JAMA news releases are made available to the public after 3 pm US Central time on the first 4 Tuesdays of each month. The Archives Journals news releases are made available to the public after 3 pm Central time on Mondays. We also provide a list of previous news releases.
THIS WEEK'S CONTENT
JAMA NEWS RELEASES
(Embargoed for Release: 3:00 p.m. CT, Tuesday, August 7, 2007)
JAMA NEWS RELEASES
STUDY REVEALS GAPS IN VACCINE FINANCING FOR UNDERINSURED CHILDREN
OSTEOPOROSIS SCREENING AND TREATMENT MAY BE COST-EFFECTIVE FOR SELECTED OLDER MEN
STUDY SUGGESTS NON-PHARMACEUTICAL INTERVENTIONS MAY BE HELPFUL IN SEVERE INFLUENZA OUTBREAKS
JAMA REPORT (VIDEO SCRIPT)
VIDEO: Windows Media | Quicktime
UNDERINSURED KIDS FALLING THROUGH THE CRACKS — THOUSANDS NOT GETTING SOME RECOMMENDED VACCINES
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Embargoed for Release: 3:00 p.m. CT, Tuesday, August 7, 2007
Media Advisory: To contact Grace M. Lee, M.D., M.P.H., call Judith Montminy at 617-432-0442. To contact editorial author Matthew M. Davis, M.D., M.A.P.P., call Krista Hopson at 734-764-2220.
STUDY REVEALS GAPS IN VACCINE FINANCING FOR UNDERINSURED CHILDREN
CHICAGO—A national survey of state immunization program managers reveals gaps in coverage for the current vaccine financing system, suggesting that many underinsured children may not receive recommended vaccinations, such as for pneumonia and meningitis, according to a report in the August 8 issue of JAMA.
“The number and cost of new vaccines routinely recommended for children and adolescents has increased considerably since 2003. New or expanded recommendations for meningococcal conjugate, tetanus-diphtheria-acellular pertussis (Tdap), hepatitis A, influenza, rotavirus, and human papillomavirus vaccines have led to a 7.5-fold increase in the cost to fully vaccinate a child in the public sector (from $155 in 1995 to $1,170 in 2007),” the authors write.
Childhood vaccines in the U.S. are financed by a patchwork of public and private sources. Anecdotal reports from state policy makers and clinicians suggest that new gaps have arisen in financial coverage of vaccines for children who are underinsured (i.e., have private insurance that does not cover all recommended vaccines). In 2000, approximately 14 percent of children were underinsured for vaccines in the United States, requiring families to either pay out-of-pocket for the cost of vaccines not covered or forego receiving vaccines, according to background information in the article.
Grace M. Lee, M.D., M.P.H., of Harvard Medical School, Children’s Hospital Boston and Harvard Pilgrim Health Care, Boston, and colleagues examined the status of financing and distribution of new pediatric vaccines at the state level. For the 2-phase study, the researchers interviewed nine state immunization program managers and subsequently interviewed and surveyed 48 state immunization program managers from January to June 2006.
The researchers found that many states were not able to provide state-purchased vaccines for underinsured children in the private sector, public sector, or both. For example, for vaccines given in the private sector, 46 percent of states did not provide publicly purchased varicella (chickenpox) vaccine to underinsured children and 70 percent of states did not provide publicly purchased meningococcal conjugate vaccine to the underinsured. For vaccines given in the public sector, 17 percent of states were unable to provide publicly purchased pneumococcal conjugate vaccine to underinsured children and 40 percent were unable to provide publicly purchased meningococcal conjugate vaccine. “This meant that underinsured children were not able to receive state-purchased vaccine in either the private or public sectors in these states. None of the vaccines we studied was covered for all underinsured children in the United States,” the authors write.
Due to limited financing for new vaccines, 10 states changed their policies for provision of publicly purchased vaccines between 2004 and early 2006 to restrict access to selected new vaccines for underinsured children. The most commonly cited barriers to implementation in underinsured children were lack of sufficient federal and state funding to purchase vaccines.
“Assuming 14 percent of children are underinsured in the United States, we estimate that 2.3 million children are unable to receive state-purchased meningococcal conjugate vaccine in the private sector, and 1.2 million children are unable to receive this vaccine even if they are referred to the public sector,” they write. “Current trends in health insurance products, including enrollment in high-deductible health plans that may or may not provide immunizations or other preventive benefits before a high deductible has been met, are likely to increase the magnitude of this gap and must be carefully monitored.”
