Use of family history in clinical guidelines for diabetes and colorectal cancer.
Peterson BA , Gwinn ML , Valdez RA . Am J Prev Med 2012 42 (1) 65-70 BACKGROUND: Family history is a risk factor for many chronic diseases and as such is often incorporated into clinical practice guidelines. PURPOSE: To assess the consistency of the use of family history in selected guidelines for colorectal cancer (CRC) and type 2 diabetes mellitus (T2DM) and to examine how these definitions influence their screening recommendations. METHODS: Using a web-based search, guidelines issued between 2001 and 2011 from Australia, Canada, the United Kingdom, the U.S., and the WHO were reviewed. In total, 21 guidelines were found that included family history information (14 for CRC and seven for T2DM). For each guideline, the definition of family history and the way this definition influenced screening recommendations was recorded. Analyses were completed on May 2011. RESULTS: Family history was defined most often as the presence of affected first-degree relatives; the number of such relatives and their ages at diagnosis were considered sometimes in making specific recommendations. The definition of family history and its impact on recommendations varied substantially, even for the same disease. CONCLUSIONS: Despite the importance of family history as a risk factor for CRC and T2DM, its use in screening recommendations is inconsistent among guidelines from major organizations; however, differences do not appear large enough to prevent achieving consensus among the guidelines for each disease. More standardized recommendations for use of family history in CRC and T2DM screening guidelines could enhance their utility for prevention. |
Teacher awareness and implementation of food and physical activity policies in Utah elementary schools, 2010
Lanier WA , Wagstaff RS , Demill JH , Friedrichs MD , Metos J . Prev Chronic Dis 2012 9 E18 INTRODUCTION: Schools are a key venue for childhood obesity prevention policies. The objective of this study was to examine factors associated with elementary school teacher awareness and implementation of their schools' food and physical activity policies. METHODS: We collected data through an online survey of teachers at Utah elementary schools with food and physical activity policies. We used bivariate analysis and logistic regression to assess association of variables with teacher awareness and implementation. RESULTS: Of 1,243 teacher respondents, 546 (44%) were aware of the food policy and 550 (44%) were aware of the physical activity policy. Food policy awareness was associated with knowing where written policies were located (odds ratio [OR], 2.7; 95% confidence interval [CI], 2.0-3.5), knowing the school health program coordinator (OR, 1.9; 95% CI, 1.4-2.7), and being reminded of policies at least once per semester (OR, 2.3; 95% CI, 1.7-2.9). Policy awareness was associated with both food (OR, 4.6; 95% CI, 3.6-6.0) and physical activity (OR, 1.6, 95% CI, 1.2-2.3) policy implementation. Helping develop the physical activity policy was associated with its implementation (OR, 2.4; 95% CI, 1.2-4.7). Thinking that students were more overweight than in the past was associated with food policy implementation (OR, 1.6; 95% CI, 1.1-2.5). CONCLUSION: Establishing food and physical activity policies at schools does not ensure teacher awareness or implementation. To promote policy awareness and implementation, school leaders should involve teachers in policy development, remind teachers of policies at least once per semester, and continue to educate teachers about childhood obesity. |
Predictors of asthma self-management education among children and adults-2006-2007 Behavioral Risk Factor Surveillance System Asthma Call-back Survey
Zahran HS , Person CJ , Bailey C , Moorman JE . J Asthma 2012 49 (1) 98-106 BACKGROUND: Patient self-management, besides expert care, is necessary to improve health outcomes among persons with asthma. Our objective was to describe the characteristics of persons with asthma likely to receive asthma self-management education. METHODS: The 2006 and 2007 Behavioral Risk Factor Surveillance System (BRFSS) Child and Adult Asthma Call-back Survey (ACBS) data were analyzed. Binary and multinomial response logistic regression models were used to examine the association between asthma self-management education and explanatory variables. RESULTS: Of the 31,278 persons who ever had asthma, 3953 of the children (75.8%) and 19,723 of the adults (72.8%) were classified as having active asthma. For both children and adults, the three most commonly reported asthma education components were being taught how to use an inhaler (78.6% and 89.8%, respectively); being taught what to do during an asthma episode (86.3% and 74.6%); and to recognize early signs or symptoms of an asthma episode (82.0% and 64.4%). Children and adults who reported routine care visits, hospitalization, and asthma episodes in the past 12 months because of asthma were more likely to report several asthma education components and higher asthma education scores. Children aged 12-17 years were more likely to report having instruction in peak flow meter use (1.3; 1.1-1.6) and inhaler use (1.3; 1.2-1.4), whereas older adults (aged 54-64 years or 65+ years), adults who were not high school (HS) graduates, and smokers were less likely to report having asthma management education than the corresponding comparison groups. CONCLUSIONS: Having a routine care visit, being hospitalized, and having an asthma episode were significantly associated with reporting multiple asthma education components, whereas being an older adult, having less than a HS degree, and being a smoker were associated with reporting fewer asthma education components. Asthma control programs should continue to monitor asthma self-management education and promote asthma education to all persons with asthma, especially for older adults, persons with less education, and smokers. |
Evidence-based health: necessary but not sufficient
Herman E , Garbe P . Prev Chronic Dis 2012 9 E28 As public health practitioners from the National Asthma Control Program (NACP) of the Centers for Disease Control and Prevention, we read the essay "From Evidence-Based Medicine to Evidence-Based Health: the Example of Asthma" (1) with great interest. We agree with the authors' hypothesis that evidence-based clinical medicine must be supplemented by asthma self-management support "that extends beyond the clinic" and "by interventions that change elements of the environment in which patients live." As the authors note, this concept is not new. Indeed, it underlies the Expert Panel Report 3: Guidelines for the Diagnosis and Management of Asthma (2). | A recent article (3) describes remarkable progress not only in understanding the pathophysiology of asthma and in producing new medications for its control but also in a public health response "to support patient- and community-level interventions and to assess the effect of the environment on asthma." The NACP has greatly expanded population-level asthma surveillance of asthma prevalence, illness, and death (4). The NACP also supports 34 states, Washington, DC, and Puerto Rico "to build and sustain programs that translate evidence-based practice into interventions." Furthermore, the Task Force on Community Preventive Services recently conducted and published a systematic review of the effectiveness of home-based, multi-trigger, multicomponent interventions in improving asthma control (5). The NACP is working through state asthma programs to implement those interventions. | Much work remains to be done to achieve evidence-based health (as defined by Moskowitz and Bodenheimer), particularly among racial/ethnic minorities, who have a disparately high prevalence of and morbidity from asthma. The authors note 3 necessary actions: linking clinical teams with community resources to address asthma triggers in housing, advocating for better housing and cleaner air, and convincing insurers to reimburse for essential educational and community health services. We suggest that these actions, although necessary, are not sufficient to decrease the burden of asthma at a population level. |
Higher incidence of clear cell adenocarcinoma of the cervix and vagina among women born between 1947 and 1971 in the United States
Smith EK , White MC , Weir HK , Peipins LA , Thompson TD . Cancer Causes Control 2012 23 (1) 207-11 Although the association between in utero exposure to diethylstilbestrol (DES) and clear cell adenocarcinoma of the cervix and vagina (CCA) was first reported among young women, subsequent case reports and cohort studies suggest that an elevated risk for CCA may persist with age. Data from the National Program of Cancer Registries (NPCR) and the Surveillance, Epidemiology and End Results (SEER) Program were used to construct indirect standardized incidence ratios (SIR) comparing CCA risk among women born during the exposure period 1947 through 1971, when DES was prescribed to pregnant women, to the relevant time period for nonexposed women born before or after DES exposure period. CCA incidence among the women born before the DES exposure period (ages 30-54 at diagnosis of CAA) or after the DES exposure period (ages 15-29 at diagnosis) were used to calculate the expected rates for women born during the DES exposure period. Among women aged 15-29 years, CCA risk increased with age and peaked in the 25-29 year age group, but the risk estimates were unstable (SIR = 6.06; 95% CI: 0.97, -251.07, SEER data). Among women aged 40-54 years, CCA risk was greatest in the 40-44 year age group (SIR = 4.55; 95% CI: 1.11, 40.19, SEER data and SIR = 3.94; 95% CI: 1.06, 33.01, NPCR/SEER data) and remained significantly elevated throughout this age group in the combined data set. Risk was not elevated among women aged 30-39 years. The observed risk of CCA, if causally related to DES exposure, reflects a persistent health impact from in utero exposure that is widespread in the general population. When assessing a woman's cancer risks, whether her mother took DES while pregnant may still be a relevant aspect of the medical history for women born during the period of DES use in pregnancy. |
Risk factors for fractures among Japanese-American men: the Honolulu Heart Program and Honolulu-Asia Aging Study
Ma C , Burchfiel C , Grove J , Fekedulegn D , Lu Y , Andrew M , Willcox B , Masaki K , Curb J , Rodriguez B . Arch Osteoporos 2011 6 (1) 197-207 SUMMARY: Baseline risk factors were associated with fractures that developed after 29-31 years among Japanese-American men. Hip fracture risk increased with increasing BMI (28% increase for 1 U increase), physical activity (7% increase for 1 U increase), and was decreased with increasing arm girth (27% decrease for 1 U increase). PURPOSE: The objective of this study was to identify risk factors among Japanese-American men aged 45-68 years at baseline that were associated with prevalence and incidence of fractures at advanced age. METHODS: We used baseline information from Honolulu Heart Program (HHP) and Honolulu-Asia Aging Study (HAAS). The HHP was a prospective study with primary focus on risk factors for cardiovascular disease. A cohort of 8,006 men of Japanese ancestry aged 45-68 years residing on Oahu was recruited in 1965 and followed for 31 years. The HAAS started in 1991 in conjunction with the HHP with a focus on age-related health conditions. Self-reported hip, spine, and forearm fracture prevalence was ascertained in 1991-1993 among 3,845 men aged 71-93 years. Incidence was obtained during the period (1994-1999) among 2,737 men aged 74-98 years. Poisson regression models were used to determine multi-variable adjusted prevalence and incidence ratios for fracture. RESULTS: Incident hip fracture was directly associated with baseline body mass index (BMI) and physical activity, and inversely associated with left upper arm girth. Incident spine fracture was directly associated with baseline age. Prevalent hip fracture was directly associated with baseline pack-years of smoking. Prevalent spine fracture was inversely associated with baseline education, and directly associated with standing height and use of medication for diabetes. Prevalent forearm fracture was inversely associated with baseline age, and directly associated with education. CONCLUSIONS: Results indicated that multiple baseline demographic lifestyle and anthropometric characteristics predict fracture risk at advanced age. In addition, associations varied by fracture location. |
Serum 25-hydroxyvitamin D levels and all-cause and cardiovascular disease mortality among US adults with hypertension: the NHANES linked mortality study
Zhao G , Ford ES , Li C , Croft JB . J Hypertens 2011 30 (2) 284-9 OBJECTIVES: Research suggests that serum concentrations of 25-hydroxyvitamin D [25(OH)D] are inversely associated with hypertension incidence. This study examined whether concentrations of 25(OH)D are inversely associated with mortality risk among US adults with hypertension. METHODS: We analyzed data from the 2001-2004 National Health and Nutrition Examination Survey with mortality data obtained through 2006. Hazard ratios with 95% confidence intervals (CIs) for all-cause and cardiovascular disease (CVD) mortality were estimated using Cox proportional hazard models. RESULTS: Of 2609 participants with hypertension, 191 died (including 68 CVD deaths) during an average of 3.7-year follow-up. Compared with participants with 25(OH)D concentrations in the highest quartile (≥29 ng/ml), the hazard ratios for all-cause mortality were 1.93 (95% CI 1.06-3.49), 1.32 (95% CI 0.85-2.04), and 1.36 (95% CI 0.84-2.22), respectively (P for trend <0.05), and the hazard ratios for CVD mortality were 3.21 (95% CI 1.14-8.99), 2.42 (95% CI 0.85-6.90), and 2.33 (95% CI 0.88-6.12), respectively (P for trend <0.05), in the first (<17 ng/ml), second (17-<23 ng/ml) and third (23-<29 ng/ml) quartiles of 25(OH)D after adjustment for potential confounding variables. Additionally, concentrations of 25(OH)D as a continuous variable were linearly and inversely associated with the risk of mortality from all causes (P = 0.012) and from CVD (P = 0.010). These relationships were not affected much by adjustment for baseline blood pressure and use of antihypertension medications. CONCLUSION: Concentrations of 25(OH)D were inversely associated with all-cause and CVD mortality among adults with hypertension in the US. Enhancing vitamin D intake may contribute to a lower risk for premature death. |
Relationship between Mycobacterium tuberculosis phylogenetic lineage and clinical site of tuberculosis
Click ES , Moonan PK , Winston CA , Cowan LS , Oeltmann JE . Clin Infect Dis 2012 54 (2) 211-9 BACKGROUND: Genotyping of Mycobacterium tuberculosis has revealed 4 major phylogenetic lineages with differential distribution worldwide. It is not clear whether different lineages are associated with different sites of infection (eg, pulmonary tuberculosis versus extrapulmonary tuberculosis). We sought to determine whether M. tuberculosis lineage is associated with the site of tuberculosis disease. METHODS: We conducted a cross-sectional analysis of all culture-confirmed cases of tuberculosis with routinely determined M. tuberculosis spoligotype-defined lineage reported to the US National Tuberculosis Surveillance System from 2004 through 2008. Odds ratios (ORs) were used to assess the relation between disease site and M. tuberculosis lineage, after adjustment for age, sex, human immunodeficiency virus infection status, region of birth, and race/ethnicity. RESULTS: Of 53972 reported culture-positive tuberculosis cases, 32000 (59.3%) were cases of M. tuberculosis that included complete spoligotype-based data on lineage. Of these, 23844 (74.5%) were exclusively pulmonary, 5085 (15.9%) were exclusively extrapulmonary, and 3071 (9.6%) were combined pulmonary and extrapulmonary. The percentages of tuberculosis cases that were exclusively extrapulmonary differed by lineage: East Asian, 13.0%; Euro-American, 13.8%; Indo-Oceanic, 22.6%; and East-African Indian, 34.3%. Compared with East Asian lineage, the odds of exclusively extrapulmonary tuberculosis relative to exclusively pulmonary tuberculosis were greater for Euro-American (adjusted OR, 1.3; 95% confidence interval [CI], 1.1-1.4), Indo-Oceanic (adjusted OR, 1.7; 95% CI, 1.5-1.9), and East-African Indian (adjusted OR, 1.6; 95% CI, 1.4-1.9) lineages. CONCLUSIONS: Phylogenetic lineage of M. tuberculosis is associated with the site of tuberculosis disease. (See the Editorial Commentary by Kato-Maeda and Nahid, on pages 220-4.) |
Operational research to improve HIV prevention in the United States
Herbst JH , Glassman M , Carey JW , Painter TM , Gelaude DJ , Fasula AM , Raiford JL , Freeman AE , Harshbarger C , Viall AH , Purcell DW . J Acquir Immune Defic Syndr 2012 59 (5) 530-6 The HIV/AIDS epidemic in the United States continues despite several recent, noteworthy advances in HIV prevention. Contemporary approaches to HIV prevention involve implementing combinations of biomedical, behavioral and structural interventions in novel ways to achieve high levels of impact on the epidemic. Methods are needed to develop optimal combinations of approaches for improving efficiency, effectiveness and scalability. This paper argues that operational research offers promise as a valuable tool for addressing these issues. We define operational research relative to domestic HIV prevention, identify and illustrate how operational research can improve HIV prevention, and pose a series of questions to guide future operational research. Operational research can help achieve national HIV prevention goals of reducing new infections, improving access to care and optimization of health outcomes of people living with HIV, and reducing HIV-related health disparities. |
Prevalence of Neisseria gonorrhoeae infections among men and women entering the National Job Training Program-United States, 2004-2009
Bradley H , Satterwhite CL . Sex Transm Dis 2012 39 (1) 49-54 BACKGROUND: National notifiable disease data indicate that there were 99 cases of gonorrhea for every 100,000 persons in the United States in 2009, the lowest recorded gonorrhea rate in US history. However, the extent to which declining case reports signify a reduction in prevalence is unknown. METHODS: Gonorrhea prevalence was estimated among 16- to 24-year-old men and women entering the National Job Training Program (NJTP) between 2004 and 2009. Multivariate logistic regression was used to assess the probability of testing positive for gonorrhea over time. RESULTS: A total of 95,184 men and 91,697 women were screened for gonorrhea upon entry to the NJTP between 2004 and 2009. For women, gonorrhea prevalence increased from 2004 (2.6%) to 2006 (2.9%), then decreased steadily through 2009 (1.8%). For men, prevalence increased from 2004 (1.3%) to 2005 (1.6%), then decreased through 2009 (0.9%). Gonorrhea prevalence among black women decreased from 3.6% in 2004 to 2.5% in 2009 and was 2 to 4 times higher than prevalence among white women. Likewise, prevalence among black men decreased from 2.0% to 1.5% and was 8 to 22 times higher than prevalence among white men. After adjusting for gonorrhea risk factors, the odds of women and men testing positive for gonorrhea decreased by 50% and 40%, respectively, from 2004 to 2009. CONCLUSIONS: Declining trends in gonorrhea infection among NJTP entrants are similar to those observed in gonorrhea case report data, suggesting that the decrease in case reports is due to a decrease in prevalence. However, targeted interventions are needed to reduce gonorrhea infections in populations with disproportionate risk. |
