ABSTRACT
INTRODUCTION: Previous FluSurv-NET studies found that adult females had a higher incidence of influenza-associated hospitalizations than males. To identify groups of women at higher risk than men, we analyzed data from 14 FluSurv-NET sites that conducted population-based surveillance for laboratory-confirmed influenza-associated hospitalizations among residents of 78 US counties. METHODS: We analyzed 6292 laboratory-confirmed, geocodable (96%) adult cases collected by FluSurv-NET during the 2010-12 influenza seasons. We used 2010 US Census and 2008-2012 American Community Survey data to calculate overall age-adjusted and age group-specific female:male incidence rate ratios (IRR) by race/ethnicity and census tract-level poverty. We used national 2010 pregnancy rates to estimate denominators for pregnant women aged 18-49. We calculated male:female IRRs excluding them and IRRs for pregnant:non-pregnant women. RESULTS: Overall, 55% of laboratory-confirmed influenza cases were female. Female:male IRRs were highest for females aged 18-49 of high neighborhood poverty (IRR 1.50, 95% CI 1.30-1.74) and of Hispanic ethnicity (IRR 1.70, 95% CI 1.34-2.17). These differences disappeared after excluding pregnant women. Overall, 26% of 1083 hospitalized females aged 18-49 were pregnant. Pregnant adult females were more likely to have influenza-associated hospitalizations than their non-pregnant counterparts (relative risk [RR] 5.86, 95% CI 5.12-6.71), but vaccination levels were similar (25.5% vs 27.8%). CONCLUSIONS: Overall rates of influenza-associated hospitalization were not significantly different for men and women after excluding pregnant women. Among women aged 18-49, pregnancy increased the risk of influenza-associated hospitalization sixfold but did not increase the likelihood of vaccination. Improving vaccination rates in pregnant women should be an influenza vaccination priority.
Subject(s)
Influenza, Human/complications , Influenza, Human/epidemiology , Population Surveillance , Pregnancy Complications, Infectious/epidemiology , Adult , Aged , Aged, 80 and over , Censuses , Ethnicity , Female , Hospitalization/statistics & numerical data , Humans , Incidence , Influenza, Human/diagnosis , Influenza, Human/virology , Male , Middle Aged , Pregnancy , Pregnancy Complications, Infectious/virology , Pregnant Women , Sex Factors , United States/epidemiologyABSTRACT
(See the Editorial Commentary by Martin on pages 368-9.)Using population-based surveillance data, we analyzed antiviral treatment among hospitalized patients with laboratory-confirmed influenza. Treatment increased after the influenza A(H1N1) 2009 pandemic from 72% in 2010-2011 to 89% in 2014-2015 (P < .001). Overall, treatment was higher in adults (86%) than in children (72%); only 56% of cases received antivirals on the day of admission.
Subject(s)
Antiviral Agents/therapeutic use , Influenza A Virus, H1N1 Subtype , Influenza, Human/drug therapy , Influenza, Human/epidemiology , Oseltamivir/therapeutic use , Adolescent , Adult , Aged , Child , Child, Preschool , Cohort Studies , Female , Humans , Infant , Infant, Newborn , Length of Stay , Longitudinal Studies , Male , Middle Aged , Pandemics , Prospective Studies , Retrospective Studies , Seasons , United States/epidemiology , Young AdultSubject(s)
Chikungunya Fever/epidemiology , Travel , Adolescent , Adult , Child , Child, Preschool , Female , Humans , Infant , Infant, Newborn , Male , Middle Aged , Rhode Island/epidemiology , Young AdultABSTRACT
During a pneumococcal disease outbreak in a pediatric psychiatric unit in a hospital in Rhode Island, USA, 6 (30%) of 20 patients and staff were colonized with Streptococcus pneumoniae serotype 15A, which is not included in pneumococcal vaccines. The outbreak subsided after implementation of antimicrobial drug prophylaxis and enhanced infection control measures.
Subject(s)
Cross Infection/epidemiology , Disease Outbreaks , Hospital Units , Pneumococcal Infections/epidemiology , Streptococcus pneumoniae/classification , Humans , Microbial Sensitivity Tests , Rhode Island/epidemiology , Risk Factors , Serotyping , Streptococcus pneumoniae/drug effects , Streptococcus pneumoniae/geneticsABSTRACT
PURPOSE: To determine the maximum tolerated dose (MTD) of raltitrexed when given with irinotecan and to evaluate the pharmacokinetics of these two agents when given in combination. METHODS: Patients with advanced solid tumors received irinotecan intravenously over 90 min on days 1 and 8 of each 21-day cycle, with raltitrexed given intravenously over 15 min after irinotecan either on day 1 (cohorts 1-7) or day 2 (cohorts 8-9). The 39 patients received irinotecan and raltitrexed in cohorts of three to six patients at the following dose levels (mg/m(2)): 100/1.0, 100/1.5, 100/2.0, 100/2.5, 100/3.0, 100/3.5, 125/3.0, 75/3.0, 100/3.0. Pharmacologic monitoring of irinotecan and raltitrexed was carried out during cycle 1. RESULTS: A total of 39 patients received irinotecan and raltitrexed in cohorts of three to six patients at nine dose levels. The MTD with dosing of irinotecan on days 1 and 8 and raltitrexed on day 1 was 100 mg/m(2) and 3.0 mg/m(2), respectively, every 21 days, with dose-limiting toxicities (DLTs) of fatigue, neutropenia and diarrhea. When raltitrexed was administered 24 h after irinotecan, these doses exceeded the MTD. No pharmacologic interactions were observed between these agents, and no correlations between pharmacokinetic parameters and toxicity were noted. Of 26 patients with colorectal cancer, 6 had objective partial responses (23%). Four of these patients had previously received a 5-FU-based regimen, two for metastatic disease. CONCLUSIONS: Irinotecan can be safely administered with raltitrexed on a day-1 and day-8 schedule at 100 mg/m(2) and 3.0 mg/m(2), respectively, every 21 days. When raltitrexed was given on day 2, these doses were not tolerated, necessitating a dose reduction of the irinotecan to 75 mg/m(2). This regimen possesses clinical activity in patients with colorectal cancer.