(JAMA. 2007;298(6):638-643. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
EDITORIAL: REASONS AND REMEDIES FOR UNDERINSURANCE FOR CHILD AND ADOLESCENT VACCINES
In an accompanying editorial, Matthew M. Davis, M.D., M.A.P.P., of the University of Michigan, Ann Arbor, comments on the study by Lee and colleagues.
“Strong proponents of immunization will likely object to the concept of universally recommended vaccines ranked on their relative merits. Nonetheless, that position fails to acknowledge the implicit prioritization of recommended vaccines that is already occurring at the state level, as illustrated by the findings by Lee et al. Rather than continuing a program in which de facto prioritization creates inconsistencies across states that are difficult for the public to understand, the public health and medical communities may benefit from making prioritization of vaccines more explicit and consistent.”
“The process of explicit prioritization is challenging in the public sector, as witnessed in recent years during shortages of influenza vaccine. However, the lists of priority populations that emerged through evidence-based deliberations about the burden of influenza illness have improved the influenza immunization effort by clarifying steps to take in case of vaccine supply shortage. Explicit prioritization of financing for newly recommended vaccines, as a remedy for shortfalls in financing for underinsured children, cannot be far behind.”
(JAMA. 2007;298(6):680-682. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: Please see the article for additional information, including other affiliations, financial disclosures, funding and support, etc.
For More Information: Contact the JAMA/Archives Media Relations Department at 312/464-JAMA (5262) or email: mediarelations{at}jama-archives.org.
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Embargoed for Release: 3:00 p.m. CT, Tuesday, August 7, 2007
Media Advisory: To contact John T. Schousboe, M.D., M.S., call Jeremiah Whitten at 952-993-6057.
OSTEOPOROSIS SCREENING AND TREATMENT MAY BE COST-EFFECTIVE FOR SELECTED OLDER MEN
CHICAGO—It may be cost-effective to screen and treat selected older men with osteoporosis, depending on their age and if they have had a prior fracture, according to a study in the August 8 issue of JAMA.
Osteoporotic fractures are recognized as a common and serious health problem among elderly men, with white men at age 60 years having a 29 percent chance of experiencing such a fracture during their remaining lifetime, according to background information in the article. One-third of all hip fractures occur in men and are associated with as much illness and increased risk of death than those that occur in women. Despite the importance of the problem of osteoporosis in men, there is a lack of evidence regarding the cost-effectiveness of common diagnostic and therapeutic interventions.
John T. Schousboe, M.D., M.S., of Park Nicollet Health Services, Minneapolis, and colleagues conducted a study to estimate the lifetime costs and health benefits of bone densitometry (measurement of bone density) followed by 5 years of oral bisphosphonate (a class of drugs used to strengthen bone) therapy for men found to have osteoporosis. The researchers created a computer simulation model for hypothetical groups of white men age 65, 70, 75, 80, or 85 years, with or without prior clinical fracture. Data from several sources were used to estimate fracture costs and population-based age-specific fracture rates and associations among prior fractures, bone density and incident fractures. The authors estimated the costs per quality-adjusted life-years (QALYs) gained for the densitometry and follow-up treatment strategy compared with no intervention, calculated from lifetime costs and accumulated QALYs for each strategy.
The researchers found that the estimated prevalence of femoral neck osteoporosis among men with a prior fracture ranged from 14.5 percent at age 65 years to 33.6 percent at age 85 years. Osteoporosis prevalence in the absence of a prior clinical fracture was lower, ranging from 7.6 percent at age 65 years to 17.6 percent at age 85 years. The densitometry and treatment strategy modestly reduced the absolute 10-year incidence of clinical fractures by a range of 2.1 percent for 65-year-old men without a prior fracture to 4.5 percent among 85-year-old men with a prior fracture.
Regarding cost-effectiveness, “universal bone densitometry followed by oral bisphosphonate therapy among those found to have osteoporosis for all men aged 70 years or older regardless of fracture history or other fracture risk factors is not cost-effective using current drug costs. However, this strategy may be cost-effective for men aged 65 years or older with a prior clinical fracture and for men aged 80 years or older without a prior fracture, assuming a societal willingness to pay per QALY gained of $50,000. This densitometry and treatment strategy may also be cost-effective for white men aged 70 years or older without a prior clinical fracture if the cost of oral bisphosphonate therapy is less than $500 per year or if the societal willingness to pay per QALY gained is $100,000.”
