Communication About Hereditary Cancers on Social Media: A Content Analysis of Tweets About Hereditary Breast and Ovarian Cancer and Lynch Syndrome.
Allen CG , Roberts M , Andersen B , Khoury MJ . J Cancer Educ 2018 35 (1) 131-137 Social media is increasingly being used as an information source and tool for individuals and organizations to share resources and engage in conversations about health topics. Because the public tends to learn about health topics and genetics from online social media sources, it is imperative to understand the amount, type, and quality of information being shared. We performed a retrospective analysis of tweets related to hereditary breast and ovarian cancer (HBOC) and Lynch syndrome (LS) between January 1, 2017 and December 31, 2017. A total of 63,770 tweets were included in our dataset. The majority were retweets (59.9%) and users came from 744 different cities. Most tweets were considered "informational" (51.4%) and were designed to provide resources to the public. Online communities (25%), organizations (20%), and providers or researchers (15%) were among the most common contributors. Our results demonstrated that conversations were primarily focused on information and resource sharing, along with individuals discussing their personal stories and testimonials about their experiences with these HBOC and LS. Future studies could consider ways to harness Twitter to help tailor and deliver health communication campaigns and education interventions to improve the public's understanding of these complex topics. |
Population-Based Assessment of HPV Genotype-Specific Cervical Cancer Survival: CDC Cancer Registry Sentinel Surveillance System.
Hallowell BD , Saraiya M , Thompson TD , Unger ER , Lynch CF , Tucker T , Copeland G , Hernandez BY , Peters ES , Wilkinson E , Goodman MT . JNCI Cancer Spectr 2018 2 (3) Background: Human papillomavirus (HPV) genotype influences the development of invasive cervical cancer (ICC); however, there is uncertainty regarding the association of HPV genotype with survival among ICC patients. Method(s): Follow-up data were collected from 693 previously selected and HPV-typed ICC cases that were part of the Centers for Disease Control and Prevention Cancer Registry Surveillance System. Cases were diagnosed between 1994 and 2005. The Kaplan-Meier method was used to estimate five-year all-cause survival. A multivariable Cox proportional hazards model was used to estimate the effect of HPV genotype on survival after adjusting for demographic, tumor, and treatment characteristics. Result(s): Five-year all-cause survival rates varied by HPV status (HPV 16: 66.9%, HPV 18: 65.7%, HPV 31/33/45/52/58: 70.8%, other oncogenic HPV genotypes: 79.0%, nononcogenic HPV: 69.3%, HPV-negative: 54.0%). Following multivariable adjustment, no statistically significant survival differences were found for ICC patients with HPV 16-positive tumors compared with women with tumors positive for HPV 18, other oncogenic HPV types, or HPV-negative tumors. Women with detectable HPV 31/33/33/ 45/52/58 had a statistically significant 40% reduced hazard of death at five years (95% confidence interval [CI] = 0.38 to 0.95), and women who tested positive for nononcogenic HPV genotypes had a statistically significant 57% reduced hazard of death at five years (95% CI = 0.19 to 0.96) compared with women with HPV 16 tumors. Few statistically significant differences in HPV positivity, tumor characteristics, treatment, or survival were found by race/ethnicity. Conclusion(s): HPV genotype statistically significantly influenced five-year survival rates among women with ICC; however, screening and HPV vaccination remain the most important factors to improve patient prognosis and prevent future cases. |
Cancer in Canada: Stage at diagnosis
Bryan S , Masoud H , Weir HK , Woods R , Lockwood G , Smith L , Brierley J , Gospodarowicz M , Badets N . Health Rep 2018 29 (12) 21-25 This article presents national data (excluding Quebec) on cancer incidence by stage at diagnosis for lung, colorectal, female breast and prostate cancers. Data from the Canadian Cancer Registry are combined for the diagnosis years 2011 to 2015. Half of all new lung cancers were diagnosed at stage IV, and of the two types of lung cancer, small cell was more often diagnosed at this stage than non-small cell. About half of colorectal cancers were diagnosed at stages III and IV, and stage-specific incidence rates were generally higher for males than females. More than 80% of female breast and almost three-quarters of prostate cancers were diagnosed at stages I and II. Later-stage diagnosis was more common in older age groups for both cancers. |
Diabetic ketoacidosis at diagnosis of type 1 diabetes and glycemic control over time: The SEARCH for Diabetes in Youth Study
Duca LM , Reboussin BA , Pihoker C , Imperatore G , Saydah S , Mayer-Davis E , Rewers A , Dabelea D . Pediatr Diabetes 2018 20 (2) 172-179 BACKGROUND: The diagnosis of type 1 diabetes (T1D) in youth is often associated with diabetic ketoacidosis (DKA). We aimed to evaluate if the presence of DKA at diagnosis of T1D is associated with less favorable hemoglobin A1c (HbA1c) trajectories over time. METHODS: The SEARCH for Diabetes in Youth study of 1396 youth aged <20 years with newly diagnosed T1D were followed for up to 13 [median 8 (IQR 6-9)] years post-diagnosis. Of these, 397 (28%) had DKA (bicarbonate level<15 mmol/l and/or pH<7.25 (venous) or <7.30 (arterial or capillary) or mention of DKA in medical records) at diabetes onset. Longitudinal HbA1c levels were measured at each follow-up visit (average number of HbA1c measures 3.4). A linear piecewise mixed effects model was used to analyze the effect of DKA status at diagnosis of T1D on long-term glycemic control, adjusting for age at diagnosis, diabetes duration at baseline, sex, race/ethnicity, household income, health insurance status, time-varying insulin regimen and glucose self-monitoring, study site, and baseline fasting C-peptide level. RESULTS: At baseline, HbA1c levels were significantly higher in youth with T1D diagnosed in DKA versus those who were not (9.9%+/-1.5% vs. 8.5%+/-1.4%, respectively). After the first year with diabetes, there was a significant difference in the rate of change in HbA1c levels by DKA status: HbA1c was 0.16% higher each year in youth with DKA compared to those without (interaction p-value<.0001), after adjusting for aforementioned covariates. CONCLUSION/INTERPRETATION: DKA at T1D diagnosis is associated with worsening glycemic control over time, independent of demographic, socioeconomic and treatment-related factors and baseline fasting C-peptide. This article is protected by copyright. All rights reserved. |
How the Comprehensive Cancer Control National Partnership shapes the public health workforce
Farrell MM , Gibson KM , Marler A , Given L , Van Kirk Villalobos A , Maynard CD , Bright FS , Kirklin GT , Green TC , Ruhe M , Thorsness J , Weiss S . Cancer Causes Control 2018 29 (12) 1205-1220 This paper explores how, through its extensive network of partners, the Comprehensive Cancer Control National Partnership (National Partnership) has provided a robust array of trainings, learning institutes, webinars, workshops, mentorship programs, and direct technical assistance to comprehensive cancer control programs and coalitions over the past 20 years. Mapping these activities to specific cancer control competencies revealed that the efforts of the National Partnership adequately address the core competencies necessary for an effective workforce and have the potential to increase practitioner capacity to adopt and implement evidence-based cancer control programs. Ensuring the continued availability and uptake of these tools, trainings and partnerships could potentially address gaps and barriers in the public health workforce related to evidence-based practice. |
Comprehensive cancer control in the U.S.: summarizing twenty years of progress and looking ahead
Hayes NS , Hohman K , Vinson C , Pratt-Chapman M . Cancer Causes Control 2018 29 (12) 1305-1309 In order to celebrate the accomplishments of the Centers for Disease Control and Prevention's (CDC) National Comprehensive Cancer Control Program (NCCCP), the Comprehensive Cancer Control National Partners (CCCNP) developed this Special Issue on Cancer Causes and Control. This, the third Special Issue on Comprehensive Cancer Control (CCC), is a reflection of 20 years of building successful partnerships to prevent and control cancer; planning and implementing strategic cancer control; collaborating to address national cancer prevention and control priorities; evaluating efforts; sharing successes; and, in later years, serving as a model for global cancer control planning and implementation. The CDC currently supports cancer control planning and implementation in all 50 states, the District of Columbia, eight tribes or tribal organizations, and seven Pacific Island Jurisdictions and U.S. territories through the NCCCP. CCC is an approach that brings together multi-sector partners to address the cancer burden in a community collectively by leveraging existing resources and identifying and addressing cancer related issues and needs. The Comprehensive Cancer Control National Partnership (CCCNP), a partnership of national organizations, has been committed to supporting comprehensive cancer control efforts since 1999. We summarize the efforts described in this Special Issue. We also describe opportunities and critical elements to continue the momentum for comprehensive cancer control well into the future. |
Uterine cancer incidence and mortality - United States, 1999-2016
Henley SJ , Miller JW , Dowling NF , Benard VB , Richardson LC . MMWR Morb Mortal Wkly Rep 2018 67 (48) 1333-1338 Uterine cancer is one of the few cancers with increasing incidence and mortality in the United States, reflecting, in part, increases in the prevalence of overweight and obesity since the 1980s (1). It is the fourth most common cancer diagnosed and the seventh most common cause of cancer death among U.S. women (1). To assess recent trends in uterine cancer incidence and mortality by race and ethnicity, CDC analyzed incidence data from CDC's National Program of Cancer Registries (NPCR) and the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) program and mortality data from the National Vital Statistics System (2). Most recent data available are through 2015 for incidence and through 2016 for mortality. Uterine cancer incidence rates increased 0.7% per year during 1999-2015, and death rates increased 1.1% per year during 1999-2016, with smaller increases observed among non-Hispanic white (white) women than among women in other racial/ethnic groups. In 2015, a total of 53,911 new uterine cancer cases, corresponding to 27 cases per 100,000 women, were reported in the United States, and 10,733 uterine cancer deaths (five deaths per 100,000 women) were reported in 2016. Uterine cancer incidence was higher among non-Hispanic black (black) and white women (27 cases per 100,000) than among other racial/ethnic groups (19-23 per 100,000). Uterine cancer deaths among black women (nine per 100,000) were higher than those among other racial/ethnic groups (four to five per 100,000). Public health efforts to help women achieve and maintain a healthy weight and obtain sufficient physical activity can reduce the risk for developing cancer of the endometrium (the lining of the uterus), the most common uterine cancer. Abnormal vaginal bleeding, including bleeding between periods or after sex or any unexpected bleeding after menopause, is an important symptom of uterine cancer (3). Through programs such as CDC's Inside Knowledge* campaign, promoting awareness among women and health care providers of the need for timely evaluation of abnormal vaginal bleeding can increase the chance that uterine cancer is detected early and treated appropriately. |
National burden of heart failure events in the United States, 2006 to 2014
Jackson SL , Tong X , King RJ , Loustalot F , Hong Y , Ritchey MD . Circ Heart Fail 2018 11 (12) e004873 BACKGROUND: Heart failure (HF)-a serious and costly condition-is increasingly prevalent. We estimated the US burden including emergency department (ED) visits, inpatient hospitalizations and associated costs, and mortality. METHODS AND RESULTS: We analyzed 2006 to 2014 data from the Healthcare Cost and Utilization Project Nationwide Emergency Department Sample, the Healthcare Cost and Utilization Project National (nationwide) Inpatient Sample, and the National Vital Statistics System. International Classification of Disease codes identified HF and comorbidities. Burden was estimated separately for ED visits, hospitalizations, and mortality. In addition, criteria were applied to identify total unique acute events. Rates of primary HF (primary diagnosis or underlying cause of death) and comorbid HF (comorbid diagnosis or contributing cause of death) were calculated, age standardized to the 2010 US population. In 2014, there were an estimated 1 068 412 ED visits, 978 135 hospitalizations, and 83 705 deaths with primary HF. There were 4 071 546 ED visits, 3 370 856 hospitalizations, and 230 963 deaths with comorbid HF. Between 2006 and 2014, the total unique acute event rate for primary HF declined from 536 to 449 per 100 000 (relative percent change of -16%; P for trend, <0.001) but increased for comorbid HF from 1467 to 1689 per 100 000 (relative percentage change, 15%; P for trend, <0.001). HF-related mortality decreased significantly from 2006 to 2009 but did not change meaningfully after 2009. For hospitalizations with primary HF, the estimated mean cost was $11 552 in 2014, totaling an estimated $11 billion. CONCLUSIONS: Given substantial healthcare and mortality burden of HF, rising healthcare costs, and the aging US population, continued improvements in HF prevention, management, and surveillance are important. |
Estimating state-level health burden of diabetes: Diabetes-attributable fractions for diabetes complications
Khavjou OA , Saydah SH , Zhang P , Poehler DC , Neuwahl SJ , Leib AR , Hoerger TJ , Wang J . Am J Prev Med 2018 56 (2) 232-240 INTRODUCTION: Limited information is available on the health burden of diabetes at the state level. This study estimated state-specific attributable fractions and the number of cases attributable to diabetes for diabetes-related complications. METHODS: For each state, diabetes-attributable fractions for nine diabetes complications were estimated: three self-reported complications from the 2013 Behavioral Risk Factor Surveillance System, hospitalizations with three complications from 2011 to 2014 State Inpatient Databases, and three complications from 2013 Medicare data. Attributable fractions were calculated using RR and diabetes prevalence and the total number of cases using attributable fractions and total number of complications. Adjusted RR of each complication for people with and without diabetes by age and sex was estimated using a generalized linear model. Analyses were conducted in 2015-2016. RESULTS: Median state-level diabetes-attributable fractions for self-reported complications were 0.14 (range, 0.10-0.19) for mobility limitations; 0.13 (range, 0.04-0.21) for limitations in instrumental activities of daily living; and 0.12 (range, 0.06-0.20) for severe visual impairment or blindness. Median state-level diabetes-attributable fractions for diabetes-associated hospitalizations were 0.19 (range, 0.08-0.24) for congestive heart failure; 0.08 (range, 0.02-0.16) for myocardial infarction; and 0.62 (range, 0.46-0.73) for lower extremity amputations. Median state-level diabetes-attributable fractions for complications among Medicare beneficiaries were 0.17 (range, 0.14-0.23) for coronary heart disease; 0.28 (range, 0.24-0.33) for chronic kidney disease; and 0.22 (range, 0.08-0.32) for peripheral vascular disease. CONCLUSIONS: Diabetes carries a significant health burden, and results vary across states. Efforts to prevent or delay diabetes or to improve diabetes management could reduce the health burden because of diabetes. |
Sustained virological response does not improve long-term glycemic control in patients with type 2 diabetes and chronic hepatitis C
Li J , Gordon SC , Rupp LB , Zhang T , Trudeau S , Holmberg SD , Moorman AC , Spradling PR , Teshale EH , Boscarino JA , Schmidt MA , Daida YG , Lu M . Liver Int 2018 39 (6) 1027-1032 BACKGROUND: Sustained virological response (SVR) to treatment for chronic hepatitis C (HCV) may improve short-term glucose control among patients with type 2 diabetes (T2D), but the long-term impact remains largely unknown. We used data from the Chronic Hepatitis Cohort Study to investigate the impact of SVR on long-term trends in HbA1c in patients with T2D. METHODS: "Index date" was defined as the date of treatment initiation (treated patients) or HCV diagnosis (untreated patients). To address treatment selection bias, we used a propensity score approach. We used a piecewise, linear-spline, mixed-effects model to evaluate changes in HbA1c over a five-year period. RESULTS: Our sample included 384 HCV patients with T2D (192 untreated, 192 treated, with SVR or treatment failure [TF]). After adjusting for BMI, HbA1c was stable among untreated and TF patients. In SVR patients, Hb1Ac trajectories evolved in three phases: 1) index through 6 months post-index, average HbA1c decreased significantly from 7.7-5.4% per 90 days (p<0.001); 2) 6-30 months post-index, HbA1c rebounded at a rate of 1.5% every 90 days (p=0.003); and 3) from 30 months onward, HbA1c stabilized at an average level of 7.9 (p-value =0.34). Results from an analysis restricted to patients receiving direct-acting antivirals were consistent with the main findings. CONCLUSION: Successful HCV treatment among patients with T2D significantly reduces HbA1 shortly after treatment, but these decreases are not sustained long-term. Less than three years after SVR, HbA1c rebounds to levels similar to untreated/TF patients, and higher than recommended for type 2 diabetic maintenance. This article is protected by copyright. All rights reserved. |
Association between plasma trans-fatty acid concentrations and diabetes in a nationally representative sample of US adults
Liu B , Sun Y , Snetselaar LG , Sun Q , Yang Q , Zhang Z , Liu L , Hu FB , Bao W . J Diabetes 2018 10 (8) 653-664 BACKGROUND: A diet high in trans-fatty acids (TFA) induces insulin resistance in rodent models and primates. However, previous epidemiological studies on the association between TFAs, based primarily on self-reported intake from the diet, and diabetes in humans have yielded conflicting results. Herein we examined the associations of objectively measured plasma TFA concentrations with diabetes in a large population-based study among US adults. METHODS: We included 3801 participants aged >/=20 years from the National Health and Nutrition Examination Survey 1999-2000 and 2009-10. Four major TFAs, namely palmitelaidic acid (C16:1 n-7t), elaidic acid (C18:1 n-9t), vaccenic acid (C18:1 n-7t), and linolelaidic acid (C18:2 n-6t, 9t), were measured in fasting plasma using gas chromatography-mass spectrometry. Diabetes was defined by self-reported physician diagnosis, plasma fasting glucose >/=126 mg/dL, or HbA1c >/=6.5%. RESULTS: After adjustment for other major risk factors, the odds ratios (95% confidence intervals) of diabetes comparing the highest with lowest quintile of plasma TFAs was 2.19 (1.27-3.79) for total TFAs (Ptrend = 0.01), 2.34 (1.48-3.72) for elaidic acid (Ptrend = 0.0004), 1.33 (0.82-2.15) for linolelaidic acid (Ptrend = 0.18), 1.58 (0.97-2.58) for palmitelaidic acid (Ptrend = 0.02), and 1.64 (0.95-2.84) for vaccenic acid (Ptrend = 0.08). In addition, total TFAs, elaidic acid, palmitelaidic acid, and vaccenic acid were significantly associated with fasting glucose, fasting insulin, the insulin resistance index, and HbA1c. CONCLUSIONS: In a nationally representative population, plasma TFAs, in particular elaidic acid, were positively associated with diabetes and biomarkers of glucose metabolism. |
Promising practices for the prevention of liver cancer: a review of the literature and cancer plan activities in the National Comprehensive Cancer Control Program
Momin B , Millman AJ , Nielsen DB , Revels M , Steele CB . Cancer Causes Control 2018 29 (12) 1265-1275 INTRODUCTION: Hepatitis B virus (HBV) and hepatitis C virus (HCV) infections are risk factors for hepatocellular carcinoma, a type of primary liver cancer, and are most prevalent in people born 1945-1965. Relatively little information is available for liver cancer prevention, compared to other cancers. In this review, we provide a summary of current promising public health practices for liver cancer prevention from the literature, as well as liver cancer-related initiatives in the National Comprehensive Cancer Control Program (NCCCP). METHODS: Two types of source materials were analyzed for this review: published literature (2005-present), and current cancer plans from the NCCCP (2005-2022). A search strategy was developed to include a review of several scientific databases. Of the 73 articles identified as potentially eligible, 20 articles were eligible for inclusion in the review. Eligible articles were abstracted using a data abstraction tool. Three independent keyword searches on 65 NCCCP plans were conducted. Keyword searches within each of the plans to identify activities related to liver cancer were conducted. Relevant information was abstracted from the plans and saved in a data table. RESULTS: Of the 20 eligible articles, 15 articles provided information on interventions related to liver cancer and hepatitis B or hepatitis C prevention. All 15 of the intervention articles were related to hepatitis; 13 were hepatitis B-focused, two were hepatitis C-focused, and 14 focused on Asian/Pacific Islander American populations. The independent keyword search of NCCCP plans produced 46 results for liver, 27 results for hepatitis, and 52 results for alcohol. Two plans included activities related to liver cancer. Twenty-four plans included activities related to hepatitis. DISCUSSION: A majority of the intervention articles published focused on HBV infection in Asian/Pacific Islander American populations, and a small percentage of NCCCP plans included liver-related content. The findings from this review will inform the development of an Action Plan on liver cancer prevention for the NCCCP, which will assist programs with the adoption and uptake of promising practices for the prevention of liver cancer. |
Prevalence of diabetic retinopathy and associated mortality among diabetic adults with and without chronic kidney disease
Pavkov ME , Harding JL , Chou CF , Saaddine JB . Am J Ophthalmol 2019 198 200-208 Purpose: To estimate prevalence and severity of diabetic retinopathy (DR) among U.S. adults with diabetes and with or without chronic kidney disease (CKD), and assess associated risk of mortality. Design(s): Cross-sectional study with national survey data. Method(s): The cohort included adults >=40 years old with diabetes in the National Health and Nutrition Examination Surveys (NHANES) 2005-2008. Vital status was determined through December 31, 2011. We defined diabetes as hemoglobin A1c >=6.5% or self-report and CKD by urinary albumin/creatinine >=30 mg/g or glomerular filtration rate <60 mL/min/1.73 m2. The main outcomes were DR and mortality. Result(s): Prevalence of DR was 27.8% (95% CI 24.3-31.7), 36.2% (95%CI 30.1-42.7), and 23.4% (95% CI 19.2-28.1), overall, with and without CKD. Prevalence of vision-threatening DR was 4.2% (95% CI 3.2-5.5), 8.2% (95% CI 5.4-12.2), and 2.0% (95% CI 1.2-3.5), respectively. In a multivariable adjusted model, DR was positively but nonsignificantly associated with CKD (OR = 1.1, 95% CI 0.7-1.7), was 40% higher per 1% increase in hemoglobin A1c (OR = 1.4, 95% CI 1.1-1.6), was 30% higher per 5 years additional diabetes duration (OR = 1.3, 95% CI 1.1-1.5), was 30% higher per 10 mm Hg increase in systolic blood pressure (OR = 1.3, 95% CI 1.1-1.5), and was 6-fold higher with insulin treatment (OR = 6.2, 95% CI 2.6-14.8). Compared with diabetic participants with neither DR nor CKD, those with DR and CKD had a 3.6-fold (95% CI 1.5-9.1) increased adjusted risk for all-cause mortality. Conclusion(s): Over one third of persons with diabetes and CKD had DR. The risk of death was higher with than without CKD and DR. Many of the studied risk factors associated with DR are modifiable. |
Examining comprehensive cancer control partnerships, plans, and program interventions: successes and lessons learned from a utilization-focused evaluation
Pyron T , Fonseka J , Young M , Zimmerman L , Moore AR , Hayes N . Cancer Causes Control 2018 29 (12) 1163-1171 The National Comprehensive Cancer Control Program has experienced exponential growth over the past 20 years due to the coordination and collaboration of many stakeholders to sustain multisector coalitions, develop and execute data-driven plans, and successfully implement evidenced-based interventions across the United States. These stakeholders have worked tirelessly to address the burden of cancer by employing strategies that promote healthy behaviors to reduce cancer risk, facilitate screening, and address the needs of cancer survivors. The interaction between the comprehensive cancer control program and the coalitions to engage in this work has been coined the 3Ps: the partnership, the CCC plan, and CCC program interventions. This article describes the efforts to evaluate the growth of the comprehensive cancer control movement, especially as it pertains to coalition contribution, plan priority development and implementation, and intervention implementation. It describes successes and lessons learned from an evaluation whose findings can be used to bolster and sustain comprehensive cancer control programs and coalitions across the U.S. |
Cost-effectiveness of a patient navigation intervention to increase colonoscopy screening among low-income adults in New Hampshire
Rice K , Sharma K , Li C , Butterly L , Gersten J , DeGroff A . Cancer 2018 125 (4) 601-609 BACKGROUND: Colonoscopy is the most widely used colorectal cancer (CRC) screening test in the United States. Through the detection and removal of potentially precancerous polyps, it can prevent CRC. However, CRC screening remains low among adults who are recommended for screening. The New Hampshire Colorectal Cancer Screening Program implemented a patient navigation (PN) intervention to increase colonoscopy screening among low-income patients in health centers in New Hampshire. In the current study, the authors examined the cost-effectiveness of this intervention. METHODS: A decision tree model was constructed using Markov state transitions to calculate the costs and effectiveness associated with PN. Costs were calculated for the implementation of PN in a statewide public health program and in endoscopy centers. The main study outcome was colonoscopy screening completion. The main decision variable was the incremental cost-effectiveness ratio associated with the PN intervention compared with usual care. RESULTS: The average cost per screening with PN was $1089 (95% confidence interval, $1075-$1103) compared with $894 with usual care (95% confidence interval, $886-$908). Among patients who were navigated, approximately 96.2% completed colonoscopy screening compared with 69.3% of those receiving usual care (odds ratio, 11.2; P <. 001). The incremental cost-effectiveness ratio indicated that 1 additional screening completion cost approximately $725 in a public health program and $548 in an endoscopy center with PN compared with usual care, both of which are less than the average Medicare reimbursement of $737 for a colonoscopy procedure. CONCLUSIONS: PN was found to be cost-effective in increasing colonoscopy screening among low-income adults in the New Hampshire Colorectal Cancer Screening Program, even at the threshold of current Medicare reimbursement rates for colonoscopy. The results of the current study support the implementation of PN in statewide public health programs and endoscopy centers. |
Assessing the impact of sexual function on perceptions of masculinity among prostate cancer survivors in the United States: findings from the prostate cancer registry
Richards AB , Davis K , Gooden RO . Aging Male 2018 23 (5) 1-5 BACKGROUND: Prostate cancer carries emasculating symptoms and treatment effects. These symptoms and treatment effects impact a man's sexual function; a central-theme to masculinity. This study seeks to assess the impact of sexual function on perceptions of masculinity. METHODS: A voluntary-sample of men self-selected into the registry. Data were based on a series of questions related to Health-Related Quality of Life and functional status. RESULTS: Based on the analysis, 50.2% of men did not feel less masculine, 33.2% of men were still interested in sex, 40.2% of men still engaged in sex "a little bit," and 34.8% of men still found sex "quite a bit" enjoyable. Additionally, 31.1% of identified issues with erectile dysfunction and 45.5% of men showed no discomfort with being sexually active. CONCLUSION: Sexual function has an impact on perceptions of masculinity but additional underlying issues outside of sexual function may contribute to perceptions of masculinity. |
An exploration of patient navigation and community health worker activities across national comprehensive cancer control programs
Rohan EA , McDougall R , Townsend JS . Health Equity 2018 2 (1) 366-374 Purpose: Health disparities persist across the cancer care continuum. Patient navigator (PN) and community health worker (CHW) interventions are designed to increase health equity. National Comprehensive Cancer Control Program (NCCCP) awardees develop and implement plans to coordinate cancer prevention and control activities, including supporting PN and CHW interventions. This content analysis examined NCCCP action plans to assess the extent to which jurisdictions report engaging in PN and/or CHW activities. Methods: We abstracted PN and CHW content from NCCCP action plans and coded content according to specific areas of PN and/or CHW intervention (e.g., screening, survivorship, and cancer type), used descriptive statistics to characterize overall results, and calculated chi-squares to determine whether programs engaged PNs and CHWs differently. Results: Eighty-two percent (n=53) of 65 NCCCP action plans had content related to PN and/or CHW activities, with more PN language (83%) than CHW (58%). These action plans described engaging PNs and CHWs in activities across the cancer continuum, but particularly for screening (60%) and survivorship (55%). Eighty-one percent of these plans described activities related to workforce development, such as training and standardizing roles and competencies. Programs engaged CHWs more often than PNs for outreach and in community settings. Conclusion: The majority of NCCCP awardees reported engaging in PN and/or CHW activities. Understanding how NCCCP awardees engage PNs and CHWs, including awardees' needs for workforce development in this area, can help Centers for Disease Control and Prevention provide more focused technical assistance as programs increase engagement of PNs and CHWs to improve health equity. |
Comprehensive cancer control: promoting survivor health and wellness
Rohan EA , Miller N , Bonner F3rd , Fultz-Butts K , Pratt-Chapman ML , Alfano CM , Santiago KC , Bergman K , Tai E . Cancer Causes Control 2018 29 (12) 1277-1285 PURPOSE: As of 2016, an estimated 15.5 million cancer survivors were living in the United States and the number of cancer survivors is expected to increase to 20.3 million by 2026. Numerous clinical studies have shown that comorbidities, such as obesity and diabetes, and unhealthy lifestyle choices, such as physical inactivity and heavy smoking, negatively influence overall quality of life and long-term survival of cancer survivors. Accordingly, survivorship programs seek to focus on overall wellness, including symptom management, monitoring for late effects of treatment, monitoring for recurrence, helping patients adapt healthy behaviors, and quality of life. This paper provides a broad overview of public health efforts to address the needs of cancer survivors. METHODS: To describe a range of examples of survivorship initiatives in comprehensive cancer control, we analyzed documents from comprehensive cancer control programs and coalitions and solicited detailed examples from several national partners. RESULTS: Comprehensive cancer control programs, coalitions, and partners are undertaking myriad initiatives to address cancer survivorship and building upon evidence-based interventions to promote healthy behaviors for cancer survivors across the country. CONCLUSION: A coordinated public health approach to caring for the growing population of cancer survivors can help address the long-term physical, psychosocial, and economic effects of cancer treatment on cancer survivors and their families. |
Prevalence and types of school-based out-of-school time programs at elementary schools and implications for student nutrition and physical activity
Sliwa SA , Calvert HG , Williams HP , Turner L . J Sch Health 2019 89 (1) 48-58 BACKGROUND: Out-of-school time (OST) programs are an important setting for supporting student health and academic achievement. This study describes the prevalence and characteristics of school-based OST programs, which can inform efforts to promote healthy behaviors in this setting. METHODS: A nationally representative sample of public elementary schools (N = 640) completed surveys in 2013-2014. Administrators reported on OST programs and policies at their school. Multivariable logistic regression models estimated the prevalence of school-based OST programs, adjusting for school characteristics. Among schools with OST programs (N = 475), chi-square tests identified school characteristics associated with having an OST policy about physical activity or nutrition. RESULTS: Three fourths of elementary schools (75.6%) had a full- or partial-year school-based OST program, with 30.8% having both. Full- and partial-year programs were significantly less prevalent in rural and township areas versus urban settings. Only 27.5% of schools with OST programs reported having physical activity and/or nutrition policies. CONCLUSIONS: Most US elementary schools have an on-site OST program, but disparities in access exist, and most lack policies or awareness of existing policies regarding physical activity and nutrition. To maximize OST programs' potential benefits, strategies are needed to increase access to programs and physical activity and/or nutrition policy adoption. |
A phase 2 trial of regorafenib as a single agent in patients with chemotherapy-refractory, advanced, and metastatic biliary tract adenocarcinoma
Sun W , Patel A , Normolle D , Patel K , Ohr J , Lee JJ , Bahary N , Chu E , Streeter N , Drummond S . Cancer 2018 125 (6) 902-909 BACKGROUND: Biliary tract cancers are rare, aggressive neoplasms. Most patients present with advanced/unresectable or metastatic disease at diagnosis, and no second-line regimen has demonstrated clinical benefit. This was a phase 2 study evaluating the efficacy and safety of regorafenib in patients who had advanced/unresectable or metastatic disease after receiving standard therapy. METHODS: In this single arm-study, patients with advanced/unresectable or metastatic biliary tract cancer who failed at least 1 line of systemic chemotherapy received regorafenib once daily on a schedule of 21-days on/7-days off in a 28-day cycle. Patients initially received a standard 160 mg dose. After toxicity assessments in the first 3 patients, the dose was reduced to 120 mg for subsequent patients, as preplanned. The primary endpoint was progression-free survival (PFS). Secondary objectives included overall survival (OS), the objective response rate, and the disease control rate. RESULTS: Forty-three patients received at least 1 dose of regorafenib, and 34 patients who received at least 1 cycle of treatment were evaluable for tumor response. The median PFS was 15.6 weeks (90% confidence interval, 12.9-24.7 weeks), and the median OS was 31.8 weeks (90% confidence interval, 13.3-74.3 weeks), with survival rates 40% at 12 months and 32% at 18 months. A partial response was achieved in 5 patients (11%), and 19 had stable disease (44%), for a disease control rate of 56%. The toxicity profile was as expected, with grade 3 and 4 adverse events reported in 40% of patients. The most common toxicities were hypophosphatemia (40%), hyperbilirubinemia (26%), hypertension (23%), and hand-foot skin reaction (7%). CONCLUSIONS: The current results suggest promising efficacy of regorafenib in patients with chemotherapy-refractory, advanced/metastatic biliary tract cancer, warranting further studies to confirm its clinical efficacy. There is a clear unmet need for effective therapies in patients who have advanced and metastatic biliary tract cancer. |
Identifying optimal approaches to scale up colorectal cancer screening: an overview of the Centers for Disease Control and Prevention (CDC)'s learning laboratory
Tangka FKL , Subramanian S , Hoover S , Lara C , Eastman C , Glaze B , Conn ME , DeGroff A , Wong FL , Richardson LC . Cancer Causes Control 2018 30 (2) 169-175 Use of recommended screening tests can reduce new colorectal cancers (CRC) and deaths, but screening uptake is suboptimal in the United States (U.S.). The Centers for Disease Control and Prevention (CDC) funded a second round of the Colorectal Cancer Control Program (CRCCP) in 2015 to increase screening rates among individuals aged 50-75 years. The 30 state, university, and tribal awardees supported by the CRCCP implement a range of multicomponent interventions targeting health systems that have low CRC screening uptake, including low-income and minority populations. CDC invited a select subset of 16 CRCCP awardees to form a learning laboratory with the goal of performing targeted evaluations to identify optimal approaches to scale-up interventions to increase uptake of CRC screening among vulnerable populations. This commentary provides an overview of the CRCCP learning laboratory, presents findings from the implementation of multicomponent interventions at four FQHCs participating in the learning laboratory, and summarizes key lessons learned on intervention implementation approaches. Lessons learned can support future program implementation to ensure scalability and sustainability of the interventions as well as guide future implementation science and evaluation studies conducted by the CRCCP learning laboratory. |
A decade of improvement in door-to-needle time among acute ischemic stroke patients, 2008 to 2017
