Browsing by Subject "influenza"
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Item Flu vaccine delivery best practice analysis for Austin/Travis County Health and Human Services Department(2014-05-06) Valilis, Evangelia; Field, LeanneInfluenza A virus and B virus infect human respiratory systems and may cause death if individuals contract a secondary pneumonia infection. Local health departments (LHDs) across the United States deliver flu vaccines to their community through several traditional and nontraditional delivery methods. The purpose of this project was to investigate flu vaccine delivery methods used by Austin/Travis County Health and Human Services (ATCHHSD) and other LHDs in the US and Texas during the 2011-2012 flu season. Presented here are the research findings of vaccine delivery practices among the 25 LHDs that completed the online questionnaire through Qualtrics, an online survey provider. Many similarities existed between the flu vaccine delivery systems of the 25 LHDs and ACTHHSD; both delivered vaccines through regular LHD clinics, massive flu clinics by appointment, drive-through clinics, strike teams, outreach to at-risk populations and external partnerships. They also primarily partnered with independent school districts and non-profits to deliver vaccines. They promoted their vaccine delivery through radio, television, Facebook and Twitter. The 25 LHDs and ATCHHSD cited well-trained staff as the largest factor for their self-reported rating on efficiency and effectiveness. Many differences between the LHDs and ATCHHSD were found; the majority of the 25 LHDs did not conduct massive flu clinics, however ATCHHSD did. Those that did conduct mass clinics began conducting them in October, rather than September, like ATCHHSD. The 25 LHDs on average vaccinated more people per employee (17) than ATCHHSD (8). On average, a vaccination at a regular clinic from the 25 LHDs cost $36 per flu vaccine, while at ATCHHSD cost it $10. Twenty percent and 25% of LHDs accepted Medicare and Medicaid respectively, while 36% accepted private insurance. ATCHHSD accepted Medicare, Medicaid but no private insurance. Lastly, the throughput time of the 25 LHDs (14 minutes) was on average, lower than ATCHHSD’s (20 minutes).Item School closure response to an influenza epidemic in AISD(2010) van de Geijn, Bryce; Lauren Ancel-MeyersInfluenza epidemics cause costs to society in a number of ways. Work hours are lost directly when infected adults stay home from work and indirectly when infected kids miss school, forcing their parents to miss work. Infections also lead to a number of medical costs as well as costs in the form of deaths. The closing of schools is often used as a method to reduce the spread of epidemics. Closing schools reduces the contacts between kids and therefore reduces the number of infections. In this way the cost of the epidemic can be greatly reduced. However, closing schools is also very costly. When schools are closed, many adults are forced to miss work for child care. An optimal response to an outbreak of influenza minimizes the cost of influenza plus the cost of school closure. Araz et al develops a method of determining optimal school closure based on data for the entire state of Texas. However, the model they use divides the population into just two classes, adults and kids. Transmission is based on one giant pool for the whole state and closing schools means closing every school in the state. However, in practice there may be a spatial element to the epidemic, with certain areas having higher proportions infected. By associating the population with schools, this I allow the closing decision to be made on a school by school basis. This will allow for a more efficient selection of school closure policy.Item Simulating School Closure Policies for Cost Effective Pandemic Decision Making(2012-06) Araz, Ozgur M.; Damien, Paul; Paltiel, David A.; Burke, Sean; van de Geijn, Bryce; Galvani, Alison; Meyers, Lauren A.; Damien, Paul; Burke, Sean; van de Geijn, Bryce; Meyers, Lauren A.Around the globe, school closures were used sporadically to mitigate the 2009 H1N1 influenza pandemic. However, such closures can detrimentally impact economic and social life. Methods: Here, we couple a decision analytic approach with a mathematical model of influenza transmission to estimate the impact of school closures in terms of epidemiological and cost effectiveness. Our method assumes that the transmissibility and the severity of the disease are uncertain, and evaluates several closure and reopening strategies that cover a range of thresholds in school-aged prevalence (SAP) and closure durations. Results: Assuming a willingness to pay per quality adjusted life-year (QALY) threshold equal to the US per capita GDP ($46,000), we found that the cost effectiveness of these strategies is highly dependent on the severity and on a willingness to pay per QALY. For severe pandemics, the preferred strategy couples the earliest closure trigger (0.5% SAP) with the longest duration closure (24 weeks) considered. For milder pandemics, the