(JAMA. 2007;298(6):629-637. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
For More Information: Contact the JAMA/Archives Media Relations Department at 312/464-JAMA (5262) or email: mediarelations{at}jama-archives.org.
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Embargoed for Release: 3:00 p.m. CT, Tuesday, August 7, 2007
Media Advisory: To contact corresponding author Martin S. Cetron, M.D., call the CDC’s Press Office at 404-639-3286. To contact lead author Howard Markel, M.D., Ph.D., call 734-845-1220.
STUDY SUGGESTS NON-PHARMACEUTICAL INTERVENTIONS MAY BE HELPFUL IN SEVERE INFLUENZA OUTBREAKS
CHICAGO—An analysis of non-pharmaceutical interventions used in the U.S. during the 1918-1919 influenza pandemic, such as closing schools and banning public gatherings, found an association between these interventions and reduced death rates, suggesting that non-pharmaceutical interventions may play a role in planning for future influenza pandemics, according to a study in the August 8 issue of JAMA.
The influenza pandemic of 1918-1919 is among the most deadly contagious events in human history, resulting in approximately 40 million deaths worldwide, including 550,000 in the United States, according to background information in the article. “The historical record demonstrates that when faced with a devastating pandemic, many nations, communities, and individuals adopt what they perceive to be effective social distancing measures or nonpharmaceutical interventions including isolation of those who are ill, quarantine of those suspected of having contact with those who are ill, school and selected business closure, and public gathering cancellations. One compelling question emerges: can lessons from the 1918-1919 pandemic be applied to contemporary pandemic planning efforts to maximize public health benefit while minimizing the disruptive social consequences of the pandemic as well as those accompanying public health response measures?” the authors write.
Howard Markel, M.D., Ph.D., of the University of Michigan Medical School, Ann Arbor, and colleagues assessed the non-pharmaceutical interventions implemented in 43 cities in the continental United States from September 1918 through February 1919 to determine whether city-to-city variation in death rates were associated with the timing, duration, and combination of non-pharmaceutical interventions. The researchers conducted historical archival research and statistical and epidemiological analyses. Non-pharmaceutical interventions were grouped into three major categories: school closure; cancellation of public gatherings; and isolation and quarantine.
There were 115,340 excess pneumonia and influenza deaths (excess death rate [EDR], 500/100,000 population) in the 43 cities during the 24 weeks analyzed. Every city adopted at least one of the three major categories of non-pharmaceutical interventions. School closure and public gathering bans activated concurrently represented the most common combination implemented in 34 cities (79 percent); this combination had a median (midpoint) duration of four weeks (range, 1-10 weeks) and was significantly associated with reductions in weekly EDR. The cities that implemented non-pharmaceutical interventions earlier had greater delays in reaching peak rates of death, lower peak rates of death, and lower total number of deaths. There was a statistically significant association between increased duration of nonpharmaceutical interventions and a reduced total number of deaths.
“These findings contrast with the conventional wisdom that the 1918 pandemic rapidly spread through each community killing everyone in its path. Although these urban communities had neither effective vaccines nor antivirals, cities that were able to organize and execute a suite of classic public health interventions before the pandemic swept fully through the city appeared to have an associated mitigated epidemic experience,” the authors write.
“Our study suggests that nonpharmaceutical interventions can play a critical role in mitigating the consequences of future severe influenza pandemics and should be considered for inclusion in contemporary planning efforts as companion measures to developing effective vaccines and medications for prophylaxis and treatment. The history of U.S. epidemics also cautions that the public’s acceptance of these health measures is enhanced when guided by ethical and humane principles.”
(JAMA. 2007;298(6):644-654. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
For More Information: Contact the JAMA/Archives Media Relations Department at 312/464-JAMA (5262) or email: mediarelations{at}jama-archives.org.
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JAMA REPORTS
VIDEO: Windows Media | Quicktime
UNDERINSURED KIDS FALLING THROUGH THE CRACKS — THOUSANDS NOT GETTING SOME RECOMMENDED VACCINE
INTRO:
You might think having health insurance for your children means they’d be covered for vaccinations. But that’s not always the case. A new study says that thousands of underinsured kids are not covered for immunizations, and they’re not getting some of the newer, more expensive vaccines, because of holes in government safety nets. Mavis Prall explains in this week’s JAMA Report.