Hantavirus pulmonary syndrome clinical findings: evaluating a surveillance case definition
Knust B , Macneil A , Rollin PE . Vector Borne Zoonotic Dis 2012 12 (5) 393-9 Clinical cases of hantavirus pulmonary syndrome (HPS) can be challenging to differentiate from other acute respiratory diseases, which can lead to delays in diagnosis, treatment, and disease reporting. Rapid onset of severe disease occurs, at times before diagnostic test results are available. This study's objective was to examine the clinical characteristics of patients that would indicate HPS to aid in detection and reporting. Test results of blood samples from U.S. patients suspected of having HPS submitted to the Centers for Disease Control and Prevention from 1998-2010 were reviewed. Patient information collected by case report forms was compared between HPS-confirmed and test-negative patients. Diagnostic sensitivity, specificity, predictive values, and likelihood ratios were calculated for individual clinical findings and combinations of variables. Of 567 patients included, 36% were HPS-confirmed. Thrombocytopenia, chest x-rays with suggestive signs, and receiving supplemental oxygenation were highly sensitive (>95%), while elevated hematocrit was highly specific (83%) in detecting HPS. Combinations that maximized sensitivity required the presence of thrombocytopenia. Using a national sample of suspect patients, we found that thrombocytopenia was a highly sensitive indicator of HPS and should be included in surveillance definitions for suspected HPS. Using a sensitive suspect case definition to identify potential HPS patients that are confirmed by highly specific diagnostic testing will ensure accurate reporting of this disease. |
How we didn't clean up until we washed our hands: shigellosis in an elementary and middle school in north Texas
Schulte JM , Williams L , Asghar J , Dang T , Bedwell S , Guerrero K , Hamaker D , Stonecipher S , Zoretic J , Chow C . South Med J 2012 105 (1) 1-4 BACKGROUND: Shigella outbreaks often continue for months and are linked frequently to poor hygiene and hand washing. Such outbreaks are found often in day care facilities, but rarely are reported in schools. We present the investigation of an outbreak in autumn 2007 at a building that housed an elementary school and a middle school in separate wings in a small Texas city north of Dallas-Fort Worth. METHODS: We canvassed local hospitals, school attendance records, and physician offices for cases. Ill individuals were interviewed using a standard questionnaire for symptoms, disease onset, and the presence of the illness in an ill person's household. RESULTS: A music teacher was the index case for this outbreak of gastrointestinal illness caused by S. sonnei. Ten percent of the students in the school building were ill, and 15 households had secondary cases. Installing liquid soap in dispensers in student restrooms was the initial control measure, followed by sustained instruction in hand washing, scheduled hand washing times, and monitored cleaning and disinfection procedures for surfaces and inanimate objects. Enhanced surveillance detected no new cases in the school district. CONCLUSIONS: Appropriate soap supplies and repeated instruction in hand washing and its monitoring were needed to control the outbreak. |
Continued evolution of highly pathogenic avian influenza A (H5N1): updated nomenclature
WHO OIE FAO H5N1 Evolution Working Group , Smith G , Donis RO . Influenza Other Respir Viruses 2012 6 (1) 1-5 BACKGROUND: Continued evolution of highly pathogenic avian influenza A (H5N1) throughout many regions of the eastern hemisphere has led to the emergence of new phylogenetic groups. A total of 1637 new H5N1 hemagglutinin (HA) sequences have become available since the previous nomenclature recommendations described in 2009 by the WHO/OIE/FAO H5N1 Evolution Working Group. A comprehensive analysis including all the new data is needed to update HA clade nomenclature. METHODS: Phylogenetic trees were constructed from data sets of all available H5N1 HA sequences. New clades were designated on the basis of phylogeny and p-distance using the pre-established nomenclature system (Emerg Infec Dis 2008; 14:e1). Each circulating H5N1 clade was subjected to further phylogenetic analysis and nucleotide sequence divergence calculations. RESULTS: All recently circulating clades (clade 1 in the Mekong River Delta, 2.1.3 in Indonesia, 2.2 in India/Bangladesh, 2.2.1 in Egypt, 2.3.2, 2.3.4 and 7 in Asia) required assignment of divergent HA genes to new second-, third-, and/or fourth-order clades. At the same time, clades 0, 3, 4, 5, 6, 8, 9, and several second- and third-order groups from clade 2 have not been detected since 2008 or earlier. CONCLUSIONS: New designations are recommended for 12 HA clades, named according to previously defined criteria. In addition, viruses from 13 clades have not been detected since 2008 or earlier. The periodic updating of this dynamic classification system allows continued use of a unified nomenclature in all H5N1 studies. (Please cite this paper as: WHO/OIE/FAO. (2012) Continued evolution of highly pathogenic avian influenza A(H5N1): Updated nomenclature. Influenza and Other Respiratory Viruses 6(1), 1-5.) |
Rotavirus disease burden among children <5 years of age - Santa Rosa, Guatemala, 2007-2009
Cortes J , Arvelo W , Lopez B , Reyes L , Kerin T , Gautam R , Patel M , Parashar U , Lindblade KA . Trop Med Int Health 2011 17 (2) 254-9 OBJECTIVES: To assess the burden of rotavirus disease in Guatemala, in view of the recent introduction of a national rotavirus vaccination programme. METHODS: We examined data from an active, facility-based surveillance system in Santa Rosa, Guatemala, from October 2007 through September 2009 among children <5 years of age presenting to the hospital or ambulatory clinics with diarrhoea (≥3 loose stools in 24 h during the last 7 days). Demographic and epidemiological data were collected, and specimens were tested for rotavirus via enzyme immunoassay. Genotyping was performed via reverse transcriptase polymerase chain reaction. RESULTS: We enrolled 347 hospitalized patients <5 years of age with diarrhoea and 1215 from ambulatory clinics. Specimens from 275 (79%) hospitalized children and 662 (54%) from ambulatory visits were tested for rotavirus. Rotavirus accounted for 32% of hospitalizations and 9% of ambulatory visits for diarrhoea, resulting in adjusted annual rates of 36 hospitalizations and 372 ambulatory visits per 10 000 children. Ninety-one per cent of hospitalizations and 81% of ambulatory visits for rotavirus diarrhoea occurred in children <2 years. G1P8 represented 71% and 95% of rotavirus genotypes for 2007-2008 and 2008-2009 rotavirus seasons, respectively. CONCLUSIONS: Rotavirus is a major cause of diarrhoea in children <5 years of age in Santa Rosa, Guatemala, highlighting the potential health benefits of vaccination and the need for continued surveillance to assess impact and effectiveness of the rotavirus vaccination programme in Guatemala. |
Rubella contact tracing associated with air travel
Kim C , Chavez P , Pierce A , Murray A , Sander M , Kenyon C , Sharangpani R , Abernathy E , Icenogle J , Kutty PK , Redd SB , Gallagher K , Neatherlin J , Marienau K . Travel Med Infect Dis 2011 10 (1) 48-51 This report reviews U.S. guidelines for the identification of persons exposed to rubella during air travel. In response to an individual with rubella who traveled on multiple flights, CDC conducted an airline contact investigation that was expanded beyond customary protocol to assess if current operating procedures are adequate. Of 250 potentially exposed airline passengers, 215 (86%) were contacted and none developed a rubella-like rash, arguing against the need to notify passengers beyond the standard protocol in most cases. |
Seroprevalence of Alkhurma and other hemorrhagic fever viruses, Saudi Arabia
Memish ZA , Albarrak A , Almazroa MA , Al-Omar I , Alhakeem R , Assiri A , Fagbo S , Macneil A , Rollin PE , Abdullah N , Stephens G . Emerg Infect Dis 2011 17 (12) 2316-8 A 2009 deployment of military units from several Saudi Arabian provinces to Jazan Province, Saudi Arabia, enabled us to evaluate exposure to Alkhurma, Crimean-Congo, dengue, and Rift Valley hemorrhagic fever viruses. Seroprevalence to all viruses was low; however, Alkhurma virus seroprevalence was higher (1.3%) and less geographically restricted than previously thought. |
Prevalence of 2009 pandemic influenza A (H1N1) virus antibodies, Tampa Bay Florida - November-December, 2009
Cox CM , Goodin K , Fisher E , Dawood FS , Hamilton JJ , Leparc GF , Gray M , Nelson L , Borse RH , Singleton JA , Reed C , Balish AL , Katz JM , Hopkins RS , Fry AM . PLoS One 2011 6 (12) e29301 BACKGROUND: In 2009, a novel influenza virus (2009 pandemic influenza A (H1N1) virus (pH1N1)) caused significant disease in the United States. Most states, including Florida, experienced a large fall wave of disease from September through November, after which disease activity decreased substantially. We determined the prevalence of antibodies due to the pH1N1 virus in Florida after influenza activity had peaked and estimated the proportion of the population infected with pH1N1 virus during the pandemic. METHODS: During November-December 2009, we collected leftover serum from a blood bank, a pediatric children's hospital and a pediatric outpatient clinic in Tampa Bay Florida. Serum was tested for pH1N1 virus antibodies using the hemagglutination-inhibition (HI) assay. HI titers ≥40 were considered seropositive. We adjusted seroprevalence results to account for previously established HI assay specificity and sensitivity and employed a simple statistical model to estimate the proportion of seropositivity due to pH1N1 virus infection and vaccination. RESULTS: During the study time period, the overall seroprevalence in Tampa Bay, Florida was 25%, increasing to 30% after adjusting for HI assay sensitivity and specificity. We estimated that 5.9% of the population had vaccine-induced seropositivity while 25% had seropositivity secondary to pH1N1 virus infection. The highest cumulative incidence of pH1N1 virus infection was among children aged 5-17 years (53%) and young adults aged 18-24 years (47%), while adults aged ≥50 years had the lowest cumulative incidence (11-13%) of pH1N1 virus infection. CONCLUSIONS: After the peak of the fall wave of the pandemic, an estimated one quarter of the Tampa Bay population had been infected with the pH1N1 virus. Consistent with epidemiologic trends observed during the pandemic, the highest burdens of disease were among school-aged children and young adults. |
Fatal disseminated Cryptococcus gattii infection in New Mexico
Walraven CJ , Gerstein W , Hardison SE , Wormley F , Lockhart SR , Harris JR , Fothergill A , Wickes B , Gober-Wilcox J , Massie L , Ku TS , Firacative C , Meyer W , Lee SA . PLoS One 2011 6 (12) e28625 We report a case of fatal disseminated infection with Cryptococcus gattii in a patient from New Mexico. The patient had no history of recent travel to known C. gattii-endemic areas. Multilocus sequence typing revealed that the isolate belonged to the major molecular type VGIII. Virulence studies in a mouse pulmonary model of infection demonstrated that the strain was less virulent than other C. gattii strains. This represents the first documented case of C. gattii likely acquired in New Mexico. |
Genital herpes and HIV infection: can we still exploit the intimate relationship?
Ballard RC . South Afr J Epidemiol Infect 2011 26 (4) 210-214 South Africa is suffering the most severe HIV epidemic on earth. Prior to emergence of HIV/AIDS, conventional sexually transmitted infections (STIs) were endemic in many underprivileged communities as a result of many social factors. Since conventional STIs may act as co-factors in both acquisition and transmission of HIV, it was initially thought that improved treatment of these infections would result in a reduction of HIV transmission. As the HIV epidemic matured, the aetiological agents causing genital ulcer disease changed, with genital herpes emerging as the most potent STI co-factor in HIV spread. Despite learning more about herpes simplex virus/HIV interactions, attempts to utilise this knowledge to design HIV prevention strategies proved disappointing. However, the lessons learned may prove to be valuable in the future. |
Hand, foot and mouth disease in Yunnan Province, China, 2008-2010
Xu W , Jiang L , Thammawijaya P , Thamthitiwat S . Asia Pac J Public Health 2011 27 (2) NP769-77 This study was done to assess the epidemic features of hand, foot and mouth disease in Yunnan Province. Surveillance data from the beginning of 2008 through the end of 2010 were analyzed to conduct the demographic data of patients and morbidity as well as the estimation between possible risk factors for severe or fatal cases. Of the 75,109 cases reported, laboratory tests confirmed 3,691 cases. Thus, the average annual incidence proportion was 55 per 100,000 population with a total case fatality rate of 0.04%. A seasonal peak was observed in May, along with a smaller winter peak in 2010. Most severe and fatal cases were caused by enterovirus 71. It is demonstrated that most of the severe and fatal cases occurred in very young children and that delayed access to health care led to the higher likelihood of serious illness. |
Hepatitis E: epidemiology and prevention
Teshale EH , Hu DJ . World J Hepatol 2011 3 (12) 285-91 Hepatitis E is caused by the hepatitis E virus (HEV), the major etiologic agent of enterically transmitted non-A hepatitis worldwide. HEV is responsible for major outbreaks of acute hepatitis in developing countries, especially in many parts of Africa and Asia. The HEV is a spherical, non-enveloped, single-stranded, positive sense RNA virus that is approximately 32 nm to 34 nm in diameter and is the only member in the family Hepeviridae and genus Hepevirus. There are four distinct genotypes of HEV (genotypes 1-4). While genotype 1 is predominantly associated with large epidemics in developing countries, genotype 3 has recently emerged as a significant pathogen in developed countries. The clinical manifestations and the laboratory abnormalities of hepatitis E are not distinguishable from that caused by other hepatitis viruses. However, high mortality among pregnant women particularly during the third trimester distinguishes HEV from other causes of acute viral hepatitis. Specific etiologic diagnosis among infected cases can be made by serological testing or detection of viral nucleic acid by reverse transcription polymerase chain reaction. Although there are vaccine candidates that had been shown to be safe and efficacious in clinical trials, none are approved currently for use. There is no specific therapy for acute hepatitis E as treatment remains supportive. |
Association between semen exposure and incident bacterial vaginosis
Gallo MF , Warner L , King CC , Sobel JD , Klein RS , Cu-Uvin S , Rompalo AM , Jamieson DJ . Infect Dis Obstet Gynecol 2011 2011 842652 OBJECTIVE: To identify correlates of incident bacterial vaginosis (BV) diagnosed with Nugent scoring among high-risk women. STUDY DESIGN: We conducted both cohort and case-crossover analyses, stratified by HIV infection status, based on 871 HIV-infected and 439 HIV-uninfected participants in the HIV Epidemiology Research Study, conducted in 4 US sites in 1993-2000. RESULTS: BV incidence was 21% and 19% among HIV-infected and -uninfected women, respectively. Fewer correlates of BV were found with case-crossover than with cohort design. Reporting frequent coitus (regardless of consistency of condom use) was correlated with BV in cohort analyses but not in case-crossover analyses. The sole correlate of BV in both types of analyses was the detection of spermatozoa on Gram stain, which is a marker of semen exposure. CONCLUSION: The inconsistent association between condom use and BV in prior studies could be from reporting bias. We found evidence of a relationship between semen exposure and incident BV. |
Bacterial vaginosis, gonorrhea, and chlamydial infection among women attending a sexually transmitted disease clinic: a longitudinal analysis of possible causal links
Gallo MF , Macaluso M , Warner L , Fleenor ME , Hook EW 3rd , Brill I , Weaver MA . Ann Epidemiol 2011 22 (3) 213-20 PURPOSE: Interactions between bacterial vaginosis (BV) and inflammatory sexually transmitted infections, such as gonorrhea and chlamydial infection, are not well understood. Furthermore, evidence regarding the sexual transmission of BV is equivocal. METHODS: We assessed associations between incident BV and incidences of gonorrhea and/or chlamydial infection ("gonorrhea/chlamydia"), as well as similarities in associations for the two processes, among 645 female patients at a sexually transmitted disease clinic in Alabama followed prospectively for 6 months from 1995 to 1998. We identified predictors of both incident BV and gonorrhea/chlamydia and used bivariate logistic regression to determine whether these predictors differed. RESULTS: Participants completed 3188 monthly, follow-up visits. Several factors associated with incident BV involved sexual intercourse: young age (<16 years) at first intercourse (adjusted odds ratio [aOR], 1.5; 95% confidence interval [CI], 1.1-1.9), recent drug use during sex (aOR, 1.7; 95% CI, 1.2-2.5), prevalent trichomoniasis (aOR, 2.8; 95% CI, 1.7-4.6) and incident syphilis (aOR, 9.7; 95% CI, 1.9-48.4). Few statistical differences between potential factors for BV and gonorrhea/chlamydia emerged. BV appeared to precede the acquisition of gonorrhea/chlamydia (pairwise odds ratio, 1.6; 95% CI, 1.1-2.3), and vice versa (pairwise odds ratio, 2.4; 95% CI, 1.7-3.5). CONCLUSIONS: Findings are consistent with a causal role of sexual behavior in the acquisition of BV and confirm that BV facilitates acquisition of gonorrhea/chlamydia and vice versa independently from other risk factors. |
Detection of acute HIV infection: we can't close the window