Tong X , Wiltz JL , George MG , Odom EC , Coleman King SM , Chang T , Yin X , Merritt RK . Circ Cardiovasc Qual Outcomes 2018 11 (12) e004981 BACKGROUND: The clinical benefit of intravenous (IV) alteplase in acute ischemic stroke is time dependent. We assessed the overall temporal changes in door-to-needle (DTN) time and examine the factors associated with DTN time </=60 and </=45 minutes. METHODS AND RESULTS: A total of 496 336 acute ischemic stroke admissions were identified in the Paul Coverdell National Acute Stroke Program from 2008 to 2017. We used generalized estimating equations models to examine the factors associated with DTN time </=60 and </=45 minutes, and calculated adjusted odds ratios and 95% CI. Between 2008 and 2017, the percentage of acute ischemic stroke patients who received IV alteplase including those transferred, increased from 6.4% to 15.3%. After excluding those who received IV alteplase at an outside hospital, a total of 39 737 (8%) acute ischemic stroke patients received IV alteplase within 4.5 hours of the time the patient last known to be well. Significant increases were seen in DTN time </=60 minutes (26.4% in 2008 to 66.2% in 2017, P<0.001), as well as DTN time </=45 minutes (10.7% in 2008 to 40.5% in 2017, P<0.001). Patients aged 55 to 84 years were more likely to receive IV alteplase within 60 minutes, while those aged 55 to 74 years were more likely to receive IV alteplase within 45 minutes, as compared with those aged 18 to 54 years. Arrival by emergency medical service, and patients with severe stroke were more likely to receive IV alteplase within 60 and 45 minutes. Conversely, women, black patients as compared with white, and patients with a medical history of diseases associated with stroke were less likely to receive DTN time </=60 or 45 minutes. CONCLUSIONS: Rapid improvements in DTN time were observed in the Paul Coverdell National Acute Stroke Program; however, opportunities to reduce disparities remain. |
Poor accordance to a DASH dietary pattern is associated with higher risk of ESRD among adults with moderate chronic kidney disease and hypertension
Banerjee T , Crews DC , Tuot DS , Pavkov ME , Burrows NR , Stack AG , Saran R , Bragg-Gresham J , Powe NR . Kidney Int 2019 95 (6) 1433-1442 The Dietary Approaches to Stop Hypertension (DASH) diet lowers blood pressure, an important risk factor for chronic kidney disease (CKD) and end-stage renal disease (ESRD). However, it is unclear whether adherence to a DASH diet confers protection against future ESRD, especially among those with pre-existing CKD and hypertension. We examined whether a DASH diet is associated with lower risk of ESRD among 1,110 adults aged >/= 20 years with hypertension and CKD (estimated glomerular filtration rate, eGFR 30-59 ml/min/1.73 m(2)) enrolled in the National Health and Nutrition Examination Survey (1988-1994). Baseline DASH diet accordance score was assessed using a 24-hour dietary recall questionnaire. ESRD was ascertained by linkage to the U.S. Renal Data System registry. We used the Fine-Gray competing risks method to estimate the relative hazard (RH) for ESRD after adjusting for sociodemographics, clinical and nutritional factors, eGFR, and albuminuria. Over a median follow-up of 7.8 years, 18.4% of subjects developed ESRD. Compared to the highest quintile of DASH diet accordance, there was a greater risk of ESRD among subjects in quintiles 1 (RH=1.7; 95% CI 1.1-2.7) and 2 (RH 2.2; 95% CI 1.1-4.1). Significant interactions were observed with diabetes status and race/ethnicity, with the strongest association between DASH diet adherence and ESRD risk observed in individuals with diabetes and in non-Hispanic blacks. Low accordance to a DASH diet is associated with greater risk of ESRD in adults with moderate CKD and hypertension, particularly in non-Hispanic blacks and persons with diabetes. |
Protect Tiny Teeth Toolkit: An oral health communications resource for providers of pregnant women and new mothers
Brailer C , Robison V , Barone L . J Womens Health (Larchmt) 2019 28 (5) 568-572 Oral health is important to general health, yet is often overlooked. During pregnancy, women may be more prone to periodontal (gum) disease and cavities, and research has shown an association between these conditions and adverse pregnancy outcomes. Additionally, a mother's oral health status is a strong predictor of her children's oral health status. Primary care providers often have an opportunity to influence their patients' attitudes and behaviors regarding the importance of oral health during pregnancy. Through a cooperative agreement with the Centers for Disease Control and Prevention, the American Academy of Pediatrics worked to create Protect Tiny Teeth, an oral health communications resource that aims to facilitate conversations between pregnant women and their health care providers, as well as educate women and families about the importance of oral health. |
Cervical adenocarcinoma in situ: Human papillomavirus types and incidence trends in five states, 2008-2015
Cleveland AA , Gargano JW , Park IU , Griffin MR , Niccolai LM , Powell M , Bennett NM , Saadeh K , Pemmaraju M , Higgins K , Ehlers S , Scahill M , Johnson Jones ML , Querec T , Markowitz LE , Unger ER . Int J Cancer 2019 146 (3) 810-818 Primary prevention through the use of human papillomavirus (HPV) vaccination is expected to impact both cervical intraepithelial neoplasia (CIN) and adenocarcinoma in situ (AIS). While CIN is well described, less is known about the epidemiology of AIS, a rare cervical precancer. We identified AIS and CIN grade 3 (CIN3) cases through population-based surveillance, and analyzed data on HPV types and incidence trends overall, and among women screened for cervical cancer. From 2008-2015, 470 AIS and 6,587 CIN3 cases were identified. The median age of women with AIS was older than those with CIN3 (35 vs 31 years; p<0.01). HPV16 was the most frequently detected type in both AIS and CIN3 (57% in AIS; 58% in CIN3), whereas HPV18 was the second most common type in AIS and less common in CIN3 (38% vs. 5%; p<0.01). AIS lesions were more likely than CIN3 lesions to be positive for high-risk types targeted by the bivalent and quadrivalent vaccines (HPV16/18, 92% vs. 63%; p<0.01), and nonavalent vaccine (HPV16/18/31/33/45/52/58, 95% vs. 87%; p<0.01). AIS incidence rates decreased significantly in the 21-24 year age group (annual percent change [APC] overall: -22.1%, 95% CI: -33.9 to -8.2; APC among screened: -16.1%, 95% CI: -28.8 to -1.2), but did not decrease significantly in any older age group. This report on the largest number of genotyped AIS cases to date suggests an important opportunity for vaccine prevention of AIS, and is the first to document a decline in AIS incidence rates among young women during the vaccine era. This article is protected by copyright. All rights reserved. |
Resurgence in diabetes-related complications
Gregg EW , Hora I , Benoit SR . JAMA 2019 321 (19) 1867-1868 The improved long-term outlook for adults after receiving a diagnosis of diabetes is one of the most important clinical and public health successes in recent decades. During the early 1990s, patients with diabetes had reductions in lifespan of 7 to 10 years and an increased risk of lower-extremity amputation (LEA) vs those without diabetes (58 vs 3 cases/10 000 persons/year, respectively) and kidney failure (28 vs 2 cases/10 000 persons/year).1 Risk of cardiovascular events, which caused the most deaths, also was higher among persons with diabetes vs those without diabetes (141 vs 38 hospitalizations for acute myocardial infarction [AMI] per 10 000 persons/year).1 But through multifaceted improvements in diabetes care, risk factor management, self-management education and support, and better integration of care, these risk differences were reduced by 28% to 68% across a range of complications between 1990 and 2010, with gains most notable for reductions in AMI, stroke, and death due to hyperglycemia.1,2 Although the excess morbidity risk remained too high and the reduction in cardiovascular disease mortality led to new types of complications and causes of death,3 a continued reduction in the overall public health burden caused by diabetes seemed promising. |
Perceived risk of colorectal and breast cancers among women who are overweight or with obesity
Hall IJ , Soman A , Smith JL , White A , Crawford A . Prev Med Rep 2019 14 (100845) 100845 Many overweight women or women with obesity do not acknowledge their high weight status and may be unaware of their elevated cancer risk. We explored the relationship between weight status and women's perceived risk of colorectal (CRC) and breast cancers, overall and by race/ethnicity, in a nationally representative sample. Data was combined from NHIS 2005, 2010, and 2015 sample adult questionnaires and cancer control supplements. The analytic sample included females aged 18 years and over without reported history of cancer diagnosis. Multivariable logistic regression was performed and adjusted estimates for perceived risk of CRC and breast cancers were examined, stratified by body mass index and race/ethnicity. Data were reported using predicted marginal risk ratio (PMR). Colorectal cancer risk perception remained lowest among Non-Hispanic (NH) Black women regardless of weight status (PMR = 0.53 obesity, 0.65 overweight, 0.55 normal) compared to NH White women after adjustment for all covariates. Hispanic women who were overweight or had obesity also saw themselves at lower risk of CRC compared to NH White women, however these findings were statistically insignificant. Breast cancer risk perception also remained low for NH Blacks and Hispanics at any weight compared with NH Whites. Greater effort is needed to develop, disseminate, and widely adopt or institutionalize multilevel weight management interventions and programs. These programs increase awareness of excess weight as a risk factor for cancer and empower women in diverse communities to achieve and maintain a healthy weight by adopting healthy behaviors related to nutrition and physical activity. |
Public health approach to improve outcomes for congenital heart disease across the life span
Jenkins KJ , Botto LD , Correa A , Foster E , Kupiec JK , Marino BS , Oster ME , Stout KK , Honein MA . J Am Heart Assoc 2019 8 (8) e009450 Congenital heart disease (CHD), which is present in around 1.0% (1 in 110) of all live births in the United States, is the most common birth defect.1, 2, 3, 4, 5 Defined generally as malformations present at birth that involve the heart or major associated blood vessels, CHD includes a remarkably heterogeneous group of chronic conditions, with very different phenotypes, prevalence, risk factors, and outcomes. CHD is a significant contributor to birth‐defect–related morbidity, mortality, and healthcare costs6 in early life and increasingly among adolescents and adults.7 Because of their broad impact at the population level, a public health approach is needed to address the challenges of these common, critical, and costly conditions.8 We sought to create a framework to address CHD from a population‐based perspective, to serve as a model for a public health agenda for the United States, with a goal of improving the lives of those with or at risk for CHD. This framework is complementary to previous work outlining the Centers for Disease Control and Prevention's scientific priorities related to CHD,9 because implementation strategies are also needed in addition to addressing gaps in scientific knowledge.9, 10, 11 |
Progress toward improved cardiovascular health in the United States
Pahigiannis K , Thompson-Paul AM , Barfield W , Ochiai E , Loustalot F , Shero S , Hong Y . Circulation 2019 139 (16) 1957-1973 The Healthy People Initiative has served as the leading disease prevention and health promotion roadmap for the nation since its inception in 1979. Healthy People 2020 (HP2020), the initiative's current iteration, sets a national prevention agenda with health goals and objectives by identifying nationwide health improvement priorities and providing measurable objectives and targets from 2010 to 2020. Central to the overall mission and vision of Healthy People is an emphasis on achieving health equity, eliminating health disparities, and improving health for all population groups. The Heart Disease and Stroke (HDS) Work Group of the HP2020 Initiative aims to leverage advances in biomedical science and prevention research to improve cardiovascular health across the nation. The initiative provides a platform to foster partnerships and empower professional societies and nongovernmental organizations, governments at the local, state, and national levels, and healthcare professionals to strengthen policies and improve practices related to cardiovascular health. Disparities in cardiovascular disease burden are well recognized across, for example, race/ethnicity, sex, age, and geographic region, and improvements in cardiovascular health for the entire population are only possible if such disparities are addressed through efforts that target individuals, communities, and clinical and public health systems. This article summarizes criteria for creating and tracking the 50 HDS HP2020 objectives in 3 areas (prevention, morbidity/mortality, and systems of care), reports on progress toward the 2020 targets for these objectives based on the most recent data available, and showcases examples of relevant programs led by participating agencies. Although most of the measurable objectives have reached the 2020 targets ahead of time (n=14) or are on track to meet the targets (n=7), others may not achieve the decade's targets if the current trends continue, with 3 objectives moving away from the targets. This summary illustrates the utility of HP2020 in tracking measures of cardiovascular health that are of interest to federal agencies and policymakers, professional societies, and other nongovernmental organizations. With planning for Healthy People 2030 well underway, stakeholders such as healthcare professionals can embrace collaborative opportunities to leverage existing progress and emphasize areas for improvement to maximize the Healthy People initiative's positive impact on population-level health. |
The phylogeography and incidence of multi-drug resistant typhoid fever in sub-Saharan Africa.
Park SE , Pham DT , Boinett C , Wong VK , Pak GD , Panzner U , Espinoza LMC , von Kalckreuth V , Im J , Schutt-Gerowitt H , Crump JA , Breiman RF , Adu-Sarkodie Y , Owusu-Dabo E , Rakotozandrindrainy R , Soura AB , Aseffa A , Gasmelseed N , Keddy KH , May J , Sow AG , Aaby P , Biggs HM , Hertz JT , Montgomery JM , Cosmas L , Fields B , Sarpong N , Razafindrabe TJL , Raminosoa TM , Kabore LP , Sampo E , Teferi M , Yeshitela B , El Tayeb MA , Sooka A , Meyer CG , Krumkamp R , Dekker DM , Jaeger A , Poppert S , Tall A , Niang A , Bjerregaard-Andersen M , Valborg Løfberg S , Seo HJ , Jeon HJ , Deerin JF , Park J , Konings F , Ali M , Clemens JD , Hughes P , Sendagala JN , Vudriko T , Downing R , Ikumapayi UN , Mackenzie GA , Obaro S , Argimon S , Aanensen DM , Page A , Keane JA , Duchene S , Dyson Z , Holt KE , Dougan G , Marks F , Baker S . Nat Commun 2018 9 (1) 5094 There is paucity of data regarding the geographical distribution, incidence, and phylogenetics of multi-drug resistant (MDR) Salmonella Typhi in sub-Saharan Africa. Here we present a phylogenetic reconstruction of whole genome sequenced 249 contemporaneous S. Typhi isolated between 2008-2015 in 11 sub-Saharan African countries, in context of the 2,057 global S. Typhi genomic framework. Despite the broad genetic diversity, the majority of organisms (225/249; 90%) belong to only three genotypes, 4.3.1 (H58) (99/249; 40%), 3.1.1 (97/249; 39%), and 2.3.2 (29/249; 12%). Genotypes 4.3.1 and 3.1.1 are confined within East and West Africa, respectively. MDR phenotype is found in over 50% of organisms restricted within these dominant genotypes. High incidences of MDR S. Typhi are calculated in locations with a high burden of typhoid, specifically in children aged <15 years. Antimicrobial stewardship, MDR surveillance, and the introduction of typhoid conjugate vaccines will be critical for the control of MDR typhoid in Africa. |
Maintenance and reappearance of extremely divergent intra-host HIV-1 variants.
Wertheim JO , Oster AM , Murrell B , Saduvala N , Heneine W , Switzer WM , Johnson JA . Virus Evol 2018 4 (2) vey030 Understanding genetic variation in human immunodeficiency virus (HIV) is clinically and immunologically important for patient treatment and vaccine development. We investigated the longitudinal intra-host genetic variation of HIV in over 3,000 individuals in the US National HIV Surveillance System with at least four reported HIV-1 polymerase (pol) sequences. In this population, we identified 149 putative instances of superinfection (i.e. an individual sequentially infected with genetically divergent, polyphyletic viruses). Unexpectedly, we discovered a group of 240 individuals with consecutively sampled viral strains that were >0.015 substitutions/site divergent, despite remaining monophyletic in the phylogeny. Viruses in some of these individuals had a maximum genetic divergence approaching that found between two random, unrelated HIV-1 subtype-B pol sequences within the US population. Individuals with these highly divergent viruses tended to be diagnosed nearly a decade earlier in the epidemic than people with superinfection or virus with less intra-host genetic variation, and they had distinct transmission risk factor profiles. To better understand this genetic variation in cases with extremely divergent, monophyletic viruses, we performed molecular clock phylogenetic analysis. Our findings suggest that, like Hepatitis C virus, extremely divergent HIV lineages can be maintained within an individual and reemerge over a period of years. |
Molecular epidemiology of noroviruses in children under 5 years of age with acute gastroenteritis in Yaoundé, Cameroon.
Mugyia AE , Ndze VN , Akoachere JTK , Browne H , Boula A , Ndombo PK , Cannon JL , Vinje J , Ndip LM . J Med Virol 2018 91 (5) 738-743 Norovirus is a common cause of acute gastroenteritis (AGE) among children in developing countries. Limited data on the prevalence and genetic variability of norovirus are available in Cameroon, where early childhood mortality due to AGE is common. We tested 902 fecal specimens from children younger than 5 years of age hospitalized with AGE between January 2010 and December 2013. Overall, 76 (8.4%) samples tested positive for norovirus, of which 83% (63/76) were among children < 12 months old. Most of the noroviruses detected were in children infected between July and December of each year. All norovirus-positive specimens were genotyped, with 80% (61/76) being GII.4 (three variants detected). Genotypes GI.2, GI.6, GII.1, GII.2, GII.3, GII.6, GII.16, GII.17, and GII.21 genotypes were also detected. Interestingly, GII.4 Sydney and GII.17 Kawasaki viruses were found as early as 2010, years before their emergence globally. This study suggests norovirus is a significant cause of moderate to severe gastroenteritis among young children in Cameroon. Results are important to highlight appropriate prevention and control strategies for reducing the burden of norovirus disease. This article is protected by copyright. All rights reserved. |
Utility of Whole-Genome Sequencing to Ascertain Locally Acquired Cases of Coccidioidomycosis, Washington, USA.
Oltean HN , Etienne KA , Roe CC , Gade L , McCotter OZ , Engelthaler DM , Litvintseva AP . Emerg Infect Dis 2019 25 (3) 501-506 Coccidioidomycosis is an emerging fungal infection in Washington, USA, and the epidemiology of the disease in this state is poorly understood. We used whole-genome sequencing to differentiate locally acquired cases in Washington on the basis of the previously identified phylogeographic population structure of Coccidioides spp. Clinical isolates from coccidioidomycosis cases involving possible Washington soil exposure were included. Of 17 human infections with epidemiologic evidence of possible local acquisition, 4 were likely locally acquired infections and 13 were likely acquired outside Washington. Isolates from locally acquired cases clustered within the previously established Washington clade of C. immitis. Genetic differences among these strains suggest multiple environmental reservoirs of C. immitis in the state. |
Case Report: Cervicovaginal co-colonization with Entamoeba gingivalis and Entamoeba polecki in association with an intrauterine device
Bradbury RS , Roy S , Ali IK , Morrison JR , Waldner D , Hebbeln K , Aldous W , Jepson R , Delavan HR , Ndubuisi M , Bishop HS . Am J Trop Med Hyg 2018 100 (2) 311-313 Amoebic trophozoites were identified in the cervicovaginal smear of a U.S. patient without travel history at the time of intrauterine device (IUD) removal. Subsequent morphologic analysis and DNA sequencing identified a mixed cervicovaginal colonization of the female genital tract with both Entamoeba gingivalis and Entamoeba polecki in association with Actinomyces species bacteria. This highlights to the potential for colonization of the genital tract with E. gingivalis, particularly in association with IUD placement, and represents the first report of E. polecki in this context. |
Viral suppression among persons in HIV care in the United States during 2009-2013: sampling bias in Medical Monitoring Project surveillance estimates
Bradley H , Althoff KN , Buchacz K , Brooks JT , Gill MJ , Horberg MA , Kitahata MM , Marconi V , Mayer KH , Mayor A , Moore R , Mugavero M , Napravnik S , Paz-Bailey G , Prejean J , Rebeiro PF , Rentsch CT , Shouse RL , Silverberg MJ , Sullivan PS , Thorne JE , Yehia B , Rosenberg ES . Ann Epidemiol 2018 31 3-7 PURPOSE: To assess sampling bias in national viral suppression (VS) estimates derived from the Medical Monitoring Project (MMP) resulting from use of an abbreviated (four-month) annual sampling period. We aimed to improve VS estimates using cohort data from the North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD) and a novel cohort-adjustment method. METHODS: Using full calendar years of NA-ACCORD data, we assessed timing of HIV care attendance (inside vs. exclusively outside MMP's four-month sampling period), VS status at last test (<200 vs. >/=200 copies/mL), and associated demographics. These external estimates were used to standardize MMP to NA-ACCORD data with multivariable regression models of care attendance and VS, yielding adjusted 2009-2013 VS estimates with 95% confidence intervals. RESULTS: Weighted percentages of VS among persons in HIV care were 67% in 2009 and 77% in 2013. These estimates are slightly lower than previously published MMP estimates (72% and 80% in 2009 and 2013, respectively). The number of persons receiving HIV care was previously underestimated by 20%, because patients receiving care exclusively outside the MMP sampling period did not contribute toward the weighted population estimate. CONCLUSIONS: Careful examination of national surveillance estimates using data triangulation and novel methodologies can improve the robustness of VS estimates. |
State minimum wage laws and newly diagnosed cases of HIV among heterosexual black residents of US metropolitan areas
Cloud DH , Beane S , Adimora A , Friedman SR , Jefferson K , Hall HI , Hatzenbuehler M , Johnson AS , Stall R , Tempalski B , Wingood GM , Wise A , Komro K , Cooper HLF . SSM Popul Health 2019 7 (100327) 100327 This ecologic cohort study explores the relationship between state minimum wage laws and rates of HIV diagnoses among heterosexual black residents of U.S metropolitan areas over an 8-year span. Specifically, we applied hierarchical linear modeling to investigate whether state-level variations in minimum wage laws, adjusted for cost-of-living and inflation, were associated with rates of new HIV diagnoses among heterosexual black residents of metropolitan statistical areas (MSAs; n=73), between 2008 and 2015. Findings suggest that an inverse relationship exists between baseline state minimum wages and initial rates of newly diagnosed HIV cases among heterosexual black individuals, after adjusting for potential confounders. MSAs with a minimum wage that was $1 higher at baseline had a 27.12% lower rate of newly diagnosed HIV cases. Exploratory analyses suggest that income inequality may mediate this relationship. If subsequent research establishes a causal relationship between minimum wage and this outcome, efforts to increase minimum wages should be incorporated into HIV prevention strategies for this vulnerable population. |
Household transmission of seasonal influenza from HIV-infected and -uninfected individuals in South Africa, 2013-2014
Cohen C , Tshangela A , Valley-Omar Z , Iyengar P , von Mollendorf C , Walaza S , Hellferscee O , Venter M , Martinson N , Mahlase G , McMorrow M , Cowling BJ , Treurnicht FK , Cohen AL , Tempia S . J Infect Dis 2018 219 (10) 1605-1615 Background: Differential transmission from HIV-infected compared to HIV-uninfected individuals may impact influenza burden. We estimated the household secondary infection risk (SIR) and serial interval (SI) for influenza transmission from HIV-infected and HIV-uninfected index cases and identified associated factors. Methods: Index cases were the first symptomatic person in a household with influenza-like illness, testing influenza positive on real-time reverse transcription polymerase chain reaction (rRT-PCR). Nasopharyngeal swabs collected from household contacts every four days were tested by rRT-PCR. Factors associated with SIR were evaluated using logistic regression. Results: We enrolled 28 HIV-infected and 57 HIV-uninfected index cases. On multivariable analysis, HIV-infected index cases were less likely to transmit influenza to household contacts (odds ratio (OR) 0.2 95% CI 0.1-0.6)(SIR 16%, 18/113 vs 27%, 59/220). Factors associated with increased SIR included index age group 1-4 years (OR 3.6, 95% CI 1.2-11.3) and 25-44 years (OR 8.0, 95% CI 1.8-36.7) and contact age group 1-4 years (OR 3.5, 95%CI 1.2-10.3) compared to 5-14 years and sleeping with index case (OR 2.7, 95%CI 1.3-5.5). HIV-infection of index case was not associated with SI. Conclusions: HIV-infection was not associated with SI. Increased infectiousness of HIV-infected individuals is likely not an important driver of community influenza transmission. |
Antiretroviral drug concentrations in breastmilk, maternal HIV viral load, and HIV transmission to the infant: results from the BAN study
Davis NL , Corbett A , Kaullen J , Nelson JAE , Chasela CS , Sichali D , Hudgens MG , Miller WC , Jamieson DJ , Kourtis AP . J Acquir Immune Defic Syndr 2018 80 (4) 467-473 BACKGROUND: Concentration of antiretroviral (ARV) drug found in plasma, and amounts of drug excreted into breastmilk, may affect HIV viral load and potentially perinatal HIV transmission. METHODS: In this cohort study with two-phase sampling, we included mothers randomized to postpartum maternal ARVs or daily infant nevirapine during 28 weeks of breastfeeding in the Breastfeeding, Antiretrovirals and Nutrition (BAN) study. Among these, we included all mothers who transmitted HIV to their infants between 2-28 weeks and 15% of mothers who did not (n=27 and 227, respectively). Spearman correlation coefficients (r2) were used to assess correlation between maternal plasma and breastmilk ARV concentration. Associations between the median effective drug concentration (EC50) and detectable maternal viral load (plasma: >40 copies/ml, breastmilk: >56 copies/ml) were assessed using mixed effects models. Cox models were used to estimate the association between maternal or infant plasma drug concentration and breastmilk HIV transmission from 2-28 weeks. RESULTS: All ARV compounds exhibited substantial correlations between maternal plasma and breastmilk concentrations (r2: 0.85-0.98, p-value <0.0001). Having plasma drug concentration above the EC50 was associated with lower odds of having detectable HIV RNA (maternal plasma OR 0.64, 95%CI 0.45-0.91; breastmilk OR 0.22, 95% CI 0.14-0.35) and a reduced rate of breastmilk HIV transmission (HR 0.40, 95% CI 0.18-0.93). Having breastmilk drug concentration above the EC50 was also associated with lower odds of having detectable maternal HIV RNA (plasma OR 0.62, 95%CI 0.45-0.85; breastmilk OR 0.42, 95% CI 0.29-0.59). CONCLUSION: Ensuring adequate drug concentration is important for viral suppression and preventing breastmilk HIV transmission. |
Where are the positives HIV testing in sub-Saharan Africa in the era of test and treat
De Cock KM , Barker JL , Baggaley R , El Sadr WM . AIDS 2019 33 (2) 349-352 When the definitive history of AIDS is written, HIV testing will feature not only as a major advance, but also as a metaphor for our uneasy approaches to the epidemic [1]. HIV testing remains suboptimally implemented and widely debated, even as the world has committed to the Sustainable Development Goals and associated calls to end AIDS [2]. |
Pediatric influenza and illness severity: what is known and what questions remain
Doyle JD , Campbell AP . Curr Opin Pediatr 2018 31 (1) 119-126 PURPOSE OF REVIEW: Influenza causes a range of illnesses in children, from uncomplicated self-limited illness to severe disease and death. This review provides an update on the severity and burden of influenza in US children over recent seasons. RECENT FINDINGS: The 2017-2018 influenza season was widespread and severe across all ages, including children. Disease severity is influenced by influenza virologic characteristics and host factors, as well as public health interventions such as influenza vaccination and antiviral treatment. In recent influenza A (H3N2)-predominant seasons (2016-2017 and 2017-2018), influenza vaccination effectiveness was higher in younger children compared with older children and adolescents, although the reasons for this are unclear. Interestingly, even in seasons when influenza A (H3N2) viruses predominate, influenza A (H1N1)pdm09 and B viruses can play a large role in severe pediatric disease. Although children less than 5 years of age and those with underlying medical conditions are at increased risk for severe disease, influenza-associated hospitalizations and deaths occur every season in healthy children. SUMMARY: Influenza causes a substantial burden of outpatient visits, hospitalizations, and deaths among children. Ongoing research is important to better characterize factors that contribute to influenza severity, and to identify strategies to improve the impact of influenza vaccination and treatment. |
Trends in geographic rates of HIV diagnoses among black females in the United States, 2010-2015
Elmore K , Bradley ELP , Lima AC , Khalil GM , Obi-Tabot E , Gant Z , Dean HD , McCree DH . J Womens Health (Larchmt) 2018 28 (3) 410-417 BACKGROUND: HIV diagnoses among females in the United States declined 22% from 2010 to 2015, including a 27% decline in diagnoses among black females. Despite this progress, disparities persist. Black females accounted for 60% of new HIV diagnoses among females in 2015. Geographic disparities also exist. This article describes geographic differences in HIV diagnoses among black females in the United States, from 2010 to 2015. MATERIALS AND METHODS: We examined HIV surveillance data from 2010 to 2015 to determine in which geographic areas decreases or increases in HIV diagnoses occurred. We used data from the National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention's (NCHHSTP) AtlasPlus to calculate percent changes in HIV diagnosis rates by geographic region for black females >/=13 years of age. RESULTS: The number of new HIV diagnoses declined 27% among black females from 2010 to 2015. The highest rates of HIV diagnosis per 100,000 population of black females, from 2010 to 2015, were in the Northeast and the South. In 2015, five of the eight states reporting the highest rates of HIV diagnosis (i.e., the highest quartile) were in the South. CONCLUSIONS: HIV diagnosis rates decreased nationally among black females, but the decreases were not uniform within regions or across the United States. Some states experienced increases, and black females in the South and Northeast remain disproportionately affected. Additional research is needed to ascertain factors associated with the increases to continue progress toward reducing HIV-related disparities among females in the United States. |
Trends and gaps in national blood transfusion services - 14 sub-Saharan African countries, 2014-2016
Kanagasabai U , Chevalier MS , Drammeh B , Mili FD , Qualls ML , Bock N , Benech I , Nelson LJ , Alemnji G , Watts DH , Kimani D , Selenic D . MMWR Morb Mortal Wkly Rep 2018 67 (50) 1392-1396 Ensuring availability of safe blood products through recruitment of voluntary, nonremunerated, blood donors (VNRDs) and prevention of transfusion-transmissible infections (TTIs), including human immunodeficiency virus (HIV), hepatitis B virus (HBV), hepatitis C virus (HCV), and syphilis, is important for public health (1,2). During 2004-2016, the U.S. President's Emergency Plan for AIDS Relief (PEPFAR) provided approximately $468 million in financial support and technical assistance* to 14 sub-Saharan African countries(dagger) with high HIV prevalence to strengthen national blood transfusion services (NBTSs)( section sign) and improve blood safety and availability. CDC analyzed these countries' 2014-2016 blood safety surveillance data to update previous reports (1,2) and summarize achievements and programmatic gaps as some NBTSs begin to transition funding and technical support from PEPFAR to local ministries of health (MOHs) (2,3). Despite a 60% increase in blood supply since 2004 and steady declines in HIV prevalence (to <1% among blood donors in seven of the 14 countries), HIV prevalence among blood donors still remains higher than that recommended by the World Health Organization (WHO) (4). PEPFAR support has contributed to significant reductions in HIV prevalence among blood donors in the majority of PEPFAR-supported countries, and linking donors who screen HIV-positive to confirmatory testing and indicated treatment, as well as further reducing TTIs, remains a public health priority (5). |
Data triangulation to estimate age-specific coverage of voluntary medical male circumcision for HIV prevention in four Kenyan counties
Kripke K , Opuni M , Odoyo-June E , Onyango M , Young P , Serrem K , Ojiambo V , Schnure M , Stegman P , Njeuhmeli E . PLoS One 2018 13 (12) e0209385 BACKGROUND: Kenya is 1 of 14 priority countries in Africa scaling up voluntary medical male circumcision (VMMC) for HIV prevention following the recommendations of the World Health Organization and the Joint United Nations Programme on HIV/AIDS. To inform VMMC target setting, we modeled the impact of circumcising specific client age groups across several Kenyan geographic areas. METHODS: The Decision Makers' Program Planning Tool, Version 2 (DMPPT 2) was applied in Kisumu, Siaya, Homa Bay, and Migori counties. Initial modeling done in mid-2016 showed coverage estimates above 100% in age groups and geographic areas where demand for VMMC continued to be high. On the basis of information obtained from country policy makers and VMMC program implementers, we adjusted circumcision coverage for duplicate reporting, county-level population estimates, migration across county boundaries for VMMC services, and replacement of traditional circumcision with circumcisions in the VMMC program. To address residual inflated coverage following these adjustments we applied county-specific correction factors computed by triangulating model results with coverage estimates from population surveys. RESULTS: A program record review identified duplicate reporting in Homa Bay, Kisumu, and Siaya. Using county population estimates from the Kenya National Bureau of Statistics, we found that adjusting for migration and correcting for replacement of traditional circumcision with VMMC led to lower estimates of 2016 male circumcision coverage especially for Kisumu, Migori, and Siaya. Even after addressing these issues, overestimation of 2016 male circumcision coverage persisted, especially in Homa Bay. We estimated male circumcision coverage in 2016 by applying correction factors. Modeled estimates for 2016 circumcision coverage for the 10- to 14-year age group ranged from 50% in Homa Bay to approximately 90% in Kisumu. Results for the 15- to 19-year age group suggest almost complete coverage in Kisumu, Migori, and Siaya. Coverage for the 20- to 24-year age group ranged from about 80% in Siaya to about 90% in Homa Bay, coverage for those aged 25-29 years ranged from about 60% in Siaya to 80% in Migori, and coverage in those aged 30-34 years ranged from about 50% in Siaya to about 70% in Migori. CONCLUSIONS: Our analysis points to solutions for some of the data issues encountered in Kenya. Kenya is the first country in which these data issues have been encountered because baseline circumcision rates were high. We anticipate that some of the modeling methods we developed for Kenya will be applicable in other countries. |
International importations of measles virus into the United States during the post-elimination era, 2001-2016
Lee AD , Clemmons NS , Patel M , Gastanaduy PA . J Infect Dis 2018 219 (10) 1616-1623 Background: Although measles was declared eliminated from the United States in 2000, measles cases and outbreaks continue to occur, resulting from importations of the disease from countries where it remains endemic. Methods: We describe the epidemiology of international importations of measles virus into the United States during the post-elimination era. Results: From 2001 to 2016, 553 imported measles cases were reported to the Centers for Disease Control and Prevention. A median of 28 importations occurred each year (range: 1880). The median age of imported case-patients was 18 years (range: three months75 years); 87% were unvaccinated or had an unknown vaccination status. U.S. residents (as opposed to foreign visitors) accounted for 62% of imported measles cases. Overall, 62% of all imported case-patients reported travel to countries in the Western Pacific and European Regions of the World Health Organization during their exposure periods. The number of measles importations from specific countries was related to the incidence of measles in and the volume of travel to and from the source country. Conclusions: ur findings emphasize the importance of measles vaccination of U.S. residents aged >/=6 months before international travel according to Advisory Committee on Immunization Practices recommendations and supporting global measles elimination efforts. |
Clinical and epidemiologic profiles for identifying norovirus in acute gastroenteritis outbreak investigations
Lively JY , Johnson SD , Wikswo M , Gu W , Leon J , Hall AJ . Open Forum Infect Dis 2018 5 (4) ofy049 Background: Noroviruses are the leading cause of acute gastroenteritis (AGE) outbreaks in the United States. However, outbreaks attributed to norovirus often lack confirmation by diagnostic testing. Clinical and epidemiologic profiles, such as the Kaplan criteria (vomiting in >50% cases, mean incubation period of 24-48 hours, mean duration of illness for 12-60 hours, and negative bacterial stool culture), have been used to distinguish norovirus outbreaks from those caused by bacteria. Methods: Kaplan criteria were evaluated among 10 023 outbreaks reported to the National Outbreak Reporting System (NORS) during 2009-2012. An alternate profile for distinguishing norovirus outbreaks from outbreaks caused by nonviral etiologies was identified using classification and regression tree (CART) modeling. Performance of the Kaplan criteria and alternate profile were compared among laboratory-confirmed outbreaks. Results: The Kaplan criteria were 63.9% sensitive and 100% specific in discriminating norovirus from nonviral outbreaks, but only 3.3% of norovirus and 1.2% of nonviral outbreaks reported all criteria. Clinical and epidemiologic characteristics identified with CART modeling (ratio of proportion of cases with fever to the proportion of cases with vomiting <1, proportion of cases with bloody stool <0.1, proportion of cases with vomiting >/=0.26) were 85.7% sensitive and 92.4% specific for distinguishing norovirus from nonviral outbreaks and were applicable to more than 8 times as many outbreaks compared with the Kaplan criteria. Conclusions: Compared with the Kaplan criteria, the CART-derived profile had higher sensitivity and broader application in reported AGE outbreaks. Thus, this alternate profile may provide a more useful tool for identifying norovirus during outbreak investigations. |
