding for vitamin A, vitamin E, and zinc levels were not related to prevaccination or postvaccination seroprotection or seroconversion for any of the vaccine components (influenza A [H1N1], A [H3N2], or B), after adjusting for age, sex, body mass index, and prevaccination HAI geometric mean titer. In conclusion, our study population showed no association between variations in levels of serum vitamin A, vitamin E, or zinc and influenza vaccine response as measured by HAI in adults older than 65 years. Thus, associations between micronutrients and other measures of vaccine response, such as cell-mediated immune parameters, should also be explored.     

“健康扶贫”——西藏食品放射性污染风险监测及个人剂量监测调查与分析

为精准实施“健康扶贫”“脱贫攻坚”工作任务、完善对口扶贫工作机制、提高贫困地区疾控工作能力、使个人剂量监测与食品放射性污染风险监测工作达到全国覆盖,依据党中央、国务院脱贫攻坚决策部署,落实精准扶贫精准脱贫基本方略,中国疾病预防控制中心辐射防护与核安全医学所从2012年对西藏开展“健康扶贫”工作,针对西藏地区职业人员的个人剂量监测及食品放射性污染风险监测工作进行了重点指导和帮扶。截至2021年4月,共援助西藏自治区开展了13个季度的免费个人剂量监测、2次培训指导和1次现场教学等工作。在食品放射性污染风险监测方面连续5年为西藏自治区进行了3次现场培训指导、60份食品样品的放射性核素检测与分析等工作。此项工作弥补了西藏在全区放射卫生监测领域的空白,显著提高了西藏自治区疾控工作能力,对西藏放射卫生事业发展和保障放射工作人员健康具有重要意义。     

Total dietary fiber intakes in the US population are related to whole grain consumption: results from the National Health and Nutrition Examination Survey 2009 to 2010

Whole grain (WG) foods have been shown to reduce chronic disease risk and overweight. Total dietary fiber is associated with WG and its health benefits. The purpose was to determine whether associations exist between WG intake (no-WG intake, 0 ounce equivalent [oz eq]; low, >0-<3 oz eq; high, ≥3 oz eq) and total dietary fiber intake among Americans 2 years and older. One-day food intake data from the US National Health and Nutrition Examination Survey 2009 to 2010 (n = 9042) showed that only 2.9% and 7.7% of children/adolescents (2-18 years) and adults (≥19 years) consumed at least 3 WG oz eq/d, respectively. For children/adolescents and adults, individuals in the high WG intake group were 59 and 76 times more likely to fall in the third fiber tertile, respectively, compared with those with no-WG intake. Total dietary fiber intake from food sources varied by WG intake group for children/adolescents and adults with more total dietary fiber consumed from ready-to-eat (RTE) and hot cereals and yeast breads/rolls in the high WG intake group compared with the no-WG intake group. Major WG sources for children/adolescents and adults included yeast bread/rolls (24% and 27%, respectively), RTE cereals (25% and 20%, respectively), and oatmeal (12% and 21%, respectively). Among those with the highest WG intake, WG RTE cereal with no added bran was the greatest contributor to total dietary fiber compared with other RTE cereal types. Whole grain foods make a substantial contribution to total dietary fiber intake and should be promoted to meet recommendations.     

英国NICE卫生技术评估流程的决策转化机制及启示

通过对英国国家健康与临床优化研究院(NICE)从2000年到2020年20年间针对卫生技术的评估方法、评估流程及评估结果及转化推广情况等进行详细梳理介绍.从加快建立我国独立的卫生技术评估机构、多元化HTA评估方法、完善评估主题遴选流程、建立健全评估委员会制度、评估流程的进一步优化、确保卫生技术评估证据来源的同步性和协调性等方面,为我国卫生技术的发展和进一步完善提供参考和借鉴.     

A retrospective survey of the safety of trivalent influenza vaccine among adults working in healthcare settings in south metropolitan Perth, Western Australia, in 2010

In Australia, annual vaccination with trivalent influenza vaccine (TIV) is recommended for healthcare providers. Each year, an influenza vaccination program is run in south metropolitan area hospitals in Perth, Western Australia. In 2010, a survey to examine side effects following vaccination and subsequent significant respiratory illnesses during the influenza season was undertaken. A total of 2245 individuals vaccinated in the area-wide hospital vaccination program responded, representing 50% of consenting recipients. Data linkage was performed to ascertain additional information such as brand details. Side effects within 48 h of receipt of the influenza vaccine were reported by 387 (17.2%). Only 30 respondents (1.3%) had to seek health advice following a side effect temporally related to influenza vaccination and 10 (0.4%) required treatment. Recipients who received Fluvax^® (364, 18.0%; CSL Biotherapies) were more likely to report side effects than those who received another brand (23, 10.2%; OR 1.94, 95% CI 1.24–3.03, P = 0.004). The difference in the side effect profiles was largely confined to systemic effects. Most respondents (1621, 72.2%) did not require time off work for a respiratory illness during the subsequent influenza season. Overall, the influenza vaccine was demonstrated to be safe among this large sample of predominantly healthcare workers. A higher rate of adverse events, albeit primarily mild, was reported among recipients of Fluvax^® in 2010.     

A prospective observational safety study on MF59 adjuvanted cell culture-derived vaccine,Celtura during the A/H1N1 (2009) influenza pandemic

Background

The present study was a prospective observational study to evaluate the safety profile of Celtura^®, a monovalent, cell culture-derived, inactivated subunit influenza vaccine prepared from A/California/07/2009(H1N1) with the adjuvant MF59^®. Subjects were enrolled prospectively during the H1N1 2009 influenza pandemic at medical centres in Colombia, Chile, Switzerland, and Germany during the period December 2009 to June 2010.

Methods

Subjects ages 18 and older were followed for the occurrence of adverse events (AEs) for six months after vaccination. Adverse events of special interest (AESIs) were neuritis, convulsion (seizure), anaphylaxis, encephalitis, vasculitis, Guillain-Barre syndrome, demyelinating conditions, Bell's palsy, and laboratory-confirmed vaccination failure.

Results

Overall, 7348 AEs were reported in 2296 of 3989 enrolled subjects (57.6%). Only two AEs were considered related to injection site reactions. No laboratory-confirmed cases of influenza were reported. There were 108 medically confirmed serious adverse events (SAEs) reported among 73 subjects with 6 such SAEs described as possibly or probably related to vaccination. Three fatal cases were reported and assessed as not related to vaccination. Two AESIs classified as convulsion were reported and assessed as not related to vaccination. Both AESIs occurred well outside the pre-specified 7 day risk window representing the likely timeframe of the occurrence of seizure following vaccination.

Conclusions

The results of this study support the overall good safety profile of MF59 adjuvanted cell culture-derived influenza vaccine as administered in adults during the 2009–2010 H1N1 influenza pandemic. No concern is raised regarding the occurrence of AESIs.