Physician over-recommendation of mammography for terminally ill women
Leach CR , Klabunde CN , Alfano CM , Smith JL , Rowland JH . Cancer 2012 118 (1) 27-37 BACKGROUND: There has been recent, sometimes intense, debate about when to begin screening and how often to screen women for breast cancer with mammography. However, there should be no controversy regarding screening women who are unlikely to benefit from the procedure, such as those with a serious, life-limiting illness who would not live long enough to benefit from the potential detection and treatment of breast cancer. Identifying characteristics of physicians who recommend mammography for terminally ill women can help guide efforts to minimize patient risks and make better use of health care resources. METHODS: The authors used data from a nationally representative survey of primary care physicians (PCPs) (N = 1196; response rate, 67.5%) conducted in 2006 and 2007 to examine PCPs' breast cancer screening recommendations for hypothetical patients ages 50 years, 65 years, and 80 years who were healthy, had a moderate comorbidity, or had a terminal comorbidity. RESULTS: Many PCPs (47.7%) reported that they would recommend mammography to a woman aged 50 years, 65 years, or 80 years with terminal lung cancer, indicating over-recommendation. Physician characteristics associated with over-recommending mammography included obstetrician/gynecologist (odds ratio [OR], 1.69) or internal medicine (OR, 0.45) specialty, being a woman (OR, 1.40), being a racial/ethnic minority (OR, 1.72), and working in a smaller practice (OR, 1.41). CONCLUSIONS: The current results indicated that physician over-recommendation of screening mammography among terminally ill women is common. Certain physician and practice characteristics, including specialty, were associated with over-recommending mammography. The authors concluded that an informed and shared mammography decision-making process for terminally ill women may eliminate unnecessary patient risks and health care expenditures. (Cancer 2012;. (c) 2011 American Cancer Society.) |
Prevalence of obesity and trends in body mass index among US children and adolescents, 1999-2010
Ogden CL , Carroll MD , Kit BK , Flegal KM . JAMA 2012 307 (5) 483-90 CONTEXT: The prevalence of childhood obesity increased in the 1980s and 1990s but there were no significant changes in prevalence between 1999-2000 and 2007-2008 in the United States. OBJECTIVES: To present the most recent estimates of obesity prevalence in US children and adolescents for 2009-2010 and to investigate trends in obesity prevalence and body mass index (BMI) among children and adolescents between 1999-2000 and 2009-2010. DESIGN, SETTING, AND PARTICIPANTS: Cross-sectional analyses of a representative sample (N = 4111) of the US child and adolescent population (birth through 19 years of age) with measured heights and weights from the National Health and Nutrition Examination Survey 2009-2010. MAIN OUTCOME MEASURES: Prevalence of high weight-for-recumbent length (≥95th percentile on the growth charts) among infants and toddlers from birth to 2 years of age and obesity (BMI ≥95th percentile of the BMI-for-age growth charts) among children and adolescents aged 2 through 19 years. Analyses of trends in obesity by sex and race/ethnicity, and analyses of trends in BMI within sex-specific age groups for 6 survey periods (1999-2000, 2001-2002, 2003-2004, 2005-2006, 2007-2008, and 2009-2010) over 12 years. RESULTS: In 2009-2010, 9.7% (95% CI, 7.6%-12.3%) of infants and toddlers had a high weight-for-recumbent length and 16.9% (95% CI, 15.4%-18.4%) of children and adolescents from 2 through 19 years of age were obese. There was no difference in obesity prevalence among males (P = .62) or females (P = .65) between 2007-2008 and 2009-2010. However, trend analyses over a 12-year period indicated a significant increase in obesity prevalence between 1999-2000 and 2009-2010 in males aged 2 through 19 years (odds ratio, 1.05; 95% CI, 1.01-1.10) but not in females (odds ratio, 1.02; 95% CI, 0.98-1.07) per 2-year survey cycle. There was a significant increase in BMI among adolescent males aged 12 through 19 years (P = .04) but not among any other age group or among females. CONCLUSIONS: In 2009-2010, the prevalence of obesity in children and adolescents was 16.9%; this was not changed compared with 2007-2008. |