Progress of polio eradication and containment requirements after eradication
Oberste MS . Transfusion 2018 58 Suppl 3 3078-3083 Wild poliovirus (WPV) is nearing eradication, and only three countries have never interrupted WPV transmission (Pakistan, Afghanistan, and Nigeria). WPV2 was last detected in 1999, and it was declared eradicated in 2015. WPV3 has not been detected since 2012. Since 2016, WPV1 has been detected in only two countries (Afghanistan and Pakistan), with only 22 cases reported in 2017 and 12 cases reported in 2018 (as of July 10). Because of WPV2 eradication and the risk of emergence of type 2 vaccine-derived polioviruses from continued use of trivalent oral polio vaccine (OPV), trivalent OPV was replaced by bivalent OPV (types 1 and 3) in a globally coordinated effort in 2016. WPV2 eradication and trivalent OPV cessation also mean that breach of containment in a facility working with type 2 poliovirus is now a major risk to reseed type 2 circulation in the community. As a result, the World Health Organization has developed a "Global Action Plan to minimize poliovirus facility-associated risk after type-specific eradication of wild polioviruses and sequential cessation of oral polio vaccine use." Because poliovirus has long been used as a standard for qualification of intravenous immunoglobulin, disinfectant products, and sanitation methods, poliovirus containment has implications far beyond poliovirus laboratories. |
Evaluation of performance of algorithms using serial hepatitis C RNA tests to predict treatment initiation and sustained virologic response among patients infected with hepatitis C
Osinubi A , Harris AM , Vellozzi C , Lom J , Miller L , Millman AJ . Am J Epidemiol 2018 188 (3) 555-561 Electronic medical record data structure prevents easy population-level monitoring of hepatitis C virus (HCV) treatment uptake and cure. Using an HCV registry from a public hospital system in Atlanta, Georgia, we developed multiple algorithms using serial HCV RNA test results as proxy measures for direct acting antiviral (DAA) treatment initiation and sustained virologic response (SVR). We calculated sensitivity and positive predictive values by comparing the algorithms to the DAA initiation and SVR results from the registry. From December 2013 - August 2016, 1,807 persons actively infected with HCV were identified in the registry. Of those, 698 initiated DAA treatment based on medical record abstraction; of 442 patients with treatment start and/or end dates, 314 had documented SVR. Treatment algorithm 2 (detectable HCV RNA result followed by 2 sequential HCV RNA tests results) and treatment algorithm 5 (detectable HCV RNA result followed by 2 sequential HCV RNA tests results > 6 weeks apart) had the highest sensitivity (87% and 85% respectively) and positive predictive value (80% and 82% respectively) combinations. Four SVR algorithms relied on fulfilling treatment algorithm definitions and having an undetectable HCV RNA test result >/= 12 weeks after the last HCV RNA result; sensitivity for all was 79% and positive predictive value was 92-93%. Algorithms using serial quantitative HCV RNA results can serve as proxy measures for evaluating population-level DAA treatment and SVR outcomes. |
Low admission plasma gelsolin concentrations identify community-acquired pneumonia patients at high risk for severe outcomes
Self WH , Wunderink RG , DiNubile MJ , Stossel TP , Levinson SL , Williams DJ , Anderson EJ , Bramley AM , Jain S , Edwards KM , Grijalva CG . Clin Infect Dis 2018 69 (7) 1218-1225 Background: Plasma gelsolin (pGSN) is an abundant circulating protein that neutralizes actin exposed by damaged cells, modulates inflammatory responses, and enhances alveolar macrophage antimicrobial activity. We investigated whether adults with low pGSN at hospital admission for community-acquired pneumonia (CAP) were at high risk for severe outcomes. Methods: Admission pGSN concentrations were measured by enzyme-linked immunosorbent assay in 455 adults hospitalized with CAP. Patients were grouped into four hierarchical, mutually-exclusive categories based on maximum clinical severity experienced during their hospitalization: (1) general floor care without intensive care (ICU) unit admission, invasive respiratory or vasopressor support (IRVS), or death; (2) ICU care without IRVS or death; (3) IRVS without death; or (4) death. Admission pGSN concentrations were compared across these discrete outcome categories. Additionally, outcomes among patients in the lowest quartile of pGSN concentration were compared with those in the upper three quartiles. Results: Overall, median (interquartile range) pGSN concentration was 38.1 (32.1, 45.7) mug/mL. Patients with more severe outcomes had lower pGSN concentrations (p=0.0001); median values were: 40.3 mug/ml for floor patients; 36.7 mug/ml for ICU patients; 36.5 mug/ml for patients receiving IRVS; and 25.7 mug/ml for patients who died. Compared with patients with higher pGSN concentrations, patients in the lowest quartile (pGSN </=32.1 mug/ml) more often required IRVS (21.2% vs 11.7%, p=0.0114) and died (8.8% vs 0.9%, p<0.0001). Conclusions: Among adults hospitalized with CAP, lower pGSN concentrations were associated with more severe clinical outcomes. Future studies are planned to investigate possible therapeutic benefits of recombinant human pGSN in this population. |
Serological and PCR-based markers of ocular Chlamydia trachomatis transmission in northern Ghana after elimination of trachoma as a public health problem
Senyonjo LG , Debrah O , Martin DL , Asante-Poku A , Migchelsen SJ , Gwyn S , deSouza DK , Solomon AW , Agyemang D , Biritwum-Kwadwo N , Marfo B , Bakajika D , Mensah EO , Aboe A , Koroma J , Addy J , Bailey R . PLoS Negl Trop Dis 2018 12 (12) e0007027 BACKGROUND: Validation of elimination of trachoma as a public health problem is based on clinical indicators, using the WHO simplified grading system. Chlamydia trachomatis (Ct) infection and anti-Ct antibody responses (anti-Pgp3) have both been evaluated as alternative indicators in settings with varying levels of trachoma. There is a need to evaluate the feasibility of using tests for Ct infection and anti-Pgp3 antibodies at scale in a trachoma-endemic country and to establish the added value of the data generated for understanding transmission dynamics in the peri-elimination setting. METHODOLOGY/PRINCIPAL FINDINGS: Dried blood spots for serological testing and ocular swabs for Ct infection testing (taken from children aged 1-9 years) were integrated into the pre-validation trachoma surveys conducted in the Northern and Upper West regions of Ghana in 2015 and 2016. Ct infection was detected using the GeneXpert PCR platform and the presence of anti-Pgp3 antibodies was detected using both the ELISA assay and multiplex bead array (MBA). The overall mean cluster-summarised TF prevalence (the clinical indicator) was 0.8% (95% CI: 0.6-1.0) and Ct infection prevalence was 0.04% (95%CI: 0.00-0.12). Anti-Pgp3 seroprevalence using the ELISA was 5.5% (95% CI: 4.8-6.3) compared to 4.3% (95%CI: 3.7-4.9) using the MBA. There was strong evidence from both assays that seropositivity increased with age (p<0.001), although the seroconversion rate was estimated to be very low (between 1.2 to 1.3 yearly events per 100 children). CONCLUSIONS/SIGNIFICANCE: Infection and serological data provide useful information to aid in understanding Ct transmission dynamics. Elimination of trachoma as a public health problem does not equate to the absence of ocular Ct infection nor cessation in acquisition of anti-Ct antibodies. |
A strategy for PrEP clinicians to manage ambiguous HIV test results during follow-up visits
Smith DK , Switzer WM , Peters P , Delaney KP , Granade TC , Masciotra S , Shouse L , Brooks JT . Open Forum Infect Dis 2018 5 (8) ofy180 Prompt determination of HIV infection status is critical during follow-up visits for patients taking pre-exposure prophylaxis (PrEP) medication. Those who are uninfected can then continue safely taking PrEP, and those few who have acquired HIV infection can initiate an effective treatment regimen. However, a few recent cases have been reported of ambiguous HIV test results using common testing algorithms in PrEP patients. We review published reports of such cases and testing options that can be used to clarify true HIV status in these situations. In addition, we review the benefits and risks of 3 antiretroviral management options in these patients: (1) continue PrEP while conducting additional HIV tests, (2) initiate antiretroviral therapy for presumptive HIV infection while conducting confirmatory tests, or (3) discontinue PrEP to reassess HIV status after a brief antiretroviral-free interval. A clinical consultation resource is also provided. |
National trends and reported risk factors among pregnant women with syphilis in the United States, 2012-2016
Trivedi S , Williams C , Torrone E , Kidd S . Obstet Gynecol 2018 133 (1) 27-32 OBJECTIVE: To describe recent syphilis trends among pregnant women and to evaluate the prevalence of reported high-risk behaviors in this population. METHODS: We analyzed U.S. national case report data for 2012-2016 to assess trends among pregnant women with all stages of syphilis. Risk behavior data collected through case interviews during routine local health department investigation of syphilis cases were used to evaluate the number of pregnant women with syphilis reporting these behaviors. RESULTS: During 2012-2016, the number of syphilis cases among pregnant women increased 61%, from 1,561 to 2,508, and this increase was observed across all races and ethnicities, all women aged 15-45 years, and all U.S. regions. Of 15 queried risk factors, including high-risk sexual behaviors and drug use, 49% of pregnant women with syphilis did not report any in the past year. The most commonly reported risk behaviors were a history of a sexually transmitted disease (43%) and more than one sex partner in the past year (30%). CONCLUSION: Syphilis cases among pregnant women increased from 2012 to 2016, and in half, no traditional behavioral risk factors were reported. Efforts to reduce syphilis among pregnant women should involve increasing health care provider awareness of the Centers for Disease Control and Prevention and the American College of Obstetricians and Gynecologists' recommendations, which include screening all pregnant women for syphilis at the first prenatal visit and rescreening high-risk women during the third trimester and at delivery. Health care providers should also consider local syphilis prevalence in addition to individual reported risk factors when deciding whether to repeat screening. |
Clinical Practice Guidelines by the Infectious Diseases Society of America: 2018 update on diagnosis, treatment, chemoprophylaxis, and institutional outbreak management of seasonal influenza
Uyeki TM , Bernstein HH , Bradley JS , Englund JA , File TMJr , Fry AM , Gravenstein S , Hayden FG , Harper SA , Hirshon JM , Ison MG , Johnston BL , Knight SL , McGeer A , Riley LE , Wolfe CR , Alexander PE , Pavia AT . Clin Infect Dis 2018 68 (6) e1-e47 These clinical practice guidelines are an update of the guidelines published by the Infectious Diseases Society of America (IDSA) in 2009, prior to the 2009 H1N1 influenza pandemic. This document addresses new information regarding diagnostic testing, treatment and chemoprophylaxis with antiviral medications, and issues related to institutional outbreak management for seasonal influenza. It is intended for use by primary care clinicians, obstetricians, emergency medicine providers, hospitalists, laboratorians, and infectious disease specialists, as well as other clinicians managing patients with suspected or laboratory-confirmed influenza. The guidelines consider the care of children and adults, including special populations such as pregnant and postpartum women and immunocompromised patients. |
School and preparedness officials' perspectives on social distancing practices to reduce influenza transmission during a pandemic: Considerations to guide future work
Faherty LJ , Schwartz HL , Ahmed F , Zheteyeva Y , Uzicanin A , Uscher-Pines L . Prev Med Rep 2019 14 100871 The objective of this qualitative study was to explore the perspectives of school and preparedness officials on the feasibility of implementing a range of social distancing practices to reduce influenza transmission during a pandemic. In the summer of 2017, we conducted 36 focus groups by teleconference and webinar lasting 90 min with school and preparedness stakeholders from across the United States. We identified and characterized 11 themes arising from the focus group protocol's domains as well as unanticipated emergent themes. These themes were: the need for effective stakeholder communication, the importance of partnering for buy-in, the role of social distancing in heightening anxiety, ensuring student safety, how practices work in combination, challenges with enforcement, lack of funding for school nurses, differing views about schools' role in protecting public health, the need for education and community engagement to ensure consistent implementation, the need for collaborative decision-making, and tension between standardizing public health guidance and adapting to local contexts. Addressing several crosscutting considerations can increase the likelihood that social distancing practices will be feasible and acceptable to school stakeholders. |
Understanding the full clinical spectrum of childhood diarrhoea in low-income and middle-income countries
Groome MJ , Parashar UD . Lancet Glob Health 2019 7 (5) e534-e535 Diarrhoea remains a leading cause of morbidity and mortality in young children, particularly in low-income and middle-income countries. Although childhood diarrhoea mortality globally declined by nearly 60% from 2000 to 2016, its incidence showed a relatively modest decline of about 13%.1 In addition to their short-term effects, diarrhoea episodes are associated with childhood growth faltering, which predisposes children to further episodes of infectious diseases.2, 3 Improved understanding of the burden, aetiology, and long-term adverse consequences of the full clinical spectrum of childhood diarrhoea is required to optimise treatment, prevention, and control strategies. |
Implementing web-based interventions in HIV primary care clinics: Pilot implementation evaluation of Positive Health Check
Harshbarger C , Burrus O , Zulkiewicz BA , Ortiz AM , Galindo CA , Garner BR , Furberg RD , Lewis MA . JMIR Form Res 2019 3 (2) e10688 BACKGROUND: Web-based interventions can help people living with HIV achieve better clinical outcomes and behaviors, but integrating them into clinical practice remains challenging. There is a gap in understanding the feasibility of implementing these interventions in HIV clinic settings from the clinicians' perspective. OBJECTIVE: The goal of the research was to determine whether Positive Health Check (PHC)-a Web-based, tailored video counseling tool focused on increasing patient adherence and retention in care and reducing HIV risk among HIV-positive patients-was acceptable, appropriate, and feasible for HIV primary care clinic staff to implement in clinic workflows. METHODS: A multiple-case study design was used to evaluate the pilot implementation. Four primary care clinics located in the southeastern United States implemented PHC over a 1-month period. Nine clinic staff across the clinics participated in structured interviews before, during, and after the implementation. In total, 54 interviews were conducted. We used a framework analysis approach to code the data and identify themes related to implementation outcomes, including acceptability, appropriateness, and feasibility. We also analyzed patient intervention use metrics (n=104) to quantify patient intervention completion rates (n=68). RESULTS: Overall, clinicians viewed PHC as acceptable and appropriate. Themes that emerged related to these implementation outcomes include the ability for PHC to increase provider-patient communication and its ability to engage patients due to the tailored and interactive design. While generally feasible to implement, challenges to the clinic workflow and physical environment were areas that clinics needed to manage to make PHC work in their clinics. CONCLUSIONS: Findings from this pilot implementation suggest that clinical staff viewed PHC as acceptable and appropriate, especially as more patients used the intervention over the pilot period. Feasibility of implementation was challenging in some cases, and lessons learned from this pilot implementation can provide information for larger scale tests of the intervention that include assessment of both implementation outcomes and clinical outcomes. |
Evaluation of the impact of antimicrobial hand towels on hand contamination with Escherichia coli among mothers in Kisumu County, Kenya, 2011-2012
Kim S , Brown AC , Murphy J , Oremo J , Owuor M , Ouda R , Person B , Quick R . Water Res 2019 157 564-571 Poor hand hygiene contributes to diarrhea in developing countries. Handwashing with soap reduces diarrhea risk, but drying hands on contaminated towels can compromise the benefits of handwashing. In response to the challenge of keeping hands clean, an antimicrobial hand towel was developed and shown to be promising in the laboratory, but has not been adequately tested in the field. We evaluated the effectiveness of an antimicrobial towel in two randomized, double-blinded crossover trials among mothers with children<5 years old in 125 households in western Kenya. In trial 1, we randomly assigned mothers to use either the treated towel or an identical untreated (placebo) towel and made surprise home visits at random times once a week for three weeks. At each visit, we tested hands for Escherichia coli using sterile hand rinses, then switched towel types in the two groups and repeated three weekly rounds of E. coli testing. In crossover trial 2, we compared E. coli contamination of maternal hands immediately following three different handwashing/drying procedures: soap and water + treated towel, water only + treated towel, and soap and water + air dry. There was no statistically significant difference in the level of E. coli contamination on maternal hands by type of towel used during trial 1 (odds ratio for treated vs untreated towel: 1.14, 95% confidence interval 0.83-1.56). In trial 2, there were no significant differences in E. coli contamination of maternal hands by handwashing/drying procedure. In these trials, use of antimicrobial hand towels did not prevent E. coli contamination of mothers' hands in Kenyan households during random testing and offered no advantages over standard handwashing and drying practices. Handwashing with soap and clean water and drying with clean towels are recommended. |
Epidemiology of norovirus outbreaks reported to the Public Health Emergency Event Surveillance System, China, 2014(-)2017
Lian Y , Wu S , Luo L , Lv B , Liao Q , Li Z , Rainey JJ , Hall AJ , Ran L . Viruses 2019 11 (4) We conducted a retrospective analysis of norovirus outbreaks reported to the National Public Health Emergency Event Surveillance System (PHEESS) in China from January 1, 2014 to December 31, 2017. We reviewed all acute gastroenteritis outbreaks (n = 692) submitted to PHEESS to identify the frequency, seasonality, geographic distribution, setting, and transmission mode of outbreaks due to norovirus. A total of 616 norovirus outbreaks resulting in 30,848 cases were reported. Among these outbreaks, 571 (93%) occurred in school settings including 239 (39%) in primary schools, 136 (22%) in childcare facilities, and 121 (20%) in secondary schools. The majority of outbreaks (63%) were due to person-to-person transmission, followed by multiple modes of transmission (11%), foodborne (5%) and waterborne (3%) transmission. These findings highlight the importance of improving hand hygiene and environmental disinfection in high-risk settings. Developing a standard and quantitative outbreak reporting structure could improve the usefulness of PHEESS for monitoring norovirus outbreaks. |
Notes from the field: Six cases of acute flaccid myelitis in children - Minnesota, 2018
Moline H , Kalaskar A , Pomputius WF 3rd , Lopez A , Routh J , Kenyon C , Griffith J . MMWR Morb Mortal Wkly Rep 2019 68 (15) 356-358 During September 14–October 1, 2018, the Minnesota Department of Health (MDH) was notified of six children hospitalized in the Minneapolis-St. Paul region with symptoms consistent with acute flaccid myelitis (AFM). A confirmed case of AFM is defined as acute onset of flaccid limb weakness with magnetic resonance image indicating spinal cord lesions largely restricted to gray matter and spanning one or more vertebral segments (1). All six cases were confirmed by CDC. After a cluster of three cases occurred in 2014, an average of fewer than one AFM case per year had been reported to MDH. |
Impact of abstinence and of reducing illicit drug use without abstinence on HIV viral load
Nance RM , Trejo MEP , Whitney BM , Delaney JAC , Altice F , Beckwith CG , Chander G , Chandler R , Christopoulous K , Cunningham C , Cunningham WE , Del Rio C , Donovan D , Eron JJ , Fredericksen RJ , Kahana S , Kitahata MM , Kronmal R , Kuo I , Kurth A , Mathews WC , Mayer KH , Moore RD , Mugavero MJ , Ouellet LJ , Quan VM , Saag MS , Simoni JM , Springer S , Strand L , Taxman F , Young JD , Crane HM . Clin Infect Dis 2019 70 (5) 867-874 BACKGROUND: Substance use is common among people living with HIV (PLWH) and a barrier to achieving viral suppression. OBJECTIVE: Among PLWH who report illicit drug use, we evaluated associations between HIV viral load (VL) and reduced use of illicit opioids, methamphetamine/crystal, cocaine/crack, and marijuana, regardless of whether or not abstinence was achieved. DESIGN: Longitudinal cohort studySetting/participantsPLWH in clinical care at 8 HIV clinics or 5 clinical studies. MEASUREMENTS: We used joint longitudinal and survival models to examine the impact of decreasing drug use and of abstinence for each drug on viral suppression. We repeated analyses using linear mixed models to examine associations between change in frequency of drug use and VL. RESULTS: The number of PLWH who were using each drug at baseline ranged from n=568 (illicit opioids) to n=4272 (marijuana). Abstinence was associated with higher odds of viral suppression (OR 1.4-2.2) and lower relative VL (ranging from 21-42% by drug) for all four drug categories. Reducing frequency of illicit opioid or methamphetamine/crystal use without abstinence was associated with VL suppression (OR 2.2, 1.6 respectively). Reducing frequency of illicit opioid or methamphetamine/crystal use without abstinence was associated with lower relative VL (47%, 38% respectively). LIMITATIONS: Observational data have limitations with causal inference. CONCLUSIONS: Abstinence was associated with viral suppression. In addition, reducing use of illicit opioids or methamphetamine/crystal, even without abstinence, was also associated with viral suppression. Findings highlight the impact of reducing substance use even when abstinence is not achieved and the potential benefits of medications, behavioral interventions, and harm-reduction interventions. |
Rates of new HIV diagnoses after reported STI, women in Louisiana 2000-2015: Implications for HIV prevention
Newman DR , Rahman MM , Brantley A , Peterman TA . Clin Infect Dis 2019 70 (6) 1115-1120 BACKGROUND: Interventions to prevent HIV in women include screening, partner notification, promoting condoms, and pre-exposure prophylaxis (PrEP). Identifying a woman's risk of acquiring HIV can help guide intervention recommendations. METHODS: We used data from Louisiana's STI and HIV registries to study 13- to 59-year-old women following their first diagnosis of syphilis, (or if none) gonorrhea, or (if none) chlamydia during 2000-2015. We measured rates of HIV reported subsequent to their STI (through 2016). Rates for women without STI were estimated by subtracting women with STI from reported cases and from Census estimates for the population. PrEP cost was estimated as $11,000 per year, and effectiveness was estimated as 100%. RESULTS: First STI were: syphilis (6,574), gonorrhea (64,995), or chlamydia (140,034). These 211,603 women had 1,865,488 person-years of follow-up and 969 HIV diagnoses. Women with no STI had 5,186 HIV diagnoses over 24,359,397 person-years. Rates of HIV diagnosis (per 100,000 person-years) were higher for women after syphilis (177.3), gonorrhea (73.2), or chlamydia (35.4) compared to women with no STI (22.4). Providing PrEP to all women diagnosed with syphilis or gonorrhea would cost $7,371,111,000 and could have prevented 546 HIV diagnoses. Limiting PrEP to one year after syphilis or gonorrhea diagnosis would cost $963,847,334 but only 143 HIV diagnoses were within 2 years after a syphilis or gonorrhea diagnosis. CONCLUSIONS: Rates of HIV diagnosis were high after women had STI, but not high enough to make PrEP cost-effective for them. Most women diagnosed with HIV did not have previously reported STI. |
Estimation of the population size of men who have sex with men in Vietnam: Social app multiplier method
Son VH , Safarnejad A , Nga NT , Linh VM , Tu LTC , Manh PD , Long NH , Abdul-Quader A . JMIR Public Health Surveill 2019 5 (2) e12451 BACKGROUND: Although the prevalence of HIV among men who have sex with men (MSM) in Vietnam has been increasing in recent years, there are no estimates of the population size of MSM based on tested empirical methods. OBJECTIVE: This study aimed to estimate the size of the MSM population in 12 provinces in Vietnam and extrapolate from those areas to generate a national population estimate of MSM. A secondary aim of this study was to compare the feasibility of obtaining the number of users of a mobile social (chat and dating) app for MSM using 3 different approaches. METHODS: This study used the social app multiplier method to estimate the size of MSM populations in 12 provinces using the count of users on a social app popular with MSM in Vietnam as the first data source and a questionnaire propagated through the MSM community using respondent-driven sampling as the second data source. A national estimation of the MSM population is extrapolated from the results in the study provinces, and the percentage of MSM reachable through online social networks is clarified. RESULTS: The highest MSM population size among the 12 provinces is estimated in Hanoi and the lowest is estimated in Binh Dinh. On average, 37% of MSM in the provinces surveyed had used the social app Jack'd in the last 30 days (95% CI 27-48). Extrapolation of the results from the study provinces with reliable estimations results in an estimated national population of 178,000 MSM (95% CI 122,000-512,000) aged 15 to 49 years in Vietnam. The percentage of MSM among adult males aged 15 to 49 years in Vietnam is 0.68% (95% CI 0.46-1.95). CONCLUSIONS: This study is the first attempt to empirically estimate the population of MSM in Vietnam and highlights the feasibility of reaching a large proportion of MSM through a social app. The estimation reported in this study is within the bounds suggested by the Joint United Nations Programme on HIV/AIDS. This study provides valuable information on MSM population sizes in provinces where reliable estimates were obtained, which they can begin to work with in program planning and resource allocation. |
Predictors of receipt of school services in a national sample of youth with ADHD
DuPaul GJ , Chronis-Tuscano A , Danielson ML , Visser SN . J Atten Disord 2018 23 (11) 1303-1319 OBJECTIVE: The objective of the study is to describe the extent to which students with ADHD received school-based intervention services and identify demographic, diagnostic, and impairment-related variables that are associated with service receipt in a large, nationally drawn sample. METHOD: Parent-reported data were obtained for 2,495 children with ADHD aged 4 to 17 years from the National Survey of the Diagnosis and Treatment of ADHD and Tourette Syndrome (NS-DATA). RESULTS: The majority (69.3%) of students with ADHD currently receive one or more school services. Educational support (62.3%) was nearly twice as prevalent as classroom behavior management (32.0%). More than 3 times as many students with ADHD had an individualized education program (IEP; 42.9%) as a Section 504 plan (13.6%). CONCLUSION: At least one in five students with ADHD do not receive school services despite experiencing significant academic and social impairment, a gap that is particularly evident for adolescents and youth from non-English-speaking and/or lower income families. |
Clustering of necropsy-confirmed porcine cysticercosis surrounding Taenia solium tapeworm carriers in Peru
Lescano AG , Pray IW , Gonzalez AE , Gilman RH , Tsang VCW , Gamboa R , Guezala MC , Aybar V , Rodriguez S , Moulton LH , Leontsini E , Gonzalvez G , O'Neal SE , Garcia HH . Am J Trop Med Hyg 2018 100 (2) 314-322 The pork tapeworm, Taenia solium, is among the leading causes of preventable epilepsy in the world and is common in rural areas of developing countries where sanitation is limited and pigs have access to human feces. Prior studies in rural villages of Peru have observed clusters of T. solium cysticercosis among pigs that live near human tapeworm carriers. Such spatial analyses, however, have been limited by incomplete participation and substandard diagnostic tests. In this study, we evaluated the association between necropsy-confirmed cysticercosis in pigs and their distance to T. solium tapeworm carriers in six villages in northern Peru. A total of six (1.4%) tapeworm carriers were detected using enzyme-linked immunosorbent assay-coproantigen assay, and seven of 10 (70%) pigs belonging to the tapeworm carriers were found with viable cyst infection on necropsy. This was significantly greater than the prevalence of viable cyst infection among pigs living < 500 m (11%) and > 500 m (0.5%) from a tapeworm carrier (P < 0.001 for distance trend). Similar statistically significant prevalence gradients were observed after adjustment for possible confounders and for other pig-level outcomes including infection with > 10 viable cysts, degenerated cyst infection, and serological outcomes. This investigation confirms that porcine cysticercosis clusters strongly around tapeworm carriers in endemic rural regions of northern Peru and supports interventions that target these hot spots. |
Downregulation of female doublesex expression by oral-mediated RNA interference reduces number and fitness of Anopheles gambiae adult females
Taracena ML , Hunt CM , Benedict MQ , Pennington PM , Dotson EM . Parasit Vectors 2019 12 (1) 170 BACKGROUND: Mosquito-borne diseases affect millions worldwide, with malaria alone killing over 400 thousand people per year and affecting hundreds of millions. To date, the best strategy to prevent the disease remains insecticide-based mosquito control. However, insecticide resistance as well as economic and social factors reduce the effectiveness of the current methodologies. Alternative control technologies are in development, including genetic control such as the sterile insect technique (SIT). The SIT is a pivotal tool in integrated agricultural pest management and could be used to improve malaria vector control. To apply the SIT and most other newer technologies against disease transmitting mosquitoes, it is essential that releases are composed of males with minimal female contamination. The removal of females is an essential requirement because released females can themselves contribute towards nuisance biting and disease transmission. Thus, females need to be eliminated from the cohorts prior to release. Manual separation of Anopheles gambiae pupae or adult mosquitoes based on morphology is time consuming, is not feasible on a large scale and has limited the implementation of the SIT technique. The doublesex (dsx) gene is one of the effector switches of sex determination in the process of sex differentiation in insects. Both males and females have specific splicing variants that are expressed across the different life stages. Using RNA interference (RNAi) to reduce expression of the female specific (dsxF) variant of this gene has proven to have detrimental effects to the females in other mosquito species, such as Aedes aegypti. We tested oral RNAi on dsx (AgdsxF) in An. gambiae. METHODS: We studied the expression pattern of the dsx gene in the An. gambiae G3 strain. We knocked down AgdsxF expression in larvae through oral delivery of double stranded RNA (dsRNA) produced by bacteria and observed its effects in adults. RESULTS: Our results show that feeding of AgdsxF dsRNA can effectively reduce (> 66%) the mRNA of female dsx transcript and that there is a concomitant reduction in the number of female larvae that achieve adulthood. Control groups produced 52% (+/- 3.9% SE) of adult males and 48% (+/- 4.0% SE) females, while AgdsxF dsRNA treated groups had 72.1% (+/- 4.0% SE) males vs 27.8% females (+/- 3.3% SE). In addition, the female adults produce fewer progeny, 37.1% (+/- 8.2% SE) less than the controls. The knockdown was sex-specific and had no impact on total numbers of viable male adults, in the male dsx transcripts or male fitness parameters such as longevity or body size. CONCLUSIONS: These findings indicate that RNAi could be used to improve novel mosquito control strategies that require efficient sex separation and male-only release of An. gambiae by targeting sex determination genes such as AgdsxF. The advantages of using RNAi in a controlled setting for mosquito rearing are numerous, as the dose and time of exposure are controlled, and the possibility of off-target effects and the waste of female production would be significantly reduced. |
Africa Centres for Disease Control and Prevention's framework for antimicrobial resistance control in Africa
Varma JK , Oppong-Otoo J , Ondoa P , Perovic O , Park BJ , Laxminarayan R , Peeling RW , Schultsz C , Li H , Ihekweazu C , Sall AA , Jaw B , Nkengasong JN . Afr J Lab Med 2018 7 (2) 830 Antimicrobial resistant (AMR) organisms are increasing globally, threatening to render existing treatments ineffective against many infectious diseases.1,2 AMR strains of bacteria, fungi, parasites, and viruses prolong illness, increase case fatality, facilitate transmission, and increase treatment costs.3,4 In Africa where many health systems are weak, the likelihood of AMR increasing and the consequences of AMR infections are particularly high, and drug resistance has already been documented for HIV and the pathogens that cause malaria, tuberculosis, typhoid, cholera, meningitis, gonorrhoea, and dysentery.5 Patients in these countries have limited access to accurate diagnosis and adequate antimicrobial treatment, which can lead to sepsis and other life-threatening complications.6,7 |
Emergency response training in California: Piloting the environmental health training in emergency response operations course in a local environmental health department
Barnett M , Zaidel B , Kalis MA . J Environ Health 2018 81 (5) 36-37 In fall 2017, San Diego County, with assistance from the California Department of Public Health, presented three sessions of the Environmental Health Training in Emergency Response Operations (EHTER Ops) course in a novel 2-day version. Until then, EHTER Ops had been offered exclusively at the Federal Emergency Management Agency's Center for Domestic Preparedness in Anniston, Alabama, as a 4-day resident course. EHTER Ops is a course that prepares participants to assess disaster-related environmental health conditions and perform tasks in a hands-on and field team focused approach. The course emphasizes the use of field equipment and instrumentation, including personal protective equipment (PPE), under disaster conditions. EHTER Ops is a companion to the EHTER Awareness Level course. This month's column describes the pilot training and provides future directions for the training. |
Lead exposure during childhood and subsequent anthropometry through adolescence in girls
Deierlein AL , Teitelbaum SL , Windham GC , Pinney SM , Galvez MP , Caldwell KL , Jarrett JM , Gajek R , Kushi LH , Biro F , Wolff MS . Environ Int 2018 122 310-315 INTRODUCTION: Cross-sectional studies suggest that postnatal blood lead (PbB) concentrations are negatively associated with child growth. Few studies prospectively examined this association in populations with lower PbB concentrations. We investigated longitudinal associations of childhood PbB concentrations and subsequent anthropometric measurements in a multi-ethnic cohort of girls. METHODS: Data were from The Breast Cancer and the Environment Research Program at three sites in the United States (U.S.): New York City, Cincinnati, and San Francisco Bay Area. Girls were enrolled at ages 6-8years in 2004-2007. Girls with PbB concentrations collected at </=10years old (mean 7.8years, standard deviation (SD) 0.82) and anthropometry collected at >/=3 follow-up visits were included (n=683). The median PbB concentration was 0.99mug/d (10th percentile=0.59mug/dL and 90th percentile=2.00mug/dL) and the geometric mean was 1.03mug/dL (95% Confidence Interval (CI): 0.99, 1.06). For analyses, PbB concentrations were dichotomized as <1mug/dL (n=342) and >/=1mug/dL (n=341). Anthropometric measurements of height, body mass index (BMI), waist circumference (WC), and percent body fat (%BF) were collected at enrollment and follow-up visits through 2015. Linear mixed effects regression estimated how PbB concentrations related to changes in girls' measurements from ages 7-14years. RESULTS: At 7years, mean difference in height was -2.0cm (95% CI: -3.0, -1.0) for girls with >/=1mug/dL versus <1mug/dL PbB concentrations; differences persisted, but were attenuated, with age to -1.5cm (95% CI: -2.5, -0.4) at 14years. Mean differences for BMI, WC, and BF% at 7years between girls with >/=1mug/dL versus <1mug/dL PbB concentrations were -0.7kg/m(2) (95% CI: -1.2, -0.2), -2.2cm (95% CI: -3.8, -0.6), and -1.8% (95% CI: -3.2, -0.4), respectively. Overall, these differences generally persisted with advancing age and at 14years, differences were -0.8kg/m(2) (95% CI: -1.5, -0.02), -2.9cm (95% CI: -4.8, -0.9), and -1.7% (95% CI: -3.1, -0.4) for BMI, WC, and BF%, respectively. CONCLUSIONS: These findings suggest that higher concentrations of PbB during childhood, even though relatively low by screening standards, may be inversely associated with anthropometric measurements in girls. |
Water quality, availability, and acute gastroenteritis on the Navajo Nation - a pilot case-control study