preferred strategies also involve the earliest closure trigger, but are shorter duration (12 weeks for low transmission rates and variable length for high transmission rates). Conclusions: These findings highlight the importance of obtaining early estimates of pandemic severity and provide guidance to public health decision-makers for effectively tailoring school closures strategies in response to a newly emergent influenza pandemic.Item Simulating school closure policies for cost effective pandemic decision making(BMC Public Health, 2012-06-18) Araz, Ozugr M.; Damien, Paul; Paltiel, David A,; Burke, Sean; van de Geijn, Bryce; Galvani, Alison; Meyers, Lauren AncelBackground: Around the globe, school closures were used sporadically to mitigate the 2009 H1N1 influenza pandemic. However, such closures can detrimentally impact economic and social life. Methods: Here, we couple a decision analytic approach with a mathematical model of influenza transmission to estimate the impact of school closures in terms of epidemiological and cost effectiveness. Our method assumes that the transmissibility and the severity of the disease are uncertain, and evaluates several closure and reopening strategies that cover a range of thresholds in school-aged prevalence (SAP) and closure durations. Results: Assuming a willingness to pay per quality adjusted life-year (QALY) threshold equal to the US per capita GDP ($46,000), we found that the cost effectiveness of these strategies is highly dependent on the severity and on a willingness to pay per QALY. For severe pandemics, the preferred strategy couples the earliest closure trigger (0.5% SAP) with the longest duration closure (24 weeks) considered. For milder pandemics, the preferred strategies also involve the earliest closure trigger, but are shorter duration (12 weeks for low transmission rates and variable length for high transmission rates). Conclusions: These findings highlight the importance of obtaining early estimates of pandemic severity and provide guidance to public health decision-makers for effectively tailoring school closures strategies in response to a newly emergent influenza pandemic.Item Spatial models for pandemic influenza: Extending human movement models across international borders(2014) Maples, Thomas; Eggo, Rosalind; Meyers, Lauren AncelModeling the spread of pandemic influenza can help public health officials decide when and where to concentrate prevention, detection, and intervention efforts. As influenza is transmitted from person to person, models for the spread of influenza and influenza-like viruses require an understanding of human movement and travel patterns. A recent movement model, known as the radiation model, has been shown to accurately predict the movement of people within the contiguous United States. Using commuter data from the 2000 US Census, we identify geographic regions of poor model fit, and demonstrate that this radiation model formulation does not accurately predict cross-border movement to Canada and Mexico. We propose a modified radiation model that takes the borders into account, adjusting the probability that a worker commutes to a foreign country. Our modifications to the radiation model significantly improve its ability to predict international movement from the United States to Canada and Mexico. The modifications particularly improve the fit of the model to commuter data for US counties near international borders. The modified radiation model could be applied to simulate the spread of pandemic influenza in North America.Item Structure of the iSH2 domain of human phosphatidylinositol 3-kinase p85b subunit reveals conformational plasticity in the interhelical turn region(2010-12) Schauder, Curtis; Ma, Li-Chung; Krug, Robert M.; Montelione, Gaetano T.; Guan, Rongjin; Krug, Robert M.Phosphatidylinositol 3-kinase (PI3K) proteins actively trigger signaling pathways leading to cell growth, proliferation and survival. These proteins have multiple isoforms and consist of a catalytic p110 subunit and a regulatory p85 subunit. The iSH2 domain of the p85 beta isoform has been implicated in the binding of nonstructural protein 1 (NS1) of influenza A viruses. Here, the crystal structure of human p85 beta iSH2 determined to 3.3 A resolution is reported. The structure reveals that this domain mainly consists of a coiled-coil motif. Comparison with the published structure of the bovine p85 beta iSH2 domain bound to the influenza A virus nonstructural protein 1 indicates that little or no structural change occurs upon complex formation. By comparing this human p85 beta iSH2 structure with the bovine p85 beta iSH2 domain, which shares 99% sequence identity, and by comparing the multiple conformations observed within the asymmetric unit of the bovine iSH2 structure, it was found that this coiled-coil domain exhibits a certain degree of conformational variability or `plasticity' in the interhelical turn region. It is speculated that this plasticity of p85 beta iSH2 may play a role in regulating its functional and molecular-recognition properties.