Outpatient Antibiotic Prescribing in Massachusetts, 2011-2015.

BACKGROUND: The objectives of this study were to develop methods to measure population-based outpatient antibiotic prescribing in Massachusetts and to describe the findings as a first step toward institution of ongoing surveillance. METHODS: We analyzed outpatient prescription claims from the Massachusetts All-Payers Claims Database from 2011 to 2015. We grouped claims for antibiotics according to the World Health Organization's Anatomical Therapeutic Chemical Classification System using the National Library of Medicine's RXNorm database. We grouped prescribers into 17 specialties. Antibiotic use rates were calculated, and simple frequencies were used to describe patterns. RESULTS: The overall annual rate of outpatient antibiotic use for individuals aged 0-64 years was 696 prescriptions per 1000 people. During 2015, 68% of people in Massachusetts had no antibiotic prescription, and 17% had only 1 prescription. There was dramatic variability in antibiotic use rates by census tract within the state (rates of penicillin use ranged from 31 to 265 prescriptions per 1000 people, macrolides from 28 to 333, cephalosporins from 8 to 89, quinolones from 13 to 118). Antibiotic use rates were generally lower in urban census tracts. From 2011 to 2015, there was a 17% decline in antibiotic prescribing, with the greatest decline for macrolides (28%). CONCLUSIONS: There was variability in antibiotic prescribing within Massachusetts by age, sex, and antibiotic class. Variation in antibiotic use across census tracts within the state was similar to the variation in use across US states. Continued measurement and detailed local population rates of antibiotic use in Massachusetts will provide feedback for local prescribers.

Using public health surveillance data to measure Clostridium difficile infection population burden in Massachusetts.

Clostridium difficile occurs both inside and outside of health care facilities, but surveillance has been traditionally limited to the hospital setting. To measure the population-based burden of C difficile infection (CDI), we used multiple routine sources of data. We found an overall rate of CDI in Massachusetts in 2016 of 132.5 per 100,000 population, with mortality in 2014 of 6.4 per 100,000 population. Population-based measurement of CDI burden appears feasible without conducting a special study.

Transfusion-transmitted babesiosis: one state's experience.

BACKGROUND: The risk for tickborne exposure to Babesia microti infection exists statewide in Massachusetts. Broad exposure complicates investigations of transfusion-transmitted babesiosis (TTB). We summarize 8 years of the epidemiology of TTB and highlight the role of public health in prevention and control. STUDY DESIGN AND METHODS: Cases of babesiosis are routinely reported to the Massachusetts Department of Public Health. These are investigated to determine whether they meet the surveillance case definition and to identify whether they were potentially transfusion transmitted. Frequencies from 2009 to 2016 are described and incidence rates calculated using population denominators from the US census. Changes over time were analyzed using simple linear regression. RESULTS: From 2009 to 2016, there were 2578 cases of babesiosis reported; of these, 45 (1.7%) were transfusion transmitted. Of the 45 cases of TTB, 15 (33%) received blood products from two or more suppliers. In 11 TTB cases, the Department of Public Health was notified first, who in turn notified the appropriate blood provider. In 2009, the crude rate of reported babesiosis was 1.2 per 100,000 population and increased significantly through 2016 to 7.8 per 100,000 population (p = 0.006). The number of blood donors reported with laboratory evidence of B. microti infection increased from 19 in 2012 to 78 in 2016; at the same time, the number of TTB cases decreased from six to three. CONCLUSION: TTB remains a major challenge, and blood donor screening strategies are currently in the process of implementation. While population and environmental changes facilitate increases in babesiosis, donor screening has the potential to eliminate TTB.

Economic Disparities and Syphilis Incidence in Massachusetts, 2001-2013.

OBJECTIVES: We used area-level indicators of poverty to describe economic disparities in the incidence rate of infectious syphilis in Massachusetts to (1) determine whether methods developed in earlier AIDS analyses in Massachusetts could be applied to syphilis and (2) characterize syphilis trends during a time of increased rates of syphilis incidence. METHODS: Using census tract data and population counts from the US Census Bureau and Massachusetts data on syphilis, we analyzed the incidence rate of syphilis infection from 2001 to 2013 by the poverty level of the census tract in which people with syphilis resided, stratified by age, sex, and race/ethnicity. RESULTS: The syphilis incidence rate increased in all census tract groups in Massachusetts from 2001 to 2013, and disparities in incidence rates by area poverty level persisted over time. The overall incidence rate of syphilis increased 6.9-fold from 2001 to 2013 in all census tract poverty-level groupings (from 1.5 to 10.3 per 100 000 population), but the rise in rate was especially high in the poorest census tracts (from 5.6 to 31.0 per 100 000 population) and among men (from 2.2 to 19.4 per 100 000 population). The highest syphilis incidence rate was among non-Hispanic black people. The largest changes in incidence rate occurred after 2010. One region had a disproportionate increase in incidence rates and a disproportionate impact on the statewide trend. CONCLUSIONS: Census tract poverty analyses can inform the targeting of interventions that make progress toward reducing disparities in rates of syphilis incidence possible.

Animal rabies in Massachusetts, 1985-2006.

In this study, we review annual rabies data from Massachusetts from 1985 to 2006, spanning the introduction of raccoon strain rabies in 1992. Of 52,034 animals tested, 9.7% (5,049/52,034) were rabid, representing 26 of over 67 species submitted. Bats were the most common rabid animals prior to 1992 (50 of 52), but raccoons (Procyon lotor) became the most common rabies-positive species upon arrival of raccoon strain rabies virus (38.2%, 2,728 of 7,138 tested), followed by striped skunks (Mephitis mephitis, 34.4%, 1,489 of 4,332), bats (5.3%, 427 of 8,053), foxes (red fox, Vulpes vulpes, and gray fox, Urocyon cinereoargenteus, 16.3%, 135 of 827), cats (0.8%, 136 of 18,050), and woodchucks (Marmota monax, 5.7%, 82 of 1,446). Cats were the most frequently tested animal (34.7%). Raccoon strain rabies spread from two foci of introduction with an initial epizootic phase of 4 yr, by which time most of the state was affected. In 1992, there was a transition from enzootic bat rabies, with little spillover to other animals, to terrestrial rabies associated with raccoon strain virus. Although raccoons were most affected by the raccoon strain virus, there was spillover to other species, particularly to skunks. The eastern United States raccoon rabies epizootic led to a marked increase in submissions for rabies testing and the number of positive animals detected; however, bat rabies cases remained at their previous levels. Wild animal rabies presents a significant threat to humans and domestic/companion animals and increased costs related to increased demand for rabies testing, postexposure prophylaxis as well as euthanasia of valuable domestic animals.