Preventing chronic disease in women of reproductive age: opportunities for health promotion and preventive services
Barfield WD , Warner L . Prev Chronic Dis 2012 9 E34 Improving the health of women of reproductive age extends beyond focusing on pregnancy and birth outcomes. Approaching women's health from a life course perspective offers an opportunity to reduce overall and pregnancy-related illnesses and deaths and to eliminate disparities through enhanced health promotion and disease prevention (1). | Recent evaluations suggest that pregnancy-related illnesses and deaths resulting from chronic disease may be increasing. In 2009, the average age for mothers at first birth was 28 years, compared with 21.4 years in 1970 (2). Older women have an increased prevalence of chronic medical conditions, leading to higher risk of adverse pregnancy outcomes. According to a nationally representative study examining trends in US hospitalizations from 1995-2006, the severity of chronic heart disease among women hospitalized during pregnancy may have increased (3). Additionally, data from the Pregnancy Mortality Surveillance System (PMSS) of the Centers for Disease Control and Prevention (CDC) (www.cdc.gov/reproductivehealth) indicate shifts in the proportion of maternal deaths from traditional direct causes of maternal deaths (eg, caused by hemorrhage or infection) toward more chronic conditions, particularly cardiovascular diseases (4). Women of reproductive age also are experiencing increases in the prevalence of chronic disease–related risk factors such as obesity, diabetes, high cholesterol, and asthma (5). Despite these increases, prevention opportunities exist to improve women's health during their reproductive years and beyond and to improve the health of future generations. |
Increased prevalence of inhibitors in Hispanic patients with severe haemophilia A enrolled in the Universal Data Collection database
Carpenter SL , Soucie JM , Sterner S , Presley R . Haemophilia 2012 18 (3) e260-5 SUMMARY: Neutralizing inhibitors develop in 20-30% of patients with severe factor VIII (FVIII) deficiency. It is well established that Blacks have a higher prevalence of inhibitors than Whites. This is the first study to definitively demonstrate increased inhibitor prevalence in the Hispanic population. We compared inhibitor prevalence among various racial and ethnic groups in a cross-sectional analysis of 5651 males with severe haemophilia A that participated in the Universal Data Collection project sponsored by the Centers for Disease Control and Prevention. We used logistic regression analysis to control for potential confounding variables. We assigned as Hispanic those participants who were white and labelled themselves Hispanic. The prevalence of high-titre inhibitors in the Hispanic participants was 24.5% compared to 16.4% for White non-Hispanic patients (OR 1.4, 95% CI 1.1, 1.7). Possibilities as to the underlying cause of increased inhibitor prevalence in minority ethnic populations include polymorphisms in the FVIII molecule, HLA subtypes and differing inflammatory responses. A better understanding may lead to tailored treatment programmes, or other therapies, to decrease or prevent inhibitor development. |
Age-specific gender differences in in-hospital mortality by type of acute myocardial infarction
