Suchergebnisse

BACKGROUND: Otherwise healthy patients with latent tuberculosis infection (LTBI) have a 10 percent lifetime risk of progression to active TB disease. This risk is higher in recently exposed persons, young children, and the immunocompromised. Treatment of LTBI decreases the risk of progression. However, traditional treatment regimens required either daily isoniazid (INH) for 9 months, with historically poor compliance, or 12-week directly-observed therapy (DOT) with INH and rifapentine (RPT), with improved compliance but challenges of coordinating weekly clinic visits, further complicated if patients must travel a great distance for care and/or miss considerable amounts of time from work or school to attend encounters. METHODS: Our referral area is complicated by congested traffic often resulting in one-way commutes in excess of 2 hours. These travel times would be prohibitive for conducting traditional weekly in-clinic DOT. In an effort to improve access to DOT, we implemented TeleMedicine LTBI DOT within a military pediatric infectious diseases clinic. Local providers were requested to refer patients aged two and older diagnosed with LTBI to our DOT TeleMedicine clinic. All patients without absolute contraindications for receiving INH and/or RPT were offered LTBI treatment via weekly TeleMedicine DOT or daily INH. If the family opted for TeleMedicine DOT, the first visit was performed in person to discuss treatment options, demonstrate use of the TeleMedicine software, and to ensure the patient was able to take the medications. Baseline information about patient travel time to our facility for patients enrolled in the LTBI DOT clinic was determined. RESULTS: To date, seven patients have completed LTBI treatment via TeleMedicine DOT. Average one-way travel time to our facility for patients participating in the TeleMedicine DOT was 72 minutes. Actual time spent in the TeleMedicine DOT encounters was less than 10 minutes. Appointments were arranged to take place outside usual school and work hours so patients ...

BACKGROUND: Influenza vaccination can reduce influenza burden, but questions have arisen about the duration of vaccine protection. While the timing of vaccination varies, annual receipt of influenza vaccine is mandated for active duty military personnel. The goal of this analysis is to determine if influenza vaccine effectiveness decreases over time. A secondary goal of this analysis is to determine if repeated influenza vaccination is associated with risk for influenza. METHODS: Otherwise healthy individuals presenting for treatment of acute respiratory infections at 5 military treatment facilities from 2009 to 2018 were enrolled in the Acute Respiratory Infection Consortium (ARIC) study. Individuals with complete demographics, influenza vaccination in the two years prior to illness, and influenza laboratory results were included in this analysis (n=1,273). Multivariate logistic regression was used to calculate the odds of an influenza diagnosis according to time since influenza vaccination, categorized in 90-day periods. The model also included age, race, month of diagnosis, influenza season, and whether the participant received 4+ influenza vaccinations in the past 5 years. RESULTS: One hundred and ninety-two individuals (15%) had laboratory confirmed influenza (Table 1). Participants were mostly active duty, male, and white. Over half of the participants received 4+ influenza vaccinations in the past 5 years. Participants who were vaccinated 90-179 and 180+ days ago had greater odds of being diagnosed with influenza than did individuals who were vaccinated < 90 days prior to illness onset (Table 2). Participants who were 18-24 years old had lower odds of influenza than individuals in other age groups. Vaccine experience (vaccinated against influenza for at least four of the past five years), race, and ethnicity were not statistically significantly associated with influenza diagnosis. Table 1. Characteristics of individuals included in the analysis of waning influenza vaccine effectiveness in the ARIC ...

BACKGROUND: Viral respiratory infections are a common cause of hospitalization for younger, otherwise-healthy populations. In this study, we describe the epidemiology of influenza-like illness in non-elderly adults within the U.S. Military Health System (MHS) by pathogen and hospitalization status. METHODS: The Acute Respiratory Infection Consortium (ARIC) is a prospective cohort of patients with influenza-like illness within the MHS. Participants between 18 and 65 years of age were identified in outpatient settings between 2012 and 2017, and were excluded if pregnant, if reporting chronic cardiac, respiratory, renal, or neurologic disease, or if on long-term aspirin therapy. Demographics, nasopharyngeal swabs and symptom data were collected; swabs were tested for viral pathogens using a target-enriched multiplex PCR panel (TEM-PCR(TM), Diatherix LLC). Data were analyzed to compare clinical features and risks for hospitalization. RESULTS: 397 participants met inclusion criteria. 34 participants required hospitalization; 363 were outpatients. Median length of hospitalization was 2 days. A virus was identified in 58.4% of outpatients (OP) and 55.9% of inpatients (IP); coronaviruses (63/363), enteroviruses (50/363), and influenza A (73/363) predominated in OP, whereas influenza A predominated among IP (35.3%, 12/34). There were no significant differences between OP and IP in terms of age, gender, ethnicity, or tobacco use. IP were more likely to be obese (BMI ≥30, 43.3% vs. 20.5%, P = 0.004) and less likely to have received influenza vaccination (45.5% vs. 16.9%, P > 0.001). IP with influenza did not report more severe symptoms (chills, cough, sore throat, diarrhea, myalgia, or headache) on enrollment but were more likely to have fever (temperature ≥38.0⁰ C) than OP (92.9 vs. 57.1%, P = 0.014). CONCLUSION: Influenza A is the most frequently identified cause of hospitalization among healthy, non-elderly adults with viral respiratory infection. Although age and tobacco use may be risks for viral acquisition, they ...