The Affordable Care Act, Medical Homes, and Childhood Asthma: A Key Opportunity for Progress

The medical homes provisions of the Affordable Care Act offer a major opportunity to advance high quality, cost-efficient health care for children with asthma. This policy brief examines evolving national medical homes policy in a childhood asthma context. Following a brief background that examines childhood asthma and explores the origins and evolution of medical homes policy (a concept developed with children in mind), the brief then describes how the Affordable Care Act can advance the implementation of medical homes policies to improve health outcomes for children with asthma

Changing pO2licy: The Elements for Improving Childhood Asthma Outcomes

Childhood asthma is a serious and chronic health issue that affects one in seven U.S. children and their families, compromising their health and quality of life and placing a heavy financial burden on families as well as an enormous strain on the health care system. Treating, managing, and ultimately preventing and reducing the burden of asthma represents a critical test of the ability of the U.S. health system – health insurers, clinical care providers, and public health agencies – to work together. Our investigation found that, as a country, we already know enough to act and improve life for the millions of children living with asthma; we’re just not aiming high enough. If we did, the nation would create and put into place an array of policy reforms that together could translate into real change

Changing Policy: The Elements for Improving Childhood Asthma Outcomes

This report lays out the facts and offers specific policy recommendations for success that could change the face of childhood asthma in America. These recommendations aim to make better use of programs and policies already in place, such as Medicaid and the Children\u27s Health Insurance Program (CHIP), as well as private sector insurance coverage and existing public health programs. The recommendations also underscore the importance of careful research -- scientific, practical, and community-based -- in order to continue to learn what works best and strengthen knowledge for future action. In a reformed health system, these initial efforts are not wasted tools. Instead, they become the critical platform on which further interventions would rest

Addressing the Challenges of Reporting on Childhood Asthma in a Changing Health Care System: Building Better Evidence for High Performance

Childhood asthma is a serious and costly chronic disease that burdens children and families as well as the health care systems that serve them. A key element to improving asthma outcomes is access to timely and useful data that can improve the quality of care and inform programs and policies to best serve those communities most burdened by asthma. This Policy Brief examines the nation’s data collection framework for childhood asthma and considers steps that might be taken to strengthen it, including the development, collection and refinement of community-level data to inform local health care systems. Through a review of the public health surveillance system related to childhood asthma, including a specific look at existing asthma data, this brief lays out the challenges to the current system and identifies opportunities to develop responsive and timely data collection, monitoring and surveillance systems, harnessing health information technology (HIT) applications to address the many challenges of childhood asthma. This brief includes recommendations for improvements in public health reporting systems including standardization of measures and a focus on the development of real-time local surveillance and mapping technologies to best inform communities working to lessen their childhood asthma burden

Anti-O-specific polysaccharide (OSP) immune responses following vaccination with oral cholera vaccine CVD 103-HgR correlate with protection against cholera after infection with wild-type Vibrio cholerae O1 El Tor Inaba in North American volunteers

Background: Cholera is an acute voluminous dehydrating diarrheal disease caused by toxigenic strains of Vibrio cholerae O1 and occasionally O139. A growing body of evidence indicates that immune responses targeting the O-specific polysaccharide (OSP) of V. cholerae are involved in mediating protection against cholera. We therefore assessed whether antibody responses against OSP occur after vaccination with live attenuated oral cholera vaccine CVD 103-HgR, and whether such responses correlate with protection against cholera. Methodology We assessed adult North American volunteers (n = 46) who were vaccinated with 5 × 108 colony-forming units (CFU) of oral cholera vaccine CVD 103-HgR and then orally challenged with approximately 1 × 105 CFU of wild-type V. cholerae O1 El Tor Inaba strain N16961, either 10 or 90 days post-vaccination. Principal findings Vaccination was associated with induction of significant serum IgM and IgA anti-OSP and vibriocidal antibody responses within 10 days of vaccination. There was significant correlation between anti-OSP and vibriocidal antibody responses. IgM and IgA anti-OSP responses on day 10 following vaccination were associated with lower post-challenge stool volume (r = −0.44, P = 0.002; r = −0.36, P = 0.01; respectively), and none of 27 vaccinees who developed a ≥1.5 fold increase in any antibody isotype targeting OSP on day 10 following vaccination compared to baseline developed moderate or severe cholera following experimental challenge, while 5 of 19 who did not develop such anti-OSP responses did (P = 0.01). Conclusion: Oral vaccination with live attenuated cholera vaccine CVD 103-HgR induces antibodies that target V. cholerae OSP, and these anti-OSP responses correlate with protection against diarrhea following experimental challenge with V. cholerae O1. Trial registration ClinicalTrials.gov NCT0189585

Immune responses to O-specific polysaccharide (OSP) in North American adults infected with Vibrio cholerae O1 Inaba.