Grytdal SP , Weatherholtz R , Esposito DH , Campbell J , Reid R , Gregoricus N , Schneeberger C , Lusk TS , Xiao L , Garrett N , Bopp C , Hammitt LL , Vinje J , Hill VR , O'Brien KL , Hall AJ . J Water Health 2018 16 (6) 1018-1028 The Navajo Nation includes approximately 250,000 American Indians living in a remote high desert environment with limited access to public water systems. We conducted a pilot case-control study to assess associations between acute gastroenteritis (AGE) and water availability, use patterns, and quality. Case patients with AGE and non-AGE controls who presented for care to two Indian Health Service hospitals were recruited. Data on demographics and water use practices were collected using a standard questionnaire. Household drinking water was tested for presence of pathogens, coliforms, and residual chlorine. Sixty-one subjects (32 cases and 29 controls) participated in the study. Cases and controls were not significantly different with respect to water sources, quality, or patterns of use. Twenty-one percent (n = 12) of study participants resided in dwellings not connected to a community water system. Eleven percent (n = 7) of subjects reported drinking hauled water from unregulated sources. Coliform bacteria were present in 44% (n = 27) of household water samples, and 68% (n = 40) of samples contained residual chlorine concentrations of <0.2 mg/L. This study highlights issues with water availability, quality, and use patterns within the Navajo Nation, including sub-optimal access to community water systems, and use of water hauled from unregulated sources. |
Correlation and temporal variability of urinary biomarkers of chemicals among couples: Implications for reproductive epidemiological studies
Nassan FL , Williams PL , Gaskins AJ , Braun JM , Ford JB , Calafat AM , Hauser R . Environ Int 2018 123 181-188 BACKGROUND: Exposure to some environmental chemicals is ubiquitous and linked to a variety of adverse outcomes, including children's health. While few studies have assessed the contribution of both male and female exposures to children's health, understanding the patterns of couple's exposure is needed to understand their joint effects. OBJECTIVE: We assessed the correlation patterns between male and female partners' concentrations of 37 environmental chemical biomarkers. We also assessed the temporal reliability of the biomarkers within couples. METHODS: We calculated Spearman pairwise correlations between specific gravity adjusted urinary biomarker concentrations and hair mercury concentrations among 380 couples enrolled in the Environment and Reproductive Health (EARTH) study at the Massachusetts General Hospital Fertility Center (2004-2017). We calculated intra-class correlation coefficients (ICCs) for couple's biomarkers to assess the temporal variability of these exposures within a couple using multiple paired-samples from couples. RESULTS: All biomarkers were positively correlated within couples (range: 0.05 for tert-butylphenyl phenyl phosphate to 0.66 for triclosan). In general, the biomarkers with the highest within couple correlation were those of chemicals for which diet (e.g., di(2-ethylhexyl) phthalate), personal care products use (e.g., triclosan, benzophenone-3), and the indoor environment (e.g., 2,5-dichlorophenol) are considered primary exposure sources. Most other biomarkers were moderately correlated (0.3-<0.6). Similar patterns of temporal reliability were observed across biomarkers. CONCLUSIONS: Urinary concentrations of several biomarkers were mostly moderately correlated within couples, suggesting similar exposure sources. Future epidemiological studies should collect samples from both partners to be able to accurately determine the contribution of maternal and paternal exposures to offspring health. |
Exposure to di-2-ethylhexyl terephthalate in the U.S. general population from the 2015-2016 National Health and Nutrition Examination Survey
Silva MJ , Wong LY , Samandar E , Preau JLJr , Jia LT , Calafat AM . Environ Int 2018 123 141-147 BACKGROUND: Di-2-ethylhexyl terephthalate (DEHTP) is used as a replacement plasticizer for other phthalates, including di-2-ethylhexyl phthalate (DEHP). Use of consumer products containing DEHTP may result in human exposure to DEHTP. OBJECTIVE: To assess exposure to DEHTP in a nationally representative sample of the U.S. general population 3years and older from the 2015-2016 National Health and Nutrition Examination Survey (NHANES). METHOD: We quantified two DEHTP metabolites, mono-2-ethyl-5-hydroxyhexyl terephthalate (MEHHTP) and mono-2-ethyl-5-carboxypentyl terephthalate (MECPTP) in 2970 urine samples by using online solid-phase extraction coupled with isotope dilution-high-performance liquid chromatography-tandem mass spectrometry. We used linear regression to examine associations between MEHHTP and MECTPP and several parameters including age, sex, race/ethnicity, and household income. We also compared the MEHHTP and MECPTP results to those of their corresponding DEHP metabolite analogs, namely mono-2-ethyl-5-hydroxyhexyl phthalate (MEHHP) and mono-2-ethyl-5-carboxypentyl phthalate (MECPP). RESULTS: The weighted detection frequencies were 96% (MEHHTP) and 99.9% (MECPTP); urinary concentrations of the two metabolites correlated significantly (Pearson correlation coefficient=0.89, p<0.0001). MECPTP concentrations were higher than MEHHTP in all age, sex, race/ethnicity groups examined. Furthermore, MECPTP adjusted geometric mean (GM) concentrations were significantly higher in samples collected in the evening than in the morning or afternoon. Females had significantly higher adjusted GM concentrations of MEHHTP and MECPTP than males. We observed no significant associations between the adjusted GM concentrations of the metabolites and race/ethnicity. Both metabolite adjusted GM concentrations increased significantly with household income, and decreased significantly with age. Only household income was significantly associated with the concentrations of MECPP, but not of MEHHP, the two DEHP metabolites. The adjusted GM of the [MEHHTP]:[MECPTP] molar concentrations ratio increased with age, and was significantly higher in samples collected in the morning than in those collected in the afternoon or evening. CONCLUSIONS: Exposure to DEHTP is widespread in the U.S. general population 3years and older. These data represent the first U.S. population-based representative background exposure to DEHTP. |
Exposure to polybrominated diphenyl ethers (PBDEs) during childhood and adiposity measures at age 8years
Vuong AM , Braun JM , Wang Z , Yolton K , Xie C , Sjodin A , Webster GM , Lanphear BP , Chen A . Environ Int 2018 123 148-155 BACKGROUND: Animal studies suggest polybrominated diphenyl ethers (PBDEs) may be obesogens. However, epidemiologic studies investigating childhood exposure to PBDEs and adiposity are limited, with several reporting an inverse association. OBJECTIVES: To investigate associations between repeated childhood PBDE concentrations and adiposity measures at age 8years. METHODS: We examined 206 children from the Health Outcomes and Measures of the Environment Study, a birth cohort in Cincinnati, OH (2003-2006). Serum PBDEs were measured at ages 1, 2, 3, 5, and 8years. We used multiple imputation to estimate missing PBDE concentrations. At 8years, we measured weight, height, waist circumference, and body fat percentage. We used multiple informant models to estimate age-specific associations between PBDEs and adiposity measures. RESULTS: We observed significant inverse associations between BDE-153 with all adiposity measures that became increasingly stronger with later childhood measurements. A 10-fold increase in BDE-153 at ages 1 and 8years was associated with 2% (95% CI -3.9, -0.1) and 7% (95% CI -9.1, -4.7) lower body fat, respectively. No statistically significant associations were found with BDE-28, -47, -99, or -100. Child sex modified some associations; inverse associations between BDE-153 and body fat were stronger among boys, while positive and null associations were noted among girls. CONCLUSIONS: Childhood BDE-153 concentrations were inversely associated with adiposity measures and these associations became stronger as BDE-153 measurements were more proximal to adiposity measures. Inverse associations could be attributed to reverse causality arising from greater storage of PBDEs in adipose tissue of children with higher adiposity. |
Urinary concentrations of monohydroxylated polycyclic aromatic hydrocarbons in adults from the U.S. Population Assessment of Tobacco and Health (PATH) Study Wave 1 (2013-2014)
Wang Y , Wong LY , Meng L , Pittman EN , Trinidad DA , Hubbard KL , Etheredge A , Del Valle-Pinero AY , Zamoiski R , van Bemmel DM , Borek N , Patel V , Kimmel HL , Conway KP , Lawrence C , Edwards KC , Hyland A , Goniewicz ML , Hatsukami D , Hecht SS , Calafat AM . Environ Int 2018 123 201-208 BACKGROUND: Polycyclic aromatic hydrocarbons (PAHs) are environmental pollutants formed from incomplete combustion of organic matter; some PAHs are carcinogens. Smoking, diet, and other activities contribute to exposure to PAHs. Exposure data to PAHs among combustible tobacco product users (e.g. cigarette smokers) exist; however, among non-combustible tobacco products users (e.g., e-cigarette users), such data are rather limited. OBJECTIVES: We sought to evaluate exposure to PAHs among participants in Wave 1 (2013-2014) of the Population Assessment of Tobacco and Health (PATH) Study based on the type of tobacco product (combustible vs non-combustible), and frequency and intensity of product use. METHODS: We quantified seven PAH urinary biomarkers in 11,519 PATH Study participants. From self-reported information, we categorized 8327 participants based on their use of tobacco products as never-tobacco user (never user, n=1700), exclusive current established combustible products user (combustible products user, n=5767), and exclusive current established non-combustible products user (non-combustible products user, n=860). We further classified tobacco users as exclusive cigarette user (cigarette user, n=3964), exclusive smokeless product user (SLT user, n=509), and exclusive e-cigarette user (e-cigarette user, n=280). Last, we categorized frequency of product use (everyday vs some days) and time since use (last hour, within 3days, over 3days). We calculated geometric mean (GM) concentrations, and evaluated associations between tobacco product user categories and PAH biomarkers concentrations. RESULTS: Combustible products users had significantly higher GMs of all biomarkers than non-combustible products users and never users; non-combustible products users had significantly higher GMs than never users for four of seven biomarkers. For all biomarkers examined, cigarette users had the highest GMs compared to other tobacco-product users. Interestingly, GMs of 2-hydroxyfluorene, 3-hydroxyfluorene and summation operator2,3-hydroxyphenanthrene were significantly higher in SLT users than in e-cigarette users; 3-hydroxyfluorene and 1-hydroxypyrene were also significantly higher in e-cigarette and SLT users than in never users. Everyday cigarette and SLT users had significantly higher GMs for most biomarkers than some days' users; cigarette and SLT users who used the product in the last hour had significantly higher GMs of most biomarkers than other occasional cigarette or SLT users respectively. By contrast, everyday e-cigarette users' GMs of most biomarkers did not differ significantly from those in some days' e-cigarette users; we did not observe clear trends by time of last use among e-cigarette users. CONCLUSIONS: Users of tobacco products had higher PAH urinary biomarker concentrations compared to never users, and concentrations differed by type and frequency of tobacco product use. |
Environmental health indicators for China: Data resources for Chinese environmental public health tracking
Ban J , Du Z , Wang Q , Ma R , Zhou Y , Li T . Environ Health Perspect 2019 127 (4) 44501 Many developed countries use environmental public health tracking to gain a better understanding of the link between environmental hazards and public health. To respond to complicated environmental health issues, the National Institute of Environmental Health (NIEH), Chinese Center for Disease Control and Prevention (China CDC), has begun to build a Chinese Environmental Public Health Tracking (CEPHT) system. On behalf of the CEPHT, authors provide insight into the CEPHT's development, current status, and future plans. In the initial stage of CEPHT, an indicator framework linking environment and public health that included a list of publicly available data sources regarding environmental hazards, public health outcomes, and risk factors in China was developed. An analysis of data availability, along with a comparison between CEPHT's indicator system and other tracking networks, revealed the existence of barriers and gaps in data integration that affect China's ability to track environmental public health. The lack of access to data, combined with inadequate data quality, has led to difficulties linking environmental hazards to their effects on public health. Current CEPHT efforts will help integrate environmental factors and exposure data with public health outcomes. For the near future, CEPHT plans to focus on increasing collaboration among data tracking agencies, improving data quality, and expanding proper data sharing. https://doi.org/10.1289/EHP4319. |
Facilitators and barriers to conducting environmental assessments for food environmental assessments for Food Environmental Assessment Reporting System, 2014-2016
Freeland AL , Masters M , Nicholas D , Kramer A , Brown LG . J Environ Health 2019 81 (8) 24-28 Environmental health specialists often perform environmental assessments (EAs) when a suspected or confirmed foodborne illness outbreak is linked to a food establishment. Information from EAs helps officials determine the cause of the outbreak and develop strategies to prevent future outbreaks; however, EAs are not always conducted. To determine facilitators and barriers to conducting EAs, we analyzed openended responses reported to the National Environmental Assessment Reporting System about these assessments. We found that EAs were conducted most often when illness was identified, a jurisdiction had a policy to investigate illnesses, and there were resources for such a response. EAs were not conducted in instances such as limited resources, insufficient training, uncooperative facility personnel, or if the establishment fell outside of health department jurisdiction. Identifying the facilitators and barriers to conducting EAs can enable health departments to develop strategies that improve their ability to conduct EAs. |
Exposure to contaminants among private well users in north Carolina: Enhancing the role of public health
Jackson CLP , Zarate-Bermudez M . J Environ Health 2019 81 (8) 36-38 North Carolina has the second highest number of residents who rely on private wells for their drinking water supply. Studies report that about 3.3 million North Carolina residents (35% of the population) use private wells, with the highest county having 85.4% of the residents using private wells. Unlike public water systems that benefit from the regulatory safeguards of the Safe Drinking Water Act, there are no federal regulations for private wells in the U.S. Testing, treating, maintaining, and managing private wells are up to well owners, often with little to no technical or financial support. | | In 2015, the Private Well and Health Program (PWHP) of the North Carolina Department of Health and Human Services received funding from the Centers for Disease Control and Prevention's Safe Water for Community Health (Safe WATCH) Program to enhance services to private well users. PWHP was understaffed, had limited access to water quality data, and lacked established partnerships, which prevented it from enhancing services for private well users to better protect their health. | | This month's column highlights how PWHP used the funding to address vulnerabilities in its private wells and water quality, as well as initiatives to close the gaps in ensuring safe drinking water for its residents. |
Exploring the science, safety, and benefits of air care products: perspectives from the inaugural air care summit
Johnson MB , Kingston R , Utell MJ , Wells JR , Singal M , Troy WR , Horenziak S , Dalton P , Ahmed FK , Herz RS , Osimitz TG , Prawer S , Yin S . Inhal Toxicol 2019 31 (1) 1-13 Seventy-one percent of US households purchase air care products. Air care products span a diverse range of forms, including scented aerosol sprays, pump sprays, diffusers, gels, candles, and plug-ins. These products are used to eliminate indoor malodors and to provide pleasant scent experiences. The use of air care products can lead to significant benefits as studies have shown that indoor malodor can cause adverse effects, negatively impacting quality of life, hygiene, and the monetary value of homes and cars, while disproportionately affecting lower income populations. Additionally, studies have also shown that scent can have positive benefits related to mood, stress reduction, and memory enhancement among others. Despite the positive benefits associated with air care products, negative consumer perceptions regarding the safety of air care products can be a barrier to their use. During the inaugural Air Care Summit, held on 18 May 2018 in the Washington, DC, metropolitan area, multidisciplinary experts including industry stakeholders, academics, and scientific and medical experts were invited to share and assess the existing data related to air care products, focusing on ingredient and product safety and the benefits of malodor removal and scent. At the Summit's completion, a panel of independent experts representing the fields of pulmonary medicine, medical and clinical toxicology, pediatric toxicology, basic science toxicology, occupational dermatology and experimental psychology convened to review the data presented, identify potential knowledge gaps, and suggest future research directions to further assess the safety and benefits of air care products. |
Maternal serum concentrations of perfluoroalkyl substances and birth size in British boys
Marks KJ , Cutler AJ , Jeddy Z , Northstone K , Kato K , Hartman TJ . Int J Hyg Environ Health 2019 222 (5) 889-895 Per- and polyfluoroalkyl substances (PFAS) have been widely used in commercial and industrial manufacturing processes since the 1950s. Inverse associations between prenatal exposure to PFAS and birth size have been found in populations around the globe. This study examined the association of prenatal maternal serum concentrations of perfluorooctane sulfonic acid (PFOS), perfluorooctanoic acid (PFOA), perfluorohexane sulfonic acid (PFHxS), and perfluorononanoic acid (PFNA) and birth size in British boys. The study included 457 mother-son dyads participating in the Avon Longitudinal Study of Parents and Children (ALSPAC). Birth weight (g), crown to heel length (cm), and head circumference (cm) were collected at delivery. PFAS were detected in all maternal serum samples during pregnancy (median: 30 weeks gestation (interquartile range: 12-33)). Median concentrations (interquartile range) were 13.8ng/mL (11.0, 17.7), 3.0ng/mL (2.3, 3.8), 1.9ng/mL (1.4, 2.5), and 0.4ng/mL (0.3, 0.5) for PFOS, PFOA, PFHxS, and PFNA, respectively. In multivariable linear regression models, inverse associations were detected between PFOS (continuous) and birth weight (beta=-8.50g, 95% CI=-15.93, -1.07g), crown to heel length (beta=-0.04cm, 95% CI=-0.08, -0.01cm), and head circumference (beta=-0.02cm, 95% CI=-0.04, -0.002cm). In conclusion, prenatal exposure to high levels of PFOS may be associated with reduced birth size in male infants. |
Blood lead levels among resettled refugee children in select US states, 2010-2014
Pezzi C , Lee D , Kennedy L , Aguirre J , Titus M , Ford R , Cochran J , Smock L , Mamo B , Urban K , Morillo J , Hughes S , Payton C , Scott K , Montour J , Matheson J , Brown MJ , Mitchell T . Pediatrics 2019 143 (5) BACKGROUND: Elevated blood lead levels (EBLLs; >/=5 microg/dL) are more prevalent among refugee children resettled in the United States than the general US population and contribute to permanent health and neurodevelopmental problems. The Centers for Disease Control and Prevention recommends screening of refugee children aged 6 months to 16 years on arrival in the United States and retesting those aged 6 months to 6 years between 3- and 6-months postarrival. METHODS: We analyzed EBLL prevalence among refugee children aged 6 months to 16 years who received a domestic refugee medical examination between January 1, 2010 and September 30, 2014. We assessed EBLL prevalence by predeparture examination country and, among children rescreened 3 to 6 months after initial testing, we assessed EBLL changes during follow-up screening. RESULTS: Twelve sites provided data on 27 284 children representing nearly 25% of refugee children resettling during the time period of this analysis. The EBLL prevalence during initial testing was 19.3%. EBLL was associated with younger age, male sex, and overseas examination country. Among 1121 children from 5 sites with available follow-up test results, EBLL prevalence was 22.7%; higher follow-up BLLs were associated with younger age and predeparture examination country. CONCLUSIONS: EBLL decreased over the time period of our analysis in this population of refugee children. Refugee children may be exposed to lead before and after resettlement to the United States. Efforts to identify incoming refugee populations at high risk for EBLL can inform prevention efforts both domestically and overseas. |
Prevalence of blood lead among children living in battery recycling communities in greater Jakarta, Indonesia
Prihartono NA , Djuwita R , Mahmud PB , Haryanto B , Helda H , Wahyono TYM , Dignam T . Int J Environ Res Public Health 2019 16 (7) This study aimed to assess the prevalence of blood lead levels (BLLs) among children 1 to 5 years old who reside near and distant to informally used lead-acid battery (ULAB) recycling locations and examine risk factors for elevated BLLs. A cross-sectional study was conducted in three greater Jakarta neighborhoods where informal ULAB recycling occurs. Venous BLLs among 279 children were analyzed using portable blood lead testing machines. Demographic, child activities, and sources of lead exposure inside and outside homes were assessed. Multivariate analysis was performed to evaluate factors associated with the prevalence of BLLs. Forty-seven percent of children had BLLs >/= 5 microg/dL and 9% had BLLs >/= 10 microg/dL. No differences in geometric mean BLLs were observed between children who lived near and distant to ULAB locations. Older child age groups [Prevalence Ratio (PR) 2.14, 95% Confidence Interval (CI) 1.16, 4.18) and low household income (PR 1.58, 95% CI 1.03, 2.40) were associated with BLLs 5-9 microg/dL. Low educational attainment of the child's father (PR 3.17, 95% CI 1.23, 8.16) and frequent outdoor child activity (PR 4.93, 95% CI 1.09, 22.21) were predictors of BLLs >/= 10 microg/dL. This study shows the association between lead exposure among children and environmental sources. Public health officials can consider expanded surveillance, health care provider education, and development of strategies to reduce lead exposure. |
The use of next generation sequencing for improving food safety: Translation into practice.
Jagadeesan B , Gerner-Smidt P , Allard MW , Leuillet S , Winkler A , Xiao Y , Chaffron S , Van Der Vossen J , Tang S , Katase M , McClure P , Kimura B , Ching Chai L , Chapman J , Grant K . Food Microbiol 2019 79 96-115 Next Generation Sequencing (NGS) combined with powerful bioinformatic approaches are revolutionising food microbiology. Whole genome sequencing (WGS) of single isolates allows the most detailed comparison possible hitherto of individual strains. The two principle approaches for strain discrimination, single nucleotide polymorphism (SNP) analysis and genomic multi-locus sequence typing (MLST) are showing concordant results for phylogenetic clustering and are complementary to each other. Metabarcoding and metagenomics, applied to total DNA isolated from either food materials or the production environment, allows the identification of complete microbial populations. Metagenomics identifies the entire gene content and when coupled to transcriptomics or proteomics, allows the identification of functional capacity and biochemical activity of microbial populations. The focus of this review is on the recent use and future potential of NGS in food microbiology and on current challenges. Guidance is provided for new users, such as public health departments and the food industry, on the implementation of NGS and how to critically interpret results and place them in a broader context. The review aims to promote the broader application of NGS technologies within the food industry as well as highlight knowledge gaps and novel applications of NGS with the aim of driving future research and increasing food safety outputs from its wider use. |
Draft Genome Sequences of Nine Vibrio sp. Isolates from across the United States Closely Related to Vibrio cholerae.
Islam MT , Liang K , Im MS , Winkjer J , Busby S , Tarr CL , Boucher Y . Microbiol Resour Announc 2018 7 (21) We are reporting whole-genome sequences of nine Vibrio sp. isolates closely related to the waterborne human pathogen Vibrio cholerae. These isolates were recovered from sources, including human samples, from different regions of the United States. Genome analysis suggests that this group of isolates represents a highly divergent basal V. cholerae lineage or a closely related novel species. |
Whole genome sequencing to characterize capsule locus and predict serogroup of invasive meningococcal isolates.
Marjuki H , Topaz N , Rodriguez-Rivera LD , Ramos E , Potts CC , Chen A , Retchless AC , Doho GH , Wang X . J Clin Microbiol 2018 57 (3) Invasive meningococcal disease is mainly caused by Neisseria meningitidis (Nm) serogroups A, B, C, X, W and Y. Serogroup is typically determined by slide agglutination serogrouping (SASG) and real-time PCR (rt-PCR). We describe a whole-genome sequencing (WGS)-based method to characterize the capsule polysaccharide synthesis (cps) locus, classify Nm serogroups, and identify mechanisms for nongroupability using 453 isolates from a global strain collection. We identified novel genomic organizations within functional cps loci, consisting of insertion-sequence (IS) elements in unique positions that did not disrupt the coding sequence. Genetic mutations (partial gene deletion, missing genes, IS insertion, internal stop, and phase variable off) that led to nongroupability were identified. WGS and SASG were in 91-100% agreement for all serogroups, while WGS and rt-PCR showed 99-100% agreement. Among isolates determined nongroupable by WGS (31 of 453), all three methods agreed 100% for those without a capsule polymerase gene. However, 61% (WGS vs. SASG) and 36% (WGS vs. rt-PCR) agreements were observed for isolates particularly with phase variations or internal stops in cps loci, which warrant further characterization by additional tests. Our WGS-based serogrouping method provides comprehensive characterization of the Nm capsule, which is critical for meningococcal surveillance and outbreak investigations. |
The contribution of parent-to-offspring transmission of telomeres to the heritability of telomere length in humans.
Delgado DA , Zhang C , Gleason K , Demanelis K , Chen LS , Gao J , Roy S , Shinkle J , Sabarinathan M , Argos M , Tong L , Ahmed A , Islam T , Rakibuz-Zaman M , Sarwar G , Shahriar H , Rahman M , Yunus M , Doherty JA , Jasmine F , Kibriya MG , Ahsan H , Pierce BL . Hum Genet 2018 138 (1) 49-60 Leukocyte telomere length (LTL) is a heritable trait with two potential sources of heritability (h(2)): inherited variation in non-telomeric regions (e.g., SNPs that influence telomere maintenance) and variability in the lengths of telomeres in gametes that produce offspring zygotes (i.e., "direct" inheritance). Prior studies of LTL h(2) have not attempted to disentangle these two sources. Here, we use a novel approach for detecting the direct inheritance of telomeres by studying the association between identity-by-descent (IBD) sharing at chromosome ends and phenotypic similarity in LTL. We measured genome-wide SNPs and LTL for a sample of 5069 Bangladeshi adults with substantial relatedness. For each of the 6318 relative pairs identified, we used SNPs near the telomeres to estimate the number of chromosome ends shared IBD, a proxy for the number of telomeres shared IBD (Tshared). We then estimated the association between Tshared and the squared pairwise difference in LTL ((DeltaLTL)(2)) within various classes of relatives (siblings, avuncular, cousins, and distant), adjusting for overall genetic relatedness (varphi). The association between Tshared and (DeltaLTL)(2) was inverse among all relative pair types. In a meta-analysis including all relative pairs (varphi > 0.05), the association between Tshared and (DeltaLTL)(2) (P = 0.01) was stronger than the association between varphi and (DeltaLTL)(2) (P = 0.43). Our results provide strong evidence that telomere length (TL) in parental germ cells impacts TL in offspring cells and contributes to LTL h(2) despite telomere "reprogramming" during embryonic development. Applying our method to larger studies will enable robust estimation of LTL h(2) attributable to direct transmission of telomeres. |
Genomic insights into multidrug-resistance, mating and virulence in Candida auris and related emerging species.
Munoz JF , Gade L , Chow NA , Loparev VN , Juieng P , Berkow EL , Farrer RA , Litvintseva AP , Cuomo CA . Nat Commun 2018 9 (1) 5346 Candida auris is an emergent multidrug-resistant fungal pathogen causing increasing reports of outbreaks. While distantly related to C. albicans and C. glabrata, C. auris is closely related to rarely observed and often multidrug-resistant species from the C. haemulonii clade. Here, we analyze near complete genome assemblies for the four C. auris clades and three related species, and map intra- and inter-species rearrangements across the seven chromosomes. Using RNA-Seq-guided gene predictions, we find that most mating and meiosis genes are conserved and that clades contain either the MTLa or MTLalpha mating loci. Comparing the genomes of these emerging species to those of other Candida species identifies genes linked to drug resistance and virulence, including expanded families of transporters and lipases, as well as mutations and copy number variants in ERG11. Gene expression analysis identifies transporters and metabolic regulators specific to C. auris and those conserved with related species which may contribute to differences in drug response in this emerging fungal clade. |
Changes in mindful parenting: Associations with changes in parenting, parentyouth relationship quality, and youth behavior
Coatsworth JD , Timpe Z , Nix RL , Duncan LG , Greenberg MT . J Soc Social Work Res 2018 9 (4) 511-529 Objective: There is growing interest in mindful parenting and how this form of intentional, compassionate interactions with youth are associated with developmental outcomes. We investigated how mindful parenting changes over time, either naturally or in response to interventions, and how that change is associated with other proximal developmental changes. Method: We used data from a longitudinal, randomized-controlled study design (N 5 432 families) to investigate the associations between changes in mindful parenting and 3 outcomes: positive parenting, parent–youth relationship quality, and youth aggression. Differences across 3 intervention conditions and between mothers and fathers were tested. Results: Across conditions, changes in mindful parenting were strongly associated with changes in all 3 outcomes for both fathers and mothers. Changes in mindful parenting showed considerable variability within and across conditions. For fathers, differences in mindful parenting change were driven primarily by changes in the core mindful parenting dimension of emotional awareness. Mothers showed comparable changes in mindful parenting across conditions. Conclusions: Findings illustrate how changes in mindful parenting are associated with proximal changes that could lead to reduced youth behavior problems (e.g., aggression or substance use) and provide additional evidence for the contribution that mindfulness activities can make to standard parent training. |
Quantifying the risk of undetected HIV, hepatitis B virus, or hepatitis C virus infection in Public Health Service increased risk donors.
Jones JM , Gurbaxani BM , Asher A , Sansom S , Annambhotla P , Moorman AC , Brooks JT , Basavaraju SV . Am J Transplant 2019 19 (9) 2583-2593 To reduce the risk of HIV, hepatitis B virus (HBV), and hepatitis C virus (HCV) transmission through organ transplantation, donors are universally screened for these infections by nucleic acid tests (NAT). Deceased organ donors are classified as "increased risk" if they engaged in specific behaviors during the 12 months before death. We developed a model to estimate the risk of undetected infection for HIV, HBV, and HCV among NAT-negative donors specific to the type and timing of donors' potential risk behavior to guide revisions to the 12-month timeline. Model parameters were estimated, including risk of disease acquisition for increased-risk groups, number of virions that multiply to establish infection, virus doubling time, and limit of detection by NAT. Monte Carlo simulation was performed. The risk of undetected infection was <1/1,000,000 for HIV after 14 days, for HBV after 35 days, and for HCV after 7 days from the time of most recent potential exposure to the day of a negative NAT. The period during which reported donor risk behaviors result in an "increased risk" designation can be safely shortened. This article is protected by copyright. All rights reserved. |
Outbreak of epidemic keratoconjunctivitis caused by human adenovirus type D53 in an eye care clinic - Los Angeles County, 2017
OYong K , Killerby M , Pan CY , Huynh T , Green NM , Wadford DA , Terashita D . MMWR Morb Mortal Wkly Rep 2018 67 (48) 1347-1349 On June 22, 2017, the Los Angeles County Department of Public Health (LAC DPH) was notified of seven patients who were seen at an eye care clinic on June 8, 2017, and later developed symptoms of epidemic keratoconjunctivitis (EKC). EKC is a contagious, severe form of viral conjunctivitis that can cause pain and blurred vision for up to 4 weeks (1). LAC DPH conducted an investigation, which identified 17 patients with EKC, including 15 who had visited the optometry clinic and two who were household contacts of clinic patients. Observations in the clinic found deficiencies in disinfection of tonometers (an instrument connected to a slit lamp and used to test for glaucoma by measuring intraocular pressure) and multiuse eye drop administration. Staff member education and revision of disinfection practices interrupted further transmission. Patient specimens tested positive for human adenovirus (HAdV) type D53 (HAdV-53). As the first documented EKC outbreak associated with HAdV-D53 in the United States, this outbreak highlights the need for rigorous implementation of recommended infection prevention practices in eye care settings. |
Notes from the field: Infections after receipt of bacterially contaminated umbilical cord blood-derived stem cell products for other than hematopoietic or immunologic reconstitution - United States, 2018
Perkins KM , Spoto S , Rankin DA , Dotson NQ , Malarkey M , Mendoza M , McNeill L , Gable P , Powell KM . MMWR Morb Mortal Wkly Rep 2018 67 (50) 1397-1399 The only Food and Drug Administration (FDA)–approved stem cell products are derived from umbilical cord blood, and their only approved use is hematopoietic and immunologic reconstitution (1). On September 17, 2018, the Texas Department of State Health Services received notification of Enterobacter cloacae and Citrobacter freundii bloodstream infections in three patients who had received injections or infusions of non-FDA–approved umbilical cord blood-derived stem cell products processed by Genetech, Inc., and distributed by Liveyon, LLC, for other than hematopoietic or immunologic reconstitution at an outpatient clinic on September 12. Patient isolates of E. cloacae had identical pulsed-field gel electrophoresis patterns, suggesting a common source. On September 22, the Florida Department of Health received notification of Escherichia coli, Enterococcus faecalis, and Proteus mirabilis joint infections in four patients who had received injections of these same products at an orthopedic clinic during February 15–August 30, 2018, also for other than hematopoietic or immunologic reconstitution. Cultures of unopened products from the clinic by a Florida hospital identified contamination with E. coli and E. faecalis. In response, on September 28, Liveyon issued a voluntary recall and immediately discontinued purchase of the Genetech-processed stem cell products (2,3). On October 4, CDC issued a nationwide call for reports of culture-confirmed infections in patients who had received the Liveyon product. |
Web Exclusive. Annals On Call - C difficile: The Most Common Health Care-Associated Infection in the United States
Centor RM , Guh AY , Kutty PK . Ann Intern Med 2019 170 (8) Oc1 In this episode of Annals On Call, Dr. Centor discusses the prevention, diagnosis, and treatment of infection with C difficile with Drs. Allison Guh and Preeta Kutty, both of whom work at the U.S. Centers for Disease Control and Prevention. |
Hospital epidemiologists' and infection preventionists' opinions regarding hospital-onset bacteremia and fungemia as a potential healthcare-associated infection metric
Dantes RB , Abbo LM , Anderson D , Hall L , Han JH , Harris AD , Leekha S , Milstone AM , Morgan DJ , Safdar N , Schweizer ML , Sengupta S , Seo SK , Rock C . Infect Control Hosp Epidemiol 2019 40 (5) 1-5 OBJECTIVE: To ascertain opinions regarding etiology and preventability of hospital-onset bacteremia and fungemia (HOB) and perspectives on HOB as a potential outcome measure reflecting quality of infection prevention and hospital care. DESIGN: Cross-sectional survey. PARTICIPANTS: Hospital epidemiologists and infection preventionist members of the Society for Healthcare Epidemiology of America (SHEA) Research Network. METHODS: A web-based, multiple-choice survey was administered via the SHEA Research Network to 133 hospitals. RESULTS: A total of 89 surveys were completed (67% response rate). Overall, 60% of respondents defined HOB as a positive blood culture on or after hospital day 3. Central line-associated bloodstream infections and intra-abdominal infections were perceived as the most frequent etiologies. Moreover, 61% thought that most HOB events are preventable, and 54% viewed HOB as a measure reflecting a hospital's quality of care. Also, 29% of respondents' hospitals already collect HOB data for internal purposes. Given a choice to publicly report central-line-associated bloodstream infections (CLABSIs) and/or HOB, 57% favored reporting either HOB alone (22%) or in addition to CLABSI (35%) and 34% favored CLABSI alone. CONCLUSIONS: Among the majority of SHEA Research Network respondents, HOB is perceived as preventable, reflective of quality of care, and potentially acceptable as a publicly reported quality metric. Further studies on HOB are needed, including validation as a quality measure, assessment of risk adjustment, and formation of evidence-based bundles and toolkits to facilitate measurement and improvement of HOB rates. |
A Population-Based Descriptive Atlas of Invasive Pneumococcal Strains Recovered Within the U.S. During 2015-2016.