Branson BM , Stekler JD . J Infect Dis 2011 205 (4) 521-4 Acute human immunodeficiency virus (HIV) infection poses a dilemma for diagnosis, clinical management, and public health. It has been variously defined as the transient symptomatic illness associated with high-titer viral replication [1], the period from initial infection to complete seroconversion [2], and the phase between the appearance of detectable HIV RNA and detectable antibodies to HIV [3]. In the context of therapeutic trials, primary HIV infection includes the acute infection interval and the first 6 months after seroconversion, during which viral set point is established [4, 5]. “Detecting acute infection” has also been used synonymously with “closing the window,” the period during which tests for HIV are negative in persons who are infected. | In this issue of the journal, Rosenberg et al [6] evaluated how well the Determine HIV-1/2 Ag/Ab Combo rapid test (Combo RT) compared with an algorithm of parallel antibody tests followed by RNA polymerase chain reaction. The Combo RT, designed for use at the point of care with finger-stick whole blood to detect HIV antibody and HIV antigen (and distinguish the two) in 20 minutes, did not fare very well in this comparison. The Combo RT is a lateral flow test (ie, an immunoassay that incorporates all necessary reagents into a single test strip). The test result is read visually, without instrumentation, after the specimen flows across the strip. Lateral flow tests have revolutionized HIV testing because they are easy to perform, require minimal training, have long-term stability, require no dedicated instrumentation, and can use whole blood specimens. In the United States, lateral flow HIV tests are used extensively in nonclinical settings. However, high hopes for point-of-care rapid tests able to identify acute infection, predicated on detecting p24 antigen, may be unrealistic. Recently developed fourth-generation HIV antigen-antibody (Ag/Ab) combination assays, designed for use in the laboratory, detect both p24 antigen and antibodies against HIV but do not distinguish between the two. They exhibit an analytic sensitivity for p24 antigen of 11–18 pg/mL [7], equivalent to approximately 30 000–50 000 copies/mL of HIV RNA [8]. In contrast, lateral flow assays using colloidal gold have a lower limit of detection in the range of 1 ng/mL [9], ∼100-fold higher than the p24 antigen concentration usually present in plasma [8]. With the ultrasensitive procedure that includes heat dissociation of p24 antigen–antibody immune complexes, signal amplification, and instrumentation, the limit of detection for p24 (without additional pretreatment of the specimen to disrupt viral particles) can be ≥250 000 RNA copies/mL [10]. The findings of Rosenberg et al substantiate this: ultrasensitive methods were used to test 7 of the 8 acute specimens and failed to detect p24 antigen in 2 that had RNA concentrations of 45 000 and ≥750 000 copies/mL. |
Rickettsia parkeri in Amblyomma maculatum ticks, North Carolina, USA, 2009-2010
Varela-Stokes AS , Paddock CD , Engber B , Toliver M . Emerg Infect Dis 2011 17 (12) 2350-3 We detected Rickettsia parkeri in 20%-33% of Amblyomma maculatum ticks sampled in North Carolina. Results highlight the high frequencies of R. parkeri-infected ticks in the state with the highest annual incidence of Rocky Mountain spotted fever. Epidemiologic studies are needed to definitively link R. parkeri to cases of spotted fever rickettsiosis. |
West Nile virus infection of birds, Mexico
Guerrero-Sanchez S , Cuevas-Romero S , Nemeth NM , Trujillo-Olivera MT , Worwa G , Dupuis A , Brault AC , Kramer LD , Komar N , Estrada-Franco JG . Emerg Infect Dis 2011 17 (12) 2245-52 West Nile virus (WNV) has caused disease in humans, equids, and birds at lower frequency in Mexico than in the United States. We hypothesized that the seemingly reduced virulence in Mexico was caused by attenuation of the Tabasco strain from southeastern Mexico, resulting in lower viremia than that caused by the Tecate strain from the more northern location of Baja California. During 2006-2008, we tested this hypothesis in candidate avian amplifying hosts: domestic chickens, rock pigeons, house sparrows, great-tailed grackles, and clay-colored thrushes. Only great-tailed grackles and house sparrows were competent amplifying hosts for both strains, and deaths occurred in each species. Tecate strain viremia levels were higher for thrushes. Both strains produced low-level viremia in pigeons and chickens. Our results suggest that certain avian hosts within Mexico are competent for efficient amplification of both northern and southern WNV strains and that both strains likely contribute to bird deaths. |
Population dynamics of Aedes aegypti and dengue as influenced by weather and human behavior in San Juan, Puerto Rico
Barrera R , Amador M , Mackay AJ . PLoS Negl Trop Dis 2011 5 (12) e1378 Previous studies on the influence of weather on Aedes aegypti dynamics in Puerto Rico suggested that rainfall was a significant driver of immature mosquito populations and dengue incidence, but mostly in the drier areas of the island. We conducted a longitudinal study of Ae. aegypti in two neighborhoods of the metropolitan area of San Juan city, Puerto Rico where rainfall is more uniformly distributed throughout the year. We assessed the impacts of rainfall, temperature, and human activities on the temporal dynamics of adult Ae. aegypti and oviposition. Changes in adult mosquitoes were monitored with BG-Sentinel traps and oviposition activity with CDC enhanced ovitraps. Pupal surveys were conducted during the drier and wetter parts of the year in both neighborhoods to determine the contribution of humans and rains to mosquito production. Mosquito dynamics in each neighborhood was compared with dengue incidence in their respective municipalities during the study. Our results showed that: 1. Most pupae were produced in containers managed by people, which explains the prevalence of adult mosquitoes at times when rainfall was scant; 2. Water meters were documented for the first time as productive habitats for Ae. aegypti; 3. Even though Puerto Rico has a reliable supply of tap water and an active tire recycling program, water storage containers and discarded tires were important mosquito producers; 4. Peaks in mosquito density preceded maximum dengue incidence; and 5. Ae. aegypti dynamics were driven by weather and human activity and oviposition was significantly correlated with dengue incidence. |
High rates of Rickettsia parkeri infection in Gulf Coast ticks (Amblyomma maculatum) and identification of "Candidatus Rickettsia andeanae" from Fairfax County, Virginia
Fornadel CM , Zhang X , Smith JD , Paddock CD , Arias JR , Norris DE . Vector Borne Zoonotic Dis 2011 11 (12) 1535-9 The Gulf Coast tick, Amblyomma maculatum, is a vector of Rickettsia parkeri, a recently identified human pathogen that causes a disease with clinical symptoms that resemble a mild form of Rocky Mountain spotted fever. Because the prevalence of R. parkeri infection in geographically distinct populations of A. maculatum is not fully understood, A. maculatum specimens collected as part of a tick and pathogen surveillance system in Fairfax County, Virginia, were screened to determine pathogen infection rates. Overall, R. parkeri was found in 41.4% of the A. maculatum that were screened. Additionally, the novel spotted fever group Rickettsia sp., tentatively named "Candidatus Rickettsia andeanae," was observed for the first time in Virginia. |
Eight years of Legionnaires' disease transmission in travellers to a condominium complex in Las Vegas, Nevada
Silk BJ , Moore MR , Bergtholdt M , Gorwitz RJ , Kozak NA , Tha MM , Brown EW , Winchester JL , Labus BJ , Rowley P , Middaugh JP , Fields BS , Hicks LA . Epidemiol Infect 2012 140 (11) 1-10 SUMMARY: Travel is a risk factor for Legionnaires' disease. In 2008, two cases were reported in condominium guests where we investigated a 2001 outbreak. We reinvestigated to identify additional cases and determine whether ongoing transmission resulted from persistent colonization of potable water. Exposures were assessed by matched case-control analyses (2001) and case-series interviews (2008). We sampled potable water and other water sources. Isolates were compared using sequence-based typing. From 2001 to 2008, 35 cases were identified. Confirmed cases reported after the cluster in 2001-2002 were initially considered sporadic, but retrospective case-finding identified five additional cases. Cases were more likely than controls to stay in tower 2 of the condominium [matched odds ratio (mOR) 6.1, 95% confidence interval (CI) 1.6-22.9]; transmission was associated with showering duration (mOR 23.0, 95% CI 1.4-384). We characterized a clinical isolate as sequence type 35 (ST35) and detected ST35 in samples of tower 2's potable water in 2001, 2002, and 2008. This prolonged outbreak illustrates the importance of striving for permanent Legionella eradication from potable water. |
When every drop counts--drought guidance for public health professionals
Kalis MA . J Environ Health 2011 74 (4) 30-1 The July/August 2009 issue of the Journal | of Environmental Health reported that | the Centers for Disease Control and | Prevention’s (CDC’s) Environmental Health | Services Branch (EHSB) was developing a | guide for public health and other professionals that addresses the health implications of | drought (Kalis, Miller, & Wilson, 2009). The | lack of data and consolidated scientific evidence or guidance on drought as it pertained | to public health initiated this effort. In fact, | this data gap has caused public health experts across the country to operate with limited guidance about drought preparedness and | with an inadequate understanding about how | water shortages can affect the health of their | communities. After a thorough development | process and in collaboration with the American Water Works Association (AWWA), U.S. | Environmental Protection Agency (U.S. EPA), | National Oceanic and Atmospheric Administration (NOAA), and other key partners, EHSB | released in September 2010 When Every Drop | Counts: Protecting Public Health During Drought | Conditions—A Guide for Public Health Professionals (CDC, U.S. EPA, NOAA & AWWA, 2010) |
Outbreak of fatal childhood lead poisoning related to artisanal gold mining in northwestern Nigeria, 2010
Dooyema CA , Neri A , Lo YC , Durant J , Dargan PI , Swarthout T , Biya O , Gidado SO , Haladu S , Sani-Gwarzo N , Nguku PM , Akpan H , Idris S , Bashir AM , Brown MJ . Environ Health Perspect 2011 120 (4) 601-7 BACKGROUND: In May 2010, a team of national and international organizations was assembled to investigate children's deaths due to lead poisoning in villages in northwestern Nigeria. OBJECTIVES: To determine the cause of the childhood lead poisoning outbreak, investigate risk factors for child mortality, and identify children aged <5 years in need of emergency chelation therapy for lead poisoning. METHODS: We administered a cross-sectional, door-to-door questionnaire in two affected villages, collected blood from children aged 2-59 months, and soil samples from family compounds. Descriptive and bivariate analyses were performed with survey, blood-lead, and environmental data. Multivariate logistic regression techniques were used to determine risk factors for childhood mortality. RESULTS: We surveyed 119 family compounds. One hundred eighteen of 463 (25%) children aged <5 years had died in the last year. We tested 59% (204/345) of children, aged <5 years, and all were lead poisoned (≥10 microg/dL); 97% (198/204) of children had blood-lead levels ≥45 microg/dL, the threshold for initiating chelation therapy. Gold ore was processed inside two-thirds of the family compounds surveyed. In multivariate modeling significant risk factors for death in the previous year from suspected lead poisoning included: the child's age, the mother performing ore-processing activities, community well as primary water source, and the soil-lead concentration in the compound. CONCLUSION: The high levels of environmental contamination, percentage of children aged <5 years with elevated blood-lead levels (97%, >45 microg/dL), and incidence of convulsions among children prior to death (82%) suggest that most of the recent childhood deaths in the two surveyed villages were caused by acute lead poisoning from gold ore-processing activities. Control measures included environmental remediation, chelation therapy, public health education, and control of mining activities. |
The International Polar Year: continuing the Arctic human health legacy
Parkinson AJ . Int J Circumpolar Health 2011 70 (5) 447-9 The International Polar Year (IPY) presenteda unique opportunity to further advance thecircumpolar human health agendas of theInternational Union for Circumpolar Healthand the Arctic Council. The Arctic HumanHealth Initiative (AHHI) was an IPY coordinatingproject that aimed to serve as a focalpoint for human health research, education, outreach, and communication activities duringIPY (2007–2009). |
Using poison center data for national public health surveillance for chemical and poison exposure and associated illness
Wolkin AF , Martin CA , Law RK , Schier JG , Bronstein AC . Ann Emerg Med 2012 59 (1) 56-61 The National Poison Data System (NPDS) is a national near-real-time surveillance system that improves situational awareness for chemical and poison exposures, according to data from US poison centers. NPDS is the successor to the Toxic Exposure Surveillance System. The Centers for Disease Control and Prevention (CDC) use these data, which are owned and managed by the American Association of Poison Control Centers, to improve public health surveillance for chemical and poison exposures and associated illness, identify early markers of chemical events, and enhance situational awareness during outbreaks. Information recorded in this database is from self-reported calls from the public or health care professionals. In 2009, NPDS detected 22 events of public health significance and CDC used the system to monitor several multistate outbreaks. One of the limitations of the system is that exposures do not necessarily represent a poisoning. Incorporating NPDS data into the public health surveillance network and subsequently using NPDS to rapidly identify chemical and poison exposures exemplifies the importance of the poison centers and NPDS to public health surveillance. This integration provides the opportunity to improve the public health response to chemical and poison exposures, minimizes morbidity and mortality, and serves as an important step forward in surveillance technology and integration. |
Influenza-like illness surveillance on the California-Mexico border, 2004-2009
Kammerer PE , Montiel S , Kriner P , Bojorquez I , Ramirez VB , Vazquez-Erlbeck M , Azziz-Baumgartner E , Blair PJ . Influenza Other Respir Viruses 2011 6 (5) 358-66 BACKGROUND: Since 2004, the Naval Health Research Center, with San Diego and Imperial counties, has collaborated with the US Centers for Disease Control and Prevention to conduct respiratory disease surveillance in the US-Mexico border region. In 2007, the Secretariat of Health, Mexico and the Institute of Public Health of Baja California joined the collaboration. OBJECTIVES: The identification of circulating respiratory pathogens in respiratory specimens from patients with influenza-like illness (ILI). METHODS: Demographic, symptom information and respiratory swabs were collected from enrollees who met the case definition for ILI. Specimens underwent PCR testing and culture in virology and bacteriology. RESULTS: From 2004 through 2009, 1855 persons were sampled. Overall, 36% of the participants had a pathogen identified. The most frequent pathogen was influenza (25%), with those aged 6-15 years the most frequently affected. In April 2009, a young female participant from Imperial County, California, was among the first documented cases of 2009 H1N1. Additional pathogens included influenza B, adenovirus, parainfluenza virus, respiratory syncytial virus, enterovirus, herpes simplex virus, Streptococcus pneumoniae, and Streptococcus pyogenes. CONCLUSIONS: The US-Mexico border is one of the busiest in the world, with a large number of daily crossings. Due to its traffic, this area is an ideal location for surveillance sites. We identified a pathogen in 36% of the specimens tested, with influenza A the most common pathogen. A number of other viral and bacterial respiratory pathogens were identified. An understanding of the incidence of respiratory pathogens in border populations is useful for development of regional vaccination and disease prevention responses. (Please cite this paper as: Kammerer et al. (2011). Influenza-like illness surveillance on the California-Mexico border, 2004-2009. Influenza and Other Respiratory Viruses DOI: 10.1111/j.1750-2659.2011.00316.x. ) |
Three outbreaks of foodborne botulism caused by unsafe home canning of vegetables - Ohio and Washington, 2008 and 2009
Date K , Fagan R , Crossland S , Maceachern D , Pyper B , Bokanyi R , Houze Y , Andress E , Tauxe R . J Food Prot 2011 74 (12) 2090-6 Foodborne botulism is a potentially fatal paralytic illness caused by ingestion of neurotoxin produced by the spore-forming bacterium Clostridium botulinum. Historically, home-canned vegetables have been the most common cause of botulism outbreaks in the United States. During 2008 and 2009, the Centers for Disease Control and Prevention (CDC) and state and local health departments in Ohio and Washington State investigated three outbreaks caused by unsafe home canning of vegetables. We analyzed CDC surveillance data for background on food vehicles that caused botulism outbreaks from 1999 to 2008. For the three outbreaks described, patients and their family members were interviewed and foods were collected. Laboratory testing of clinical and food samples was done at the respective state public health laboratories. From 1999 to 2008, 116 outbreaks of foodborne botulism were reported. Of the 48 outbreaks caused by home-prepared foods from the contiguous United States, 38% (18) were from home-canned vegetables. Three outbreaks of Type A botulism occurred in Ohio and Washington in September 2008, January 2009, and June 2009. Home-canned vegetables (green beans, green bean and carrot blend, and asparagus) served at family meals were confirmed as the source of each outbreak. In each instance, home canners did not follow canning instructions, did not use pressure cookers, ignored signs of food spoilage, and were unaware of the risk of botulism from consuming improperly preserved vegetables. Home-canned vegetables remain a leading cause of foodborne botulism. These outbreaks illustrate critical areas of concern in current home canning and food preparation knowledge and practices. Similar gaps were identified in a 2005 national survey of U.S. adults. Botulism prevention efforts should include targeted educational outreach to home canners. |
Analysis of a non-structural gene reveals evidence of possible hepatitis C virus (HCV) compartmentalization.