VIDEO:
NAT SOT UP FULL FOR :03
Child crying/receiving vaccination
AUDIO:
“Crying”
VIDEO:
B-ROLL
Let shot roll – mom picks up baby
Dr. Palfrey talking to dad and son
Needle going into skin
AUDIO:
IT’S HARD TO HEAR A CHILD IN PAIN, BUT DOCTORS LIKE SEAN PALFREY AT BOSTON MEDICAL CENTER KNOW, THE PINCH OF A NEEDLE PROVIDES PROTECTION FROM MANY SERIOUS DISEASES.
VIDEO:
SOT/FULL
@ :13
Super: Sean Palfrey, M.D.
Pediatrician
Runs :06
AUDIO:
“By immunizing the children, you’re not just protecting the children but you’re protecting their families and communities”
VIDEO:
B-ROLL
Children receiving vaccines
GFX/JAMA COVER
Nurse’s gloved hand drawing vaccine from vial
AUDIO:
BUT SOME CHILDREN AND FAMILIES DON’T HAVE ACCESS TO IMMUNIZATION, EVEN IF THEY HAVE HEALTH INSURANCE. SO IN MOST STATES, THOSE KIDS ARE REFERRED TO PUBLIC HEALTH CLINICS TO GET VACCINATED. BUT ACCORDING TO A NEW STUDY IN JAMA, JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, NEWER, MORE EXPENSIVE VACCINES MAY NOT BE PROVIDED.
VIDEO:
SOT/FULL
@ :35
Super: Grace Lee, M.D., M.P.H.
Harvard Medical School/Harvard Pilgrim Health Care
Runs :10
AUDIO:
“Even if these kids were referred to public health clinics to receive vaccines, they couldn’t receive them because states just didn’t have enough funding available to provide these vaccines to these underinsured kids.”
VIDEO:
B-ROLL
Dr. Lee talking with colleagues
Vaccines in refrigerator at BMC
AUDIO:
DR. GRACE LEE OF HARVARD MEDICAL SCHOOL AND HARVARD PILGRIM HEALTH CARE WAS AN AUTHOR OF THE STUDY. SHE SAYS UNDERINSURED KIDS ARE OFTEN LEFT TO PAY OUT OF POCKET FOR VACCINES.
VIDEO:
SOT/FULL
Grace Lee, M.D., M.P.H.
Harvard Medical School/Harvard Pilgrim Health Care
Runs :12
AUDIO:
“With the growing number of vaccines and the growing cost of vaccines what we’re finding is that state immunization programs just don’t have the funding to be able to provide these newer, more expensive vaccines.”
VIDEO:
B-ROLL
Various nurse’s hands handling vaccine needles and vials
AUDIO:
FOR EXAMPLE, PNEUMOCOCCAL AND MENINGOCOCCAL VACCINES WERE OFTEN UNAVAILABLE TO UNDERINSURED CHILDREN AND TEENS.
VIDEO:
SOT/FULL
Grace Lee, M.D., M.P.H.
Harvard Medical School/Harvard Pilgrim Health Care
Runs :10
AUDIO:
“In 40 percent of states they were unable to provide meningococcal conjugate vaccine, which is a vaccine that can protect adolescents against meningitis.”
VIDEO:
B-ROLL
Group of teens walking down hill outside
More kids receiving vaccines
Backtime below bite
AUDIO:
SHE ESTIMATES THIS COULD AFFECT MORE THAN A MILLION KIDS WHO SEEK THIS VACCINE AT PUBLIC CLINICS. DR. LEE SAYS SHE HOPES INSURANCE PLANS, AND THE GOVERNMENT, CAN FIND WAYS TO HELP IMMUNIZE UNDERINSURED KIDS OF ALL AGES. THIS MOM IS GRATEFUL TO HAVE ACCESS TO VACCINES FOR HER KIDS.
VIDEO:
NAT SOT UP FULL for :06
Mom holding squirming baby in exam room
Edit covered with video of baby receiving shot in his leg
AUDIO:
“I think vaccination is very important... and keep them healthy.”
VIDEO:
B-ROLL
Above shot plays out
AUDIO:
THIS IS MAVIS PRALL WITH THE JAMA REPORT.
TAG:
To conduct this study, the researchers surveyed immunization program managers from 48 states about the challenges they face. A number of public health providers said they are struggling with ethical dilemmas when budget constraints make them turn away families who ask for help with immunizations. For more information, visit www.jama.com.