Beall B , Chochua S , Gertz RE Jr , Li Y , Li Z , McGee L , Metcalf BJ , Ricaldi J , Tran T , Walker H , Pilishvili T . Front Microbiol 2018 9 2670 Invasive pneumococcal disease (IPD) has greatly decreased since implementation in the U.S. of the 7 valent conjugate vaccine (PCV7) in 2000 and 13 valent conjugate vaccine (PCV13) in 2010. We used whole genome sequencing (WGS) to predict phenotypic traits (serotypes, antimicrobial phenotypes, and pilus determinants) and determine multilocus genotypes from 5334 isolates (~90% of cases) recovered during 2015-2016 through Active Bacterial Core surveillance. We identified 44 serotypes; 26 accounted for 98% of the isolates. PCV13 serotypes (inclusive of serotype 6C) accounted for 1503 (28.2%) isolates, with serotype 3 most common (657/5334, 12.3%), while serotypes 1 and 5 were undetected. Of 305 isolates from children <5 yrs, 60 (19.7%) were of PCV13 serotypes 19A, 19F, 3, 6B, and 23F (58/60 were 19A, 19F, or 3). We quantitated MLST-based lineages first detected during the post-PCV era (since 2002) that potentially arose through serotype-switching. The 7 predominant emergent post-PCV strain complexes included 23B/CC338, 15BC/CC3280, 19A/CC244, 4/CC439, 15A/CC156, 35B/CC156, and 15BC/CC156. These strains accounted for 332 isolates (6.2% of total) and were more frequently observed in children <5 yrs (17.7%; 54/305). Fifty-seven categories of recently emerged (in the post PCV7 period) putative serotype-switch variants were identified, accounting for 402 isolates. Many of these putative switch variants represented newly emerged resistant strains. Penicillin-nonsusceptibility (MICs > 0.12 mug/ml) was found among 22.4% (1193/5334) isolates, with higher penicillin MICs (2-8 mug/ml) found in 8.0% (425/5334) of isolates that were primarily (372/425, 87.5%) serotypes 35B and 19A. Most (792/1193, 66.4%) penicillin-nonsusceptible isolates were macrolide-resistant, 410 (34.4%) of which were erm gene positive and clindamycin-resistant. The proportion of macrolide-resistant isolates increased with increasing penicillin MICs; even isolates with reduced penicillin susceptibility (MIC = 0.06 mug/ml) were much more likely to be macrolide-resistant than basally penicillin-susceptible isolates (MIC < 0.03 mug/ml). The contribution of recombination to strain diversification was assessed through quantitating 35B/CC558-specific bioinformatic pipeline features among non-CC558 CCs and determining the sizes of gene replacements. Although IPD has decreased greatly and stabilized in the post-PCV13 era, the species continually generates recombinants that adapt to selective pressures exerted by vaccines and antimicrobials. These data serve as a baseline for monitoring future changes within each invasive serotype. |
Provider perspectives on demand creation for maternal vaccines in Kenya
Bergenfeld I , Nganga SW , Andrews CA , Fenimore VL , Otieno NA , Wilson AD , Chaves SS , Verani JR , Widdowson MA , Wairimu WN , Wandera SN , Atito RO , Adero MO , Frew PM , Omer SB , Malik FA . Gates Open Res 2018 2 34 Background . Expansion of maternal immunization, which offers some of the most effective protection against morbidity and mortality in pregnant women and neonates, requires broad acceptance by healthcare providers and their patients. We aimed to describe issues surrounding acceptance and demand creation for maternal vaccines in Kenya from a provider perspective. Methods . Nurses and clinical officers were recruited for semi-structured interviews covering resources for vaccine delivery, patient education, knowledge and attitudes surrounding maternal vaccines, and opportunities for demand creation for new vaccines. Interviews were conducted in English and Swahili, transcribed verbatim from audio recordings, and analyzed using codes developed from interview guide questions and emergent themes. Results . Providers expressed favorable attitudes about currently available maternal immunizations and introduction of additional vaccines, viewing themselves as primarily responsible for vaccine promotion and patient education. The importance of educational resources for both patients and providers to maintain high levels of maternal immunization coverage was a common theme. Most identified barriers to vaccine acceptance and delivery were cultural and systematic in nature. Suggestions for improvement included improved patient and provider education, including material resources, and community engagement through religious and cultural leaders. Conclusions . The distribution of standardized, evidence-based print materials for patient education may reduce provider overwork and facilitate in-clinic efforts to inform women about maternal vaccines. Continuing education for providers should address communication surrounding current vaccines and those under consideration for introduction into routine schedules. Engagement of religious and community leaders, as well as male decision-makers in the household, will enhance future acceptance of maternal vaccines. |
Global funders consortium for universal influenza vaccine development
Bresee JS , McKinlay MA , Abramson J , Klugman KP , Wairagkar N . Vaccine 2018 37 (2) 211-213 A century after the great influenza pandemic of 1918, influenza remains a major public health threat. Annual epidemics are associated with significant mortality and morbidity globally, leading to an estimated 290,000–650,000 deaths each year [1]. In addition, the ongoing threat of the next pandemic requires significant resources and attention to ensure that communities and governments are prepared to mitigate the health and societal impact that would likely be much larger than the seasonal toll from influenza [2]. Vaccines against influenza have long been used to reduce seasonal disease risk and to reduce illness and spread of pandemic influenza [3], [4], [5], [6]. However, the variable and moderate effectiveness, the limited ability to prevent influenza caused by antigenically dissimilar challenge viruses, and the complex and lengthy process for semiannual vaccine production, highlight the limitations of current vaccines to optimally address both seasonal and pandemic threats [7], [8], [9], [10]. As a result, growing interest in developing improved influenza vaccines has been voiced by public health authorities and other global stakeholders. |
Prevention of influenza hospitalization among adults in the US, 2015-16: Results from the US Hospitalized Adult Influenza Vaccine Effectiveness Network (HAIVEN)
Ferdinands JM , Gaglani M , Martin ET , Middleton D , Monto AS , Murthy K , Silveira FP , Talbot HK , Zimmerman R , Alyanak E , Strickland C , Spencer S , Fry AM . J Infect Dis 2018 220 (8) 1265-1275 Background: Evidence establishing effectiveness of influenza vaccination for prevention of severe illness is limited. The US Hospitalized Adult Influenza Vaccine Effectiveness Network (HAIVEN) is a multi-year test-negative case-control study initiated in 2015-16 to estimate effectiveness of vaccine in preventing influenza hospitalization among adults. Methods: Adults aged >/=18 years admitted to eight US hospitals with acute respiratory illness and testing positive for influenza by PCR were cases; those testing negative were controls. VE was estimated with logistic regression adjusting for age, comorbidities and other confounding factors and stratified by frailty, two-year vaccination history, and clinical presentation. Results: We analyzed data from 236 cases and 1231 controls; mean age was 58 years. Over 90% of patients had >/=1 comorbidity elevating risk of influenza complications. Fifty percent of cases and 70% of controls were vaccinated. Vaccination was 51% (95%CI 29, 65) and 53% (95%CI 11, 76) effective in preventing hospitalization due to influenza A(H1N1)pdm09 and influenza B virus infection, respectively. Vaccine was protective for all age groups. Conclusions: During the 2015-16 US influenza A(H1N1)pdm09-predominant season, we found that vaccination halved the risk of influenza-association hospitalization among adults, most of whom were at increased risk of serious influenza complications due to comorbidity or age. |
Influenza vaccine effectiveness
Ferdinands JM , Patel MM , Foppa IM , Fry AM . Clin Infect Dis 2018 69 (1) 190-191 We read with interest the article by Ray and colleagues and the accompanying editorial by Dr Lipsitch [1, 2]. Ray et al identified a 2-fold increased risk of influenza among individuals vaccinated for >5 months compared to those recently vaccinated. More than a dozen papers have reported findings of declining vaccine effectiveness (VE) with increasing time since vaccination using the test-negative design [3]. We agree with Dr Lipsitch that caution is warranted when inferring that waning immunity is the mechanistic cause of the observed decline in VE. |
Comparing influenza vaccine types: the path towards improved influenza vaccine strategies
Flannery B , Fry AM . J Infect Dis 2018 220 (8) 1237-1239 The 2017–2018 influenza season was a reminder that seasonal influenza can be associated with a large burden of severe disease and that adults aged ≥65 years are disproportionately affected; 660 000 hospitalizations and 68 000 deaths were estimated to be associated with influenza virus infection in this age group [1]. Older adults are a priority group for annual influenza vaccination. The 2017–2018 season, notable for the predominance of A(H3N2) viruses, also was a reminder that the H3N2 vaccine component is not as effective as other vaccine components. Vaccines reduced the risk of laboratory-confirmed influenza A and B–associated outpatient visits by 40%, but vaccine effectiveness (VE) estimates against A(H3N2) viruses were 24% [2]. Since 2004–2005, VE point estimates against A(H3N2) viruses have been lower than against 2009 pandemic influenza A(H1N1) virus (A[H1N1]pdm09) or influenza B viruses, and VE estimates against A(H3N2) viruses are usually lowest among older adults [2–4]. Thus, understanding why influenza vaccines are less effective against A(H3N2) viruses and identifying new strategies to improve VE are critical, especially during A(H3N2-predominant seasons, such as 2017–2018. |
Cost of a human papillomavirus vaccination project, Zimbabwe
Hidle A , Gwati G , Abimbola T , Pallas SW , Hyde T , Petu A , McFarland D , Manangazira P . Bull World Health Organ 2018 96 (12) 834-842 Objective: To determine the cost of Zimbabwe's human papillomavirus (HPV) vaccination demonstration project. Methods: The government of Zimbabwe conducted the project from 2014-2015, delivering two doses of HPV vaccine to 10-year-old girls in two districts. School delivery was the primary vaccination strategy, with health facilities and outreach as secondary strategies. A retrospective cost analysis was conducted from the provider perspective. Financial costs (government expenditure) and economic costs (financial plus the value of existing or donated resources including vaccines) were calculated by activity, per dose and per fully immunized girl. Results: The project delivered 11 599 vaccine doses, resulting in 5724 fully immunized girls (5540 at schools, 168 at health facilities and 16 at outreach points). The financial cost for service delivery per fully immunized girl was United States dollars (US$) 5.34 in schools, US$ 34.90 at health facilities and US$ 288.63 at outreach; the economic costs were US$ 17.39, US$ 41.25 and US$ 635.84, respectively. The mean financial cost per dose was US$ 19.76 and per fully immunized girl was US$ 40.03 (economic costs were US$ 45.00 and US$ 91.19, respectively). The largest number of doses delivered (5788) occurred during the second vaccination round (the second group's first dose concurrently delivered with the first group's second dose), resulting in the lowest financial and economic service delivery costs per dose: US$ 1.97 and US$ 6.79, respectively. Conclusion: The mean service delivery cost was lower in schools (primary strategy) and when more girls were vaccinated in each round, demonstrating scale efficiency. |
Cost-effectiveness of adult vaccinations: A systematic review
Leidner AJ , Murthy N , Chesson HW , Biggerstaff M , Stoecker C , Harris AM , Acosta A , Dooling K , Bridges CB . Vaccine 2018 37 (2) 226-234 BACKGROUND: Coverage levels for many recommended adult vaccinations are low. The cost-effectiveness research literature on adult vaccinations has not been synthesized in recent years, which may contribute to low awareness of the value of adult vaccinations and to their under-utilization. We assessed research literature since 1980 to summarize economic evidence for adult vaccinations included on the adult immunization schedule. METHODS: We searched PubMed, EMBASE, EconLit, and Cochrane Library from 1980 to 2016 and identified economic evaluation or cost-effectiveness analysis for vaccinations targeting persons aged >/=18years in the U.S. or Canada. After excluding records based on title and abstract reviews, the remaining publications had a full-text review from two independent reviewers, who extracted economic values that compared vaccination to "no vaccination" scenarios. RESULTS: The systematic searches yielded 1688 publications. After removing duplicates, off-topic publications, and publications without a "no vaccination" comparison, 78 publications were included in the final analysis (influenza=25, pneumococcal=18, human papillomavirus=9, herpes zoster=7, tetanus-diphtheria-pertussis=9, hepatitis B=9, and multiple vaccines=1). Among outcomes assessing age-based vaccinations, the percent indicating cost-savings was 56% for influenza, 31% for pneumococcal, and 23% for tetanus-diphtheria-pertussis vaccinations. Among age-based vaccination outcomes reporting $/QALY, the percent of outcomes indicating a cost per QALY of </=$100,000 was 100% for influenza, 100% for pneumococcal, 69% for human papillomavirus, 71% for herpes zoster, and 50% for tetanus-diphtheria-pertussis vaccinations. CONCLUSIONS: The majority of published studies report favorable cost-effectiveness profiles for adult vaccinations, which supports efforts to improve the implementation of adult vaccination recommendations. |
Comparative immunogenicity of enhanced seasonal influenza vaccines in older adults: a systematic review and meta-analysis
Ng TWY , Cowling BJ , Gao HZ , Thompson MG . J Infect Dis 2018 219 (10) 1525-1535 Introduction: A number of enhanced influenza vaccines have been developed for use in older adults, including the high-dose, MF59-adjuvanted, and intradermal vaccines. Methods: We conducted a systematic review examining the improvements in antibody responses measured by the hemagglutination inhibition (HAI) assay associated with these enhanced vaccines, compared to each other, and compared to standard-dose vaccine using random effects models. Results: Thirty-nine trials were included. Compared to adults aged 60 years receiving standard-dose vaccines, those receiving enhanced vaccines had significantly higher post-vaccination titers (for all vaccine strains) and higher proportions with elevated titers >/=40 (for most vaccine strains). High-dose vaccine elicited 82% higher post-vaccination titer to A(H3N2) compared to standard-dose vaccine; this was significantly higher than 52% estimated for MF59-adjuvanted versus standard-dose vaccines (p=0.04), which was higher than 32% estimated for intradermal versus standard-dose vaccines (p<0.01). Conclusions: Overall, by summarizing current evidence, we found enhanced vaccines had greater antibody responses than standard-dose vaccine. Indications of differences among enhanced vaccines highlight that further research is needed in order to compare new vaccine options; this is especially needed during seasons with mismatched circulating strains and for immune outcomes other than HAI titers as well as vaccine efficacy. |
Obstetrician-gynecologists' strategies to address vaccine refusal among pregnant women
O'Leary ST , Riley LE , Lindley MC , Allison MA , Albert AP , Fisher A , Jiles AJ , Crane LA , Hurley LP , Beaty B , Brtnikova M , Kempe A . Obstet Gynecol 2018 133 (1) 40-47 OBJECTIVE: To describe 1) obstetrician-gynecologists' (ob-gyns') perceptions of the frequency of vaccine refusal among pregnant patients and perceived reasons for refusal and 2) ob-gyns' strategies used when encountering vaccine refusal and perceived effectiveness of those strategies. METHODS: We conducted an email and mail survey among a nationally representative network of ob-gyns from March 2016 to June 2016. RESULTS: The response rate was 69% (331/477). Health care providers perceived that pregnant women more commonly refused influenza vaccine than tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccine: 62% of respondents reported 10% or greater of pregnant women they care for in a typical month refused influenza vaccine compared with 32% reporting this for Tdap vaccine. The most commonly reported reasons for vaccine refusal were patients' belief that influenza vaccine makes them sick (48%), belief they are unlikely to get a vaccine-preventable disease (38%), general worries about vaccines (32%), desire to maintain a natural pregnancy (31%), and concern that their child could develop autism as a result of maternal vaccination (25%). The most commonly reported strategies ob-gyns used to address refusal were stating that it is safe to receive vaccines in pregnancy (96%), explaining that not getting the vaccine puts the fetus or newborn at risk (90%), or that not getting the vaccine puts the pregnant woman's health at risk (84%). The strategy perceived as most effective was stating that not getting vaccinated puts the fetus or newborn at risk. CONCLUSION: Ob-gyns perceive vaccine refusal among pregnant women as common and refusal of influenza vaccine as more common than refusal of Tdap vaccine. Emphasizing the risk of disease to the fetus or newborn may be an effective strategy to increase vaccine uptake. |
Approaches to monitoring intussusception following rotavirus vaccination
Tate JE , Parashar UD . Expert Opin Drug Saf 2018 18 (1) 21-27 INTRODUCTION: In 1998, the first licensed rotavirus vaccine was associated with intussusception, an unexpected adverse event, following reports of this condition to an adverse event reporting system. This rotavirus vaccine was withdrawn from the market and newer rotavirus vaccines have been extensively evaluated for an association with intussusception. Areas Covered: We review the different study designs that have been used both pre- and post-licensure to evaluate the association of rotavirus vaccines with intussusception and discuss the pros and cons of each design. Each of these study designs has their own strengths and weaknesses and the choice of the design often depends on the objective and the timing of the study and the resources available. For post-licensure monitoring of rotavirus vaccines, the self-controlled case-series design has become the most commonly used design to monitor this association. Expert Opinion: Use of this common study design has enabled comparison of findings across diverse settings. As new rotavirus vaccines enter the market, use of the self-controlled case-series design will enable examination of this association in a timely manner. |
Influenza virus N-linked glycosylation and innate immunity
York IA , Stevens J , Alymova IV . Biosci Rep 2018 39 (1) Influenza viruses cause seasonal epidemics and sporadic pandemics in humans. The virus's ability to change its antigenic nature through mutation and recombination, and the difficulty in developing highly effective universal vaccines against it, make it a serious global public health challenge. Influenza virus's surface glycoproteins, hemagglutinin and neuraminidase, are all modified by the host cell's N-linked glycosylation pathways. Host innate immune responses are the first line of defense against infection, and glycosylation of these major antigens plays an important role in the generation of host innate responses toward the virus. Here, we review the principal findings in the analytical techniques used to study influenza N-linked glycosylation, the evolutionary dynamics of N-linked glycosylation in seasonal vs. pandemic and zoonotic strains, its role in host innate immune responses, and the prospects for lectin-based therapies. As the efficiency of innate immune responses is a critical determinant of disease severity and adaptive immunity, the study of influenza glycobiology is of clinical as well as research interest. |
The MMR vaccine and autism
DeStefano F , Shimabukuro TT . Annu Rev Virol 2019 6 (1) 585-600 Autism is a developmental disability that can cause significant social, communication, and behavioral challenges. A report published in 1998, but subsequently retracted by the journal, suggested that measles, mumps, and rubella (MMR) vaccine causes autism. However, autism is a neurodevelopmental condition that has a strong genetic component with genesis before one year of age, when MMR vaccine is typically administered. Several epidemiologic studies have not found an association between MMR vaccination and autism, including a study that found that MMR vaccine was not associated with an increased risk of autism even among high-risk children whose older siblings had autism. Despite strong evidence of its safety, some parents are still hesitant to accept MMR vaccination of their children. Decreasing acceptance of MMR vaccination has led to outbreaks or resurgence of measles. Health-care providers have a vital role in maintaining confidence in vaccination and preventing suffering, disability, and death from measles and other vaccine-preventable diseases. Expected final online publication date for the Annual Review of Virology Volume 6 is September 30, 2019. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates. |
Evaluating vaccination policies to accelerate measles elimination in China: a meta-population modelling study
Hao L , Glasser JW , Su Q , Ma C , Feng Z , Yin Z , Goodson JL , Wen N , Fan C , Yang H , Rodewald LE , Feng Z , Wang H . Int J Epidemiol 2019 48 (4) 1240-1251 BACKGROUND: Measles is among the most highly infectious human diseases. By virtue of increasingly effective childhood vaccination, together with targeted supplemental immunization activities (SIAs), health authorities in the People's Republic of China have reduced measles' reproduction number from about 18 to 2.3. Despite substantial residual susceptibility among young adults, more in some locales than others, sustained routine childhood immunization likely would eliminate measles eventually. To support global eradication efforts, as well as expedite morbidity and mortality reductions in China, we evaluated alternative SIAs via mechanistic mathematical modelling. METHODS: Our model Chinese population is stratified by immune status (susceptible to measles infection; infected, but not yet infectious; infectious; and recovered or immunized), age (0, 1-4, 5-9, ..., 65+ years) and location (31 provinces). Contacts between sub-populations are either empirical or a mixture of preferential and proportionate with respect to age and decline exponentially with distance between locations at age-dependent rates. We estimated initial conditions and most parameters from recent cross-sectional serological surveys, disease surveillance and demographic observations. Then we calculated the reproduction numbers and gradient of the effective number with respect to age- and location-specific immunization rates. We corroborated these analytical results by simulating adolescent and young adult SIAs using a version of our model in which the age-specific contact rates vary seasonally. RESULTS: Whereas the gradient indicates that vaccinating young adults generally is the optimal strategy, simulations indicate that a catch-up campaign among susceptible adolescent schoolchildren would accelerate elimination, with timing dependent on uptake. CONCLUSIONS: These results are largely due to indirect effects (i.e. fewer infections than immunized people might otherwise cause), which meta-population models with realistic mixing are uniquely capable of reproducing accurately. |
Trends in anogenital wart incidence among Tennessee Medicaid enrollees, 2006-2014: The impact of human papillomavirus vaccination
Shing JZ , Hull PC , Zhu Y , Gargano JW , Markowitz LE , Cleveland AA , Pemmaraju M , Park IU , Whitney E , Mitchel EF , Griffin MR . Papillomavirus Res 2019 7 141-149 INTRODUCTION: Evidence of human papillomavirus (HPV) vaccine impact on anogenital warts (AGWs) by race or urbanicity in the US is lacking. We evaluated HPV vaccine impact in Tennessee by assessing AGW trends among Tennessee Medicaid (TennCare) enrollees aged 15-39 years from 2006-2014. METHODS: Persons with incident AGWs were identified using diagnosis/pharmacy codes from TennCare billing claims. We calculated sex-specific annual AGW incidence by age group, race, and urbanicity; estimated annual percent changes (APCs) using log-linear models; and performed pairwise comparisons by race and urbanicity. RESULTS: AGW incidence decreased among females aged 15-19 (APC=-10.6; P<0.01) and 20-24 years (APC=-3.9; P=0.02). Overall trends were similar between Whites and Blacks, and between those living in metropolitan statistical areas (MSAs) and non-MSAs. Rates among males aged 15-19 years began decreasing after 2010. Among enrollees aged 25-39 years, rates increased or were stable. CONCLUSIONS: Following introduction of the HPV vaccine in 2006, AGWs decreased among age groups most likely to be vaccinated. The change in trend among young males after 2010 suggests early herd effects. Our findings indicate vaccine effects and support the importance of improving adherence to current vaccination recommendations for preventing AGWs and other HPV-related diseases. |
Detecting moderate or complex congenital heart defects in adults from an electronic health records system
Diallo AO , Krishnaswamy A , Shapira SK , Oster ME , George MG , Adams JC , Walker ER , Weiss P , Ali MK , Book W . J Am Med Inform Assoc 2018 25 (12) 1634-1642 Background: The prevalence of moderate or complex (moderate-complex) congenital heart defects (CHDs) among adults is increasing due to improved survival, but many patients experience lapses in specialty care or their CHDs are undocumented in the medical system. There is, to date, no efficient approach to identify this population. Objective: To develop and assess the performance of a risk score to identify adults aged 20-60 years with undocumented specific moderate-complex CHDs from electronic health records (EHR). Methods: We used a case-control study (596 adults with specific moderate-complex CHDs and 2384 controls). We extracted age, race/ethnicity, electrocardiogram (EKG), and blood tests from routine outpatient visits (1/2009 through 12/2012). We used multivariable logistic regression models and a split-sample (4: 1 ratio) approach to develop and internally validate the risk score, respectively. We generated receiver operating characteristic (ROC) c-statistics and Brier scores to assess the ability of models to predict the presence of specific moderate-complex CHDs. Results: Out of six models, the non-blood biomarker model that included age, sex, and EKG parameters offered a high ROC c-statistic of 0.96 [95% confidence interval: 0.95, 0.97] and low Brier score (0.05) relative to the other models. The adult moderate-complex congenital heart defect risk score demonstrated good accuracy with 96.4% sensitivity and 80.0% specificity at a threshold score of 10. Conclusions: A simple risk score based on age, sex, and EKG parameters offers early proof of concept and may help accurately identify adults with specific moderate-complex CHDs from routine EHR systems who may benefit from specialty care. |
Willingness to change medications linked to increased fall risk: A comparison between age groups
Haddad YK , Karani MV , Bergen G , Marcum ZA . J Am Geriatr Soc 2018 67 (3) 527-533 OBJECTIVE: To describe and compare two age groups' knowledge of medications linked to falls and willingness to change these medications to reduce their fall risk. METHOD: We analyzed data from community-dwelling adults age 55 and older (n = 1812): 855 adults aged 55 to 64 years and 957 older adults (65 and older) who participated in the 2016 summer wave of the ConsumerStyles survey, an annual Web-based survey. The data are weighted to match the US Current Population Survey proportions on nine US Census Bureau demographic characteristics. MEASUREMENTS: Survey respondents were asked about medication use, knowledge of side effects, their willingness to change their medications to reduce fall risk, communication in the previous year about fall risk with their healthcare provider, and their comfort in discussing fall risk with their healthcare provider. All data were weighted to match the 2016 population estimates. Descriptive statistics and chi(2) (p </= .05) were used to identify differences between the two age groups. RESULTS: About one-fifth of all respondents reported using at least one class of medication that increases fall risk. Older adults were less likely to report using medications for mood or sadness, less likely to report knowing the side effects of pain medications, and more willing to change their sleep medications compared with their younger counterparts. Among all respondents using these medication classes, less than one-third knew the potential fall-related side effects. However, most of them expressed willingness to change their medication if advised by their healthcare provider. CONCLUSION: Most older adults were unaware of potential fall risks associated with medications prescribed to address pain, difficulty sleeping, mood or sadness, and anxiety- or nervousness-related health issues. However, most were willing to change their medication if recommended by a healthcare provider. |
A randomized, controlled trial of the impact of the Couple CARE for Parents of Newborns Program on the prevention of intimate partner violence and relationship problems
Heyman RE , Slep AMS , Lorber MF , Mitnick DM , Xu S , Baucom KJW , Halford WK , Niolon PH . Prev Sci 2018 20 (5) 620-631 Effective, accessible prevention programs are needed for adults at heightened risk for intimate partner violence (IPV). This parallel group randomized controlled trial examines whether such couples receiving the American version of Couple CARE for Parents of Newborns (CCP; Halford et al. 2009) following the birth of a child, compared with controls, report fewer first occurrences of clinically significant IPV, less frequent physical and psychological IPV, and improved relationship functioning. Further, we test whether intervention effects are moderated by level of risk for IPV. Couples at elevated risk for IPV (N = 368) recruited from maternity units were randomized to CCP (n = 188) or a 24-month waitlist (n = 180) and completed measures of IPV and relationship functioning at baseline, post-program (when child was 8 months old), and two follow-ups (at 15 and 24 months). Intervention effects were tested using intent to treat (ITT) as well as complier average causal effect (CACE; Jo and Muthen 2001) structural equation models. CCP did not significantly prevent clinically significant IPV nor were there significant main effects of CCP on clinically significant IPV, frequency of IPV, or most relationship outcomes in the CACE or ITT analyses. Risk moderated the effect of CCP on male-to-female physical IPV at post-program, with couples with a planned pregnancy declining, but those with unplanned pregnancies increasing. This study adds to previous findings that prevention programs for at-risk couples are not often effective and may even be iatrogenic for some couples. |
Decreasing residential fire death rates and the association with the prevalence of adult cigarette smoking - United States, 1999-2015
Kegler SR , Dellinger AM , Ballesteros MF , Tsai J . J Safety Res 2018 67 197-201 INTRODUCTION: Each year from 1999 through 2015, residential fires caused between 2,000 and 3,000 deaths in the U.S., totaling approximately 45,000 deaths during this period. A disproportionate number of such deaths are attributable to smoking in the home. This study examines national trends in residential fire death rates, overall and smoking-related, and their relationship to adult cigarette smoking prevalence, over this same period. METHODS: Summary data characterizing annual U.S. residential fire deaths and annual prevalence of adult cigarette smoking for the years 1999-2015, drawn from the National Vital Statistics System, the National Fire Protection Association, and the National Health Interview Survey were used to relate trends in overall and smoking-related rates of residential fire death to changes in adult cigarette smoking prevalence. RESULTS: Statistically significant downward trends were identified for both the rate of residential fire death (an average annual decrease of 2.2% - 2.6%) and the rate of residential fire death attributed to smoking (an average annual decrease of 3.5%). The decreasing rate of residential fire death was strongly correlated with a gradually declining year-to-year prevalence of adult cigarette smoking (r=0.83), as was the decreasing rate of residential fire death attributed to smoking (r=0.80). CONCLUSIONS AND PRACTICAL APPLICATIONS: Decreasing U.S. residential fire death rates, both overall and smoking-related, coincided with a declining prevalence of adult cigarette smoking during 1999-2015. These findings further support tobacco control efforts and fire prevention strategies that include promotion of smoke-free homes. While the general health benefits of refraining from smoking are widely accepted, injury prevention represents a potential benefit that is less recognized. |
From the CDC a qualitative study of middle and high school professionals experiences and views on concussion: Identifying opportunities to support the return to school process
Sarmiento K , Donnell Z , Bell E , Hoffman R . J Safety Res 2018 68 223-229 INTRODUCTION: Current research recommends that students returning to school after a concussion should receive a return to school plan that is tailored to their individual symptoms. School professionals play important roles in designing and implementing the supports outlined in return to school plans. METHODS: This qualitative study explored middle and high school professionals' experiences with concussion, particularly their knowledge and perceptions of the injury and their experience with supporting students with concussion. Six focus groups were conducted with two to four school professionals per group, including two groups of teachers, two groups of school psychologists and counselors, and two groups of school nurses. Findings were coded into four categories: (a) challenges with identifying a concussion; (b) strategies for communicating with students about concussion; (c) barriers to implementing return to learn plans; and (d) establishing a collaborative school support team. RESULTS: School professionals who participated in the focus groups were knowledgeable about concussion and the importance of helping their student recover. Participants also understood the importance of recognizing the signs and symptoms of concussion and communicating with students and parents about this injury. However, the study participants reported various challenges related to concussion identification and management, including the perceived validity of concussion symptom reporting by students. A team-based approach was mentioned across all groups as the preferred method for school-based concussion management for students. CONCLUSION: School professionals in this study were eager to address concussion in their schools, but desire guidance on how to overcome social norms around concussion identification and reporting. In addition, there is a need for consistent use of written instructions from healthcare providers to help guide return to learn (RTL) accommodations. Practical applications: The findings from this study can help inform the integration of concussion, and other health, management plans in schools. |
Rates of neglect in a national sample: Child and family characteristics and psychological impact
Vanderminden J , Hamby S , David-Ferdon C , Kacha-Ochana A , Merrick M , Simon TR , Finkelhor D , Turner H . Child Abuse Negl 2018 88 256-265 BACKGROUND: Childhood neglect is an understudied form of childhood maltreatment despite being the most commonly reported to authorities. OBJECTIVE: This study provides national estimates of neglect subtypes, demographic variations in exposure to neglect subtypes, and examines the psychological impact. PARTICIPANTS AND SETTING: Pooled data from two representative U.S. samples from the National Surveys of Children's Exposure to Violence (NatSCEV) survey conducted in 2011 and 2014, representing the experiences of children and youth aged 1 month to 17 years (N = 8503). METHODS: Telephone surveys were used to obtain sociodemographic characteristics, six measures of past year and lifetime exposure to neglect, and assessments of trauma symptoms, suicidal ideation, alcohol use, and illicit drug use. RESULTS: More than 1 in 17 U.S. children (6.07%) experienced some form of neglect in the past year, and more than 1 in 7 (15.14%) experienced neglect at some point in their lives. Supervisory neglect, due to parental incapacitation or parental absence, was most common. Families with two biological parents had lower rates (4.29% in the past year) than other household configurations (range from 7.95% to 14.10%; p < .05). All types of neglect were associated with increased trauma symptoms and suicidal ideation (for 10-17 year olds), and several were associated with increased risk of underage alcohol and illicit drug use. CONCLUSION: More attention needs to be paid to the impact of supervisory neglect. These results underscore the importance of prevention strategies that provide the supports necessary to build safe, stable, and nurturing relationships and environments that help children thrive. |
The need to improve information on road user type in National Vital Statistics System mortality data
Mack KA , Hedegaard H , Ballesteros MF , Warner M , Eames J , Sauber-Schatz E . Traffic Inj Prev 2019 20 (3) 1-6 OBJECTIVES: Both the National Vital Statistics System (NVSS) and the Fatality Analysis Reporting System (FARS) can be used to examine motor vehicle crash (MVC) deaths. These 2 data systems operate independently, using different methods to collect and code information about the type of vehicle (e.g., car, truck, bus) and road user (e.g., occupant, motorcyclist, pedestrian) involved in an MVC. A substantial proportion of MVC deaths in NVSS are coded as "unspecified" road user, which reduces the utility of the NVSS data for describing burden and identifying prevention measures. This study aimed to describe characteristics of unspecified road user deaths in NVSS to further our understanding of how these groups may be similar to occupant road user deaths. METHODS: Using data from 1999 to 2015, we compared NVSS and FARS MVC death counts by road user type, overall and by age group, gender, and year. In addition, we examined factors associated with the categorization of an MVC death as unspecified road user such as state of residence of decedent, type of medical death investigation system, and place of death. RESULTS: The number of MVC occupant deaths in NVSS was smaller than that in FARS in each year and the number of unspecified road user deaths in NVSS was greater than that in FARS. The sum of the number of occupant and unspecified road user deaths in NVSS, however, was approximately equal to the number of FARS occupant deaths. Age group and gender distributions were roughly equivalent for NVSS and FARS occupants and NVSS unspecified road users. Within NVSS, the number of MVC deaths listed as unspecified road user varied across states and over time. Other categories of road users (motorcyclists, pedal cyclists, and pedestrians) were consistent when comparing NVSS and FARS. CONCLUSIONS: Our findings suggest that the unspecified road user MVC deaths in NVSS look similar to those of MVC occupants according to selected characteristics. Additional study is needed to identify documentation and reporting challenges in individual states and over time and to identify opportunities for improvement in the coding of road user type in NVSS. |
Building capacity for injury prevention: a process evaluation of a replication of the Cardiff Violence Prevention Programme in the Southeastern USA
Mercer Kollar LM , Sumner SA , Bartholow B , Wu DT , Moore JC , Mays EW , Atkins EV , Fraser DA , Flood CE , Shepherd JP . Inj Prev 2019 26 (3) 221-228 OBJECTIVES: Violence is a major public health problem in the USA. In 2016, more than 1.6 million assault-related injuries were treated in US emergency departments (EDs). Unfortunately, information about the magnitude and patterns of violent incidents is often incomplete and underreported to law enforcement (LE). In an effort to identify more complete information on violence for the development of prevention programme, a cross-sectoral Cardiff Violence Prevention Programme (Cardiff Model) partnership was established at a large, urban ED with a level I trauma designation and local metropolitan LE agency in the Atlanta, Georgia metropolitan area. The Cardiff Model is a promising violence prevention approach that promotes combining injury data from hospitals and LE. The objective was to describe the Cardiff Model implementation and collaboration between hospital and LE partners. METHODS: The Cardiff Model was replicated in the USA. A process evaluation was conducted by reviewing project materials, nurse surveys and interviews and ED-LE records. RESULTS: Cardiff Model replication centred around four activities: (1) collaboration between the hospital and LE to form a community safety partnership locally called the US Injury Prevention Partnership; (2) building hospital capacity for data collection; (3) data aggregation and analysis and (4) developing and implementing violence prevention interventions based on the data. CONCLUSIONS: The Cardiff Model can be implemented in the USA for sustainable violent injury data surveillance and sharing. Key components include building a strong ED-LE partnership, communicating with each other and hospital staff, engaging in capacity building and sustainability planning. |
Prevalence of violence victimization and perpetration among persons aged 13-24 years - four Sub-Saharan African countries, 2013-2015
Swedo EA , Sumner SA , Hillis SD , Aluzimbi G , Apondi R , Atuchukwu VO , Auld AF , Chipimo PJ , Conkling M , Egbe OE , Kalanda MSH , Mapoma CC , Phiri E , Wasula LN , Massetti GM . MMWR Morb Mortal Wkly Rep 2019 68 (15) 350-355 Violence is a major public health and human rights concern, claiming over 1.3 million lives globally each year (1). Despite the scope of this problem, population-based data on physical and sexual violence perpetration are scarce, particularly in low-income and middle-income countries (2,3). To better understand factors driving both children becoming victims of physical or sexual violence and subsequently (as adults) becoming perpetrators, CDC collaborated with four countries in sub-Saharan Africa (Malawi, Nigeria, Uganda, and Zambia) to conduct national household surveys of persons aged 13-24 years to measure experiences of violence victimization in childhood and subsequent perpetration of physical or sexual violence. Perpetration of physical or sexual violence was prevalent among both males and females, ranging among males from 29.5% in Nigeria to 51.5% in Malawi and among females from 15.3% in Zambia to 28.4% in Uganda. Experiencing physical, sexual, or emotional violence in childhood was the strongest predictor for perpetrating violence; a graded dose-response relationship emerged between the number of types of childhood violence experienced (i.e., physical, sexual, and emotional) and perpetration of violence. Efforts to prevent violence victimization need to begin early, requiring investment in the prevention of childhood violence and interventions to mitigate the negative effects of violence experienced by children. |
Streptococcus mitis Expressing Pneumococcal Serotype 1 Capsule.
