Sanjay Mahant1,2, Matt Hall3, Amanda C Schondelmeyer4,5, Jay G Berry6, David W Kimberlin7, Samir S Shah4,5. 1. Division of Pediatric Medicine, Department of Pediatrics and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada; sanjay.mahant@sickkids.ca. 2. Child Health Evaluative Sciences, Research Institute, Hospital for Sick Children, Toronto, Canada. 3. Children's Hospital Association, Lenexa, Kansas. 4. Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio. 5. Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio. 6. Division of General Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts; and. 7. Division of Pediatric Infectious Diseases, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama.
Abstract
OBJECTIVES: To examine the incidence, mortality, and health care use related to neonatal herpes simplex virus (HSV) infection. METHODS: A retrospective longitudinal cohort study using a multistate Medicaid claims database. We identified neonates hospitalized with HSV infection from 2009 to 2015 by using discharge diagnosis codes and managed them for 6 months after discharge. Incidence rates were corrected for the imperfect sensitivity and specificity of thediagnosis codes for identifying HSV infection. RESULTS: Of 2 107 124 births from 2009 to 2015, 900 neonates were identified with HSV infection, with a corrected incidence rate of 4.5 (95% confidence interval [CI]: 4.2-4.8) per 10 000 births. The yearly disease incidence increased by 56%, from 3.4 (95% CI: 2.8-4.2) per 10 000 births (or 1 in 2941 births) in 2009 to 5.3 (95% CI: 4.6-6.1) per 10 000 births (or 1 in 1886 births) in 2015 (P < .001). Of the 900 neonates with HSV infection, 54 (6.0% [95% CI: 4.4%-7.6%]) died during the index hospitalization; there was no increase in the yearly mortality rate. Of the 692 (81.2%) infants with follow-up data, 316 (45.7%) had an emergency department visit, and 112 (16.2%) had a hospital readmission. Total payments at 6 months amounted to $60 620 431, a median of $87 602 per case of neonatal HSV infection. CONCLUSIONS: We observed an increase in neonatal HSV infection incidence over a recent 7-year period in a Medicaid population. Associated health care use and payments were substantial. Public health interventions targeting disease prevention and early diagnosis are needed.
OBJECTIVES: To examine the incidence, mortality, and health care use related to neonatal herpes simplex virus (HSV) infection. METHODS: A retrospective longitudinal cohort study using a multistate Medicaid claims database. We identified neonates hospitalized with HSV infection from 2009 to 2015 by using discharge diagnosis codes and managed them for 6 months after discharge. Incidence rates were corrected for the imperfect sensitivity and specificity of thediagnosis codes for identifying HSV infection. RESULTS: Of 2 107 124 births from 2009 to 2015, 900 neonates were identified with HSV infection, with a corrected incidence rate of 4.5 (95% confidence interval [CI]: 4.2-4.8) per 10 000 births. The yearly disease incidence increased by 56%, from 3.4 (95% CI: 2.8-4.2) per 10 000 births (or 1 in 2941 births) in 2009 to 5.3 (95% CI: 4.6-6.1) per 10 000 births (or 1 in 1886 births) in 2015 (P < .001). Of the 900 neonates with HSV infection, 54 (6.0% [95% CI: 4.4%-7.6%]) died during the index hospitalization; there was no increase in the yearly mortality rate. Of the 692 (81.2%) infants with follow-up data, 316 (45.7%) had an emergency department visit, and 112 (16.2%) had a hospital readmission. Total payments at 6 months amounted to $60 620 431, a median of $87 602 per case of neonatal HSV infection. CONCLUSIONS: We observed an increase in neonatal HSV infection incidence over a recent 7-year period in a Medicaid population. Associated health care use and payments were substantial. Public health interventions targeting disease prevention and early diagnosis are needed.
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