Background

The Louisiana Office of Public Health (LAOPH) established a hepatitis C (HCV) Elimination Plan to expand curative HCV treatment to people living with HCV. The core of the plan is a modified-subscription model that allows unrestricted access to direct acting antivirals (DAAs) for people with Medicaid coverage or people incarcerated in Louisiana. This model went into effect July 15, 2019, shortly after the removal of Medicaid restrictions that limited treatment to those with severe liver damage or comorbidities.

Objective

Analyze HCV screening and treatment records between 7/15/2019 and 12/31/2021 to monitor progress of LAOPH’s HCV Elimination Plan.

Methods

Medicaid screening and treatment claims and Department of Corrections (DOC) treatment data are provided monthly to LAOPH, matched to LAOPH HCV surveillance data, and analyzed to track elimination progress.

Results

In this time period, 179,462 Medicaid recipients were screened for HCV, and 8,906 recipients were treated. In DOC, 14,736 people were screened and 1,368 treated. The majority of those treated were male (65%), White (55%), and between 30-59 years old (74%). Of Medicaid recipients, 76% of those treated had no documented opioid use disorder. The majority of Medicaid recipients who started treatment, completed treatment (88%) and had SVR testing done (73%); of those with SVR testing, 89% achieved cure. For people in DOC, majority who started treatment had SVR testing done (95%), and of those, a majority achieved cure (96%).

Conclusion

The analysis of surveillance and Medicaid claims data has been crucial in monitoring the progress of Louisiana’s HCV Elimination Plan.

Clostridioides difficile (C. diff) is among the most common healthcare-associated infections and causes about half million infections in the United States each year. Infection is associated with fecal-oral transmission and prolonged antibiotic use. C. diff is not reportable in Allegheny County, and the burden is poorly described.

Our objective was to examine C. diff-related hospitalizations and deaths in Allegheny County to quantify severe outcomes and assess trends.

Hospitalization data were provided by the Pennsylvania Healthcare Cost Containment Council (PHC4) and death data were accessed from CDC WONDER from 2006-2021. We defined a C. diff-related hospitalization as having an ICD-9 or ICD-10 code for C. diff (00845, A047) as the primary or among the first eight secondary diagnoses. We defined C. diff-related deaths as having an ICD code for C. diff as an underlying or contributing cause.

Total C. diff-related hospitalizations among Allegheny County residents decreased 74% from 3,502 in 2006 (1.7% of hospitalizations) to 912 in 2021 (0.7% of hospitalizations). Total C. diff-related deaths decreased 75% from 118 in 2006 (0.8% of deaths) to 29 in 2021 (0.2% of deaths). The risk of C. diff hospitalization or death was higher in those >65 years compared to those <65 and higher in females than males.

The decrease in severe outcomes of C. diff in Allegheny County since 2006 may be attributable to improved infection control measures in healthcare facilities and antimicrobial stewardship. These measures are recommended for prevention of severe C. diff and its complications.

Group B Streptococcus (GBS) is a leading cause of infant morbidity and mortality in the United States. Routine maternal screening at 36-37 weeks gestation for GBS has been recommended for more than 20 years. Early onset GBS (EO-GBS) infection occurs within the first 7 days of life and can be prevented with intrapartum antibiotics after positive screening. The Georgia Emerging Infections Program (GA EIP) conducts active surveillance for EO-GBS disease. We analyzed Georgia EO-GBS data to describe the epidemiology of the cases and opportunities for improvement.

Epidemiologic and clinical data were collected through medical record review for all Georgia EO-GBS cases identified between 2017-2021. Data were analyzed using Chi-square tests and Student’s T-test on the SAS 9.4 platform.

Georgia had a total of 163 EO-GBS cases reported with a mean gestational age of 35 weeks. Our cases were predominantly male (54%), 40% White and 50% Black. 90% of our cases received prenatal care of at least one visit before delivery (mean=10 visits). GBS screening results were available at delivery for 74% of cases, and 31% of eligible mothers received intrapartum antibiotics.

GBS screening as part of prenatal care and intrapartum antibiotics are critical components of an infant GBS infection prevention strategy. Obstetricians should highlight the importance of screening, particularly for Black mothers as their neonates are more often affected by GBS infection in Georgia. Georgia data show that there are opportunities to improve screening, communication of results, and intrapartum antibiotic treatment among term infants.

Background: Influenza creates an economic burden of around $5 billion each year. Monitoring travel is a possible preventative measure to decrease this burden. However, it is unclear if preventing further importation of cases once transmission is widespread would limit seasonal influenza burden.

Objectives: To determine whether continued importation of influenza cases influences the trajectory of a season.

Methods: Using an agent-based model, we simulated an influenza outbreak in Allegheny County, Pennsylvania. We programmed the model with four scenarios: one importation of fifty flu cases and one importation of fifty flu cases followed by a second importation of ten, fifty, or two hundred more cases after thirty days. We compared the epidemic curves and case numbers for the scenarios with two imports to the scenario with only one to determine whether a second importation caused an increase in the overall outbreak size.

Results: When compared to a scenario with no second import, an additional import of ten cases or of fifty cases caused negligible change (<1%) in total cases. An additional import of 200 cases caused a 3.4% increase overall. The epidemic curves show very little difference between scenarios until two hundred cases are added in a second import, which is unlikely to occur in reality.

Conclusion: Once seasonal influenza transmission is widespread, another importation of a similar influenza type has little to no effect on the season’s trajectory in an agent-based model. Public health efforts mid-season would be better placed in other mitigation measures over travel restrictions or traveler monitoring.