BackgroundAntibodies targeting O-specific polysaccharide (OSP) of Vibrio cholerae may protect against cholera; however, little is known about this immune response in infected immunologically naïve humans.MethodologyWe measured serum anti-OSP antibodies in adult North American volunteers experimentally infected with V. cholerae O1 Inaba El Tor N16961. We also measured vibriocidal and anti-cholera toxin B subunit (CtxB) antibodies and compared responses to those in matched cholera patients in Dhaka, Bangladesh, an area endemic for cholera.Principal findingsWe found prominent anti-OSP antibody responses following initial cholera infection: these responses were largely IgM and IgA, and highest to infecting serotype with significant cross-serotype reactivity. The anti-OSP responses peaked 10 days after infection and remained elevated over baseline for ≥ 6 months, correlated with vibriocidal responses, and may have been blunted in blood group O individuals (IgA anti-OSP). We found significant differences in immune responses between naïve and endemic zone cohorts, presumably reflecting previous exposure in the latter.ConclusionsOur results define immune responses to O-specific polysaccharide in immunologically naive humans with cholera, find that they are largely IgM and IgA, may be blunted in blood group O individuals, and differ in a number of significant ways from responses in previously humans. These differences may explain in part varying degrees of protective efficacy afforded by cholera vaccination between these two populations.Trial registration numberClinicalTrials.gov NCT01895855

Anti-O-specific polysaccharide (OSP) immune responses following vaccination with oral cholera vaccine CVD 103-HgR correlate with protection against cholera after infection with wild-type <i>Vibrio cholerae</i> O1 El Tor Inaba in North American volunteers

<div><p>Background</p><p>Cholera is an acute voluminous dehydrating diarrheal disease caused by toxigenic strains of <i>Vibrio cholerae</i> O1 and occasionally O139. A growing body of evidence indicates that immune responses targeting the O-specific polysaccharide (OSP) of <i>V</i>. <i>cholerae</i> are involved in mediating protection against cholera. We therefore assessed whether antibody responses against OSP occur after vaccination with live attenuated oral cholera vaccine CVD 103-HgR, and whether such responses correlate with protection against cholera.</p><p>Methodology</p><p>We assessed adult North American volunteers (n = 46) who were vaccinated with 5 × 10⁸ colony-forming units (CFU) of oral cholera vaccine CVD 103-HgR and then orally challenged with approximately 1 × 10⁵ CFU of wild-type <i>V</i>. <i>cholerae</i> O1 El Tor Inaba strain N16961, either 10 or 90 days post-vaccination.</p><p>Principal findings</p><p>Vaccination was associated with induction of significant serum IgM and IgA anti-OSP and vibriocidal antibody responses within 10 days of vaccination. There was significant correlation between anti-OSP and vibriocidal antibody responses. IgM and IgA anti-OSP responses on day 10 following vaccination were associated with lower post-challenge stool volume (r = −0.44, <i>P</i> = 0.002; r = −0.36, <i>P</i> = 0.01; respectively), and none of 27 vaccinees who developed a ≥1.5 fold increase in any antibody isotype targeting OSP on day 10 following vaccination compared to baseline developed moderate or severe cholera following experimental challenge, while 5 of 19 who did not develop such anti-OSP responses did (<i>P</i> = 0.01).</p><p>Conclusion</p><p>Oral vaccination with live attenuated cholera vaccine CVD 103-HgR induces antibodies that target <i>V</i>. <i>cholerae</i> OSP, and these anti-OSP responses correlate with protection against diarrhea following experimental challenge with <i>V</i>. <i>cholerae</i> O1.</p><p>Trial registration</p><p>ClinicalTrials.gov <a href="https://clinicaltrials.gov/ct2/show/NCT01895855" target="_blank">NCT01895855</a></p></div

Correlation between fold increase of Inaba OSP specific antibody responses and cumulative diarrheal volume.

<p>X axis represents the fold-increase (day 10 to day 0) of IgM, IgA, and IgG responses against <i>V</i>. <i>cholerae</i> O1 Inaba OSP and Y axis represents cumulative diarrhea following experimental challenge with wild type <i>V</i>. <i>cholerae</i> O1 Inaba 10 or 90 days post vaccination with Inaba CVD 103-HgR. Dashed horizontal lines mark moderate (3L) or severe (5L) diarrheal values. Dashed vertical line denotes 1.5-fold anti-OSP antibody value change (day 10 post-vaccination compared to day 0 pre-vaccination).</p

Serum Inaba OSP-specific antibody isotype fold increase (≥1.5) and Inaba-specific vibriocidal fold increase (≥4) on day 10 following vaccination as a predictor of protection against development of mild, moderate or severe diarrhea following subsequent challenge.

<p>Serum Inaba OSP-specific antibody isotype fold increase (≥1.5) and Inaba-specific vibriocidal fold increase (≥4) on day 10 following vaccination as a predictor of protection against development of mild, moderate or severe diarrhea following subsequent challenge.</p