Blackard JT , Ma G , Welge JA , Martin CM , Sherman KE , Taylor LE , Mayer KH , Jamieson DJ . J Med Virol 2012 84 (2) 242-252 Viral diversity is a hallmark of hepatitis C virus (HCV) infection; however, only limited data are available regarding HCV variability in extrahepatic sites, and none have systematically compared diversity in non-structural and structural genomic regions. Therefore, HCV diversity in the NS5B and envelope 1 (E1) hypervariable region 1 (HVR1) genes was evaluated in matched sera and peripheral blood mononuclear cells (PBMCs) obtained from 13 HCV-infected women. Multiple clonal sequences were compared to evaluate quasispecies diversity and viral compartmentalization in PBMCs. Genetic distances were higher for E1/HVR1 compared to NS5B in both the sera and PBMCs (P=0.0511 and 0.0284). Genetic distances were higher in serum NS5B compared to PBMC NS5B (P=0.0003); however, they were not different when comparing E1/HVR1 in sera to PBMCs. By phylogenetic analysis of NS5B, evidence of possible PBMC compartmentalization was observed for one woman, while statistical methods were consistent with PBMC compartmentalization for six women. Evidence of compartmentalization within a non-structural genomic region may suggest that viral adaptation to a unique extracellular microenvironment(s) may be required for efficient replication and could contribute to HCV persistence. (2011 Wiley Periodicals, Inc.) |
Japanese encephalitis virus genotype replacement, Taiwan, 2009-2010.
Chen YY , Fan YC , Tu WC , Chang RY , Shih CC , Lu IH , Chien MS , Lee WC , Chen TH , Chang GJ , Chiou SS . Emerg Infect Dis 2011 17 (12) 2354-6 Genotype I of Japanese encephalitis virus first appeared in Taiwan in 2008. Phylogenetic analysis of 37 viruses from pig farms in 2009-2010 classified these viruses into 2 unique subclusters of genotype I viruses and suggested multiple introductions and swift replacement of genotype III by genotype I virus in Taiwan. |
Diversity of 16S-23S rDNA internal transcribed spacer (ITS) reveals phylogenetic relationships in Burkholderia pseudomallei and its near-neighbors.
Liguori AP , Warrington SD , Ginther JL , Pearson T , Bowers J , Glass MB , Mayo M , Wuthiekanun V , Engelthaler D , Peacock SJ , Currie BJ , Wagner DM , Keim P , Tuanyok A . PLoS One 2011 6 (12) e29323 Length polymorphisms within the 16S-23S ribosomal DNA internal transcribed spacer (ITS) have been described as stable genetic markers for studying bacterial phylogenetics. In this study, we used these genetic markers to investigate phylogenetic relationships in Burkholderia pseudomallei and its near-relative species. B. pseudomallei is known as one of the most genetically recombined bacterial species. In silico analysis of multiple B. pseudomallei genomes revealed approximately four homologous rRNA operons and ITS length polymorphisms therein. We characterized ITS distribution using PCR and analyzed via a high-throughput capillary electrophoresis in 1,191 B. pseudomallei strains. Three major ITS types were identified, two of which were commonly found in most B. pseudomallei strains from the endemic areas, whereas the third one was significantly correlated with worldwide sporadic strains. Interestingly, mixtures of the two common ITS types were observed within the same strains, and at a greater incidence in Thailand than Australia suggesting that genetic recombination causes the ITS variation within species, with greater recombination frequency in Thailand. In addition, the B. mallei ITS type was common to B. pseudomallei, providing further support that B. mallei is a clone of B. pseudomallei. Other B. pseudomallei near-neighbors possessed unique and monomorphic ITS types. Our data shed light on evolutionary patterns of B. pseudomallei and its near relative species. |
Molecular epidemiology of anthrax cases associated with recreational use of animal hides and yarn in the United States.
Marston CK , Allen CA , Beaudry J , Price EP , Wolken SR , Pearson T , Keim P , Hoffmaster AR . PLoS One 2011 6 (12) e28274 To determine potential links between the clinical isolate to animal products and their geographic origin, we genotyped (MLVA-8, MVLA-15, and canSNP analysis) 80 environmental and 12 clinical isolates and 2 clinical specimens from five cases of anthrax (California in 1976 [n = 1], New York in 2006 [n = 1], Connecticut in 2007 [n = 2], and New Hampshire in 2009[n = 1]) resulting from recreational handling of animal products. For the California case, four clinical isolates were identified as MLVA-8 genotype (GT) 76 and in the canSNP A.Br.Vollum lineage, which is consistent with the Pakistani origin of the yarn. Twenty eight of the California isolates were in the A.Br.Vollum canSNP lineage and one isolate was in the A.Br. 003/004 canSNP sub-group. All 52 isolates and both clinical specimens related to the New York and Connecticut cases were MLVA-8 GT 1. The animal products associated with the NY and CT cases were believed to originate from West Africa, but no isolates from this region are available to be genotyped for comparison. All isolates associated with the New Hampshire case were identical and had a new genotype (GT 149). Isolates from the NY, CT and NH cases diverge from the established canSNP phylogeny near the base of the A.Br.011/009. This report illustrates the power of the current genotyping methods and the dramatically different epidemiological conditions that can lead to infections (i.e., contamination by a single genotype versus widespread contamination of numerous genotypes). These cases illustrate the need to acquire and genotype global isolates so that accurate assignments can be made about isolate origins. |
A pilot study of host genetic variants associated with influenza-associated deaths among children and young adults.
Ferdinands JM , Denison AM , Dowling NF , Jost HA , Gwinn ML , Liu L , Zaki SR , Shay DK . Emerg Infect Dis 2011 17 (12) 2294-302 We compared the prevalence of 8 polymorphisms in the tumor necrosis factor and mannose-binding lectin genes among 105 children and young adults with fatal influenza with US population estimates and determined in subanalyses whether these polymorphisms were associated with sudden death and bacterial co-infection among persons with fatal influenza. No differences were observed in genotype prevalence or minor allele frequencies between persons with fatal influenza and the reference sample. Fatal cases with low-producing MBL2 genotypes had a 7-fold increased risk for invasive methicillin-resistant Staphylococcus aureus (MRSA) co-infection compared with fatal cases with high- and intermediate-producing MBL2 genotypes (odds ratio 7.1, 95% confidence interval 1.6-32.1). Limited analysis of 2 genes important to the innate immune response found no association between genetic variants and fatal influenza infection. Among children and young adults who died of influenza, low-producing MBL2 genotypes may have increased risk for MRSA co-infection. |
Unsafe sexual behaviors among HIV-positive men and women in Honduras: the role of discrimination, condom access, and gender
Paz-Bailey G , Isern Fernandez V , Morales Miranda S , Jacobson JO , Mendoza S , Paredes MA , Danaval DC , Mabey D , Monterroso E . Sex Transm Dis 2012 39 (1) 35-41 BACKGROUND: We conducted a study among HIV-positive men and women in Honduras to describe demographics, HIV risk behaviors and sexually transmitted infection prevalence, and identify correlates of unsafe sex. METHODS: Participants were recruited from HIV clinics and nongovernmental organizations in Tegucigalpa and San Pedro Sula, Honduras in a cross-sectional study in 2006. We used audio-assisted computer interviews on demographics; behaviors in the past 12 months, 6 months, and 30 days; and access to care. Assays performed included herpes (HSV-2 Herpes Select), syphilis (rapid plasma reagin [RPR] and Treponema pallidum particle agglutination assay [TPPA]) serology, and other sexually transmitted infections by polymerase chain reaction (PCR). Bivariate and multivariate analyses were conducted to assess variables associated with unprotected sex across all partner types in the past 12 months. RESULTS: Of 810 participants, 400 were from Tegucigalpa and 410 from San Pedro Sula; 367 (45%) were men. Mean age was 37 years (interquartile range: 31-43). Consistent condom use for men and women was below 60% for all partner types. In multivariate analysis, unprotected sex was more likely among women (odds ratio [OR]: 1.9, 95% confidence interval [CI]: 1.2-3.1, P = 0.007), those with HIV diagnoses within the past year (OR: 2.0, 95% CI: 1.1-3.7, P = 0.016), those reporting difficulty accessing condoms (OR: 2.6, 95% CI: 1.4-4.7, P = 0.003), and those reporting discrimination (OR: 1.8, 95% CI: 1.1-3.0, P = 0.016). CONCLUSIONS: Programs targeting HIV-positive patients need to address gender-based disparities, improve condom access and use, and help establish a protective legal and policy environment free of stigma and discrimination. |
Ongoing sexually transmitted disease acquisition and risk-taking behavior among US HIV-infected patients in primary care: implications for prevention interventions
Mayer KH , Bush T , Henry K , Overton ET , Hammer J , Richardson J , Wood K , Conley L , Papp J , Caliendo AM , Patel P , Brooks JT . Sex Transm Dis 2012 39 (1) 1-7 BACKGROUND: To better understand the factors associated with HIV- and sexually transmitted disease (STD)-transmitting behavior among HIV-infected persons, we estimated STD prevalence and incidence and associated risk factors among a diverse sample of HIV-infected patients in primary care. METHODS: We analyzed data from 557 participants in the SUN Study, a prospective observational cohort of HIV-infected adults in primary care in 4 US cities. At enrollment and 6 months thereafter, participants completed an audio computer-assisted self-interview about their sexual behavior, and were screened for genitourinary, rectal, and pharyngeal Neisseria gonorrhoeae and Chlamydia trachomatis infections by nucleic acid amplification testing, and for serologic evidence of syphilis. Women provided cervicovaginal samples and men provided urine to screen for Trichomonas vaginalis by polymerase chain reaction. RESULTS: Thirteen percent of participants had a prevalent STD at enrollment and 7% an incident STD 6 months later. The most commonly diagnosed infections were rectal chlamydia, oropharyngeal gonorrhea, and chlamydial urethritis among the men and trichomoniasis among the women. Other than trichomoniasis, 94% of incident STDs were identified in men who have sex with men. Polysubstance abuse other than marijuana, and having ≥4 sex partners in the 6 months before testing were associated with diagnosis of an incident STD. CONCLUSIONS: STDs were commonly diagnosed among contemporary HIV-infected patients receiving routine outpatient care, particularly among sexually active men who have sex with men who used recreational drugs. These findings underscore the need for frequent STD screening, prevention counseling, and substance abuse treatment for HIV-infected persons in care. |
Compliance with bloodborne pathogen standards at eight correctional facilities
Lehman EJ , Huy JM , Viet SM , Gomaa A . J Correct Health Care 2011 18 (1) 29-44 This study had three objectives: (a) to examine compliance with the Occupational Safety and Health Administration (OSHA) Bloodborne Pathogens (BBPs) Standard at eight correctional facilities, (b) to identify potential barriers to compliance, and (c) to discuss steps to address these barriers. Eight facilities of different sizes and locations were visited to examine employer adherence to 15 selected BBP risk reduction activities. Facility compliance was less than 50% for four activities: updating exposure control plans, implementing use of appropriate safer medical devices, soliciting employee input on selection of safer devices, and training medical staff when such devices are implemented. Inconsistent compliance may be due to difficulties in applying the standards in the correctional health care work setting. Any BBP training and health communication activities targeted to correctional health care workers should be tailored to the correctional facility setting. |
London Plane Tree bioaerosol exposure and allergic sensitization in Sydney, Australia
Sercombe JK , Green BJ , Rimmer J , Burton PK , Katelaris CH , Tovey ER . Ann Allergy Asthma Immunol 2011 107 (6) 493-500 BACKGROUND: Exposure to London Plane Tree (Platanus) bioaerosols in Sydney, Australia has been anecdotally linked to respiratory irritation, rhinitis, and conjunctivitis. OBJECTIVE: To determine the relationships between Platanus bioaerosol exposure, allergic sensitization, and symptoms. METHODS: Sixty-four subjects with self-reported Platanus symptoms were recruited from inner-urban Sydney. Allergic sensitization was determined by skin prick test (SPT) to 13 allergens. Airborne concentrations of Platanus pollen, trichomes, and achene fibers, and other pollen and fungal spores, were measured over the spring and summer of 2006-2007. Subjects' allergic symptoms were monitored concurrently. The Halogen immunoassay (HIA) was used to measure subjects' immunoglobulin E (IgE) reactivity to collected bioaerosols. RESULTS: Platanus pollen constituted 76% of total pollen between July 2006 and April 2007. Airborne concentrations of Platanus pollen peaked from August until October. Non-Platanus pollen peaked from July to December. Elevated concentrations of trichomes and achene fibers occurred from September to December and August to October, respectively. As determined by SPT, 85.9% of subjects were sensitized, 65.6% to any pollen tested, 56.3% to Lolium perenne, and 23.4% to Platanus. Higher mean daily symptom scores were only associated with high counts of non-Platanus pollens. HIA analysis demonstrated IgE binding to Platanus pollen in all Platanus sensitized subjects. Personal nasal air sampling detected airborne trichomes that were capable of being inhaled. Platanus trichomes or achene fibers did not bind IgE from any subject. CONCLUSIONS: Platanus bioaerosols exist in high concentrations between August and November in inner-urban Sydney but were not associated with seasonal symptoms. Platanus trichomes are inhaled and may constitute a respiratory irritant. |
No evidence of murine leukemia virus-related viruses in live attenuated human vaccines.