Lessa FC , Milucky J , Rouphael NG , Bennett NM , Talbot HK , Harrison LH , Farley MM , Walston J , Pimenta F , Gertz RE , Rajam G , Carvalho MDG , Beall B , Whitney CG . Sci Rep 2018 8 (1) 17959 Streptococcus pneumoniae's polysaccharide capsule is an important virulence factor; vaccine-induced immunity to specific capsular polysaccharide effectively prevents disease. Serotype 1 S. pneumoniae is rarely found in healthy persons, but is highly invasive and a common cause of meningitis outbreaks and invasive disease outside of the United States. Here we show that genes for polysaccharide capsule similar to those expressed by pneumococci were commonly detected by polymerase chain reaction among upper respiratory tract samples from older US adults not carrying pneumococci. Serotype 1-specific genes were predominantly detected. In five oropharyngeal samples tested, serotype 1 gene belonging to S. mitis expressed capsules immunologically indistinct from pneumococcal capsules. Whole genome sequencing revealed three distinct S. mitis clones, each representing a cps1 operon highly similar to the pneumococcal cps1 reference operon. These findings raise important questions about the contribution of commensal streptococci to natural immunity against pneumococci, a leading cause of mortality worldwide. |
Sputum smear microscopy in the Xpert ® MTB/RIF era.
Van Deun A , Tahseen S , Affolabi D , Hossain MA , Joloba ML , Angra PK , Ridderhof JC , de Jong BC , Rieder HL . Int J Tuberc Lung Dis 2018 23 (1) 12-18 A balanced perspective is advocated for the assessment and application of the most recent and the oldest diagnostic methods for pulmonary tuberculosis (TB)—the molecular Xpert(®) MTB/RIF assay and microscopy for acid-fast bacilli. We discuss their respective merits and shortcomings and identify threats that may hamper their use in TB control. Neither test on its own provides all the information needed for diagnosis and treatment monitoring. Considering all aspects important for both individual patient care and disease control, neither seems ‘better' than the other. The required advancement of microscopy had already been hampered before the introduction of the GeneXpert technology by unsuccessful and probably misguided attempts to decentralise culture-based diagnosis and drug susceptibility testing. It seems evident that systematic replacement of microscopy by Xpert is not a viable option for the foreseeable future. Instead, the two methods should complement each other to arrive at a comprehensive, accessible and continuous service for a maximum number of patients. This will intrinsically prioritise targeting the most potent transmitters with the worst prognosis, simultaneously offering optimised prospects for efficient TB control. New microscopy and Xpert applications are expected to ultimately make control programmes independent of culture-based methods in diagnosis, treatment monitoring and outcome assessment. |
A high throughput neutralization test based on GFP expression by recombinant rabies virus
Burgado J , Greenberg L , Niezgoda M , Kumar A , Olson V , Wu X , Satheshkumar PS . PLoS Negl Trop Dis 2018 12 (12) e0007011 The effectiveness of rabies vaccination in both humans and animals is determined by the presence of virus neutralizing antibodies (VNAs). The Rapid Fluorescent Focus Inhibition Test (RFFIT) is the method traditionally used for detection and quantification of VNAs. It is a functional in vitro test for assessing the ability of antibodies in serum to bind and prevent infection of cultured cells with rabies virus (RABV). The RFFIT is a labor intensive, low throughput and semi-quantitative assay performed by trained laboratorians. It requires staining of RABV-infected cells by rabies specific fluorescent antibodies and manual quantification of fluorescent fields for titer determination. Although the quantification of fluorescent fields observed in each sample is recorded, the corresponding images are not stored or captured to be used for future analysis. To circumvent several of these disadvantages, we have developed an alternative, automated high throughput neutralization test (HTNT) for determination of rabies VNAs based on green fluorescent protein (GFP) expression by a recombinant RABV and compared with the RFFIT. The HTNT assay utilizes the recombinant RABV ERA variant expressing GFP with a nuclear localization signal (NLS) for efficient quantification. The HTNT is a quantitative method where the number of RABV-infected cells are determined and the images are stored for future analysis. Both RFFIT and HTNT results correlated 100% for a panel of human and animal positive and negative rabies serum samples. Although, the VNA titer values are generally agreeable, HTNT titers tend to be lower than that of RFFIT, probably due to the differences in quantification methods. Our data demonstrates the potential for HTNT assays in determination of rabies VNA titers. |
Impact of external quality assurance on the quality of Xpert MTB/RIF testing in Viet Nam
Gumma V , DeGruy K , Bennett D , Kim Thanh N , Albert H , Bond KB , Gutreuter S , Alexander H , Lan Thi Phong N , Rush TH , Viet Nhung N , Hung NV . J Clin Microbiol 2018 57 (3) Following the World Health Organization's (WHO) endorsement of the Xpert MTB/RIF (Cepheid, Sunnyvale, CA, USA) assay in 2010, Viet Nam's National TB Control Programme (NTP) began implementing GeneXpert instruments in NTP laboratories. In 2013, Viet Nam's National Tuberculosis (TB) Programme implemented an Xpert MTB/RIF External Quality Assurance (EQA) programme in collaboration with the United States Centers for Disease Control and Prevention (CDC) and the Foundation for Innovative New Diagnostics (FIND). Proficiency testing (PT) panels comprising five dried tube specimens (DTS) were sent to participating sites approximately twice per annum from October 2013 to July 2016. The number of enrolled laboratories increased from 22 to 39 during the study period. Testing accuracy was assessed by comparing reported and expected results, percentage scores were assigned, and feedback reports were provided to sites. On-site evaluation (OSE) was conducted for under-performing laboratories. Results from the first five rounds demonstrate the positive impact of PT and targeted OSE visits on testing quality. On average, for every additional round of feedback, the odds of achieving PT scores of >/=80% increased 2.04-fold (95% CI 1.39-3.00). Future work will include scale up of PT to all sites and maintaining performance of participating laboratories, while developing local panel production capacity. |
Rapid detection of new B/Victoria-lineage haemagglutinin variants of influenza B viruses by pyrosequencing
Lau H , Deng YM , Xu X , Sessions W , Barr IG . Diagn Microbiol Infect Dis 2018 93 (4) 311-317 During 2016/2017, several antigenically and genetically distinct variant viruses of the influenza B/Victoria/2/87-lineage (B/Vic) viruses, which have either deletions or mutations in the haemagglutinin (HA) emerged and co-circulated with other influenza B viruses from both the B/Vic and B/Yamagata/16/88-lineages (B/Yam). In this study we developed a pyrosequencing assay that can detect and differentiate multiple influenza B virus variants currently in circulation. The assay targets a region of HA sequence that is unique for each of the B/Yam, B/Vic and B/Vic variant viruses. Our results demonstrated that it is a rapid, robust, high-throughput assay, highly sensitive and specific in differentiating among the B/Yam, B/Vic and B/Vic variant viruses, giving it an advantage over an existing rRT-PCR method. It works well for influenza virus isolates as well as original clinical respiratory specimens, and can therefore be used to provide important information for surveillance by closely monitoring the spread of these B/Vic variants. |
Rapid antimicrobial susceptibility testing and beta-lactam-induced cell morphology changes of Gram-negative biological threat pathogens by optical screening
McLaughlin HP , Sue D . BMC Microbiol 2018 18 (1) 218 BACKGROUND: For Yersinia pestis, Burkholderia pseudomallei, and Burkholderia mallei, conventional broth microdilution (BMD) is considered the gold standard for antimicrobial susceptibility testing (AST) and, depending on the species, requires an incubation period of 16-20 h, or 24-48 h according to the Clinical and Laboratory Standards Institute (CLSI) guidelines. After a diagnosis of plague, melioidosis or glanders during an outbreak or after an exposure event, the timely distribution of appropriate antibiotics for treatment or post-exposure prophylaxis of affected populations could reduce mortality rates. RESULTS: Herein, we developed and evaluated a rapid, automated susceptibility test for these Gram-negative bacterial pathogens based on time-lapse imaging of cells incubating in BMD microtitre drug panels using an optical screening instrument (oCelloScope). In real-time, the instrument screened each inoculated well containing broth with various concentrations of antibiotics published by CLSI for primary testing: ciprofloxacin (CIP), doxycycline (DOX) and gentamicin (GEN) for Y. pestis; imipenem (IPM), ceftazidime (CAZ) and DOX for B. mallei; and IPM, DOX, CAZ, amoxicillin-clavulanic acid (AMC) and trimethoprim-sulfamethoxazole (SXT) for B. pseudomallei. Based on automated growth kinetic data, the time required to accurately determine susceptibility decreased by >/=70% for Y. pestis and >/= 50% for B. mallei and B. pseudomallei compared to the times required for conventional BMD testing. Susceptibility to GEN, IPM and DOX could be determined in as early as three to six hours. In the presence of CAZ, susceptibility based on instrument-derived growth values could not be determined for the majority of B. pseudomallei and B. mallei strains tested. Time-lapse video imaging of these cultures revealed that the formation of filaments in the presence of this cephalosporin at inhibitory concentrations was detected as growth. Other beta-lactam-induced cell morphology changes, such as the formation of spheroplasts and rapid cell lysis, were also observed and appear to be strain- and antibiotic concentration-dependent. CONCLUSIONS: A rapid, functional AST was developed and real-time video footage captured beta-lactam-induced morphologies of wild-type B. mallei and B. pseudomallei strains in broth. Optical screening reduced the time to results required for AST of three Gram-negative biothreat pathogens using clinically relevant, first-line antibiotics compared to conventional BMD. |
In vitro activity of EDTA and TOL-463 against Neisseria gonorrhoeae
Nash EE , Henning TC , Pham CD , Pettus K , Sharpe S , Kersh EN . Diagn Microbiol Infect Dis 2018 93 (4) 369-371 Neisseria gonorrhoeae quickly develops drug resistance. Time-kill curves revealed that EDTA and TOL-463 inhibit growth similar to penicillin, ciprofloxacin, and azithromycin. Furthermore, synergistic and additive antimicrobial interactions occurred when EDTA and TOL-463 were combined with penicillin or azithromycin, respectively, suggesting that further investigations into these unconventional antimicrobials may be advantageous. |
Acute vibration induces peripheral nerve sensitization in a rat tail model: Possible role of oxidative stress and inflammation
Pacurari M , Waugh S , Krajnak K . Neuroscience 2018 398 263-272 Prolonged occupational exposure to hand-held vibrating tools leads to pain and reductions in tactile sensitivity, grip strength and manual dexterity. The goal of the current study was to use a rat-tail vibration model to determine how vibration frequency influences factors related to nerve injury and dysfunction. Rats were exposed to restraint, or restraint plus tail vibration at 62.5 Hz or 250 Hz. Nerve function was assessed using the current perception threshold (CPT) test. Exposure to vibration at 62.5 and 250 Hz, resulted in a reduction in the CPT at 2000 and 250 Hz electrical stimulation (i.e. increased Abeta and Adelta, nerve fiber sensitivity). Vibration exposure at 250 Hz also resulted in an increased sensitivity of C-fibers to electrical stimulation and thermal nociception. These changes in nerve fiber sensitivity were associated with increased expression of interleukin (IL)-1beta and tumor necrosis factor (TNF)-alpha in ventral tail nerves, and increases in circulating concentrations of IL-1 beta in rats exposed to 250 Hz vibration. There was an increase in glutathione, but no changes in other measures of oxidative activity in the peripheral nerve. However, measures of oxidative stress were increased in the dorsal root ganglia (DRG). These changes in pro-inflammatory factors and markers of oxidative stress in the peripheral nerve and DRG were associated with inflammation, and reductions in myelin basic protein and post-synaptic density protein (PSD)-95 gene expression, suggesting that vibration induced changes in sensory function may be the result of changes at the exposed nerve, the DRG and/or the spinal cord. |
Development of Onchocerca volvulus in humanized NSG mice and detection of parasite biomarkers in urine and serum
Patton JB , Bennuru S , Eberhard ML , Hess JA , Torigian A , Lustigman S , Nutman TB , Abraham D . PLoS Negl Trop Dis 2018 12 (12) e0006977 BACKGROUND: The study of Onchocerca volvulus has been limited by its host range, with only humans and non-human primates shown to be susceptible to the full life cycle infection. Small animal models that support the development of adult parasites have not been identified. METHODOLOGY/PRINCIPAL FINDINGS: We hypothesized that highly immunodeficient NSG mice would support the survival and maturation of O. volvulus and alteration of the host microenvironment through the addition of various human cells and tissues would further enhance the level of parasite maturation. NSG mice were humanized with: (1) umbilical cord derived CD34+ stem cells, (2) fetal derived liver, thymus and CD34+ stem cells or (3) primary human skeletal muscle cells. NSG and humanized NSG mice were infected with 100 O. volvulus infective larvae (L3) for 4 to 12 weeks. When necropsies of infected animals were performed, it was observed that parasites survived and developed throughout the infection time course. In each of the different humanized mouse models, worms matured from L3 to advanced fourth stage larvae, with both male and female organ development. In addition, worms increased in length by up to 4-fold. Serum and urine, collected from humanized mice for identification of potential biomarkers of infection, allowed for the identification of 10 O. volvulus-derived proteins found specifically in either the urine or the serum of the humanized O. volvulus-infected NSG mice. CONCLUSIONS/SIGNIFICANCE: The newly identified mouse models for onchocerciasis will enable the development of O. volvulus specific biomarkers, screening for new therapeutic approaches and potentially studying the human immune response to infection with O. volvulus. |
Identifying preanalytic and postanalytic laboratory quality gaps using a data warehouse and structured multidisciplinary process
Raebel MA , Quintana LM , Schroeder EB , Shetterly SM , Pieper LE , Epner PL , Bechtel LK , Smith DH , Sterrett AT , Chorny JA , Lubin IM . Arch Pathol Lab Med 2018 143 (4) 518-524 CONTEXT.-: The laboratory total testing process includes preanalytic, analytic, and postanalytic phases, but most laboratory quality improvement efforts address the analytic phase. Expanding quality improvement to preanalytic and postanalytic phases via use of medical data warehouses, repositories that include clinical, utilization, and administrative data, can improve patient care by ensuring appropriate test utilization. Cross-department, multidisciplinary collaboration to address gaps and improve patient and system outcomes is beneficial. OBJECTIVE.-: To demonstrate medical data warehouse utility for characterizing laboratory-associated quality gaps amenable to preanalytic or postanalytic interventions. DESIGN.-: A multidisciplinary team identified quality gaps. Medical data warehouse data were queried to characterize gaps. Organizational leaders were interviewed about quality improvement priorities. A decision aid with elements including national guidelines, local and national importance, and measurable outcomes was completed for each gap. RESULTS.-: Gaps identified included (1) test ordering; (2) diagnosis, detection, and documentation, and (3) high-risk medication monitoring. After examination of medical data warehouse data including enrollment, diagnoses, laboratory, pharmacy, and procedures for baseline performance, high-risk medication monitoring was selected, specifically alanine aminotransferase, aspartate aminotransferase, complete blood count, and creatinine testing among patients receiving disease-modifying antirheumatic drugs. The test utilization gap was in monitoring timeliness (eg, >60% of patients had a monitoring gap exceeding the guideline recommended frequency). Other contributors to selecting this gap were organizational enthusiasm, regulatory labeling, and feasibility of a significant laboratory role in addressing the gap. CONCLUSIONS.-: A multidisciplinary process facilitated identification and selection of a laboratory medicine quality gap. Medical data warehouse data were instrumental in characterizing gaps. |
Novel mass spectrometry based detection and identification of variants of rabies virus nucleoprotein in infected brain tissues
Reed M , Stuchlik O , Carson WC , Orciari L , Yager PA , Olson V , Li Y , Wu X , Pohl J , Satheshkumar PS . PLoS Negl Trop Dis 2018 12 (12) e0006984 Human rabies is an encephalitic disease transmitted by animals infected with lyssaviruses. The most common lyssavirus that causes human infection is rabies virus (RABV), the prototypic member of the genus. The incubation period of RABV in humans varies from few weeks to several months in some instances. During this prodromal period, neither antibodies nor virus is detected. Antibodies, antigen and nucleic acids are detectable only after the onset of encephalitic symptoms, at which point the outcome of the disease is nearly 100% fatal. Hence, the primary intervention for human RABV exposure and subsequent post-exposure prophylaxis relies on testing animals suspected of having rabies. The most widely used diagnostic tests in animals focus on antigen detection, RABV-encoded nucleoprotein (N protein) in brain tissues. N protein accumulates in the cytoplasm of infected cells as large and granular inclusions, which are visualized in infected brain tissues by immuno-microscopy using anti-N protein antibodies. In this study, we explored a mass spectrometry (MS) based method for N protein detection without the need for any specific antibody reagents or microscopy. The MS-based method described here is unbiased, label-free, requires no amplification and determines any previously sequenced N protein available in the database. The results demonstrate the ability of MS/MS based method for N protein detection and amino acid sequence determination in animal diagnostic samples to obtain RABV variant information. This study demonstrates a potential for future developments of rabies diagnostic tests based on MS platforms. |
Chronic stress exposure and daily stress appraisals relate to biological aging marker p16(INK4a)
Rentscher KE , Carroll JE , Repetti RL , Cole SW , Reynolds BM , Robles TF . Psychoneuroendocrinology 2018 102 139-148 Previous research has linked exposure to adverse social conditions with DNA damage and accelerated telomere shortening, raising the possibility that chronic stress may impact biological aging pathways, ultimately increasing risk for age-related diseases. Less clear, however, is whether these stress-related effects extend to additional hallmarks of biological aging, including cellular senescence, a stable state of cell cycle arrest. The present study aimed to investigate associations between psychosocial stress and two markers of cellular aging-leukocyte telomere length (LTL) and cellular senescence signal p16(INK4a). Seventy-three adults (Mage = 43.0, SD = 7.2; 55% female) with children between 8-13 years of age completed interview-based and questionnaire measures of their exposures to and experiences of stress, as well as daily reports of stress appraisals over an 8-week diary period. Blood samples were used to assess markers of cellular aging: LTL and gene expression of senescent cell signal p16(INK4a) (CDKN2A). Random effects models covarying for age, sex, ethnicity/race, and BMI revealed that participants with greater chronic stress exposure over the previous 6 months (b = 0.011, p = .04), perceived stress (b = 0.020, p < .001), and accumulated daily stress appraisals over the 8-week period (b = 0.013, p = .02) showed increased p16(INK4a). No significant associations with LTL were found. These findings extend previous work on the impact of stress on biological aging by linking chronic stress exposure and daily stressful experiences to an accumulation of senescent cells. Findings also support the hypothesis that chronic stress is associated with accelerated aging by inducing cellular senescence, a common correlate of age-related diseases. |
The fungal Cyp51 specific inhibitor VT-1598 demonstrates in vitro and in vivo activity against Candida auris
Wiederhold NP , Lockhart SR , Najvar LK , Berkow EL , Jaramillo R , Olivo M , Garvey EP , Yates CM , Schotzinger RJ , Catano G , Patterson TF . Antimicrob Agents Chemother 2018 63 (3) Candida auris is an emerging pathogen associated with significant mortality and often multi-drug resistance. VT-1598, a tetrazole-based fungal CYP51-specific inhibitor, was evaluated in vitro and in vivo against C. auris Susceptibility testing was performed against 100 clinical isolates of C. auris by broth microdilution. Neutropenic mice were infected intravenously with C. auris, and treatment began 24 hours post-inoculation with vehicle control, oral VT-1598 (5, 15, and 50 mg/kg once daily), oral fluconazole (20 mg/kg once daily), or intraperitoneal caspofungin (10 mg/kg once daily), which continued for 7 days. Fungal burden was assessed in the kidneys and brains on day 8 in the fungal burden arm, and on the days the mice succumbed to infection or on day 21 in the survival arm. VT-1598 plasma trough concentrations were also assessed on day 8. VT-1598 demonstrated in vitro activity against C. auris, with a mode MIC of 0.25 mug/mL and MICs ranging from 0.03 to 8 mug/mL. Treatment with VT-1598 resulted in significant and dose-dependent improvements in survival (median survival 15 and >21 days for VT-1598 15 and 50 mg/kg, respectively) and reductions in kidney and brain fungal burden (1.88 to 3.61 log10 CFU/g reduction) compared to control (5 days). The reductions in fungal burden correlated with plasma trough concentrations. Treatment with caspofungin, but not fluconazole, also resulted in significant improvements in survival and reductions in fungal burden compared to control. These results suggest that VT-1598 may be a future option for the treatment of invasive infections caused by C. auris. |
A brief overview of HPLC-MS analysis of alkyl methylphosphonic acid degradation products of nerve agents
B'Hymer C . J Chromatogr Sci 2019 57 (7) 606-617 The analysis of degradation products from the classic chemical warfare nerve agents by high-performance liquid chromatography-mass spectrometry has been of much interest in recent years owing to the possible use as a terrorist weapon, and the incidents of chemical weapon usage in recent years in war torn countries. The alkyl methylphosphonic acid degradation products are of a particular interest, and they represent a specific chromatographic technical challenge for use in typical separation systems. Various published methods are summarized in this review and some of the problems associated with the analysis of these compounds are discussed. Future trends of the analysis in this area of research are also considered. |
Performance and workflow assessment of six nucleic acid extraction technologies for use in resource limited settings
Beall SG , Cantera J , Diaz MH , Winchell JM , Lillis L , White H , Kalnoky M , Gallarda J , Boyle DS . PLoS One 2019 14 (4) e0215753 Infectious disease nucleic acid amplification technologies (NAAT) have superior sensitivity, specificity, and rapid time to result compared to traditional microbiological methods. Recovery of concentrated, high quality pathogen nucleic acid (NA) from complex specimen matrices is required for optimal performance of several NA amplification/detection technologies such as polymerase chain reaction (PCR). Fully integrated NAAT platforms that enable rapid sample-to-result workflows with minimal user input are generally restricted to larger reference lab settings, and their complexity and cost are prohibitive to widespread implementation in resource limited settings (RLS). Identification of component technologies for incorporation of reliable and affordable sample preparation with pathogen NA amplification/detection into an integrated platform suitable for RLS, is a necessary first step toward achieving the overarching goal of reducing infectious disease-associated morbidity and mortality globally. In the current study, we evaluate the performance of six novel NA extraction technologies from different developers using blinded panels of stool, sputum and blood spiked with variable amounts of quality-controlled DNA- and/or RNA-based microbes. The extraction efficiencies were semi-quantitatively assessed using validated real-time reverse transcription (RT)-PCR assays specific for each microbe and comparing target-specific RT-PCR results to those obtained with reference NA extraction methods. The technologies were ranked based on overall diagnostic accuracy (analytical sensitivity and specificity). Sample input and output volumes, total processing time, user-required manual steps and cost estimates were also examined for suitability in RLS. Together with the performance analysis, these metrics were used to select the more suitable candidate technologies for further optimization of integrated NA amplification and detection technologies for RLS. |
Optimization of commercially available Zika virus antibodies for use in a laboratory-developed immunohistochemical assay
Bollweg BC , Silva-Flannery L , Spivey P , Hale GL . J Pathol Clin Res 2018 4 (1) 19-25 Zika virus (ZIKV) infection during pregnancy can cause adverse fetal outcomes and severe irreversible congenital birth defects including microcephaly. Immunohistochemistry (IHC) is a valuable diagnostic tool for detecting ZIKV antigens in tissues from cases of fetal loss in women infected with ZIKV, and for providing insights into disease pathogenesis. As a result, there is increasing demand for commercially available ZIKV antibodies for use in IHC assays. ZIKV antibodies were selected and obtained from commercial sources to include both mouse and rabbit hosts, and a variety of antigenic targets. Pretreatment conditions and antibody concentrations resulting in optimal immunohistochemical staining were determined using ZIKV cell control and polymerase chain reaction (PCR)-confirmed ZIKV case control material (fetal brain tissue). Cross-reactivity of the antibodies against other flaviviruses (dengue virus serogroups 1-4, yellow fever virus, Japanese encephalitis virus, West Nile virus) and chikungunya virus was also evaluated. Immunostaining using the commercially available antibodies was compared to a previously validated ZIKV IHC assay used for primary diagnosis. Four antibodies demonstrated optimal staining similar to the previously validated ZIKV IHC assay. Two of the four antibodies cross-reacted with dengue virus, while the other two antibodies showed no cross-reactivity with dengue, other flaviviruses, or chikungunya virus. Differences in the cross-reactivity profiles could not be entirely explained by the antigenic target. Commercially available ZIKV antibodies can be optimized for use in IHC testing to aid in ZIKV diagnostic testing and an evaluation of tissue tropism. |
Health care, family, and community factors associated with mental, behavioral, and developmental disorders and poverty among children aged 2-8 years - United States, 2016
Cree RA , Bitsko RH , Robinson LR , Holbrook JR , Danielson ML , Smith C , Kaminski JW , Kenney MK , Peacock G . MMWR Morb Mortal Wkly Rep 2018 67 (50) 1377-1383 Childhood mental, behavioral, and developmental disorders (MBDDs) are associated with adverse outcomes that can persist into adulthood (1,2). Pediatric clinical settings are important for identifying and treating MBDDs (3). Early identification and treatment of MBDDs can promote healthy development for all children (4), especially those living in poverty who are at increased risk for MBDDs (3,5) but might have reduced access to care (6). CDC analyzed data from the 2016 National Survey of Children's Health (NSCH) on MBDDs, risk factors, and use of federal assistance programs (e.g., Supplemental Nutrition Assistance Program [SNAP]) to identify points to reach children in poverty. In line with previous research (3,6), compared with children in higher-income households, those in lower-income households more often had ever received a diagnosis of an MBDD (22.1% versus 13.9%), and less often had seen a health care provider in the previous year (80.4% versus 93.8%). Among children living below 200% of the federal poverty level (FPL) who did not see a health care provider in the previous year, seven of 10 were in families receiving at least one public assistance benefit. Public assistance programs might offer collaboration opportunities to provide families living in poverty with information, co-located screening programs or services, or connection to care. |
Treatment patterns and costs among children aged 2 to 17 years with ADHD in New York State Medicaid in 2013
Guo L , Danielson M , Cogan L , Hines L , Armour B . J Atten Disord 2018 25 (4) 463-472 OBJECTIVE: To identify children with ADHD enrolled in New York State (NYS) Medicaid and characterize ADHD-associated costs by treatment category. METHOD: In 2013, 1.4 million children aged 2 to 17 years were enrolled in NYS Medicaid. Medicaid claims and encounters were used to identify children with ADHD, classify them by type of treatment received, and estimate associated costs. RESULTS: The ADHD cohort comprised 5.4% of all Medicaid-enrolled children, with 35.0% receiving medication only, 16.2% receiving psychological services only, 42.2% receiving both, and 6.6% receiving neither. The total costs for the ADHD cohort (US$729.3 million) accounted for 18.1% of the total costs for children enrolled in NYS Medicaid. CONCLUSION: This study underscores the importance of achieving a better understanding of children with ADHD enrolled in NYS Medicaid. A framework to categorize children with ADHD based on their treatment categories may help to target interventions to improve the quality of care and reduce costs. |
A compilation of national plans, policies and government actions for rare diseases in 23 countries
Khosla N , Valdez R . Intractable Rare Dis Res 2018 7 (4) 213-222 Previous studies have focused on the comparison of specific laws among multiple countries and regions; for example, laws related to facilitating treatments with orphan drugs or laws seeking to address the multiple needs of patients with rare diseases. The purpose of this scoping review is to examine and compare published reports on national plans, polices and legislation related to all rare diseases in different countries. We also examine strategies or programs that countries may have for these diseases. Articles were obtained from journals and books published between January 1, 2000, through December 15, 2017. Reports from the grey literature (documents issued by government and private organizations) were included if they were available on the internet. The databases used were Google and Google Scholar, PubMed, and the websites of Orphanet and the National Organization for Rare Disorders (NORD). We obtained information on 23 countries. Among these countries, the way in which rare diseases were defined varied from having similar definitions to no definition. Multinational programs supported by common or similar laws are likely to have a greater impact on rare diseases than single country programs. |
One-carbon cofactor intake and risk of neural tube defects among women who meet folic acid recommendations: A multicenter case-control study
Petersen JM , Parker SE , Crider KS , Tinker SC , Mitchell AA , Werler MM . Am J Epidemiol 2019 188 (6) 1136-1143 We aimed to investigate associations between individual and concurrent (>/=2) intakes of one-carbon cofactors vitamins B6 and B12, choline, betaine, and methionine and neural tube defect (NTD) outcomes among mothers meeting the folic acid recommendations. In the Slone Birth Defects Study (case-control design; North America, 1998-2015), mothers of 164 NTD cases and 2,831 nonmalformed controls completed food frequency questionnaires and structured interviews. Estimated intakes of one-carbon cofactors were dichotomized (high vs. low) for all except betaine (low or middle vs. high). We used logistic regression models to estimate odds ratios and 95% confidence intervals adjusted for center, age, and race. The analysis was restricted to mothers with estimated daily total folate intake of >/=400 mug during periconception. Fewer cases, compared with controls, had high intakes for each one-carbon cofactor except betaine, where the starkest contrast occurred in the middle group. Women with concurrent high intakes of B6, B12, choline, and methionine and moderate intake of betaine had approximately half the risk of an NTD-affected pregnancy (odds ratio = 0.49, 95% confidence interval: 0.23, 1.08). These findings suggest that, in the presence of folic acid, one-carbon cofactors-notably when consumed together-might reduce NTD risk. Additional research should inform any changes to clinical recommendations. |
Analysis of gateroad stability at two longwall mines based on field monitoring results and numerical model analysis
Esterhuizen GS , Gearhart DF , Klemetti T , Dougherty H , van Dyke M . Int J Min Sci Technol 2018 29 (1) 35-43 Coal mine longwall gateroads are subject to changing loading conditions induced by the advancing longwall face. The ground response and support requirements are closely related to the magnitude and orientation of the stress changes, as well as the local geology. This paper presents the monitoring results of gateroad response and support performance at two longwall mines at a 180-m and 600-m depth of cover. At the first mine, a three-entry gateroad layout was used. The second mine used a four-entry, yield-abutment-yield gateroad pillar system. Local ground deformation and support response were monitored at both sites. The monitoring period started during the development stage and continued during first panel retreat and up to second panel retreat. The two data sets were used to compare the response of the entries in two very different geotechnical settings and different gateroad layouts. The monitoring results were used to validate numerical models that simulate the loading conditions and entry response for these widely differing conditions. The validated models were used to compare the load path and ground response at the two mines. This paper demonstrates the potential for numerical models to assist mine engineers in optimizing longwall layouts and gateroad support systems. |
Development of a fault-rupture environment in 3D: A numerical tool for examining the mechanical impact of a fault on underground excavations
Kim BH , Larson MK . Int J Min Sci Technol 2018 29 (1) 105-111 While faults are commonly simulated as a single planar or non-planar interface for a safety or stability analysis in underground mining excavation, the real 3D structure of a fault is often very complex, with different branches that reactivate at different times. Furthermore, these branches are zones of nonzero thickness where material continuously undergoes damage even during interseismic periods. In this study, the initiation and the initial evolution of a strike-slip fault was modeled using the FLAC3D software program. The initial and boundary conditions are simplified, and mimic the Riedel shear experiment and the constitutive model in the literature. The FLAC3D model successfully replicates and creates the 3D fault zone as a strike-slip type structure in the entire thickness of the model. The strike-slip fault structure and normal displacement result in the formation of valleys in the model. Three panels of a longwall excavation are virtually placed and excavated beneath a main valley. The characteristics of stored and dissipated energy associated with the panel excavations are examined and observed at different stages of shear strain in the fault to evaluate bump potential. Depending on the shear strain in the fault, the energy characteristics adjacent to the longwall panels present different degrees of bump potential, which is not possible to capture by conventional fault simulation using an interface. |
Ground response to high horizontal stresses during longwall retreat and its implications for longwall headgate support
Zhang P , Gearhart D , Dyke MV , Su D , Esterhuizen E , Tulu B . Int J Min Sci Technol 2018 26 (1) 27-33 Roof falls in longwall headgate can occur when weak roof and high horizontal stress are present. To prevent roof falls in the headgate under high horizontal stress, it is important to understand the ground response to high horizontal stress in the longwall headgate and the requirements for supplemental roof support. In this study, a longwall headgate under high horizontal stress was instrumented to monitor stress change in the pillars, deformations in the roof, and load in the cable bolts. The conditions in the headgate were monitored for about six months as the longwall face passed by the instrumented site. The roof behavior in the headgate near the face was carefully observed during longwall retreat. Numerical modeling was performed to correlate the modeling results with underground observation and instrumentation data and to quantify the effect of high horizontal stress on roof stability in the long-wall headgate. This paper discusses roof support requirements in the longwall headgate under high horizontal stress in regard to the pattern of supplemental cable bolts and the critical locations where additional supplemental support is necessary. |
