Flu vaccine effectiveness in those hospitalized in a large diverse health system

 说明(申请人提供)：老年人是流感住院和死亡的主要患者，是确定流感疫苗有效性(VE)的优先对象。大学。匹兹堡大学和UPMC医疗系统(UPMC)位于阿勒格尼县(AC)，那里是可报告流感的地区，拥有美国最老的五个人口之一。我们提议在两家UPMC医院进行一项流感VE试验阴性病例对照研究，以确定VE与成人住院之间的关系。十多年来，UPMC一直在美国新闻的荣誉榜上，包括“最具连线”，并拥有强大的研究传统。流感季节将根据多家医院急救人员的症状监测来确定，卫生署。(Achd)，&来自UPMC每年进行的14,000个呼吸道病毒检查(RVP)的实验室数据。Theradoc信息学将识别进行过RVP的成年住院患者。参与者的调查数据将直接输入NIH的RedCap。脆弱性可通过调查和/或电子病历(EMR)数据(例如，查尔逊共病指数)进行评估，以评估混杂因素和效果修饰物。我们的数据中心管理RedCap数据、住院EMR数据和免疫接种数据，以便上传到CDC。基于人群的流感住院发病率将根据ACHD和UPMC圣玛格丽特医院的住院数据和匹兹堡超级计算中心的基于代理的建模来确定。我们的团队是这个项目的有力候选者，因为：1)UPMC是占主导地位的地区卫生系统，具有很强的债券评级；2)感染控制人员建议RVP建立诊断，而我们团队在医院的领导职责可以进一步影响RVP的使用；3)我们公布的数据显示，UPMC的Genmark RVP和CDC的PCR在检测流感方面具有极好的一致性；4)研究表明，对老年人更好地保护老年人免受大剂量流感(HD)疫苗的伤害；UPMC推荐和大量推广HD疫苗，尽管有常规疫苗可用，允许进行疫苗类型比较；5)UPMC的EMR将住院患者和门诊患者的疫苗接种记录联系起来，并与国家免疫登记机构联系；6)它包括以前合作过的各种、出版得很好的调查人员。

 DESCRIPTION (provided by applicant): The elderly suffer the majority of influenza hospitalizations and deaths and are a priority for determining influenza vaccine effectiveness (VE). The Univ. of Pittsburgh and UPMC Health System (UPMC) are located in Allegheny County (AC), in which influenza is reportable & which has one of the 5 oldest populations in the U.S. We propose a test-negative case-control study of influenza VE in 2 UPMC hospitals to determine VE against hospitalizations of adults. UPMC has been on the US News honor roll for over a decade, including "most wired" and has a strong research tradition. The influenza season will be determined from syndromic surveillance from multiple hospital EDs, the Health Dept. (ACHD), & from lab data from >14,000 respiratory viral panels (RVP) done annually at UPMC. Theradoc informatics will identify adult inpatients who have had an RVP conducted. Enrollees' survey data will be directly entered into NIH's REDCap. Frailty can be assessed by survey and/or electronic medical record (EMR) data (e.g., Charleson Co-morbidity Index) to assess confounders and effect modifiers. Our Data Center manages REDCap data, EMR data from hospitalizations, & immunization data for uploading to CDC. Population-based incidence of influenza hospitalizations will be determined from ACHD and UPMC St. Margaret hospitalization data and by agent-based modeling at the Pittsburgh Supercomputing Center. Our team is a strong candidate for this project because: 1) UPMC is the dominant regional health system with a strong bond rating; 2) infection control personnel recommend RVPs to establish diagnoses, and our team's leadership responsibilities at the hospitals can further influence the use of RVPs; 3) we have published data showing excellent concordance between UPMC's GenMark RVP and the CDC's PCR for detecting influenza; 4) research shows better protection in the elderly from high-dose influenza (HD) vaccine; UPMC has recommended and promoted HD vaccine in large quantities, although regular vaccine is available, allowing for vaccine type comparisons; 5) UPMC's EMR links inpatient and outpatient vaccination records, and interfaces with the state immunization registry; 6) it includes diverse, well-published investigators who have worked together previously.