Switzer WM , Zheng H , Simmons G , Zhou Y , Tang S , Shankar A , Kapusinszky B , Delwart EL , Heneine W . PLoS One 2011 6 (12) e29223 BACKGROUND: The association of xenotropic murine leukemia virus (MLV)-related virus (XMRV) in prostate cancer and chronic fatigue syndrome reported in previous studies remains controversial as these results have been questioned by recent data. Nonetheless, concerns have been raised regarding contamination of human vaccines as a possible source of introduction of XMRV and MLV into human populations. To address this possibility, we tested eight live attenuated human vaccines using generic PCR for XMRV and MLV sequences. Viral metagenomics using deep sequencing was also done to identify the possibility of other adventitious agents. RESULTS: All eight live attenuated vaccines, including Japanese encephalitis virus (JEV) (SA-14-14-2), varicella (Varivax), measles, mumps, and rubella (MMR-II), measles (Attenuvax), rubella (Meruvax-II), rotavirus (Rotateq and Rotarix), and yellow fever virus were negative for XMRV and highly related MLV sequences. However, residual hamster DNA, but not RNA, containing novel endogenous gammaretrovirus sequences was detected in the JEV vaccine using PCR. Metagenomics analysis did not detect any adventitious viral sequences of public health concern. Intracisternal A particle sequences closest to those present in Syrian hamsters and not mice were also detected in the JEV SA-14-14-2 vaccine. Combined, these results are consistent with the production of the JEV vaccine in Syrian hamster cells. CONCLUSIONS: We found no evidence of XMRV and MLV in eight live attenuated human vaccines further supporting the safety of these vaccines. Our findings suggest that vaccines are an unlikely source of XMRV and MLV exposure in humans and are consistent with the mounting evidence on the absence of these viruses in humans. |
Updated recommendations of the Advisory Committee on Immunization Practices for healthcare personnel vaccination: a necessary foundation for the essential work that remains to build successful programs
Shefer A , Strikas R , Bridges CB . Infect Control Hosp Epidemiol 2012 33 (1) 71-4 Many adults are susceptible to vaccine-preventable diseases | (VPDs) because they have never received protection from | vaccination, because of waning immunity from vaccination, | or because of lack of immunity due to never having been | infected.1 | Influenza is unique among VPDs in that frequent | changes in circulating influenza viruses and limited duration | of immunity after vaccination require annual vaccination for | optimal protection. Other VPDs can also cause significant | morbidity and mortality. Ensuring that as many healthcare | personnel (HCP) as possible are immune to VPDs is important, given those individuals' increased risk of exposure | to and infection with VPDs and their risk of transmitting | VPDs to vulnerable patients.2 |
Early impact of the US Tdap vaccination program on pertussis trends
Skoff TH , Cohn AC , Clark TA , Messonnier NE , Martin SW . Arch Pediatr Adolesc Med 2012 166 (4) 344-9 OBJECTIVE: To evaluate the impact of the adolescent Tdap vaccination (tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis vaccine) program on pertussis trends in the United States. DESIGN: Retrospective analysis of nationally reported pertussis cases, January 1, 1990, through December 31, 2009. SETTING: United States. PARTICIPANTS: Confirmed and probable pertussis cases. Intervention The US Tdap vaccination program. MAIN OUTCOME MEASURE: Rate ratios of reported pertussis incidence (defined as incidence among 11- to 18-year-olds divided by the combined incidence in all other age groups) modeled through segmented regression analysis and age-specific trends in reported pertussis incidence over time. RESULTS: A total of 200,401 pertussis cases were reported in the United States from 1990 to 2009. Overall incidence ranged from 1.0 to 8.8 per 100,000 persons (1991 and 2004, respectively). Slope coefficients (estimated annual rate of change in rate ratios) from segmented regression showed a steady increase in pertussis incidence among adolescents 11 to 18 years old compared with all other age groups before Tdap introduction (slope = 0.22; P < .001), and a steep decreasing trend postintroduction (slope = -0.48; P < .001) suggesting a direct impact of vaccination among adolescents. Indirect effects of adolescent vaccination were not observed among infants younger than 1 year. CONCLUSIONS: Changes in pertussis incidence in the United States from 2005 to 2009 revealed a divergence between 11- to 18-year-olds and other age groups, suggesting that targeted use of Tdap among adolescents reduced disease preferentially in this age group. Increased Tdap coverage in adolescents and adults is needed to realize the full direct and indirect benefits of vaccination. |
HPV vaccine implementation in STD clinics - STD Surveillance Network
Meites E , Llata E , Hariri S , Zenilman J , Longfellow L , Schwebke J , Tabidze I , Mettenbrink C , Jenkins H , Guerry S , Pathela P , Asbel L , Stover JA , Bernstein K , Kerani RP , Dunne EF , Markowitz LE . Sex Transm Dis 2012 39 (1) 32-34 We surveyed selected public sexually transmitted disease clinics in the United States regarding human papillomavirus vaccine availability, target populations, funding sources, and barriers. Although nearly all had experience offering other vaccines, only 7 of 42 clinics (17%) offered human papillomavirus vaccine. Vaccine cost, staff time, and follow-up issues were commonly reported barriers. |
Human papillomavirus vaccine and sexual behavior among adolescent and young women
Liddon NC , Leichliter JS , Markowitz LE . Am J Prev Med 2012 42 (1) 44-52 BACKGROUND: Vaccines to prevent certain types of human papillomavirus (HPV) and associated cancers are recommended for routine use among young women. Nationally representative reports of vaccine uptake have not explored the relationship between HPV vaccine initiation and various sexual behaviors. PURPOSE: Explore sexual behavior and demographic correlates of HPV vaccine initiation from a nationally representative survey of adolescent and young adult women. METHODS: In 2007-2008, a total of 1243 girls/women aged 15-24 years responded to questions about receiving HPV vaccine in the National Survey of Family Growth (NSFG). In 2010, demographic and sexual behavior correlates were evaluated in bivariate and multivariate analyses by age. RESULTS: HPV vaccine initiation was higher among those aged 15-19 years than those aged 20-24 years (30.3% vs 15.9%, p<0.001). No differences existed by race/ethnicity for those aged 15-19 years, but among women aged 20-24 years, non-Hispanic blacks were less likely than non-Hispanic whites to have received the HPV vaccine (AOR=0.15). HPV vaccine initiation was greater for those with insurance regardless of age. HPV vaccination was not associated with being sexually active or number of sex partners at either age. Among sexually active adolescents aged 15-19 years, those who received HPV vaccine were more likely to always wear a condom (AOR=3.0). CONCLUSIONS: This study highlights disparities in HPV vaccine initiation by insurance status among girls/women aged 15-24 years and by race/ethnicity among women aged >19 years. No association was found between HPV vaccination and risky sexual behavior. |
Influenza vaccination coverage among US nursing home nursing assistants: the role of working conditions
Groenewold M , Baron S , Tak S , Allred N . J Am Med Dir Assoc 2012 13 (1) 85 e17-23 OBJECTIVES: To estimate influenza vaccination coverage among nursing assistants (NAs) working in US nursing homes, and to identify demographic and occupational predictors of vaccination status among NAs. DESIGN, SETTING, AND PARTICIPANTS: Cross-sectional analysis of data on 2873 NAs from the 2004 National Nursing Assistant Survey. Multivariable-adjusted vaccination coverage (prevalence) ratios for demographic and occupational characteristics were calculated using Poisson regression. MEASUREMENTS: Outcome variable was NAs' influenza vaccination status, yes or no, based on the question, "During the past 12 months, did you receive a flu shot?" RESULTS: Coverage for all NAs working in US nursing homes was estimated to be 37.1%. NAs 45 or older were more likely to be vaccinated than younger NAs (prevalence ratio [PR] = 1.23, 95% confidence interval [CI]: 1.07-1.41). Significant negative associations with vaccination status were found for NAs who were non-Hispanic blacks (PR = 0.82, 95% CI: 0.70-0.97), disagreed that they were respected/rewarded for their work (PR = 0.85, 95% CI: 0.71-1.00), worked at for-profit facilities (PR = 0.83, 95% CI: 0.72-0.95), and reported receiving fewer than 7 of 15 nonwage job benefits (PR = 0.77, 95% CI: 0.67-0.90). CONCLUSION: Influenza coverage among nursing home NAs appears to be similar to nationally reported coverage estimates among health care providers in the United States in general. In addition to individual characteristics, occupational characteristics reflective of working conditions are associated with vaccination status among NAs, suggesting that further research into these types of associations may be useful in identifying which institutions may benefit from outreach efforts and types of interventions to increase vaccination coverage. |
Cancers that U.S. physicians believe the HPV vaccine prevents: findings from a physician survey, 2009
Saraiya M , Rosser JI , Cooper CP . J Womens Health (Larchmt) 2012 21 (2) 111-7 BACKGROUND: There is strong scientific evidence that human papillomavirus (HPV) vaccines, which protect against two oncogenic HPV types (16 and 18), can prevent cervical, vaginal, and vulvar cancers in women. In addition, recent research has established that the HPV vaccine can prevent anal cancer and has implied that it may also prevent oropharyngeal cancers. METHODS: A 2009 web-based survey of 1500 physicians from four specialties (pediatricians, family practitioners, internists, and obstetrician-gynecologists) explored knowledge about which female cancers the HPV vaccine was effective in preventing. Physician characteristics associated with the belief that the HPV vaccine prevents cervical, vaginal, vulvar, anal, and other cancers were examined using logistic regression models. RESULTS: Nearly all respondents (97.8%) identified cervical cancer as being prevented by the HPV vaccine; however, lower awareness that the vaccine prevents vaginal (23.8%), vulvar (27.8%), and anal cancer (28.4%) was found. Physician specialty was the most significant covariate identified, with obstetrician-gynecologists being more likely than other physicians to report that the HPV vaccine protected against vaginal (p<0.001), vulvar (p<0.001), and anal (p<0.001) cancers. CONCLUSIONS: Physicians may benefit from educational efforts clarifying which noncervical cancers can be prevented by the HPV vaccine. Education is needed across all medical specialties, but it is particularly important for pediatricians and family practitioners, the physicians most likely to administer the HPV vaccine to young adolescents. |
Use of human papillomavirus vaccines among young adult women in the United States: an analysis of the 2008 National Health Interview Survey
Anhang Price R , Tiro JA , Saraiya M , Meissner H , Breen N . Cancer 2011 117 (24) 5560-5568 BACKGROUND: The Centers for Disease Control and Prevention recommends catch-up administration of human papillomavirus (HPV) vaccines to girls and women ages 13 to 26 who have not been vaccinated previously. In response to debate regarding catch-up vaccination of young adult women, this study examined whether 18- to 26-year-old women most likely to benefit from catch-up vaccination were aware of the HPV vaccine, and initiated the vaccine series by the end of 2008. METHODS: We used data from the 2008 National Health Interview Survey to assess HPV vaccine awareness and use, and reasons for not vaccinating, among women aged 18-26 years (n = 1583). Sociodemographic, health care access, and health history factors associated with vaccine initiation were assessed using multivariate logistic regression. RESULTS: Overall, 11.7% of women aged 18-26 years reported receiving at least 1 dose of the HPV vaccine by the end of 2008. In multivariate analyses, younger age, history of previous HPV infection, unmarried status, health insurance, flu shot in the past year, and receipt of 1 or more recommended lifetime vaccines were significantly associated with HPV vaccine initiation. Two-fifths (39.6%) of unvaccinated women were interested in receiving the HPV vaccine (n = 1327). Primary reasons for lack of interest in the vaccine were belief that it was not needed, not knowing enough about it, concerns about safety, and not being sexually active. CONCLUSION: HPV vaccine coverage among young adult women was low, and lower among the uninsured than the insured. Public financing and care provision programs have the potential to expand vaccine coverage among uninsured women, who are at increased risk of cervical cancer. (Copyright 2011 American Cancer Society). |
Community-based values for 2009 pandemic influenza A H1N1 illnesses and vaccination-related adverse events
Lavelle TA , Meltzer MI , Gebremariam A , Lamarand K , Fiore AE , Prosser LA . PLoS One 2011 6 (12) e27777 OBJECTIVE: To evaluate community-based values for avoiding pandemic influenza (A) H1N1 (pH1N1) illness and vaccination-related adverse events in adults and children. METHODS: Adult community members were randomly selected from a nationally representative research panel to complete an internet survey (response rate = 65%; n = 718). Respondents answered a series of time trade-off questions to value four hypothetical health state scenarios for varying ages (1, 8, 35, or 70 years): uncomplicated pH1N1 illness, pH1N1 illness-related hospitalization, severe allergic reaction to the pH1N1 vaccine, and Guillain-Barre syndrome. We calculated descriptive statistics for time trade-off amounts and derived quality adjusted life year losses for these events. Multivariate regression analyses evaluated the effect of scenario age, as well as respondent socio-demographic and health characteristics on time trade-off amounts. RESULTS: Respondents were willing to trade more time to avoid the more severe outcomes, hospitalization and Guillain-Barre syndrome. In our adjusted and unadjusted analyses, age of the patient in the scenario was significantly associated with time trade-off amounts (p-value<0.05), with respondents willing to trade more time to prevent outcomes in children versus adults. Persons who had received the pH1N1 vaccination were willing to trade significantly more time to avoid hospitalization, severe allergic reaction, and Guillain-Barre syndrome, controlling for other variables in adjusted analyses.(p-value<0.05) CONCLUSIONS: Community members placed the highest value on preventing outcomes in children, compared with adults, and the time trade-off values reported were consistent with the severity of the outcomes presented. Considering these public values along with other decision-making factors may help policy makers improve the allocation of pandemic vaccine resources. |
Bullying perpetration and subsequent sexual violence perpetration among middle school students
Espelage DL , Basile KC , Hamburger ME . J Adolesc Health 2012 50 (1) 60-65 This study examines the association between bullying experiences and sexual violence (SV) perpetration among a sample of middle school students (n = 1391; males and females in grades 58) across five middle schools in a Midwestern state. We include waves 1 and 2 of a larger longitudinal study that aimed to track the overlap between bullying and SV victimization and/or perpetration across a 3-year period. Wave 1 data were collected in the spring of 2008, and wave 2 data were collected in the fall of 2008. Student participants completed a series of scales in a paper and pencil survey. After missing data imputation, a total sample of 1391 students was analyzed. Using cutoff scores, 12% of males and 12% of females could be considered bully perpetrators. Thirty-two percent of the boys (22% of girls) reported making sexual comments to other students, 5% of boys (7% of girls) spread a sexual rumor, and 4% of boys (2% of girls) pulled at someone's clothing. Bullying perpetration and homophobic teasing were significant predictors of sexual harassment perpetration over time. Given the overlap among bullying, homophobic teasing perpetration, and SV perpetration, future studies should address the link among these forms of aggression so that prevention programs can be enhanced to address gender-based bullying and sexual harassment. |
Lessons from the past
Paulozzi L , Dellinger A , Degutis L . Inj Prev 2011 18 (1) 70 The National Center for Health Statistics (NCHS) recently announced that poisoning had passed motor vehicle (MV) crashes as the leading cause of injury death in the USA in 2008.1 The NCHS also noted that nearly 90% of poisoning deaths were due to drugs, which have driven the overall poisoning mortality increase since at least 1980. Much of the increase in drug poisoning mortality was due to prescription drugs, especially opioid painkillers. Similar trends related to prescription opioids have been noted in other developed countries.2 3 | Preliminary mortality data from 2009 suggest an additional large decline in MV crash deaths,4 5 while emergency department data suggest a continued increase in prescription drug overdoses in 2009.6 It is likely that drug poisoning alone now causes more deaths than MV crashes in the USA. | These reported and anticipated changes represent a major milestone in injury prevention. A hundred years ago, falls were the leading mechanism of injury death in the USA.7 Beginning around 1910, MV crash death rates began to rise rapidly as personal MVs proliferated, surpassing other causes of injury death such as poisoning, fires, burns and drowning. By 1925 MV crash deaths had surpassed falls deaths to become the leading cause of injury death. MV crashes remained the leading cause for almost a century until the re-ranking in 2008. | |
Looking ahead toward community-level strategies to prevent sexual violence
Degue S , Holt MK , Massetti GM , Matjasko JL , Tharp AT , Valle LA . J Womens Health (Larchmt) 2011 21 (1) 1-3 The Division of Violence Prevention within CDC's National Center for Injury Prevention and Control recently undertook a systematic review of primary prevention strategies for sexual violence (SV) perpetration. This review identified the lack of community-level strategies to prevent SV as a critical gap in the literature. Community-level strategies function by modifying the characteristics of settings (e.g., schools, workplaces, neighborhoods) that increase the risk for violence victimization and perpetration. Identification of evidence-based strategies at the community level would allow implementation of ecologic approaches to SV prevention with a greater potential for reducing the prevalence of SV perpetration. The field will face several challenges in identifying and evaluating the effectiveness of promising community-level strategies to prevent SV. These challenges include limited knowledge of community-level and societal-level risk factors for SV, a lack of theoretical or empirical guidance in the SV literature for identification of promising community-level approaches, and challenges in evaluating SV outcomes at the community level. Recognition of these challenges should guide future research and foster dialogue within the SV prevention field. The development and evaluation of community-level approaches to SV prevention represent a vital and logical next step toward the implementation of effective, multilevel prevention efforts and a population-level reduction in the prevalence of SV. |
Intimate partner violence perpetration by court-ordered men: distinctions among subtypes of physical violence, sexual violence, psychological abuse, and stalking
Hall JE , Walters ML , Basile KC . J Interpers Violence 2011 27 (7) 1374-95 This study continues previous work documenting the structure of violence perpetrated by males against their female intimate partners. It assesses the construct validity of a measurement model depicting associations among eight subtypes of perpetration: moderate physical violence, severe physical violence, forced or coerced sexual violence, sexual violence where consent was not possible, emotional/verbal psychological abuse, dominance/isolation psychological abuse, interactional contacts/surveillance related stalking, and stalking involving mediated contacts. Data were obtained from a sample of 340 men arrested for physical assault of a female spouse or partner, and court ordered into batterer intervention programs. Men were surveyed before starting the intervention. Confirmatory factor analyses (CFA) supported the validity of model as evidenced by good model to data fit and satisfaction of requirements for fit statistics. In addition, the eight factor solution was characterized by a slightly better model to data fit than a four factor higher order solution described in the author's previous work. Latent variable correlations across the broader categories of intimate partner violence (IPV) revealed that the violence subtypes were mostly moderately positively correlated and ranged from .381 (emotional/verbal psychological abuse with interactional contacts/surveillance related stalking) to .795 (dominance/isolation psychological with abuse with forced sex). Future studies should determine whether there are distinct risk factors and health outcomes associated with each of the eight IPV perpetration subtypes and identify possible patterns of co-occurrence. |
Detection of murine leukemia virus or mouse DNA in commercial RT-PCR reagents and human DNAs.
Zheng H , Jia H , Shankar A , Heneine W , Switzer WM . PLoS One 2011 6 (12) e29050 The xenotropic murine leukemia virus (MLV)-related viruses (XMRV) have been reported in persons with prostate cancer, chronic fatigue syndrome, and less frequently in blood donors. Polytropic MLVs have also been described in persons with CFS and blood donors. However, many studies have failed to confirm these findings, raising the possibility of contamination as a source of the positive results. One PCR reagent, Platinum Taq polymerase (pol) has been reported to contain mouse DNA that produces false-positive MLV PCR results. We report here the finding of a large number of PCR reagents that have low levels of MLV sequences. We found that recombinant reverse-transcriptase (RT) enzymes from six companies derived from either MLV or avian myeloblastosis virus contained MLV pol DNA sequences but not gag or mouse DNA sequences. Sequence and phylogenetic analysis showed high relatedness to Moloney MLV, suggesting residual contamination with an RT-containing plasmid. In addition, we identified contamination with mouse DNA and a variety of MLV sequences in commercially available human DNAs from leukocytes, brain tissues, and cell lines. These results identify new sources of MLV contamination and highlight the importance of careful pre-screening of commercial specimens and diagnostic reagents to avoid false-positive MLV PCR results. |
Single-walled carbon nanotube-induced mitotic disruption.
Sargent LM , Hubbs AF , Young SH , Kashon ML , Dinu CZ , Salisbury JL , Benkovic SA , Lowry DT , Murray AR , Kisin ER , Siegrist KJ , Battelli L , Mastovich J , Sturgeon JL , Bunker KL , Shvedova AA , Reynolds SH . Mutat Res 2011 745 28-37 Carbon nanotubes were among the earliest products of nanotechnology and have many potential applications in medicine, electronics, and manufacturing. The low density, small size, and biological persistence of carbon nanotubes create challenges for exposure control and monitoring and make respiratory exposures to workers likely. We have previously shown mitotic spindle aberrations in cultured primary and immortalized human airway epithelial cells exposed to 24, 48 and 96mcg/cm(2) single-walled carbon nanotubes (SWCNT). To investigate mitotic spindle aberrations at concentrations anticipated in exposed workers, primary and immortalized human airway epithelial cells were exposed to SWCNT for 24-72h at doses equivalent to 20 weeks of exposure at the Permissible Exposure Limit for particulates not otherwise regulated. We have now demonstrated fragmented centrosomes, disrupted mitotic spindles and aneuploid chromosome number at those doses. The data further demonstrated multipolar mitotic spindles comprised 95% of the disrupted mitoses. The increased multipolar mitotic spindles were associated with an increased number of cells in the G2 phase of mitosis, indicating a mitotic checkpoint response. Nanotubes were observed in association with mitotic spindle microtubules, the centrosomes and condensed chromatin in cells exposed to 0.024, 0.24, 2.4 and 24mcg/cm(2) SWCNT. Three-dimensional reconstructions showed carbon nanotubes within the centrosome structure. The lower doses did not cause cytotoxicity or reduction in colony formation after 24h; however, after three days, significant cytotoxicity was observed in the SWCNT-exposed cells. Colony formation assays showed an increased proliferation seven days after exposure. Our results show significant disruption of the mitotic spindle by SWCNT at occupationally relevant doses. The increased proliferation that was observed in carbon nanotube-exposed cells indicates a greater potential to pass the genetic damage to daughter cells. Disruption of the centrosome is common in many solid tumors including lung cancer. The resulting aneuploidy is an early event in the progression of many cancers, suggesting that it may play a role in both tumorigenesis and tumor progression. These results suggest caution should be used in the handling and processing of carbon nanotubes. |
Discovery of a novel enzymatic cleavage site for botulinum neurotoxin F5.