Four years after implementation of a national micronutrient powder program in Kyrgyzstan, prevalence of iron deficiency and iron deficiency anemia is lower, but prevalence of vitamin A deficiency is higher
Lundeen EA , Lind JN , Clarke KEN , Aburto NJ , Imanalieva C , Mamyrbaeva T , Ismailova A , Timmer A , Whitehead RDJr , Praslova L , Samohleb G , Minbaev M , Addo OY , Serdula MK . Eur J Clin Nutr 2018 73 (3) 416-423 BACKGROUND/OBJECTIVES: In 2009, the Ministry of Health of Kyrgyzstan launched a national Infant and Young Child Nutrition (IYCN) program which included point-of-use fortification of foods with micronutrient powders (MNP) containing iron, vitamin A, and other micronutrients. Caretakers of children aged 6-23 months were given 30 sachets of MNP every 2 months. Micronutrient surveys were conducted in 2009 and 2013. The objective of the study was to compare the prevalence of anemia and deficiencies of iron and vitamin A among children aged 6-29 months prior to the MNP program (2009) with those after full implementation (2013). SUBJECTS/METHODS: Cross-sectional national surveys were conducted in 2009 (n = 666) and 2013 (n = 2150). Capillary blood samples were collected to measure hemoglobin, iron (ferritin and soluble transferrin receptor [sTfR]) and vitamin A (retinol binding protein [RBP]) status, and inflammation status (C-reactive protein [CRP] and alpha-1-acid glycoprotein [AGP]). Ferritin, sTfR, and RBP were adjusted for inflammation; hemoglobin was adjusted for altitude. RESULTS: The prevalence of anemia was non-significantly lower in 2013 compared to 2009 (32.7% vs. 39.0%, p = 0.076). Prevalence of inflammation-adjusted iron deficiency (54.8% vs. 74.2%, p<0.001) and iron deficiency anemia (IDA, 25.5% vs. 35.1%, p = 0.003) were lower and the prevalence of inflammation-adjusted vitamin A deficiency was higher (4.3% vs. 2.0%, p = 0.013) in 2013 compared to 2009. CONCLUSIONS: Four years after the initiation of a national Infant and Young Child Nutrition program including the introduction of point-of-use fortification with MNP, the prevalence of iron deficiency and IDA is lower, but the prevalence of vitamin A deficiency is higher. |
Field evaluation of sequential hand wipes for flame retardant exposure in an electronics recycling facility
Beaucham CC , Ceballos D , Mueller C , Page E , La Guardia MJ . Chemosphere 2018 219 472-481 Flame retardants have been associated with endocrine disorders, thyroid disruption, reproductive toxicity, and immunological interference. Through dismantling and recycling electronics and electric products, flame retardants can be released into the air and settle on work surfaces which may lead to dermal exposure. Hand wipe sampling is commonly used to evaluate dermal exposure. This study assesses the removal efficiency of wipes on the hands of recycling employees, and to compare the efficacy of two common surface wipe sampling materials. We used three sequential hand wipes and quantified the percentage of flame retardants that was removed by each hand wipe in the sequence. Two common wipe materials (gauze and twill) were used to compare the ability to remove flame retardants. The wipes were collected from 12 employees at a U.S. electronics recycling facility immediately at the end of their shift, prior to washing their hands. Results show that although the first wipe removed the highest median percent of the sum of the three wipes for most flame retardants, there was a wide range of the percentages of total individual flame retardants removed by both gauze (4%-98%) or twill hand wipe (1%-89%). Approximately half of the flame retardants a high percentage (>50%) removed by the second and third wipes. This suggests that a single wipe is not sufficient to characterize the extent of dermal contamination. The average of the total amount of flame retardants removed by twill wipes was greater than the average using gauze, but the difference was not statistically significant. |
Effectiveness of a no-cost-to-workers, slip-resistant footwear program for reducing slipping-related injuries in food service workers: a cluster randomized trial
Bell JL , Collins JW , Chiou S . Scand J Work Environ Health 2018 45 (2) 194-202 Objective This study evaluated the effectiveness of a no-cost-to-workers, slip-resistant footwear (SRF) program in preventing workers' compensation injury claims caused by slipping on wet or greasy floors. Methods The study population was a dynamic cohort of food service workers from 226 school districts' kindergarten through 12th grade food service operations. A two-arm cluster randomized controlled study design was implemented, with school districts randomized to the intervention group receiving SRF. Data were analyzed according to the intent-to-treat principle. Logistic regression was used to analyze dichotomous response data (injured based on workers' compensation injury claims data, or not injured, for each month worked). Changes in slipping injury rates from baseline to post-intervention follow-up periods were compared between treatment groups. Results The probability of a slipping injury was reduced significantly in the intervention group, from a baseline measure of 3.54 slipping injuries per 10 000 worker-months to 1.18 slipping injuries per 10 000 worker-months in the follow-up period [adjusted odds ratio (OR adj) 0.33, 95% confidence interval (CI) 0.17-0.63]. In the control group, slipping injuries were 2.01 per 10 000 worker-months in the baseline, and 2.30 per 10 000 worker-months in the follow-up. The interaction between treatment group and time period (baseline or follow-up) indicated that the decline seen in the intervention group was significantly different than the increase seen in the control group (OR adj0.29, 95% CI 0.11-0.74, adjusted for age >55 years). Conclusions This study provides evidence for the effectiveness of a no-cost-to-workers SRF program in reducing slipping-related workers' compensation injury claims in food service workers. |
NIOSH's Respiratory Health Division: 50 years of science and service
Cummings KJ , Johns DO , Mazurek JM , Hearl FJ , Weissman DN . Arch Environ Occup Health 2018 74 1-15 The year 2017 marked the 50th anniversary of NIOSH's Respiratory Health Division (RHD). RHD began in 1967 as the Appalachian Laboratory for Occupational Respiratory Diseases (ALFORD), with a focus on coal workers' pneumoconiosis. ALFORD became part of NIOSH in 1971 and added activities to address work-related respiratory disease more generally. Health hazard evaluations played an important role in understanding novel respiratory hazards such as nylon flock, diacetyl, and indium-tin oxide. Epidemiologic and laboratory studies addressed many respiratory hazards, including coal mine dust, silica, asbestos, cotton dust, beryllium, diesel exhaust, and dampness and mold. Surveillance activities tracked the burden of diseases and enhanced the quality of spirometry and chest radiography used to screen workers. RHD's efforts to improve scientific understanding, inform strategies for prevention, and disseminate knowledge remain important now and for the future. |
Summary of recommendations from the National Institute for Occupational Safety and Health Fire Fighter Fatality Investigation and Prevention Program, 20062014
Hard DL , Marsh SM , Merinar TR , Bowyer ME , Miles ST , Loflin ME , Moore PH . J Safety Res 2018 68 21-25 Introduction: The NIOSH Fire Fighter Fatality Investigation and Prevention Program (FFFIPP) conducts independent investigations of selected fire fighter line-of-duty deaths (LODD) and offers recommendations to prevent similar deaths. The purpose of the current study was to provide information on more recent FFFIPP recommendations and to determine if recommendations have changed over time. Methods: Fatality investigations completed from 2006 to 2014 were selected for this study with recommendations being assigned into twelve major categories when possible. The most frequently occurring recommendations were then rank ordered overall and then by medical and traumatic fire fighter LODD. Results: There were 1,067 total recommendations made in the published fire fighter investigative reports for both medical and trauma-related fire fighter fatalities for the period 2006–2014. Of these, 784 (73%) could be placed within one of the 12 categories noted previously. The top 10 recommendation categories overall were: 1. Medical screening, 2. Fitness and wellness program, 3. Training, 4. Medical clearance, 5. Standard Operating Procedures/Standard Operating Guidelines (SOPs/SOGs), 6. Incident command, 7. Strategy and tactics, 8. Communications, 9. Personal protective equipment and 10. Staffing. Conclusions: The leading recommendations from the NIOSH FFFIPP medical investigations between 2006 and 2014 did not change compared to those made between 1998 and 2005, with the exception of the addition of “medical clearance for duty”. There were changes for the traumatic injury leading recommendations for 2006–2014, with the major change being “training”, which was the leading FFFIPP recommendation for traumatic injuries for this time period. Practical applications: The intent of the FFFIPP is to influence fire departments and fire fighters to critically assess and evaluate situations/circumstances similar to those identified by NIOSH investigations and implement the recommendations offered to prevent additional fire fighter fatalities. |
Airflow obstruction among ever-employed U.S. adults aged 18-79 years by industry and occupation: NHANES 2007-2008 to 2011-2012
Kurth L , Doney B , Halldin C , Hale J , Frenk SM . Am J Ind Med 2018 62 (1) 30-42 INTRODUCTION: This study estimated the prevalence of spirometry-defined airflow obstruction by industry and occupation and chronic obstructive pulmonary disease (COPD) among ever-employed U.S. adults. METHODS: Data came from the National Health and Nutrition Examination Survey (NHANES) 2007-2008 to 2011-2012, a nationally representative study of the non-institutionalized civilian U.S. POPULATION: Data on respondent's current and/or longest held job were used to create prevalence estimates and adjusted prevalence odds ratios (PORs) for airflow obstruction and COPD. RESULTS: Among ever-employed U.S. adults, airflow obstruction prevalence was 12.40% and COPD was 3.47%. High airflow obstruction prevalence and significant PORs were reported in mining; manufacturing; construction; and services to buildings industries as well as extraction; bookbinders, prepress, and printing; installers and repairers; and construction occupations. CONCLUSION: Prevalence of airflow obstruction varies by industry and occupation. Industries and occupations with increased risk were identified using the most current NHANES data including detailed occupations and spirometry. |
CE: Original research: Antineoplastic drug administration by pregnant and nonpregnant nurses: An exploration of the use of protective gloves and gowns
Lawson CC , Johnson CY , Nassan FL , Connor TH , Boiano JM , Rocheleau CM , Chavarro JE , Rich-Edwards JW . Am J Nurs 2018 119 (1) 28-35 Findings from this cross-sectional study indicate a need for expanded training in safe handling practices. Background: Many antineoplastic (chemotherapeutic) drugs are known or probable human carcinogens, and many have been shown to be reproductive toxicants in cancer patients. Evidence from occupational exposure studies suggests that health care workers who have long-term, low-level occupational exposure to antineoplastic drugs have an increased risk of adverse reproductive outcomes. It's recommended that, at minimum, nurses who handle or administer such drugs should wear double gloves and a nonabsorbent gown to protect themselves. But it's unclear to what extent nurses do. PURPOSE: This study assessed glove and gown use by female pregnant and nonpregnant nurses who administer antineoplastic drugs in the United States and Canada. METHODS: We used data collected from more than 40,000 nurses participating in the Nurses' Health Study 3. The use of gloves and gowns and administration of antineoplastic drugs within the past month (among nonpregnant nurses) or within the first 20 weeks of pregnancy (among pregnant nurses) were self-reported via questionnaire. RESULTS: Administration of antineoplastic drugs at any time during their career was reported by 36% of nonpregnant nurses, including 27% who reported administering these drugs within the past month. Seven percent of pregnant nurses reported administering antineoplastic drugs during the first 20 weeks of pregnancy. Twelve percent of nonpregnant nurses and 9% of pregnant nurses indicated that they never wore gloves when administering antineoplastic drugs, and 42% of nonpregnant nurses and 38% of pregnant nurses reported never using a gown. The percentage of nonpregnant nurses who reported not wearing gloves varied by type of administration: 32% of those who administered antineoplastic drugs only as crushed pills never wore gloves, compared with 5% of those who administered such drugs only via infusion. CONCLUSIONS: Despite longstanding recommendations for the safe handling of antineoplastic and other hazardous drugs, many nurses-including those who are pregnant-reported not wearing protective gloves and gowns, which are considered the minimum protective equipment when administering such drugs. These findings underscore the need for further education and training to ensure that both employers and nurses understand the risks involved and know which precautionary measures will minimize such exposures. |
Evaluation of exposure assessment tools under REACH: Part I-Tier 1 Tools
Lee EG , Lamb J , Savic N , Basinas I , Gasic B , Jung C , Kashon ML , Kim J , Tischer M , van Tongeren M , Vernez D , Harper M . Ann Work Expo Health 2018 63 (2) 218-229 Tier 1 occupational exposure assessment tools recommended for use under the Registration, Evaluation, Authorization, and restriction of CHemicals (REACH) were evaluated using newly collected measurement data. Evaluated tools included the ECETOC TRAv2 and TRAv3, MEASEv1.02.01, and EMKG-EXPO-TOOL. Fifty-three exposure situations (ESs) based on tasks/chemicals were developed from National Institute for Occupational Safety and Health field surveys. During the field surveys, high quality contextual information required for evaluating the tools was also collected. For each ES, applicable tools were then used to generate exposure estimates using a consensus approach. Among 53 ESs, only those related to an exposure category of liquids with vapor pressure (VP) > 10 Pa had sufficient numbers of exposure measurements (42 ESs with n = 251 for TRAv2 and TRAv3 and 40 ESs with n = 243 for EMKG-EXPO-TOOL) to be considered in detail. The results for other exposure categories (aqueous solutions, liquids with VP </= 10 Pa, metal processing, powders, and solid objects) had insufficient measurement to allow detailed analyses (results listed in the Supplementary File). Overall, EMKG-EXPO-TOOL generated more conservative results than TRAv2 and TRAv3 for liquids with high VP. This finding is at least partly due to the fact that the EMKG-EXPO-TOOL only considers pure substances and not mixtures of chemical agents. For 34 out of 40 ESs available for chemicals with VP > 10 Pa, the liquid was a mixture rather than a pure substance. TRAv3 was less conservative than TRAv2, probably due to additional refinement of some input parameters. The percentages of exposure measurement results exceeding the corresponding tool estimates for liquids with VP > 10 Pa by process category and by input parameters were always higher for TRAv3 compared to those for TRAv2. Although the conclusions of this study are limited to liquids with VP > 10 Pa and few process categories, this study utilized the most transparent contextual information compared to previous studies, reducing uncertainty from assumptions for unknown input parameters. A further validation is recommended by collecting sufficient exposure data covering other exposure categories and all process categories under REACH. |
Evaluation of exposure assessment tools under REACH: Part II-Higher Tier Tools
Lee EG , Lamb J , Savic N , Basinas I , Gasic B , Jung C , Kashon ML , Kim J , Tischer M , van Tongeren M , Vernez D , Harper M . Ann Work Expo Health 2018 63 (2) 230-241 Stoffenmanager(R)v4.5 and Advanced REACH Tool (ART) v1.5, two higher tier exposure assessment tools for use under REACH, were evaluated by determining accuracy and robustness. A total of 282 exposure measurements from 51 exposure situations (ESs) were collected and categorized by exposure category. In this study, only the results of liquids with vapor pressure (VP) > 10 Pa category having a sufficient number of exposure measurements (n = 251 with 42 ESs) were utilized. In addition, the results were presented by handling/activity description and input parameters for the same exposure category. It should be noted that the performance results of Stoffenmanager and ART in this study cannot be directly compared for some ESs because ART allows a combination of up to four subtasks (and nonexposed periods) to be included, whereas the database for Stoffenmanager, separately developed under the permission of the legal owner of Stoffenmanager, permits the use of only one task to predict exposure estimates. Thus, it would be most appropriate to compare full-shift measurements against ART predictions (full shift including nonexposed periods) and task-based measurements against task-based Stoffenmanager predictions. For liquids with VP > 10 Pa category, Stoffenmanager(R)v4.5 appeared to be reasonably accurate and robust when predicting exposures [percentage of measurements exceeding the tool's 90th percentile estimate (%M > T) was 15%]. Areas that could potentially be improved include ESs involving the task of handling of liquids on large surfaces or large work pieces, allocation of high and medium VP inputs, and absence of local exhaust ventilation input. Although the ART's median predictions appeared to be reasonably accurate for liquids with VP > 10 Pa, the %M > T for the 90th percentile estimates was 41%, indicating that variance in exposure levels is underestimated by ART. The %M > T using the estimates of the upper value of 90% confidence interval (CI) of the 90th percentile estimate (UCI90) was considerably reduced to 18% for liquids with VP > 10 Pa. On the basis of this observation, users might be to consider using the upper limit value of 90% CI of the 90th percentile estimate for predicting reasonable worst case situations. Nevertheless, for some activities and input parameters, ART still shows areas to be improved. Hence, it is suggested that ART developers review the assumptions in relation to exposure variability within the tool, toward improving the tool performance in estimating percentile exposure levels. In addition, for both tools, only some handling/activity descriptions and input parameters were considered. Thus, further validation studies are still necessary. |
Insights into emissions and exposures from use of industrial-scale additive manufacturing machines
Stefaniak AB , Johnson AR , du Preez S , Hammond DR , Wells JR , Ham JE , LeBouf RF , Martin SB , Duling MG , Bowers LN , Knepp AK , de Beer DJ , du Plessis JL . Saf Health Work 2018 10 (2) 229-236 Background Emerging reports suggest the potential for adverse health effects from exposure to emissions from some additive manufacturing (AM) processes. There is a paucity of real-world data on emissions from AM machines in industrial workplaces and personal exposures among AM operators. Methods Airborne particle and organic chemical emissions and personal exposures were characterized using real-time and time-integrated sampling techniques in four manufacturing facilities using industrial-scale material extrusion and material jetting AM processes. Results Using a condensation nuclei counter, number-based particle emission rates (ERs) (number/min) from material extrusion AM machines ranged from 4.1 x 1010 (Ultem filament) to 2.2 x 1011 [acrylonitrile butadiene styrene and polycarbonate filaments). For these same machines, total volatile organic compound ERs (microg/min) ranged from 1.9 x 104 (acrylonitrile butadiene styrene and polycarbonate) to 9.4 x 104 (Ultem). For the material jetting machines, the number-based particle ER was higher when the lid was open (2.3 x 1010 number/min) than when the lid was closed (1.5-5.5 x 109 number/min); total volatile organic compound ERs were similar regardless of the lid position. Low levels of acetone, benzene, toluene, and m,p-xylene were common to both AM processes. Carbonyl compounds were detected; however, none were specifically attributed to the AM processes. Personal exposures to metals (aluminum and iron) and eight volatile organic compounds were all below National Institute for Occupational Safety and Health (NIOSH)-recommended exposure levels. Conclusion Industrial-scale AM machines using thermoplastics and resins released particles and organic vapors into workplace air. More research is needed to understand factors influencing real-world industrial-scale AM process emissions and exposures. |
'Internet of ears' and hearables for hearing loss prevention
Themann CL , Kardous CA , Beamer BR , Morata TC . Hear J 2019 72 (4) 32-34 New technologies are reshaping health interventions across disciplines. This technological surge offers a clear opportunity to expand and improve hearing health, particularly in hearing loss prevention. A person's hearing health trajectory is defined by his or her overall hazardous exposures, environmental factors, and genetic determinates.1 Among the many factors that can contribute to hearing health (such as overall health, smoking, diet, and ototoxicant exposure), reducing noise exposure—particularly at work—has the greatest potential to significantly decrease the burden of hearing loss and tinnitus.2 About 24 percent of hearing impairment cases among U.S. workers is attributable to workplace noise exposures. Because noise-induced hearing loss is preventable, approximately one-fourth of hearing impairment cases in this population may be avoided by adopting preventive measures.3 While progress has been made toward the prevention of work-related hearing loss, it remains among the most common occupational illnesses. Overall, nearly one in four U.S. adults has audiometric evidence of noise-induced hearing loss—and most do not realize it.4 People continue to focus on the use of hearing protection to reduce noise exposure, even though only limited evidence is available on the effectiveness of this approach.5 However, new technologies to measure and control noise and test hearing hold the promise of expedited progress. |
Demonstrating the financial impact of mining injuries with the "Safety Pays in Mining" web application
Heberger JR . Min Eng 2018 70 (12) 37-43 The "Safety Pays in Mining" web application, developed by the U.S. National Institute for Occupational Safety and Health Mining Program, helps mines determine the potential costs associated with mining injuries. This web app groups injuries by type, either by the cause of the injury or by the nature of the injury. When the user selects one of more than 30 common types of mining injuries, the app provides information on the distribution of costs of workers' compensation claims for that type of injury. Based on other user inputs, the app will estimate the total costs of the selected injuries, including an estimate of additional indirect costs, the estimated impact of total injury costs on mining company profits, and provide some examples of other items, such as services or equipment, on which companies could spend the savings that result from the prevention of injuries. This paper reviews the app by discussing its development, how it is used to show the true costs of mining injuries, and how mines can benefit from using it. |
Data transport over leaky feeder systems using Internet-Protocol-enabled land mobile radios
Jacksha R , Sunderman C . Min Eng 2018 70 (12) 44-47 Mine monitoring through various sensors is a vital component of successful miner safety and health programs. Data from environmental, geotechnical, infrastructure and other types of sensors are increasingly used to discover and mitigate health and safety concerns in underground mines. In many smaller underground mines, as well as in the new development headings of larger underground mines, leaky feeder communication systems may be the only available means to transport crucial monitoring data. In addition, data transport is increasingly being delivered using Internet Protocol (IP), while older forms of serial communication are being retired. This paper presents the selection, configuration and testing methodologies employed by researchers from the U.S. National Institute for Occupational Safety and Health (NIOSH) to integrate commercially available land mobile data radios into an existing leaky feeder communication system to provide IP data transport. |
Using performance management strategies to improve mine emergency training and preparedness
Ryan ME , Diamond J , Brnich MJ , Hoebbel C . Coal Age 2018 123 (9) 37-39 The MINER Act of 2006 called for significant improvements to emergency response training and preparedness at U.S. underground coal mines. Yet, results from a recent survey on self-escape competency by the National Institute for Occupational Safety and Health (NIOSH) suggest that underground coal mineworkers may still be underprepared for self-escape. These findings can motivate safety trainers to identify strategies for improving the workforce’s self-escape preparedness for every worker during every shift in the event of an underground mine emergency. |
Patterns of heat strain among a sample of U.S. underground miners
Yeoman K , DuBose W , Bauerle T , Victoroff T , Finley S , Poplin G . J Occup Environ Med 2018 61 (3) 212-218 OBJECTIVE: This study characterizes physiological measures of heat exposure among U.S. underground miners. METHODS: Core body temperature measured by using ingestible sensors during subjects' normal work shifts was categorized into four temperature zones: <37.5 degrees C, 37.5 degrees C to <38 degrees C, 38 degrees C to <38.5 degrees C, and >/=38.5 degrees C. RESULTS: On average, subjects changed temperature zones 13.8 times per shift. Temperatures increased above the recommended limit of 38 degrees C nearly 5 times per shift for an average of 26 minutes each episode. CONCLUSIONS: Unlike previous heat stress research that reported only maximum and mean temperature measurements, this analysis demonstrates a dynamic pattern of physiologic heat strain, with core body temperatures changing frequently and exceeding the 38 degrees C limit multiple times per shift. Further research is needed on the impact of multiple short-term, intermittent heat exposures on miners. |
A field study on the possible attachment of DPM and respirable dust in mining environments
Gaillard S , Sarver E , Cauda E . J Sustain Min 2019 18 (2) 100-108 Typcial monitoring procedures for diesel particulate matter (DPM) in mines include the collection of filter samples using particle size selectors. The size selectors are meant to separate the DPM, which is generally considered to occur in the submicron range (i.e., < 0.8 μm), from larger dust particles that could present analytical interferences. However, previous studies have demonstrated that this approach can sometimes result in undersampling, therefore, excluding significant fractions of the DPM mass. The excluded fraction may represent oversized DPM particles, but another possibility is that submicron DPM attaches to supramicron dust particles such that it is effectively oversized. To gain insights into this possibility, a field study was conducted in an underground stone mine. Submicron, respirable, and total airborne particulate filter samples were collected in three locations to determine elemental carbon (EC) and total carbon (TC), which are commonly used as analytical surrogates for DPM. Concurrent with the collection of the filter samples, a low-flow sampler with an electrostatic precipitator was also used to collect airborne particulates onto 400-mesh copper grids for analysis by transmission electron microscope (TEM). Results indicated that, while typical submicron sampling did account for the majority of DPM mass in the study mine, DPM-dust attachment can indeed occur. The effect of exposure to such attached particulates has not been widely investigated. |
The effect of mobile phone text message reminders on health workers' adherence to case management guidelines for malaria and other diseases in Malawi: lessons from qualitative data from a cluster-randomized trial
Kaunda-Khangamwa BN , Steinhardt LC , Rowe AK , Gumbo A , Moyo D , Nsona H , Troell P , Zurovac D , Mathanga D . Malar J 2018 17 (1) 481 BACKGROUND: Mobile health (mHealth), which uses technology such as mobile phones to improve patient health and health care delivery, is increasingly being tested as an intervention to promote health worker (HW) performance. This study assessed the effect of short messaging services (SMS) reminders in a study setting. Following a trial of text-message reminders to HWs to improve case management of malaria and other childhood diseases in southern Malawi that showed little effect, qualitative data was collected to explore the reasons why the intervention was ineffective and describe lessons learned. METHODS: Qualitative data collection was undertaken to lend insight into quantitative results from a trial in which 105 health facilities were randomized to three arms: (1) twice-daily text-message reminders to HWs, including clinicians and drug dispensers, on case management of malaria; (2) twice-daily text-message reminders to HWs on case management of malaria, pneumonia and diarrhoea; and, (3) a control arm. In-depth interviews were conducted with 50 HWs in the intervention arms across seven districts. HWs were asked about acceptability and feasibility of the text-messaging intervention and its perceived impact on recommended case management. The interviews were recorded, transcribed and translated into English for a thematic and framework analysis. Nvivo 11 software was used for data management and analysis. RESULTS: A total of 50 HWs were interviewed at 22 facilities. HWs expressed high acceptance of text-message reminders and appreciated messages as job aids and practical reference material for their day-to-day work. However, HWs said that health systems barriers, including very high outpatient workload, commodity stock-outs, and lack of supportive supervision and financial incentives demotivated them, limited their ability to act on messages and therefore adherence to case management guidelines. Drug dispensers were more likely than clinicians to report usage of text-message reminders. Despite these challenges, nearly all HWs expressed a desire for a longer duration of the SMS intervention. CONCLUSIONS: Text-message reminders to HWs can provide a platform to improve understanding of treatment guidelines and case management decision-making skills, but might not improve actual adherence to guidelines. More interaction, for example through targeted supervision or two-way technology communication, might be an essential intervention component to help address structural barriers and facilitate improved clinical practice. |
Evaluating the quality of routinely reported data on malaria commodity stocks in Guinea, 2014-2016
Sun Y , Guilavogui T , Camara A , Dioubate M , Toure BD , Bahati C , Fargier MP , Butts J , Condo P , Sarr A , Plucinski MM . Malar J 2018 17 (1) 461 BACKGROUND: Ensuring malaria commodity availability at health facilities is a cornerstone of malaria control. Since 2013, the Guinea National Malaria Control Programme has been routinely collecting data on stock levels of key malaria commodities through a monthly routine malaria information system (RMIS). In parallel, biannual end-user verification (EUV) surveys have also assessed malaria commodity availability at a subset of health facilities, potentially representing a duplication of efforts. METHODS: Data on 12 malaria commodity stock levels verified during four EUV surveys conducted between 2014 and 2016 was compared to data for the corresponding months submitted by the same health facilities through the RMIS. The sensitivity and specificity of the RMIS in detecting stock-outs was calculated, as was the percent difference between average stock levels reported through the two systems. RESULTS: Of the 171 health facilities visited during the four EUV surveys, 129 (75%) had data available in the RMIS. Of 351 commodity stock-outs observed during the EUV in the sampled reporting health facilities, 256 (73%) were also signaled through the corresponding RMIS reports. When the presence of malaria commodity stocks was confirmed during the EUV surveys, the RMIS also reported available stock 87% (677/775) of the time. For all commodities, the median percent difference in average stock levels between the EUV and RMIS was 4% (interquartile range - 7 to 27%). CONCLUSION: The concordance between stock levels reported through the RMIS and those verified during the EUV visits provides certain evidence that RMIS data can inform quantification and procurement decisions. However, lower than acceptable rates of reporting and incomplete detection of stock-outs from facilities that do report suggest that further systems strengthening is needed to improve RMIS reporting completeness and data quality. |
Community-based participatory research in travel medicine to identify barriers to preventing malaria in VFR travelers
Walz EJ , Wanduragala D , Adedimeji AA , Volkman HR , Gaines J , Angelo KM , Boumi AE , Coyle C , Dunlop SJ , Stauffer WM . J Travel Med 2018 26 (1) The use of participatory approaches involving community stakeholders is novel in travel medicine research. We describe various community-based participatory methods, using the examples of community advisory boards (CABs), community-based organisations (CBOs), and focus groups as mechanisms for achieving a desired interventional outcome. While these methodologies can be applied to many settings, we used them to investigate barriers to malaria prevention in travellers visiting friends and relatives (VFRs) and to implement interventions targeting VFRs. |
Primary care and public health collaboration reports: A qualitative review of integration aims, participants, and success determinants
McVicar KL , Ivanitskaya LV , Bradley DW , Montero JT . Popul Health Manag 2018 22 (5) 422-432 This qualitative review of 57 published case reports aimed to analyze primary care and public health integration efforts in 45 states to summarize collaboration aims, participants, and systemic, organizational, and interactional success determinants. Chronic disease management, maternal and child health, and wellness and health promotion were the most commonly reported aims of collaboration between primary care and public health entities in the United States. Typical participants were government public health structures, health delivery systems, communities, academia, state professional medical associations, and employers and businesses. Systemic, organizational, and interactional determinants included adequate funding, multiple stakeholder engagement, leadership, data and information sharing, capitalization on collaborator resources, community engagement, steering committees, effective communication, regular meetings, shared mission, vision, and goals, previous positive relationships, collaborations, and partnerships. The present study contributes to the body of knowledge of when, where, and under what contextual circumstances collaboration and integration have been perceived as effective. Future research could extrapolate which determinants are more essential than others and focus on how systemic, organizational, and interactional factors are interrelated. To advance the practice of successful integration between primary care and public health entities, longitudinal research is needed to examine the degree of integration and sustainability. |
Father-son communication about consistent and correct condom use
Guilamo-Ramos V , Thimm-Kaiser M , Benzekri A , Rodriguez C , Fuller TR , Warner L , Koumans EHA . Pediatrics 2018 143 (1) OBJECTIVES: With this study, we explore communication about consistent and correct condom use among African American and Latino male adolescents ages 15 to 19 and their fathers. METHODS: Twenty-five father-son dyads completed semistructured interviews designed to elicit specific preferences for teaching and learning about consistent and correct condom use and strategies for addressing common condom use errors and problems. For analysis, we used in vivo coding and vertical and horizontal analysis techniques. RESULTS: Fathers and sons agreed that communication about condom use is feasible and acceptable. However, fathers tended to convey vague messages regarding protecting oneself from the negative consequences of sexual activity. Furthermore, both fathers and sons reported barriers hindering conversations. Secondly, the style and frequency of condom use conversations can help overcome barriers and support father-son relationship management. Talking frequently in 1-on-1 settings and using strategies to reduce discomfort made communication easier. Lastly, fathers and sons reported distinct preferences for teaching and learning about condom use. Sons wanted fathers to give specific guidance on the use and management of condoms. Fathers expressed interest in opportunities for improving their own condom knowledge and skills. Fathers identified gaps in their own condom use knowledge as a limitation to effective instruction of their sons. CONCLUSIONS: A father-focused communication intervention about condom use is feasible and acceptable. Enhancing the intergenerational benefits of father-son communication by addressing specific father-son preferences and learning needs for condom use instruction, as well as communication barriers, represents a novel mechanism for reducing male sexual reproductive health disparities. |
Effect of population-based antenatal screening and treatment of genitourinary tract infections on birth outcomes in Sylhet, Bangladesh (MIST): a cluster-randomised clinical trial
