Poor adherence to and persistence with biologics in generalized pustular psoriasis: A claim-based study using real-world data from two large US databases.

Background: Generalized pustular psoriasis (GPP) is a rare skin disease characterized by episodes of widespread sterile pustules. Methods: A retrospective cohort study using data from the US IBM MarketScan Commercial and Optum Clinformatics Data Mart databases between October 1, 2015 and March 31, 2020 was performed to describe adherence and persistence to biologics in patients with GPP. Patients were aged ≥18 years with newly diagnosed GPP (International Classification of Diseases code L40.1) and had ≥1 inpatient or ≥2 outpatient claims. Results: Biologics were dispensed to 110 of 502 (22%) and 73 of 528 (14%) patients from MarketScan and Optum databases, respectively. The mean proportion of days covered (PDC) (range) was similar in both databases (MarketScan, 65% [8%-100%]; Optum, 59% [8%-99%]), and good adherence (≥80% PDC) was uncommon (MarketScan, 36%; Optum, 24%). Mean (standard deviation) persistence was similar in both databases (MarketScan, 287 [122] days; Optum, 261 [134] days). In Optum, the mean PDC was similar between age categories; good adherence was more common in patients aged 18 to 64 years (28%) versus ≥65 years (13%). Mean persistence was longer in patients aged 18 to 64 years (267 days) versus ≥65 years (242 days). Conclusions: Overall, adherence and persistence were generally poor and varied according to the biologic class, database, and age. Improving adherence may help improve GPP treatment outcomes.

Factors associated with receiving hepatitis B vaccination among high-risk adults in the United States: an analysis of the National Health Interview Survey, 2000.

BACKGROUND AND OBJECTIVES: Although an effective vaccine against hepatitis B has been licensed in the United States since 1981, and successful childhood vaccination programs have been implemented, hepatitis B virus transmission continues to occur among high-risk adults. In this study, we identified factors associated with receipt of one or more doses of hepatitis B vaccine among adults at high risk for hepatitis B infection. METHODS: We analyzed data from the 2000 National Health Interview Survey of selected adults ages 18-49 years who were at high risk for hepatitis B infection (n=1,036). Multivariable regression analysis was conducted to determine factors independently associated with vaccination. RESULTS: Although more than 80% (n=841) of high-risk adults reported previous visits to a clinician during the past year, only 30% (n=498) of men and 31% (n=538) of women reported having received a single dose of hepatitis B vaccine. Young age (18-29 years), never being married, past blood donation, and past human immunodeficiency virus (HIV) testing were independently associated with receiving vaccination for men. For women, young age (18-29 years) and previous vaccinations were significant factors associated with vaccination receipt. Additionally, having a primary care source (men) and seeing an obstetrician-gynecologist provider in the past year (women) were significantly associated with vaccination. CONCLUSIONS: Hepatitis B vaccination rates for high-risk adults are low, and missed opportunities are frequent. Additional strategies are needed to increase immunization rates of adults at high risk for hepatitis B.

Implementation of non-pharmaceutical interventions by New York City public schools to prevent 2009 influenza A.

INTRODUCTION: Children are important transmitters of influenza in the community and a number of non-pharmaceutical interventions (NPIs), including hand washing and use of hand sanitizer, have been recommended to mitigate the transmission of influenza, but limited information is available regarding schools' ability to implement these NPIs during an influenza outbreak. We evaluated implementation of NPIs during fall 2009 in response to H1N1 pandemic influenza (pH1N1) by New York City (NYC) public schools. METHODS: From January 25 through February 9, 2010, an online survey was sent to all the 1,632 NYC public schools and principals were asked to participate in the survey or to designate a school nurse or other school official with knowledge of school policies and characteristics to do so. RESULTS: Of 1,633 schools, 376(23%) accessed and completed the survey. Nearly all respondents (99%) implemented at least two NPIs. Schools that had a Flu Response Team (FRT) as a part of school emergency preparedness plan were more likely to implement the NPI guidelines recommended by NYC public health officials than schools that did not have a FRT. Designation of a room for isolating ill students, for example, was more common in schools with a FRT (72%) than those without (53%) (p<0.001). CONCLUSIONS: Implementing an NPI program in a large school system to mitigate the effects of an influenza outbreak is feasible, but there is potential need for additional resources in some schools to increase capacity and adherence to all recommendations. Public health influenza-preparedness plans should include school preparedness planning and FRTs.

Use of nonpharmaceutical interventions to reduce transmission of 2009 pandemic influenza A (pH1N1) in Pennsylvania public schools.

BACKGROUND: School-based recommendations for nonpharmaceutical interventions (NPIs) were issued in response to the threat of 2009 pandemic influenza A (pH1N1). The implementation and effectiveness of these recommendations has not been assessed. METHODS: In November 2009, a Web-based survey of all Pennsylvania public schools was conducted to assess the use of recommended NPIs. RESULTS: Overall, 1040 (31%) of 3351 schools participated in the survey. By fall 2009, 820 (84%) of 979 respondents reported that their school had an influenza plan in place, a 44% higher proportion than in the spring 2009 (p < .01). Most schools communicated health messages (eg, staying home when sick), implemented return to school requirements, and made hand sanitizer available. Schools with a spring influenza plan (N = 568) were less likely to report substantial influenza-like illness (ILI) during the fall wave of influenza than the 299 schools without a spring influenza plan (63% vs 71%, p = .02). This association persisted after controlling for schools with substantial ILI in the spring. CONCLUSION: The reported use of NPIs in participating Pennsylvania public schools improved substantially from spring to fall and was generally consistent with issued recommendations. The proactive implementation of a number of NPIs and the early implementation of communication and education initiatives might have cumulatively reduced the impact of pH1N1 in some schools.

Response to 2009 pandemic influenza A H1N1 among public schools of Georgia, United States--fall 2009.

BACKGROUND: Little is known about the extent of implementation or the effectiveness of the Centers for Disease Control and Prevention's (CDC) recommended non-pharmaceutical interventions (NPIs) in schools to control the spread of 2009 pandemic influenza A H1N1 (pH1N1). METHODS: A web-based, cross-sectional survey of all public K-12 schools in Georgia, USA was conducted about preparedness and response to pH1N1, and absenteeism and respiratory illness. Schools that reported ≥10% absenteeism and at least two times the normal level of respiratory illness in the same week were designated as having experienced significant respiratory illness and absenteeism (SRIA) during that week. RESULTS: Of 2248 schools surveyed, 704 (31.3%) provided sufficient data to include in our analysis. Participating schools were spread throughout Georgia, USA and were similar to non-participating schools. Of 704 schools, 160 (22.7%) reported at least 1 week of SRIA. Most schools reported implementing the CDC recommendations for the control of pH1N1, and only two schools reported canceling or postponing activities. Schools that communicated with parents about influenza in the summer, had shorter school days, and were located in urban areas were less likely to experience SRIA. CONCLUSIONS: Most Georgia schools in the United States adopted the CDC recommendations for pH1N1 mitigation and few disruptions of school activities were reported. Early and timely communication with parents, as well as shorter school days, may have been effective in limiting the effect of pH1N1 on schools.