Kalb SR , Baudys J , Webb RP , Wright P , Smith TJ , Smith LA , Fernandez R , Raphael BH , Maslanka SE , Pirkle JL , Barr JR . FEBS Lett 2011 586 (2) 109-15 Botulinum neurotoxins (BoNTs) cause botulism by cleaving proteins necessary for nerve transmission. There are seven serotypes of BoNT, A-G, characterized by their response to antisera. Many serotypes are further distinguished into differing subtypes based on amino acid sequence some of which result in functional differences. Our laboratory previously reported that all tested subtypes within each serotype have the same site of enzymatic activity. Recently, three new subtypes of BoNT/F; /F3, /F4, and /F5, were reported. Here, we report that BoNT/F5 cleaves substrate synaptobrevin-2 in a different location than the other BoNT/F subtypes, between (54)L and (55)E. This is the first report of cleavage of synaptobrevin-2 in this location. STRUCTURED SUMMARY OF PROTEIN INTERACTIONS: BoNT/F5cleavesSynaptobrevin-2 by protease assay (View interaction: 1, 2) BoNT/F1cleavesSynaptobrevin-2 by protease assay (View interaction: 1, 2). |
Multiwalled carbon nanotubes induce a fibrogenic response by stimulating reactive oxygen species production, activating NF-κB signaling, and promoting fibroblast-to-myofibroblast transformation.
He X , Young SH , Schwegler-Berry D , Chisholm WP , Fernback JE , Ma Q . Chem Res Toxicol 2011 24 (12) 2237-48 Carbon nanotubes (CNTs) are novel materials with unique electronic and mechanical properties. The extremely small size, fiberlike shape, large surface area, and unique surface chemistry render their distinctive chemical and physical characteristics and raise potential hazards to humans. Several reports have shown that pulmonary exposure to CNTs caused inflammation and lung fibrosis in rodents. The molecular mechanisms that govern CNT lung toxicity remain largely unaddressed. Here, we report that multiwalled carbon nanotubes (MWCNTs) have potent, dose-dependent toxicity on cultured human lung cells (BEAS-2B, A549, and WI38-VA13). Mechanistic analyses were carried out at subtoxic doses (≤20 mcg/mL, ≤ 24 h). MWCNTs induced substantial ROS production and mitochondrial damage, implicating oxidative stress in cellular damage by MWCNT. MWCNTs activated the NF-kB signaling pathway in macrophages (RAW264.7) to increase the secretion of a panel of cytokines and chemokines (TNFa, IL-1b, IL-6, IL-10, and MCP1) that promote inflammation. Activation of NF-kB involved rapid degradation of IkBa, nuclear accumulation of NF-kBp65, binding of NF-kB to specific DNA-binding sequences, and transactivation of target gene promoters. Finally, MWCNTs induced the production of profibrogenic growth factors TGFb1 and PDGF from macrophages that function as paracrine signals to promote the transformation of lung fibroblasts (WI38-VA13) into myofibroblasts, a key step in the development of fibrosis. Our results revealed that MWCNTs elicit multiple and intertwining signaling events involving oxidative damage, inflammatory cytokine production, and myofibroblast transformation, which potentially underlie the toxicity and fibrosis in human lungs by MWCNTs. |
Characterization of highly antimicrobial-resistant clinical pneumococcal isolates recovered in a Chinese hospital during 2009-2010
Zhang B , Gertz RE Jr , Liu Z , Li Z , Fu W , Beall B . J Med Microbiol 2012 61 42-8 Ninety-one consecutive pneumococcal isolates (primarily from sputum), recovered in Chongqing Southwest Hospital during a 12 month period in 2009-2010 from individuals of all ages with suspected cases of pneumococcal disease, were subjected to PCR-serotyping, Quellung reaction serotyping, antimicrobial-susceptibility testing and multilocus sequence typing (MLST). Although 20 different serotypes were observed, most isolates (69, 75.8 %) were of serotypes included in the pneumococcal 13-valent conjugate vaccine (PCV13), including 33 of the 46 (71.7 %) isolates recovered from individuals less than 5 years of age. The prevalent serotypes were 19F (34 %), 19A (9.9 %), 6B (9.9 %), 23F (7.7 %), 14 (6.6 %) and 6A (4.4 %). PCR-determined serotypes were in agreement with Quellung testing, with the exception of two serotype 33C isolates. Most or all isolates within each PCV13 serotype were represented by one genotype, with the globally disseminated MLST sequence types (STs) ST271, ST320, ST90 and ST81 each accounting for the highly resistant isolates within serotypes 19F, 19A, 6B and 23F, respectively. Sixty-six (72.5 %) isolates were resistant to combinations of beta-lactam antibiotics (BLAs). A total of 63 of these 66 (95.5 %) BLA-resistant isolates were of serotypes included in PCV13; however, 3 serogroup 15 isolates were also BLA-resistant. Most isolates (88/91 = 96.7 %) were resistant to erythromycin and clindamycin. The majority of isolates were also resistant to tetracycline (76, 84 %) and to cotrimoxazole (67, 74 %). This work revealed that the majority of antimicrobial-resistant isolates (50/91 = 54.9 %) recovered in this Chinese hospital were represented by four global clones. Serotypes for these as well as more obscure strains were readily determined by using PCR. |
Simultaneous quantification of hemagglutinin and neuraminidase of influenza virus using isotope dilution mass spectrometry
Williams TL , Pirkle JL , Barr JR . Vaccine 2011 30 (14) 2475-82 Influenza vaccination is the primary method for preventing influenza and its severe complications. Licensed inactivated vaccines for seasonal or pandemic influenza are formulated to contain a preset amount of hemagglutinin (HA), the critical antigen to elicit protection. There is currently no regulatory method that quantifies neuraminidase (NA), the other major membrane-bound protein thought to have protective capability. This is primarily due to the limitations both in sensitivity and in selectivity of current means to quantify these antigens. Current methods to establish the HA concentration of vaccines rely on indirect measurements that are subject to considerable experimental variability. We present a liquid chromatography-tandem mass spectrometry (LC/MS/MS) method for the absolute quantification of viral proteins in a complex mixture. Through use of an isotope dilution approach, HA and NA from viral subtypes H1N1, H3N2, and B were determined both directly and rapidly. Three peptides of each subtype were used in the analysis of HA to ensure complete digestion of the protein and accuracy of the measurement. This method has been applied to purified virus preparations, to monovalent bulk concentrates, to trivalent inactivated influenza vaccines, and even crude allantoic fluid with improved speed, sensitivity, precision, and accuracy. Detection of 1mcg/mL of protein is easily obtained using this method. The sensitivity of the method covers the range expected in vaccine preparations, including adjuvant-based vaccine. This LC/MS/MS approach substantially increases the selectivity, accuracy and precision used to quantify the amount of viral proteins in seasonal and pandemic influenza vaccines and reduce the time and effort to deliver influenza vaccines for public health use during the next influenza pandemic. |
Suppression of alpha interferon signaling by hepatitis E virus
Dong C , Mohammad Z , Mixson-Hayden T , Dai X , Liang J , Meng J , Kamili S . Hepatology 2011 55 (5) 1324-32 The interferon (IFN) system is integral to the host response against viruses to which many viruses have developed strategies to overcome its antiviral effects. The effects of hepatitis E virus (HEV), the causative agent of hepatitis E, on IFN signaling have not been investigated primarily because of the non-availability of an efficient in vitro culture system or small animal models of infection. Herein, we report the generation of A549 cell lines persistently infected with genotype 3 HEV, designated as HEV-A549 cells and the effects HEV has on IFN-alpha-mediated Janus kinase-signal transducer and activator of transcription (JAK-STAT) signaling. Treatment of HEV-A549 cells with 250, 500, and 1000 Units/ml of IFN-alpha for 72 hours showed dose-dependant reduction of HEV RNA levels by 10%, 20%, and 50% respectively. IFN-alpha-stimulated genes coding for the antiviral proteins, dsRNA-activated protein kinase (PKR) and 2',5'-oligoadenylate synthetase(2,5-OAS), were down-regulated in IFN-alpha-treated HEV-A549 cells. HEV infection also prevented IFN-alpha-induced phosphorylation of STAT1. Regulation of STAT1 by HEV was specific, as phosphorylation of STAT2, tyrosine kinase (Tyk) 2, and Jak1 by IFN-alpha were unaltered. Additionally, STAT1 levels were markedly increased in HEV-A549 cells compared to naive A549 cells. Furthermore, binding of HEV ORF3 protein to STAT1 in HEV-A549 cells was observed. HEV ORF3 protein alone inhibited IFN-alpha-induced phosphorylation of STAT1 and down-regulated the IFN-alpha-stimulated genes encoding PKR, 2,5-OAS and myxovirus resistance A (MxA). Conclusions: HEV inhibits IFN-alpha signaling through the regulation of STAT1 phosphorylation in A549 cells. These findings have implications for the development of new strategies against hepatitis E. (HEPATOLOGY 2011.) |
Time-dependent slowly-reversible inhibition of monoamine oxidase A by N-substituted 1,2,3,6-tetrahydropyridines
Wichitnithad W , O'Callaghan JP , Miller DB , Train BC , Callery PS . Bioorg Med Chem 2011 19 (24) 7482-92 A novel class of N-substituted tetrahydropyridine derivatives was found to have multiple kinetic mechanisms of monoamine oxidase A inhibition. Eleven structurally similar tetrahydropyridine derivatives were synthesized and evaluated as inhibitors of MAO-A and MAO-B. The most potent MAO-A inhibitor in the series, 2,4-dichlorophenoxypropyl analog 12, displayed time-dependent mixed noncompetitive inhibition. The inhibition was reversed by dialysis, indicating reversible enzyme inhibition. Evidence that the slow-binding inhibition of MAO-A with 12 involves a covalent bond was gained from stabilizing a covalent reversible intermediate product by reduction with sodium borohydride. The reduced enzyme complex was not reversible by dialysis. The results are consistent with slowly reversible, mechanism-based inhibition. Two tetrahydropyridine analogs that selectively inhibited MAO-A were characterized by kinetic mechanisms differing from the kinetic mechanism of 12. As reversible inhibitors of MAO-A, tetrahydropyridine analogs are at low risk of having an adverse effect of tyramine-induced hypertension. |
Vapor conjugation of toluene diisocyanate to specific lysines of human albumin
Hettick JM , Siegel PD , Green BJ , Liu J , Wisnewski AV . Anal Biochem 2011 421 (2) 706-11 Exposure to toluene diisocyanate (TDI), an industrially important crosslinking agent used in the production of polyurethane products, can cause asthma in sensitive workers. Albumin has been identified as a major reaction target for TDI in vivo, and TDI-albumin reaction products have been proposed to serve as exposure biomarkers and to act as asthmagens, yet they remain incompletely characterized. In the current study, we used a multiplexed tandem mass spectrometry (MS/MS) approach to identify the sites of albumin conjugation by TDI vapors, modeling the air/liquid interface of the lung. Vapor phase TDI was found to react with human albumin in a dose-dependent manner, with up to 18 potential sites of conjugation, the most susceptible being Lys351 and the dilysine site Lys413-414. Sites of vapor TDI conjugation to albumin were quantitatively limited compared with those recently described for liquid phase TDI, especially in domains IIA and IIIB of albumin. We hypothesize that the orientation of albumin at the air/liquid interface plays an important role in vapor TDI conjugation and, thus, could influence biological responses to exposure and the development of in vitro assays for exposure and immune sensitivity. |
Measurement of impulse peak insertion loss for four hearing protection devices in field conditions
Murphy WJ , Flamme GA , Meinke DK , Sondergaard J , Finan DS , Lankford JE , Khan A , Vernon J , Stewart M . Int J Audiol 2011 51 Suppl 1 S31-42 OBJECTIVE: In 2009, the U.S. Environmental Protection Agency (EPA) proposed an impulse noise reduction rating (NRR) for hearing protection devices based upon the impulse peak insertion loss (IPIL) methods in the ANSI S12.42-2010 standard. This study tests the ANSI S12.42 methods with a range of hearing protection devices measured in field conditions. DESIGN: The method utilizes an acoustic test fixture and three ranges for impulse levels: 130-134, 148-152, and 166-170 dB peak SPL. For this study, four different models of hearing protectors were tested: Bilsom 707 Impact II electronic earmuff, E A R Pod Express, E A R Combat Arms version 4, and the Etymotic Research, Inc. Electronic BlastPLG EB1. STUDY SAMPPLE: Five samples of each protector were fitted on the fixture or inserted in the fixture's ear canal five times for each impulse level. Impulses were generated by a 0.223 caliber rifle. RESULTS: The average IPILs increased with peak pressure and ranged between 20 and 38 dB. For some protectors, significant differences were observed across protector examples of the same model, and across insertions. CONCLUSIONS: The EPA's proposed methods provide consistent and reproducible results. The proposed impulse NRR rating should utilize the minimum and maximum protection percentiles as determined by the ANSI S12.42-2010 methods. |
Mechanisms of crystalline silica-induced pulmonary toxicity revealed by global gene expression profiling
Sellamuthu R , Umbright C , Li S , Kashon M , Joseph P . Inhal Toxicol 2011 23 (14) 927-37 A proper understanding of the mechanisms underlying crystalline silica-induced pulmonary toxicity has implications in the management and potential prevention of the adverse health effects associated with silica exposure including silicosis, cancer and several auto-immune diseases. Human lung type II epithelial cells and rat lungs exposed to crystalline silica were employed as experimental models to determine global gene expression changes in order to understand the molecular mechanisms underlying silica-induced pulmonary toxicity. The differential gene expression profile induced by silica correlated with its toxicity in the A549 cells. The biological processes perturbed by silica exposure in the A549 cells and rat lungs, as identified by the bioinformatics analysis of the differentially expressed genes, demonstrated significant similarity. Functional categorization of the differentially expressed genes identified cancer, cellular movement, cellular growth and proliferation, cell death, inflammatory response, cell cycle, cellular development, and genetic disorder as top ranking biological functions perturbed by silica exposure in A549 cells and rat lungs. Results of our study, in addition to confirming several previously identified molecular targets and mechanisms involved in silica toxicity, identified novel molecular targets and mechanisms potentially involved in silica-induced pulmonary toxicity. Further investigations, including those focused on the novel molecular targets and mechanisms identified in the current study may result in better management and, possibly, reduction and/or prevention of the potential adverse health effects associated with crystalline silica exposure. |
Evaluation of anti-vibration effectiveness of glove materials using an animal model
Xu XS , Riley DA , Persson M , Welcome DE , Krajnak K , Wu JZ , Govinda Raju SR , Dong RG . Biomed Mater Eng 2011 21 (4) 193-211 Gloves with anti-vibration features are increasingly used to reduce impact vibrations or shocks transmitted to the hands of power tool operators. Selection and evaluation of the glove materials are important steps in the designs of such gloves. In the current study, we proposed an approach to objectively evaluate the effectiveness of the glove materials using a rat-tail impact model. As a critical part of a systematic investigation, we examined the vibration reduction characteristics of typical resilient glove materials (air bladders and viscoelastic gels) and the impact vibrations transmitted to the rat tail. A special test platform that mimics impact tool vibrations was constructed and used in the experiment. A scanning laser vibrometer was used to measure the vibration at points across the platform surface under several different test conditions. The peak acceleration was found to be greatly attenuated by the glove materials, especially by using strips from a gel-filled glove. The rat tail was found to effectively absorb the high-frequency vibration. However, the glove materials and the rat tail did not reduce the frequency-weighted acceleration. The implications of the experimental results are discussed. |
Fas/FasL pathway-mediated alveolar macrophage apoptosis involved in human silicosis
Yao SQ , Rojanasakul LW , Chen ZY , Xu YJ , Bai YP , Chen G , Zhang XY , Zhang CM , Yu YQ , Shen FH , Yuan JX , Chen J , He QC . Apoptosis 2011 16 (12) 1195-204 In vitro and in vivo studies have demonstrated that lung cell apoptosis is associated with lung fibrosis; however the relationship between apoptosis of alveolar macrophages (AMs) and human silicosis has not been addressed. In the present study, AM apoptosis was determined in whole-lung lavage fluid from 48 male silicosis patients, 13 male observers, and 13 male healthy volunteers. The relationships between apoptosis index (AI) and silica exposure history, soluble Fas (sFas)/membrane-bound Fas (mFas), and caspase-3/caspase-8 were analyzed. AI, mFas, and caspase-3 were significantly higher in lung lavage fluids from silicosis patients than those of observers or healthy volunteers, but the level of sFas demonstrated a decreasing trend. AI was related to silica exposure, upregulation of mFas, and activation of caspase-3 and -8, as well as influenced by smoking status after adjusting for confounding factors. These results indicate that AM apoptosis could be used as a potential biomarker for human silicosis, and the Fas/FasL pathway may regulate this process. The present data from human lung lavage samples may help to understand the mechanism of silicosis and in turn lead to strategies for preventing or treating this disease. |
Design of online solid phase extraction-liquid chromatography-tandem mass spectrometry (SPE-LC-MS/MS) hyphenated systems for quantitative analysis of small organic compounds in biological matrices