Lee AC , Mullany LC , Quaiyum M , Mitra DK , Labrique A , Christian P , Ahmed P , Uddin J , Rafiqullah I , DasGupta S , Rahman M , Koumans EH , Ahmed S , Saha SK , Baqui AH . Lancet Glob Health 2019 7 (1) e148-e159 BACKGROUND: One-third of preterm births are attributed to pregnancy infections. We implemented a community-based intervention to screen and treat maternal genitourinary tract infections, with the aim of reducing the incidence of preterm birth. METHODS: We did an unblinded cluster-randomised controlled trial in two subdistricts of Sylhet, Bangladesh. Clusters were defined as the contiguous area served by a single community health worker, and each cluster comprised several contiguous villages, contained roughly 4000 people, and had about 120 births per year. Eligible participants within clusters were all ever-married women and girls of reproductive age (ie, aged 15-49 years) who became pregnant during the study period. Clusters were randomly assigned (1:1) to the intervention or control groups via a restricted randomisation procedure. In both groups, community health workers made home visits to identify pregnant women and girls and provide antenatal and postnatal care. Between 13 and 19 weeks' gestation, participants in the intervention group received home-based screening for abnormal vaginal flora and urinary tract infections. A random 10% of the control group also received the intervention to examine the similarity of infection prevalence between groups. If present, abnormal vaginal flora (ie, Nugent score >/=4 was treated with oral clindamycin (300 mg twice daily for 5 days) and urinary tract infections with cefixime (400 mg once daily for 3 days) or oral nitrofurantoin (100 mg twice daily for 7 days). Both infections were retreated if persistent. The primary outcome was the incidence of preterm livebirths before 37 weeks' gestation among all livebirths. This trial is registered with ClinicalTrials.gov, number NCT01572532. The trial is closed to new participants, with follow-up completed. FINDINGS: Between Jan 2, 2012, and July 28, 2015, 9712 pregnancies were enrolled (4840 in the intervention group, 4391 in the control group, and 481 in the control subsample). 3818 livebirths in the intervention group and 3557 livebirths in the control group were included in the primary analysis. In the intervention group, the prevalence of abnormal vaginal flora was 16.3% (95% CI 15.1-17.6) and that of urinary tract infection was 8.6% (7.7-9.5). The effective coverage of successful treatment in the intervention group was 58% in participants with abnormal vaginal flora (ie, abnormal vaginal flora resolved in 361 [58%] of the 622 participants who initially tested positive), and 71% in those with urinary tract infections (ie, resolution in 224 [71%] of the 317 participants who initially tested positive). Overall, the incidence of preterm livebirths before 37 weeks' gestation did not differ significantly between the intervention and control groups (21.8% vs 20.6%; relative risk 1.07 [95% CI 0.91-1.24]). INTERPRETATION: A population-based antenatal screening and treatment programme for genitourinary tract infections did not reduce the incidence of preterm birth in Bangladesh. FUNDING: Eunice Kennedy Shriver National Institute of Child Health and Human Development and Saving Lives at Birth Grand Challenges. |
Affordable Care Act-dependent insurance coverage and access to care among young adult women with a recent live birth
Li R , Bauman B , D'Angelo DV , Harrison LL , Warner L , Barfield W , Cox S . Med Care 2018 57 (2) 109-114 BACKGROUND: The Affordable Care Act (ACA)-dependent coverage Provision (the Provision), implemented in 2010, extended family insurance coverage to adult children until age 26. OBJECTIVES: To examine the impact of the ACA Provision on insurance coverage and care among women with a recent live birth. RESEARCH DESIGN, SUBJECTS, AND OUTCOME MEASURES: We conducted a difference-in-difference analysis to assess the effect of the Provision using data from the Pregnancy Risk Assessment Monitoring System among 22,599 women aged 19-25 (treatment group) and 22,361 women aged 27-31 years (control group). Outcomes include insurance coverage in the month before and during pregnancy, and at delivery, and receipt of timely prenatal care, a postpartum check-up, and postpartum contraceptive use. RESULTS: Compared with the control group, the Provision was associated with a 4.7-percentage point decrease in being uninsured and a 5.9-percentage point increase in private insurance coverage in the month before pregnancy, and a 5.4-percentage point increase in private insurance coverage and a 5.9-percentage point decrease in Medicaid coverage during pregnancy, with similar changes in insurance coverage at delivery. Findings demonstrated a 3.6-percentage point increase in receipt of timely prenatal care, and no change in receipt of a postpartum check-up or postpartum contraceptive use. CONCLUSIONS: Among women with a recent live birth, the Provision was associated with a decreased likelihood of being uninsured and increased private insurance coverage in the month before pregnancy, a shift from Medicaid to private insurance coverage during pregnancy and at delivery, and an increased likelihood of receiving timely prenatal care. |
Effect of menstruation on girls and their schooling, and facilitators of menstrual hygiene management in schools: surveys in government schools in three states in India, 2015
Sivakami M , Maria van Eijk A , Thakur H , Kakade N , Patil C , Shinde S , Surani N , Bauman A , Zulaika G , Kabir Y , Dobhal A , Singh P , Tahiliani B , Mason L , Alexander KT , Thakkar MB , Laserson KF , Phillips-Howard PA . J Glob Health 2019 9 (1) 010408 Background: Lack of menstrual knowledge, poor access to sanitary products and a non-facilitating school environment can make it difficult for girls to attend school. In India, interventions have been developed to reduce the burden of menstruation for school girls by government and non-governmental organizations (NGOs). We sought to identify challenges related to menstruation, and facilitators of menstrual management in schools in three states in India. Methods: Surveys were conducted among menstruating school girls in class 8-10 (above 12 years of age) of 43 government schools selected through stratified random sampling in three Indian states (Maharashtra, Chhattisgarh, Tamil Nadu) in 2015. For comparison, ten model schools supported by NGOs or UNICEF with a focussed menstrual hygiene education program were selected purposely in the same states to represent the better-case scenario. We examined awareness about menarche, items used for menstruation, and facilitators on girls' experience of menstruation in regular schools and compared with model schools. Factors associated with school absence during menstruation were explored using multivariate analysis. Findings: More girls (mean age 14.1 years) were informed about menstruation before menarche in model schools (56%, n = 492) than in regular schools (36%, n = 2072, P < 0.001). Girls reported menstruation affected school attendance (6% vs 11% in model vs regular schools respectively, P = 0.003) and concentration (40% vs 45%, P = 0.1) and was associated with pain (31% vs 38%, P = 0.004) and fear of stain or smell (11% vs 16%, P = 0.002). About 45% of girls reported using disposable pads in both model and regular schools, but only 55% and 29% of pad-users reported good disposal facilities, respectively (P < 0.001). In multivariate analysis, reported absenteeism during menstruation was significantly lower in Tamil Nadu (adjusted prevalence ratio (APR) 95% confidence interval (CI) = 0.24, 0.14-0.40) and Maharashtra (APR 0.56, CI = 0.40-0.77) compared to Chhattisgarh, and halved in model compared to regular schools (APR 0.50, CI = 0.34-0.73). Pain medication in school (APR 0.71, CI = 0.51-0.97) and use of disposable pads (APR 0.57, CI = 0.42-0.77) were associated with lower absenteeism and inadequate sanitary facilities with higher absenteeism during menstruation. Conclusions: Menstrual hygiene education, accessible sanitary products, pain relief, and adequate sanitary facilities at school would improve the schooling-experience of adolescent girls in India. |
Effects of patient education on desire for twins and use of elective single embryo transfer procedures during ART treatment: A systematic review
Sunderam S , Boulet SL , Jamieson DJ , Kissin DM . Reprod Biomed Soc Online 2018 6 102-119 Twin births among users of assisted reproductive technology (ART) pose serious risks to both mothers and infants. However, patients may prefer twins and may be unaware of the risks of twin pregnancies. Increasing use of elective single embryo transfers (eSET) through improved patient education could help to reduce twin births and related adverse health consequences. A systematic review of PUBMED and EMBASE databases was conducted to evaluate the effectiveness of patient education among ART users on knowledge of twin pregnancy risks, desire for twins, preference for or use of eSET, and twin pregnancy rates. Of 187 references retrieved, six met the selection criteria. Most focused on patients undergoing their first ART cycle aged < 35 years. Patient education was delivered via written materials, DVDs or discussion. Four studies reporting on knowledge of risks or desire for twins showed significant effects of oral and written descriptions of multiple pregnancy complications, risks of twins versus singletons, and DVDs with factual information. Five studies showed increased eSET use or preference after patients were educated on the risks of multiple pregnancy and success rates associated with different types of ART procedures, when combined with clinic policies that supported single blastocyst transfers or provided options for insurance. In younger ART users, patient education on twin pregnancy risks and success rates of eSET may improve knowledge of twin pregnancy risks and increase use of eSET, and may be important for wider implementation of eSET in countries such as the USA where the use of eSET remains low. Clinic policies of single blastocyst transfers or financial incentives may strengthen these effects. |
Spatial and temporal trends of cesarean deliveries in Uganda: 2012-2016
Atuheire EB , Opio DN , Kadobera D , Ario AR , Matovu JKB , Harris J , Bulage L , Nakiganda B , Tumwesigye NM , Zhu BP , Kaharuza F . BMC Pregnancy Childbirth 2019 19 (1) 132 BACKGROUND: Cesarean section (CS) is an important intervention in complicated births when the safety of the mother or baby is compromised. Despite worldwide concerns about the overutilization of CS in recent years, many African women and their newborns still die because of limited or no access to CS services. We evaluated temporal and spatial trends in CS births in Uganda and modeled future trends to inform programming. METHODS: We performed secondary analysis of total births data from the Uganda National Health Management Information System (HMIS) reports during 2012-2016. We reviewed data from 3461 health facilities providing basic, essential obstetric and emergency obstetric care services in all 112 districts. We defined facility-based CS rate as the proportion of cesarean deliveries among total live births in facilities, and estimated the population-based CS rate using the total number of cesarean deliveries as a proportion of annual expected births (including facility-based and non-facility-based) for each district. We predicted CS rates for 2021 using Generalised Linear Models with Poisson family, Log link and Unbiased Sandwich Standard errors. We used cesarean deliveries as the dependent variable and calendar year as the independent variable. RESULTS: Cesarean delivery rates increased both at facility and population levels in Uganda. Overall, the CS rate for live births at facilities was 9.9%, increasing from 8.5% in 2012 to 11% in 2016. The overall population-based CS rate was 4.7%, and increased from 3.2 to 5.9% over the same period. Health Centre IV level facilities had the largest annual rate of increase in CS rate between 2012 and 2016. Among all 112 districts, 80 (72%) had a population CS rate below 5%, while 38 (34%) had a CS rate below 1% over the study period. Overall, Uganda's facility-based CS rate is projected to increase by 36% (PRR 1.36, 95% CI 1.35-1.36) in 2021 while the population-based CS rate is estimated to have doubled (PRR 2.12, 95% CI 2.11-2.12) from the baseline in 2016. CONCLUSION: Cesarean deliveries are increasing in Uganda. Health center IVs saw the largest increases in CS, and while there was regional heterogeneity in changes in CS rates, utilization of CS services is inadequate in most districts. We recommend expansion of CS services to improve availability. |
Estimating marginal proportions and intraclass correlations with clustered binary data
Carrasco JL , Pan Y , Abellana R . Biom J 2018 61 (3) 574-599 A logistic regression with random effects model is commonly applied to analyze clustered binary data, and every cluster is assumed to have a different proportion of success. However, it could be of interest to obtain the proportion of success over clusters (i.e. the marginal proportion of success). Furthermore, the degree of correlation among data of the same cluster (intraclass correlation) is also a relevant concept to assess, but when using logistic regression with random effects it is not possible to get an analytical expression of the estimators for marginal proportion and intraclass correlation. In our paper, we assess and compare approaches using different kinds of approximations: based on the logistic-normal mixed effects model (LN), linear mixed model (LMM), and generalized estimating equations (GEE). The comparisons are completed by using two real data examples and a simulation study. The results show the performance of the approaches strongly depends on the magnitude of the marginal proportion, the intraclass correlation, and the sample size. In general, the reliability of the approaches get worsen with low marginal proportion and large intraclass correlation. LMM and GEE approaches arises as reliable approaches when the sample size is large. |
An alternative approach to relapse analysis: using Monte Carlo methods and proportional rates of response
Friedel JE , Galizio A , Berry MS , Sweeney MM , Odum AL . J Exp Anal Behav 2018 111 (2) 289-308 Relapse is the recovery of a previously suppressed response. Animal models have been useful in examining the mechanisms underlying relapse (e.g., reinstatement, renewal, reacquisition, resurgence). However, there are several challenges to analyzing relapse data using traditional approaches. For example, null hypothesis significance testing is commonly used to determine whether relapse has occurred. However, this method requires several a priori assumptions about the data, as well as a large sample size for between-subjects comparisons or repeated testing for within-subjects comparisons. Monte Carlo methods may represent an improved analytic technique, because these methods require no prior assumptions, permit smaller sample sizes, and can be tailored to account for all of the data from an experiment instead of some limited set. In the present study, we conducted reanalyses of three studies of relapse (Berry, Sweeney, & Odum, ; Galizio et al., ; Odum & Shahan, ) using Monte Carlo techniques to determine if relapse occurred and if there were differences in rate of response based on relevant independent variables (such as group membership or schedule of reinforcement). These reanalyses supported the previous findings. Finally, we provide general recommendations for using Monte Carlo methods in studies of relapse. |
The progress of tobacco control research in sub-Saharan Africa in the past 50 years: A systematic review of the design and methods of the studies
Mamudu HM , Subedi P , Alamin AE , Veeranki SP , Owusu D , Poole A , Mbulo L , Ogwell Ouma AE , Oke A . Int J Environ Res Public Health 2018 15 (12) Over one billion of the world's population are smokers, with increasing tobacco use in low- and middle-income countries. However, information about the methodology of studies on tobacco control is limited. We conducted a literature search to examine and evaluate the methodological designs of published tobacco research in Sub-Saharan Africa (SSA) over the past 50 years. The first phase was completed in 2015 using PubMed, Embase, CINAHL, and Cochrane Central Register of Controlled Trials. An additional search was completed in February 2017 using PubMed. Only tobacco/smoking research in SSA countries with human subjects and published in English was selected. Out of 1796 articles, 447 met the inclusion criteria and were from 26 countries, 11 of which had one study each. Over half of the publications were from South Africa and Nigeria. The earliest publication was in 1968 and the highest number of publications was in 2014 (n = 46). The majority of publications used quantitative methods (91.28%) and were cross-sectional (80.98%). The commonest data collection methods were self-administered questionnaires (38.53%), interviews (32.57%), and observation (20.41%). Around half of the studies were among adults and in urban settings. We conclud that SSA remains a "research desert" and needs more investment in tobacco control research and training. |
From the CDC the Prevention for States program: Preventing opioid overdose through evidence-based intervention and innovation
Robinson A , Christensen A , Bacon S . J Safety Res 2018 68 231-237 INTRODUCTION: Since 1999, overdose deaths involving opioids have substantially increased. In 2016, 42,249 opioid-related deaths occurred-a 27.7% increase from the previous year (Hedegaard et al., 2017). As the nation's public health agency, the Centers for Disease Control and Prevention (CDC) has been actively involved in efforts to prevent opioid misuse, opioid use disorder, and opioid overdose since 2014. One of CDC's three principal opioid overdose prevention programs, the Prevention for States (PfS) program, began funding 16 state partners in August 2015 and then expanded to fund a total of 29 states in March 2016. The PfS program aims to prevent opioid morbidity and mortality by implementing evidence-based strategies such as enhancing and maximizing prescription drug monitoring programs (PDMPs) and implementing community or health systems interventions. METHODS: In this article, we will describe the origins of the PfS program, provide an overview of program strategies, and locate PfS strategies in the larger landscape of nation-wide opioid overdose prevention efforts advanced by other partners and stakeholders. To describe the implementation of PfS, we offer an iterative model of using information to inform strategy selection, implementation, and evaluation. This model is a product of our observations of program implementation over time and has emerged, post hoc, as a helpful framework for organizing our insights and reflections on the work. RESULTS: For each step of the model, we provide examples of how CDC has supported funded state partners in these efforts. Lastly, we describe innovative facets of the program and implications for both ongoing and future programs. Practical applications: Opioid overdose morbidity and mortality continues to increase across the United States. Adoption of the strategies and the program implementation paradigm described in this article when implementing prevention activities could improve the ability of public health programs to reverse this trend. |
Exposure to secondhand smoke among nonsmokers - United States, 1988-2014
Tsai J , Homa DM , Gentzke AS , Mahoney M , Sharapova SR , Sosnoff CS , Caron KT , Wang L , Melstrom PC , Trivers KF . MMWR Morb Mortal Wkly Rep 2018 67 (48) 1342-1346 Exposure to secondhand smoke from burning tobacco products can cause sudden infant death syndrome, respiratory infections, ear infections, and asthma attacks in infants and children, and coronary heart disease, stroke, and lung cancer in adult nonsmokers (1). There is no risk-free level of secondhand smoke exposure (2). CDC analyzed questionnaire and laboratory data from the National Health and Nutrition Examination Survey (NHANES) to assess patterns of secondhand smoke exposure among U.S. nonsmokers. The prevalence of secondhand smoke exposure among U.S. nonsmokers declined substantially during 1988-2014, from 87.5% to 25.2%. However, no change in exposure occurred between 2011-2012 and 2013-2014, and an estimated one in four nonsmokers, or approximately 58 million persons, were still exposed to secondhand smoke during 2013-2014. Moreover, marked disparities persisted across population groups. Exposure prevalence was highest among nonsmokers aged 3-11 years (37.9%), non-Hispanic blacks (50.3%), and those who were living in poverty (47.9%), in rental housing (38.6%), or with someone who smoked inside the home (73.0%), or among persons who had less than a high school education (30.7%). Comprehensive smoke-free laws and policies for workplaces and public places and smoke-free rules for homes and vehicles can further reduce secondhand smoke exposure among all nonsmokers. |
Waterpipe tobacco smoke: Characterization of toxicants and exposure biomarkers in a cross-sectional study of waterpipe employees
Kaplan B , Sussan T , Rule A , Moon K , Grau-Perez M , Olmedo P , Chen R , Carkoglu A , Levshin V , Wang L , Watson C , Blount B , Calafat AM , Jarrett J , Caldwell K , Wang Y , Breysse P , Strickland P , Cohen J , Biswal S , Navas-Acien A . Environ Int 2019 127 495-502 INTRODUCTION: Few studies have comprehensively characterized toxic chemicals related to waterpipe use and secondhand waterpipe exposure. This cross-sectional study investigated biomarkers of toxicants associated with waterpipe use and passive waterpipe exposure among employees at waterpipe venues. METHOD: We collected urine specimens from employees in waterpipe venues from Istanbul, Turkey and Moscow, Russia, and identified waterpipe and cigarette smoking status based on self-report. The final sample included 110 employees. Biomarkers of exposure to sixty chemicals (metals, volatile organic compounds (VOCs), polycyclic aromatic hydrocarbons (PAHs), nicotine, and heterocyclic aromatic amines (HCAAs)) were quantified in the participants' urine. RESULTS: Participants who reported using waterpipe had higher urinary manganese (geometric mean ratio (GMR): 2.42, 95% confidence interval (CI): 1.16, 5.07) than never/former waterpipe or cigarette smokers. Being exposed to more hours of secondhand smoke from waterpipes was associated with higher concentrations of cobalt (GMR: 1.38, 95% CI: 1.10, 1.75). Participants involved in lighting waterpipes had higher urinary cobalt (GMR: 1.43, 95% CI: 1.10, 1.86), cesium (GMR: 1.21, 95% CI: 1.00, 1.48), molybdenum (GMR: 1.45, 95% CI: 1.08, 1.93), 1-hydroxypyrene (GMR: 1.36, 95% CI: 1.03, 1.80), and several VOC metabolites. CONCLUSION: Waterpipe tobacco users and nonsmoking employees of waterpipe venues had higher urinary concentrations of several toxic metals including manganese and cobalt as well as of VOCs, in a distinct signature compared to cigarette smoke. Employees involved in lighting waterpipes may have higher exposure to multiple toxic chemicals compared to other employees. |
Are low to moderate average alcohol consumption and isolated episodes of binge drinking in early pregnancy associated with facial features related to fetal alcohol syndrome in five-year-old children
Kesmodel US , Nygaard SS , Mortensen EL , Bertrand J , Denny CH , Glidewell A , Astley Hemingway S . Alcohol Clin Exp Res 2019 43 (6) 1199-1212 BACKGROUND: Fetal alcohol syndrome (FAS) typically is observed among individuals with high prenatal alcohol exposures (PAE), but exposure histories obtained in clinical diagnostic settings are often inaccurate. The present analysis used the Lifestyle During Pregnancy Study (LDPS) to assess the potential effects of low to moderate average weekly alcohol consumption and binge drinking in early pregnancy on facial features associated with FAS among children five years of age. METHODS: The analysis is a prospective follow-up study of 670 women and their children sampled from the LDPS cohort based on maternal alcohol consumption during pregnancy. The 4-Digit Code FAS Facial Photographic software was used to measure the magnitude of expression of the three diagnostic facial features of FAS from standardized digital photographs. Logistic regression was used to estimate the odds of presenting with the FAS/Partial FAS (PFAS) facial phenotypes relative to different patterns of prenatal alcohol exposure. RESULTS: Ten children presented with the FAS/PFAS facial phenotypes. None of the children sampled met the central nervous system (CNS) criteria for FAS or PFAS at age 5 years. All remained at risk for PFAS since some types of CNS dysfunction associated with this diagnosis may only be assessed at older ages. The FAS/PFAS facial phenotypes were 8.5-fold more likely among children exposed to an average of 1-4 drinks per week, and 2.5-fold more likely among children with a single binge exposure in gestational weeks 3-4 compared to children with no such exposures. The magnitude of expression of the FAS facial phenotype was significantly correlated with all other diagnostic features of FAS: growth deficiency, microcephaly, and measures of CNS dysfunction. CONCLUSIONS: These findings suggest that low to moderate levels of PAE or isolated binge exposures may place some fetuses at risk for FAS/PFAS. Thus, conservative advice is still for women to abstain from alcohol consumption during pregnancy. This article is protected by copyright. All rights reserved. |
Notes from the Field: An Outbreak of Salmonella Agbeni Infections Linked to Turtle Exposure - United States, 2017.
Koski L , Stevenson L , Huffman J , Robbins A , Latash J , Omoregie E , Kline K , Nichols M . MMWR Morb Mortal Wkly Rep 2018 67 (48) 1350 In June 2017, PulseNet, the national molecular subtyping network for foodborne disease surveillance, identified 17 Salmonella Agbeni clinical isolates with indistinguishable XbaI enzyme pattern (outbreak strain) by pulsed-field gel electrophoresis. The same Salmonella Agbeni XbaI pattern was isolated from a turtle in 2015; in a 2016 investigation involving the same outbreak strain, 63% of patients reported contact with turtles (CDC, unpublished data, 2016). Despite prohibition of sale of small turtles (shell length less <4 inches) in the United States since 1975 (1), illness outbreaks associated with turtle contact continue to occur. Ill persons in previous Salmonella Poona and Salmonella Pomona outbreaks linked to turtles were geographically concentrated in the Southwest region of the United States (2,3). Turtle production is known to be higher in the Southeast region of the country (2). An outbreak investigation by CDC and health departments was initiated to identify the source of the 2017 illness outbreak. |
Sounding the alarm: Defining thresholds to trigger a public health response to monkeypox
Guagliardo SAJ , Reynolds MG , Kabamba J , Nguete B , Shongo Lushima R , Wemakoy OE , McCollum AM . PLoS Negl Trop Dis 2018 12 (12) e0007034 Endemic to the Democratic Republic of the Congo (DRC), monkeypox is a zoonotic disease that causes smallpox-like illness in humans. Observed fluctuations in reported cases over time raises questions about when it is appropriate to mount a public health response, and what specific actions should be taken. We evaluated three different thresholds to differentiate between baseline and heightened disease incidence, and propose a novel, tiered algorithm for public health action. Monkeypox surveillance data from Tshuapa Province, 2011-2013, were used to calculate three different statistical thresholds: Cullen, c-sum, and a World Health Organization (WHO) method based on monthly incidence. When the observed cases exceeded the threshold for a given month, that month was considered to be 'aberrant'. For each approach, the number of aberrant months detected was summed by year-each method produced vastly different results. The Cullen approach generated a number of aberrant signals over the period of consideration (9/36 months). The c-sum method was the most sensitive (30/36 months), followed by the WHO method (12/24 months). We conclude that triggering public health action based on signals detected by a single method may be inefficient and overly simplistic for monkeypox. We propose instead a response algorithm that integrates an objective threshold (WHO method) with contextual information about epidemiological and spatiotemporal links between suspected cases to determine whether a response should be operating under i) routine surveillance ii) alert status, or iii) outbreak status. This framework could be modified and adopted by national and zone level health workers in monkeypox-endemic countries. Lastly, we discuss considerations for selecting thresholds for monkeypox outbreaks across gradients of endemicity and public health resources. |
Rabies in a dog imported from Egypt - Connecticut, 2017
Hercules Y , Bryant NJ , Wallace RM , Nelson R , Palumbo G , Williams JN , Ocana JM , Shapiro S , Leavitt H , Slavinsk S , Newman A , Crum DA , Joseph BE , Orciari LA , Li Y , Yager P , Condori RE , Stauffer KE , Brown C . MMWR Morb Mortal Wkly Rep 2018 67 (50) 1388-1391 In 2007, the United States successfully eliminated canine rabies virus variant. Globally, however, dogs remain the principal source of human rabies infections. Since 2007, three cases of canine rabies virus variant were reported in dogs imported into the United States, one each from India (2007), Iraq (2008), and Egypt (2015) (1-3). On December 20, 2017, a dog imported into the United States from Egypt was identified with rabies, representing the second case from Egypt in 3 years. An Egyptian-based animal rescue organization delivered four dogs from Cairo, Egypt, to a flight parent (a person solicited through social media, often not affiliated with the rescue organization, and usually compensated with an airline ticket), who transported the dogs to the United States. The flight parent arrived at John F. Kennedy International Airport (JFK) in New York City and, via transporters (persons who shuttle dogs from one state to another), transferred the dogs to foster families; the dogs ultimately were adopted in three states. The Connecticut Department of Public Health Laboratory (CDPHL) confirmed the presence of a canine rabies virus variant in one of the dogs, a male aged 6 months that was adopted by a Connecticut family. An investigation revealed the possibility of falsified rabies vaccination documentation presented on entry at JFK, allowing the unvaccinated dog entry to the United States. This report highlights the continuing risk posed by the importation of dogs inadequately vaccinated against rabies from high-risk countries and the difficulties in verifying any imported dog's health status and rabies vaccination history. |
Human tularaemia associated with exposure to domestic dogs-United States, 2006-2016
Kwit NA , Schwartz A , Kugeler KJ , Mead PS , Nelson CA . Zoonoses Public Health 2018 66 (4) 417-421 Dogs have been implicated in the zoonotic transmission of numerous pathogens. Whereas cats are known to transmit Francisella tularensis to humans via bite and other routes, the role of dogs in facilitating infection is much less understood. We reviewed tularaemia case investigation records collected through national surveillance during 2006-2016 to summarize those with dog involvement, characterize the nature of dog-related exposure and describe associated clinical characteristics. Among 1,814 human tularaemia cases, 735 (41%) supplemental case investigation records were available for review; and of those, 24 (3.3%) were classified as dog-related. Median age of patients was 51 years (range: 1-82); 54% were female. Two thirds (67%) of cases presented with ulceroglandular/glandular tularaemia; pneumonic (13%) and oropharyngeal (13%) illness occurred less frequently. Dog-related exposures were classified as follows: direct contact via bite, scratch or face snuggling/licking (n = 12; 50%); direct contact with dead animals retrieved by domestic dogs (n = 8; 33%); and contact with infected ticks acquired from domestic dogs (n = 4; 17%). Prevention of dog-related tularaemia necessitates enhanced tularaemia awareness and tick avoidance among pet owners, veterinarians, health care providers and the general public. |
Enhanced arboviral surveillance to increase detection of Jamestown Canyon Virus Infections, Wisconsin, 2011-2016
Matkovic E , Hoang Johnson DK , Staples JE , Mora-Pinzon MC , Elbadawi LI , Osborn RA , Warshauer DM , Wegner MV , Davis JP . Am J Trop Med Hyg 2018 100 (2) 445-451 Jamestown Canyon virus (JCV), a mosquito-borne Orthobunyavirus (within the California serogroup), can cause severe neuroinvasive disease. According to national data during 2000-2013, 42% of the 31 documented JCV disease cases in the United States were detected in residents from Wisconsin. The Wisconsin Division of Public Health enhanced JCV surveillance by implementing routine use of JCV-specific immunoglobulin M (IgM) antibody testing followed by confirmatory JCV-specific plaque reduction neutralization testing on all patients with suspected cases of arboviral infection who had tests positive for arboviral immunoglobin at commercial laboratories. During 2011-2016, of the 287 Wisconsin specimens tested on the Arbovirus IgM Antibody Panel, 30 JCV cases were identified (26 confirmed and four probable). Twenty-seven (90%) JCV cases were detected after 2013. Among all cases, 17 (56%) were male and the median age was 54 years (range: 10-84 years). Fifteen patients had neuroinvasive disease, including meningitis (n = 9) and meningoencephalitis (n = 6). Although historically considered rare, the relatively high rate (0.12 cases/100,000 population) of diagnosis of JCV infections among Wisconsin residents during 2013-2016 compared with that in previous years suggests occurrence is widespread throughout Wisconsin and historically may have been under-recognized. This study aims to raise awareness of JCV infection for differential diagnosis among the arboviral diseases. Improved and timely diagnosis of arboviral disease is important in that it will provide more information regarding emerging infections and promote preventive measures to avoid mosquito-borne exposure and infection among residents of and visitors to affected areas. |
Notes from the field: Identification of a Triatoma sanguisuga "kissing bug" - Delaware, 2018
Eggers P , Offutt-Powell TN , Lopez K , Montgomery SP , Lawrence GG . MMWR Morb Mortal Wkly Rep 2019 68 (15) 359 In July 2018, a family from Kent County, Delaware contacted the Delaware Division of Public Health (DPH) and the Delaware Department of Agriculture (DDA) to request assistance identifying an insect that had bitten their child’s face while she was watching television in her bedroom during the late evening hours. The parents were concerned about possible disease transmission from the insect. Upon investigation, DPH learned that the family resided in an older single-family home near a heavily wooded area. A window air conditioning unit was located in the bedroom where the bite occurred. The family reported no recent travel outside the local area. |
Using healthcare-seeking behaviour to estimate the number of Nipah outbreaks missed by hospital-based surveillance in Bangladesh
Hegde ST , Salje H , Sazzad HMS , Hossain MJ , Rahman M , Daszak P , Klena JD , Nichol ST , Luby SP , Gurley ES . Int J Epidemiol 2019 48 (4) 1219-1227 BACKGROUND: Understanding the true burden of emergent diseases is critical for assessing public-health impact. However, surveillance often relies on hospital systems that only capture a minority of cases. We use the example of Nipah-virus infection in Bangladesh, which has a high case-fatality ratio and frequent person-to-person transmission, to demonstrate how healthcare-seeking data can estimate true burden. METHODS: We fit logistic-regression models to data from a population-based, healthcare-seeking study of encephalitis cases to characterize the impact of distance and mortality on attending one of three surveillance hospital sites. The resulting estimates of detection probabilities, as a function of distance and outcome, are applied to all observed Nipah outbreaks between 2007 and 2014 to estimate the true burden. RESULTS: The probability of attending a surveillance hospital fell from 82% for people with fatal encephalitis living 10 km away from a surveillance hospital to 54% at 50 km away. The odds of attending a surveillance hospital are 3.2 (95% confidence interval: 1.6, 6.6) times greater for patients who eventually died (i.e. who were more severely ill) compared with those who survived. Using these probabilities, we estimated that 119 Nipah outbreaks (95% confidence interval: 103, 140)-an average of 15 outbreaks per Nipah season-occurred during 2007-14; 62 (52%) were detected. CONCLUSIONS: Our findings suggest hospital-based surveillance missed nearly half of all Nipah outbreaks. This analytical method allowed us to estimate the underlying burden of disease, which is important for emerging diseases where healthcare access may be limited. |
Content Index (Achived Edition)
- Chronic Diseases and Conditions
- Communicable Diseases
- Community Health Services
- Disease Reservoirs and Vectors
- Drug Safety
- Environmental Health
- Food Safety
- Genetics and Genomics
- Health Behavior and Risk
- Healthcare Associated Infections
- Immunity and Immunization
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- Occupational Safety and Health - Mining
- Parasitic Diseases
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- Substance Use and Abuse
- Zoonotic and Vectorborne Diseases
About
CDC Science Clips is an online, continuously updated, searchable database of scientific literature published by CDC authors. Each article features an Altmetric Attention Score to track social and mainstream media mentions. If you are aware of a CDC-authored publication that does not appear in this database, please let us know.
- Page last reviewed:Feb 1, 2024
- Page last updated:Apr 29, 2024
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