Kuklenyik Z , Calafat AM , Barr JR , Pirkle JL . J Sep Sci 2011 34 (24) 3606-18 Three online solid phase extraction-liquid chromatography-tandem mass spectrometry (SPE-LC-MS/MS) method examples are presented where two different types of chromatographic columns or solvent systems were coupled to meet specific analytical objectives: (i) SPE of target analytes by restricted access media from high ionic strength urine matrix was coupled with reversed phase LC-MS/MS conditions accommodating high ionization potentials of the analytes (urinary bisphenol A and other phenolic derivatives); (ii) strong cation exchange SPE of analytes of diverse polarity and pK(a) was coupled with reversed phase LC-MS/MS analysis (urinary atrazine metabolites); (iii) pre-concentration of low pg per sample analytes by weak anion exchange SPE was hyphenated with ion pair LC-MS analysis (intracellular nucleotide triphosphate analogs). With these examples we suggest a conductive generic work flow for the development of online SPE-LC-MS methods and show how advanced commercial LC devices and software allow for the design of complex yet highly versatile analytical separation systems suited to the unique physicochemical properties of the target analytes. |
Diagnostic accuracy of tests for Helicobacter pylori in an Alaska Native population
Bruden DL , Bruce MG , Miernyk KM , Morris J , Hurlburt D , Hennessy TW , Peters H , Sacco F , Parkinson AJ , McMahon BJ . World J Gastroenterol 2011 17 (42) 4682-8 AIM: To evaluate the accuracy of two non-invasive tests in a population of Alaska Native persons. High rates of Helicobacter pylori (H. pylori) infection, H. pylori treatment failure, and gastric cancer in this population necessitate documentation of infection status at multiple time points over a patient's life. METHODS: In 280 patients undergoing endoscopy, H. pylori was diagnosed by culture, histology, rapid urease test, (13)C urea breath test (UBT), and immunoglobulin G antibodies to H. pylori in serum. The performances of (13)C-UBT and antibody test were compared to a gold standard defined by a positive H. pylori test by culture or, in case of a negative culture result, by positive histology and a positive rapid urease test. RESULTS: The sensitivity and specificity of the (13)C-UBT were 93% and 88%, respectively, relative to the gold standard. The antibody test had an equivalent sensitivity of 93% with a reduced specificity of 68%. The false positive results for the antibody test were associated with previous treatment for an H. pylori infection [relative risk (RR) = 2.8]. High levels of antibodies to H. pylori were associated with chronic gastritis and male gender, while high scores in the (13)C-UBT test were associated with older age and with the H. pylori bacteria load on histological examination (RR = 4.4). CONCLUSION: The (13)C-UBT outperformed the antibody test for H. pylori and could be used when a non-invasive test is clinically necessary to document treatment outcome or when monitoring for reinfection. |
Disruptive effects of prefeeding and haloperidol administration on multiple measures of food-maintained behavior in rats
Hayashi Y , Wirth O . Behav Processes 2011 89 (3) 314-8 Four rats responded under a choice reaction-time procedure. At the beginning of each trial, the rats were required to hold down a center lever for a variable duration, release it following a high- or low-pitched tone, and press either a left or right lever, conditionally on the tone. Correct choices were reinforced with a probability of .95 or .05 under blinking or static houselights, respectively. After performance stabilized, disruptive effects of free access to food pellets prior to sessions (prefeeding) and intraperitoneal injection of haloperidol were examined on multiple behavioral measures (i.e., the number of trials completed, percent of correct responses, and reaction time). Resistance to prefeeding depended on the probability of food delivery for the number of trials completed and reaction time. Resistance to haloperidol, on the other hand, was not systematically affected by the probability of food delivery for all dependent measures. |
Kinetics of nevirapine and its impact on HIV-1 RNA levels in maternal plasma and breast milk over time after perinatal single dose nevirapine
Aizire J , McConnell MS , Mudiope P , Mubiru M , Matovu F , Parsons TL , Elbireer A , Nolan M , Janoff EN , Fowler MG . J Acquir Immune Defic Syndr 2012 60 (5) 483-8 OBJECTIVE: To determine kinetics after single dose nevirapine (sdNVP) and the impact on HIV RNA (viral load: VL) in maternal plasma and breast milk (BM). METHODS: Cohort of 120 HIV-1 infected pregnant Ugandan women received perinatal sdNVP alone and followed with their infants through 24 weeks post-delivery.We assessed the relationship of nevirapine concentration (tandem mass-spectroscopy) and HIV-1 VL (Roche AMPLICOR HIV-1 Kit, v1.5) in maternal plasma and BM over time. RESULTS: At week 1 postpartum, NVP (≥10ng/ml) was detected in all 53 plasma and 47/51(92.2%) BM samples with median (interquartile ranges: IQR) of, respectively, 171(78-214) ng/ml and 112(64-158) ng/ml, p=0.075, which decreased subsequently with traces persisting through week 4 in plasma. Plasma and BM VL dropped by week 1 and were highly correlated at delivery: R=0.71, p<0.001 and week1: R=0.69, p<0.001 but not thereafter. At week 1, VL correlated inversely with NVP concentration in plasma: R=0.39, p=0.004 and BM: R=0.48, p=0.013. There was a VL rebound in both compartments which peaked at week 4 to levels greater than at week 1, (significantly in plasma (p<0.001) but not in BM) and remained stable thereafter. Median VL was consistently greater (11-50 fold) in plasma than BM at all time points (all p<0.001). CONCLUSION: After sdNVP, NVP concentration was comparably high through week 1, accompanied by suppression of plasma and BM VL. A longer "tail" (>1 week) of potent postnatal antiretroviral drugs is warranted to minimize the observed VL rebound and potential for NVP resistance as a result of persistent NVP traces. |
Detection and molecular characterization of noroviruses and sapoviruses in children admitted to hospital with acute gastroenteritis in Vietnam
Trang NV , Luan le T , Kim-Anh le T , Hau VT , Nhung le TH , Phasuk P , Setrabutr O , Shirley H , Vinje J , Anh DD , Mason CJ . J Med Virol 2012 84 (2) 290-7 Noroviruses (NoV) and sapoviruses (SaV) are recognized as important causes of acute gastroenteritis in children worldwide. In this study, the prevalence and genetic variability of NoV and SaV were determined in hospitalized children <5 years of age with acute gastroenteritis in Hanoi, Vietnam. A total of 501 fecal specimens collected between November-2007 and October-2008, that previously had been tested for rotavirus (RV), were tested for NoV and SaV by realtime RT-PCR. Positive samples were genotyped by conventional RT-PCR followed by sequencing. GII NoV was detected in 180 (36%) and SaV in 7 (1.4%) of the samples. NoV was detected year-round ranging from 9.5% in April to 81.5% in September among RV negative samples. NoV GII.4 Minerva (2006b) was the dominant genotype (93%) with a few other genotypes detected including GII.3 (4.4%), GII.13 (1.7%), and GII.2 (0.6%) but no GI strains. Only GI and GII SaV strains were detected in this study. No difference in NoV prevalence between age groups was noted. Frequency of vomiting or fever was similar between children with NoV and RV infection, yet, NoV caused diarrhea with longer duration. In conclusion, NoV is the second most frequent cause of diarrhea in hospitalized children in North Vietnam. (J. Med. Virol. 84:290-297, 2012. (c) 2011 Wiley Periodicals, Inc.) |
Point-of-care HIV testing at antenatal care and maternity sites: experience in Battambang Province, Cambodia
Heller T , Kunthea S , Bunthoeun E , Sok K , Seuth C , Killam WP , Sovanna T , Sathiarany V , Kanal K . Int J STD AIDS 2011 22 (12) 742-7 Worldwide elimination of HIV transmission from mother-to-child is theoretically achievable. In Cambodia, antenatal care (ANC) prevalence has dropped from 1.6% (2003) to 0.71% (2009). However, success in minimizing vertical transmission has been limited by low testing uptake at ANC and delivery. We trained midwives in counselling and performance of an HIV rapid test, incorporated point-of-care testing into routine antenatal and maternity services and determined acceptability, feasibility, accuracy, cost and yield after one year. In all, 97.3% of ANC clients and 73.0% of maternity admissions had unknown HIV status. Testing was offered to 97.6% and 95.0% of untested ANC and maternity clients, respectively. Acceptance rates were 95.5% and 99.4%. Partner testing rate was 38.6%. HIV was diagnosed in 0.1% of ANC clients, 0.4% of partners and 0.9% of women at delivery. For an operational district with an average population of 158,000, point-of-care testing was estimated in one year to identify 19 HIV-infected pregnant women, nine men, 14 discordant couples and 16 exposed infants who otherwise would have not received prophylaxis. Cost was less than $3.75 per person tested. Point-of-care testing during ANC and at delivery is feasible, acceptable and contributes to reducing mother-to-child transmission. |
Antigenemia, RNAemia, and innate immunity in children with acute rotavirus diarrhea
Moon S , Wang Y , Dennehy P , Simonsen KA , Zhang J , Jiang B . FEMS Immunol Med Microbiol 2011 64 (3) 382-91 Antigenemia is commonly detected in children with acute rotavirus diarrhea, but the prevalence of viremia has not been clearly defined. We examined antigenemia in plasma and RNAemia in peripheral blood mononuclear cells (PBMC) of children with acute diarrhea by EIA, RT-PCR, and Southern hybridization, using primers and a probe specific to rotavirus NSP4 gene. We detected the presence of rotavirus antigen in 33.3% and almost full-length NSP4 gene in 70.8% of the acute-phase plasma and PBMC, respectively. In contrast, antigenemia and RNAemia were detected in 0% and 4.2% of the convalescent-phase plasma and PBMC, respectively, which were similar to antigenemia (0%) and RNAemia (7.7%) in healthy controls. We demonstrated an increase in the proportions of activated mDC and activated pDC in acute-phase PBMC of patients when compared to those in convalescent-phase of patients and in PBMC of healthy controls. The activation of mDC peaked on days 2 to 4 after illness onset and the activation of acute-phase pDC appeared to correlate with levels of antigenemia. High prevalence of NSP4 gene in acute-phase PBMC indicates possible rotavirus replication in white blood cells and extraintestinal spread and the activation of DC may have implications for the prevention of rotavirus disease in children. |
Associations between preconception counseling and maternal behaviors before and during pregnancy
Williams L , Zapata LB , D'Angelo DV , Harrison L , Morrow B . Matern Child Health J 2011 16 (9) 1854-61 Preconception counseling (PCC) is a vital component of preconception care. Through counseling, providers educate and recommend strategies to improve health and birth outcomes for women of reproductive age. The objective of our analysis was to assess the associations between receipt of PCC and positive maternal behaviors before and during pregnancy. We analyzed 2004-2008 Pregnancy Risk Assessment Monitoring System data from Maine, New Jersey, Utah, and Vermont. Multivariable logistic regression was used to investigate the associations between receipt of PCC and prepregnancy daily multivitamin consumption, first-trimester entry into prenatal care, and cessation of smoking and drinking before pregnancy among women who smoked/drank in the 2 years preceding the survey, adjusting for a wide range of maternal characteristics. Overall, 32% of women reported receipt of PCC, with particularly low rates reported among women with an unintended pregnancy (14%) and no health insurance prior to pregnancy (14%). Receipt of PCC was associated with daily prepregnancy multivitamin consumption (adjusted odds ratio [AOR] = 4.4; 95% confidence interval [CI] = 4.0, 4.7), first-trimester entry into prenatal care for women with an intended pregnancy (AOR = 2.1; 95% CI = 1.8, 2.4), and drinking cessation before pregnancy among women who drank in the 2 years preceding the survey (AOR = 1.3; 95% CI = 1.2, 1.5). PCC was associated with positive maternal behaviors that increase the likelihood of a healthy woman, pregnancy, and infant. Unfortunately, less than one-third of women with a recent live birth reported receiving PCC. These data provide population-based evidence suggesting the value of PCC in the promotion of healthy maternal behaviors for women with intended or unintended pregnancies. |
Evaluation of the approach to respirable quartz exposure control in U.S. coal mines
Joy GJ . J Occup Environ Hyg 2012 9 (2) 65-8 Occupational exposure to high levels of respirable quartz can result in respiratory and other diseases in humans. The Mine Safety and Health Adminstration (MSHA) regulates exposure to respirable quartz in coal mines indirectly through reductions in the respirable coal mine dust exposure limit based on the content of quartz in the airborne respirable dust. This reduction is implemented when the quartz content of airborne respirable dust exceeds 5% by weight. The intent of this dust standard reduction is to restrict miners' exposure to respirable quartz to a time-weighted average concentration of 100 mcg/m(3). The effectiveness of this indirect approach to control quartz exposure was evaluated by analyzing respirable dust samples collected by MSHA inspectors from 1995 through 2008. The performance of the current regulatory approach was found to be lacking due to the use of a variable property-quartz content in airborne dust-to establish a standard for subsequent exposures. In one situation, 11.7% (4370/37,346) of samples that were below the applicable respirable coal mine dust exposure limit exceeded 100 mcg/m(3) quartz. In a second situation, 4.4% (895/20,560) of samples with 5% or less quartz content in the airborne respirable dust exceeded 100 mcg/m(3) quartz. In these two situations, the samples exceeding 100 mcg/m(3) quartz were not subject to any potential compliance action. Therefore, the current respirable quartz exposure control approach does not reliably maintain miner exposure below 100 mcg/m(3) quartz. A separate and specific respirable quartz exposure standard may improve control of coal miners' occupational exposure to respirable quartz. |
Headform and n95 filtering facepiece respirator interaction: contact pressure simulation and validation
Lei Z , Yang JJ , Zhuang Z . J Occup Environ Hyg 2012 9 (1) 46-58 This article presents a computational and experimental study of contact pressure between six N95 filtering facepiece respirators (FFRs) and five newly developed digital headforms (small, medium, large, long/narrow, and short/wide). Contact interaction is simulated using the finite element method and validated by experiments using a pressure mapping system. The headform model has multiple layers: a skin layer, muscle layer, fatty tissue layer, and bone layer. Each headform is divided into five parts (two parts for the cheeks, one part for the upper forehead, one part for the chin, and one part for the back side of the head). Each respirator model comprises multiple layers and two straps. The simulation process has two stages for each respirator/headform combination. The first stage is to wrap the straps around the back of the headform and pull the respirator away from the face. The second stage is to release the respirator so that the respirator moves toward the face. Strap forces and contact interactions are generated between the respirators and the headforms. Meanwhile, a real-time surface pressure mapping system is used to record the pressures at six key locations to validate the computational results. There is a strong correlation between computational and experimental results (R(2) = 0.88). By comparing the pressure values from simulations and experiments, we have validated the simulation models. |
Occupational injuries, illnesses, and fatalities among workers in the services sector industries: 2003 to 2007
Utterback DF , Charles LE , Schnorr TM , Tiesman HM , Storey E , Vossenas P . J Occup Environ Med 2011 54 (1) 31-41 OBJECTIVE: Provide descriptive statistics and discuss priorities for injury and fatality risks among services sector workers. METHODS: Bureau of Labor Statistics Survey of Occupational Injuries and Illnesses and Census of Fatal Occupational Injuries data for 2003 to 2007 were analyzed to identify occupational injury and fatality risks for services sector industry groups. RESULTS: Many services sector industry groups experienced, on average, greater than one occupational fatality per week, and survey of occupational injuries and illnesses days-away-from-work rates in excess of those for all US workers. Overall, transportation incidents and homicides are leading factors contributing to fatalities. CONCLUSIONS: These results indicate the need for adoption of safety and health prevention practices in numerous industry groups. For groups that experience elevated injury and fatality rates, priorities for research and intervention can be identified through these data. |
Indium lung disease
Cummings KJ , Nakano M , Omae K , Takeuchi K , Chonan T , Xiao YL , Harley RA , Roggli VL , Hebisawa A , Tallaksen RJ , Trapnell BC , Day GA , Saito R , Stanton ML , Suarthana E , Kreiss K . Chest 2011 141 (6) 1512-1521 BACKGROUND: Reports of pulmonary fibrosis, emphysema, and, more recently, pulmonary alveolar proteinosis (PAP) in indium workers suggested that workplace exposure to indium compounds caused several different lung diseases. METHODS: To better understand the pathogenesis and natural history of indium lung disease, a detailed, systematic, multidisciplinary analysis of clinical, histopathological, radiological, and epidemiologic data for all reported cases and workplaces was undertaken. RESULTS: Ten men (median age, 35 years) who produced, used, or reclaimed indium compounds were diagnosed with interstitial lung disease (ILD) 4-13 years after first exposure (n=7) or PAP 1-2 years after first exposure (n=3). Common pulmonary histopathological features in these patients included intraalveolar exudate typical of alveolar proteinosis (n=9), cholesterol clefts and granulomas (n=10), and fibrosis (n=9). Two patients with ILD had pneumothoraces. Lung disease progressed following cessation of exposure in most patients and was fatal in two. Radiographical data revealed that two patients with PAP subsequently developed fibrosis and one also developed emphysematous changes. Epidemiologic investigations demonstrated the potential for exposure to respirable particles and an excess of lung abnormalities among co-workers. CONCLUSIONS: Occupational exposure to indium compounds was associated with PAP, cholesterol ester crystals and granulomas, pulmonary fibrosis, emphysema, and pneumothoraces. The available evidence suggests exposure to indium compounds causes a novel lung disease that may begin with PAP and progress to include fibrosis and emphysema, and, in some cases, premature death. Prospective studies are needed to better define the natural history and prognosis of this emerging lung disease and identify effective prevention strategies. |
Training for safety in emergencies: inoculating for underground coal mine emergencies
Kingsley Westerman CY , Margolis KA , Kowalski-Trakofler KM . Prof Saf 2011 56 (11) 42-46 The potential for emergencies is ever-present in coal mining. This is illustrated by statistics which show that employees in coal mining are more likely to be killed or to incur a nonfatal injury or illness, and their injuries are more likely to be severe, than workers in private industry as a whole. As a result of this constant exposure to harm, coal miners must be highly trained to deal with various emergency scenarios. Some existing underground coal mine training focuses on rote performance of prescribed actions. For example, coal miners are taught when and how to put on self-contained self rescuers, which are respirators that provide 60 minutes of breathable air. Preparation based on inoculation theory principles differs from more traditional training in that it involves teaching trainees to think for themselves rather than simply teaching them how to perform a task or use a safety device. The principles of inoculation theory can be used for emergency safety training for miners as well as for workers in other high-risk industries. |
Understanding and quantifying arc flash hazards in the mining industry
Homce GT , Cawley JC . IEEE Trans Ind Appl 2011 47 (6) 2437-2444 Arc flash generally refers to the dangerous exposure to thermal energy released by an arcing fault on an electrical power system, and in recent years, arc flash hazards have become a prominent safety issue in many industries. This problem, however, has not been effectively addressed in the mining industry. Mine Safety and Health Administration (MSHA) data for the period 1990 through 2001 attribute 836 injuries to "noncontact electric arc burns," making them the most common cause of electrical injury in mining. This paper presents results from several elements of a recent National Institute for Occupational Safety and Health study of arc flash hazards in mining and provides information and recommendations that can help reduce these injuries. The characteristics of past arc flash injuries in mining are first outlined, such as the electrical components and work activities involved (based on MSHA data). This is followed by a review of important concepts and terminology needed to understand this hazard. Next, methods for identifying, measuring, and managing arc flash hazards on a power system are covered, with emphasis on recommendations found in NFPA 70E, Standard for Electrical Safety in the Workplace. Finally, results are presented from a detailed arc flash hazard analysis performed on a sample mine electrical power system using IEEE 1584-2004a, focusing on components and locations presenting severe hazards, as well as engineering solutions for reducing the risk to personnel. |
The influence of dust standards on the prevalence and severity of coal worker's pneumoconiosis at autopsy in the United States of America
Vallyathan V , Landsittel DP , Petsonk EL , Kahn J , Parker JE , Osiowy KT , Green FHY . Arch Pathol Lab Med 2011 135 (12) 1550-1556 CONTEXT: Coal worker's pneumoconiosis is a major occupational lung disease in the United States. The disease is primarily controlled through reducing dust exposure in coal mines using technological improvements and through the establishment of dust standards by regulatory means. OBJECTIVE: To determine if dust standards established in the US Federal Coal Mine Health and Safety Act of 1969 have reduced the prevalence and severity of coal worker's pneumoconiosis. DESIGN: The study population included materials from 6103 deceased coal miners submitted to the National Coal Workers' Autopsy Study from 1971 through 1996. Type and severity of coal worker's pneumoconiosis were classified using standardized diagnostic criteria. RESULTS: Among miners who worked exclusively prior to the 1969 dust standard, 82.6% had coalmacules, 46.3% coal nodules, 28.2% silicotic nodules, and 10.3% progressive massive fibrosis. Lower prevalences were noted among miners exposed exclusively to post-1970 dust levels: 58.8% had coal macules, 15.0% coal nodules, 8.0% silicotic nodules, and 1.2% progressive massive fibrosis. The differences in prevalence were highly significant (P < .001) for all types of pneumoconiosis, including progressive massive fibrosis, after adjustment for age, years of mining, and smoking status. CONCLUSIONS: The study confirms a beneficial impact of the first 25 years of the dust standard established by the 1969 act on the prevalence and severity of coal worker's pneumoconiosis in US coal miners. However, pneumoconiosis continues to occur among miners who have worked entirely within the contemporary standard, suggesting a need for further reductions in exposure to respirable coal mine dust. (Arch Pathol Lab Med. 2011; 135:1550-1556; doi:10.5858/arpa.2010-0393-OA) |
A deeper look at contractor injuries in underground coal mines
Pappas D , Mark C . Min Eng 2011 63 (11) 73-79 Over the past decade, the number of contractors working in underground coal mines has nearly doubled; however, the effect this has had on the industry's injury rates has been the subject of much speculation. The confusion exists because the U.S. Mine Safety and Health Administration (MSHA) database does not assign contractor hours to the individual mining operations where they worked. To better understand the safety record of the contractor segment of the industry, the National Institute for Occupational Safety and Health (NIOSH) undertook a comprehensive analysis of the data contained in the MSHA database. The first part of the study compared overall contractor and operator trends from 1983 to 2009 related to employment, hours worked and injury rate. One unexpected finding was that the larger contractors tended to have higher injury rates than the smaller ones. The second part of the study directly addressed the role of contractors on the safety record of 10 large underground coal mines. A detailed analysis provided both injuries and estimated contractor hours worked at these mines for the period 1992-2007. Comparison between the estimated contractor injury rates and the reported operator injury rates at these mines indicated that the contractor injury rates were significantly higher at most of the operations studied. However, the industry-wide data indicates that contractor and operator injury rates have converged since 2005 and are now equivalent. |
Potential serological biomarkers of cerebral malaria
Lucchi NW , Jain V , Wilson NO , Singh N , Udhayakumar V , Stiles JK . Dis Markers 2011 31 (6) 327-35 Biomarkers have been used to diagnose and prognosticate the progress and outcome of many chronic diseases such as neoplastic and non communicable diseases. However, only recently did the field of malaria research move in the direction of actively identifying biomarkers that can accurately discriminate the severe forms of malaria. Malaria continues to be a deadly disease, killing close to a million people (mostly children) every year. One life-threatening complication of malaria is cerebral malaria (CM). Studies carried out in Africa have demonstrated that even with the best treatment, as high as 15-30% of CM patients die and about 10-24% of CM survivors suffer short-or long-term neurological impairment. The transition from mild malaria to CM can be sudden and requires immediate intervention. Currently, there is no biological test available to confirm the diagnosis of CM and its complications. It is hoped that development of biomarkers to identify CM patients and potential risk for adverse outcomes would greatly enhance better intervention and clinical management to improve the outcomes. We review here what is currently known regarding biomarkers for CM outcomes. A PubMed literature search was performed using the following search terms: "malaria," "cerebral malaria," "biomarkers," "mortality" and "neurological sequelae." This search revealed a paucity of usable biomarkers for CM management. We propose three main areas in which researchers can attempt to identify CM biomarkers: 1) early biomarkers, 2) diagnostic biomarkers and 3) prognostic biomarkers. |
Fax referrals, academic detailing, and tobacco quitline use: a randomized trial
Sheffer MA , Baker TB , Fraser DL , Adsit RT , McAfee TA , Fiore MC . Am J Prev Med 2012 42 (1) 21-8 BACKGROUND: Fax referral programs quickly and economically can link smokers' visiting primary care clinics to state-based telephone quitlines. Yet, it is unclear how to optimize use of this strategy. PURPOSE: To evaluate the potential of enhanced academic detailing in clinics (i.e., on-site training, technical assistance, and performance feedback) to boost utilization of a fax referral program called Fax to Quit. DESIGN: Participants were randomized to one of two intervention conditions. SETTING/PARTICIPANTS: Participants were drawn from 49 primary care clinics in southeastern Wisconsin. The sample size was based on a power analysis in which the control intervention condition was estimated to generate 0.5 referrals/clinic/month and the experimental condition 2.0 referrals/clinic/month. INTERVENTIONS: One of two fax referral program interventions was administered: the control condition Fax to Quit-Only (F2Q-Only) or the experimental condition Fax to Quit plus Enhanced Academic Detailing (F2Q+EAD). MAIN OUTCOME MEASURES: Clinic- and clinician-specific referral and quality referral rates (those resulting in quitline enrollment) were measured for 13 months post-intervention, starting in March 2009. RESULTS: Mean number of post-intervention referrals/clinician to the Wisconsin Tobacco Quitline was 5.6 times greater for F2Q+EAD (8.5, SD=7.0) compared to F2Q-Only (1.6, SD=3.6, p<0.001). The F2Q+EAD (4.8, SD=4.1) condition produced a greater mean number of quality referrals/clinician than did the F2Q-Only (0.86, SD=1.8, p<0.001) condition. Data were analyzed in 2010. CONCLUSIONS: Enhanced academic detailing, which included on-site training, technical assistance, and performance feedback, increased the number of referrals more than fivefold over a fax referral program implemented without such enhanced academic detailing. TRIAL REGISTRATION: This study is registered at Clinicaltrials.govNCT00989755. |
Mental health conditions among school-aged children: geographic and sociodemographic patterns in prevalence and treatment
Ghandour RM , Kogan MD , Blumberg SJ , Jones JR , Perrin JM . J Dev Behav Pediatr 2012 33 (1) 42-54 OBJECTIVE: To explore geographic differences in diagnosed emotional and behavioral mental health conditions and receipt of treatment. METHODS: Data are from the 2007 National Survey of Children's Health, a nationally representative, parent-reported, cross-sectional survey. Pediatric mental health conditions were identified using parents' responses to 3 questions regarding whether a health care provider had ever told them that their child had depression, anxiety problems, or behavioral or conduct problems. Parents also reported on past-year treatment or counseling by a mental health professional. State-level differences in condition prevalence were identified using unadjusted and adjusted prevalence estimates. Multivariate logistic regression assessed the odds of not receiving treatment by state and diagnoses. RESULTS: Nearly 8% of children aged 6 to 17 years have ever been diagnosed with depression or anxiety, and 5.4% have ever been diagnosed with behavioral or conduct problems. State-level estimates of parent-reported depression or anxiety varied from 4.8% in Georgia to 14.4% in Vermont, while prevalence of behavioral problems ranged from 3.2% in California to 9.2% in Louisiana. Nearly 10% of all school-aged children and 53.1% of those ever diagnosed with either condition type received past-year treatment. The odds of receiving past-year parent-reported treatment did not differ by state of residence with the exception of Louisiana and Nevada: children ever diagnosed had approximately 2.5 times the odds of not receiving past-year treatment in these states. CONCLUSION: The prevalence of parent-reported mental health disorders among children varies by geographic and sociodemographic factors, while receipt of treatment is generally dependent on sociodemographic and health-related factors. |
Smokeless and flavored tobacco products in the U.S. 2009 styles survey results
Regan AK , Dube SR , Arrazola R . Am J Prev Med 2012 42 (1) 29-36 BACKGROUND: A number of noncigarette tobacco products, including some novel products, recently have been marketed by the tobacco industry, which raises concerns from tobacco control authorities. PURPOSE: This study aimed to assess current popularity of several noncigarette tobacco products in the U.S. METHODS: In 2009, a total of 10,587 adults completed a consumer mail-in survey (ConsumerStyles). Based on survey results, the weighted percentages of adults who heard and tried snus, dissolvable tobacco products, flavored little cigars, and flavored cigarettes were computed in 2010. A subset of this sample (n=4556) completed the HealthStyles survey, which included items about health perceptions of these products and use in the past 30 days. RESULTS: The percentage of U.S. adults in the sample who were aware of these products ranged from 10.4% (dissolvable tobacco) to 44.6% (flavored little cigars). One third of adults who had heard of flavored little cigars tried them and 10.1% had used them in the past 30 days; among those who had heard of them, 27.4% tried flavored cigarettes and 12.6% tried snus. In general, young adults, men, and smokers were most likely to have heard of each product. At least one third of adults were uncertain if these products were as harmful as cigarettes (range=37.3% [snus] to 50.3% [dissolvable tobacco]). CONCLUSIONS: The awareness of these tobacco products in this sample varied. Groups with a higher prevalence of smoking and tobacco use (e.g., men, people with low levels of education) may be a target audience for marketing and promotions. As availability of products change, continued surveillance is warranted in the U.S. |
Molecular sub-typing suggests that the environment of rehabilitation centers may be a potential source of Aspergillus fumigatus infecting rehabilitating seabirds
Burco JD , Etienne KA , Massey JG , Ziccardi MH , Balajee SA . Med Mycol 2012 50 (1) 91-98 Aspergillosis remains a major cause of infection-related avian mortality in birds that are debilitated and undergoing rehabilitation for release into the wild. This study was designed to understand the source of avian aspergillosis in seabirds undergoing rehabilitation at selected northern California aquatic bird rehabilitation centers. Air, surface and water sampling was performed between August 2007 and July 2008 in three such centers and selected natural seabird loafing sites. Average air Aspergillus fumigatus counts were at least nine times higher in samples obtained from the rehabilitation sites (M = 7.34, SD = 9.78 CFU/m(3)), when compared to those found at natural sites (M = 0.76, SD = 2.24 CFU/m(3)), t (205) = -5.99, P < 0.001. A total of 37 A. fumigatus isolates from birds with confirmed aspergillosis and 42 isolates from environmental samples were identified using both morphological and molecular methods, and subsequently sub-typed using an eight-locus microsatellite panel with the neighbor joining algorithm. Results of the study demonstrated the presence of five clonal groups, 13 genotypically related clusters, and 59 distinct genotypes. Six of the 13 genotypically related clusters contained matching genotypes between clinical isolates and local environmental isolates from the rehabilitation center in which these birds were housed. We present evidence that the environment of rehabilitation centers may be a source for A. fumigatus infection in rehabilitated seabirds. (2012 ISHAM.) |
National surveillance for human and pet contact with oral rabies vaccine baits, 2001-2009
Roess AA , Rea N , Lederman E , Dato V , Chipman R , Slate D , Reynolds MG , Damon IK , Rupprecht CE . J Am Vet Med Assoc 2012 240 (2) 163-8 OBJECTIVE: To determine the rate and absolute number of human and pet exposures to oral rabies vaccine (ORV) bait containing liquid vaccinia rabies glycoprotein recombinant vaccine and to evaluate factors that might affect human contact with bait to modify the program and reduce human exposure to the vaccine. DESIGN: Retrospective analysis of surveillance data (2001 to 2009). SAMPLE: Reports on human and pet contact with ORV baits in states with ORV surveillance programs. PROCEDURES: Data were collected from passive, multistate ORV surveillance systems in Alabama, Arizona, Florida, Georgia, Maine, Maryland, Massachusetts, New Hampshire, New Jersey, New York, North Carolina, Ohio, Pennsylvania, Tennessee, Texas, Vermont, Virginia, and West Virginia. Data collected included the nature of human or pet contact with bait and vaccine, the caller's knowledge of the ORV bait program, local human population density, and other relevant demographic data. RESULTS: All 18 states participated in the surveillance program for at least 1 year, for a combined 68 years of observation. One thousand four hundred thirty-six calls were reported, representing 3,076 found baits (6.89/100,000 baits dropped); 296 (20%) calls were related to human contact with ruptured bait, and 550 (38%) involved pet contact with the bait. Six adverse events in humans were reported, one of which required hospitalization. Fifty-nine adverse events in pets were noted, all of which were nonserious. CONCLUSIONS AND CLINICAL RELEVANCE: Findings from surveillance activities have been used to improve baiting strategies and minimize human and pet contact with ORV baits. Overall, human and pet contact with ORV baits was infrequent. Surveillance has led to early identification of persons exposed to ORV and rapid intervention. |
Sealpox virus in marine mammal rehabilitation facilities, North America, 2007-2009
Roess AA , Levine RS , Barth L , Monroe BP , Carroll DS , Damon IK , Reynolds MG . Emerg Infect Dis 2011 17 (12) 2203-8 Sealpox, a zoonotic disease affecting pinnipeds (seals and sea lions), can occur among captive and convalescing animals. We surveyed 1 worker each from 11 marine mammal centers and interviewed 31 other marine mammal workers to ascertain their knowledge of and experience with sealpox virus and to identify factors associated with sealpox virus outbreaks among pinnipeds in marine rehabilitation facilities. Demographic and health data were obtained for 1,423 pinnipeds at the 11 facilities. Among the 23 animals in which sealpox was clinically diagnosed, 4 arrived at the facility ill, 11 became ill <5 weeks after arrival, and 2 became ill >5 weeks after arrival; the timing of illness onset was unknown for 6 animals. Most infections occurred in pinnipeds <1 year of age. Nine affected animals were malnourished; 4 had additional illnesses. Sealpox had also occurred among workers at 2 facilities. Sealpox is a noteworthy zoonosis of rehabilitating convalescing pinnipeds; workplace education can help to minimize risks for human infection. |
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