Zhang Z , Fang J , Gillespie C , Wang G , Hong Y , Yoon PW . Am J Cardiol 2012 109 (8) 1097-103 Younger women hospitalized with an acute myocardial infarction (MI) have a poorer prognosis than men. Whether this is true for patients with acute ST-segment elevation MI (STEMI) and non-STEMI (NSTEMI) is not extensively studied. Using the MarketScan 2004 to 2007 Commercial and Medicare supplemental admission databases, we assessed gender differences in in-hospital mortality according to age in 91,088 patients (35,899 with STEMI, 55,189 with NSTEMI) who were 18 to 89 years old and had acute MI as their primary diagnosis. Patients with STEMI had significantly higher in-hospital mortality than those with NSTEMI (4.35% vs 3.53%, p <0.0001). Compared to men women were older, had higher co-morbidity scores, and were less likely to undergo revascularization during hospitalization in the STEMI and NSTEMI populations. In patients with STEMI the unadjusted women-to-men odds ratio for in-hospital mortality was 2.29 (95% confidence interval 1.48 to 3.55) for the 18- to 49-year age group, 1.68 (1.28 to 2.21) for 50 to 59, 1.48 (1.17 to 1.88) for 60 to 69, 1.28 (1.06 to 1.57) for 70 to 79, and 1.01 (0.83 to 1.23) for 80 to 89. Corresponding unadjusted odds ratios were 1.51 (0.87 to 2.61), 1.46 (1.11 to 1.92), 1.29 (1.04 to 1.61), 0.83 (0.70 to 0.99) and 0.82 (0.70 to 0.94) for patients with NSTEMI. After adjustment for potential confounding factors, excess risk for in-hospital mortality in younger women versus their men counterparts (<60 years old) persisted in STEMI. In patients with NSTEMI the difference between younger women and younger men was not statistically significant; however, older women (≥70 years old) had better survival than men. In conclusion, higher risk of in-hospital mortality in younger women compared to younger men is more evident in patients with STEMI. |
Sugar-sweetened and diet beverage consumption is associated with cardiovascular risk factor profile in youth with type 1 diabetes
Bortsov AV , Liese AD , Bell RA , Dabelea D , D'Agostino RB Jr , Hamman RF , Klingensmith GJ , Lawrence JM , Maahs DM , McKeown R , Marcovina SM , Thomas J , Williams DE , Mayer-Davis EJ . Acta Diabetol 2011 48 (4) 275-82 The prevalence of cardiovascular disease (CVD) risk factors among youth with type 1 diabetes is high and associated with age, gender, and race/ethnicity. It has also been shown that youth with type 1 diabetes often do not follow dietary recommendations. The objective of this cross-sectional observational study was to explore the association of sugar-sweetened and diet beverage intake with A1c, plasma lipids, adiponectin, leptin, systolic, and diastolic blood pressure in youth with type 1 diabetes. We examined data from 1,806 youth age 10-22 years with type 1 diabetes, of which 22% were minority (10% Hispanic, 8% African Americans, 4% other races) and 48% were female. Sugar-sweetened beverage, diet beverage, and mineral water intake was assessed with a food frequency questionnaire. After adjustment for socio-demographic and clinical covariates, physical activity and total energy intake, high sugar-sweetened beverage intake (at least one serving per day vs. none), was associated with higher levels of total cholesterol, LDL cholesterol, and plasma triglycerides, but not with A1c. High diet beverage intake was associated with higher A1c, total cholesterol, LDL cholesterol, and triglycerides. These associations were partially confounded by body mass index, saturated fat and total fiber intake. High sugar-sweetened beverage intake may have an adverse effect on CVD risk in youth with type 1 diabetes. Diet beverage intake may be a marker of unhealthy lifestyle which, in turn, is associated with worse metabolic control and CVD risk profile in these youth. Youth with diabetes should be encouraged to minimize sugar-sweetened beverage intake. |
Neuraminidase H275Y and hemagglutinin D222G mutations in a fatal case of 2009 pandemic influenza A (H1N1) virus infection.
Devries A , Wotton J , Lees C , Boxrud D , Uyeki T , Lynfield R . Influenza Other Respir Viruses 2012 6 (6) e85-8 Oseltamivir-resistant 2009 H1N1 influenza virus infections associated with neuraminidase (NA) H275Y have been identified sporadically. Strains possessing the hemagglutinin (HA) D222G mutation have been detected in small numbers of fatal 2009 H1N1 cases. We report the first clinical description of 2009 H1N1 virus infection with both NA-H275Y and HA-D222G mutations detected by pyrosequencing of bronchioalveolar lavage fluid obtained on symptom day 19. The 59-year-old immunosuppressed patient had multiple conditions conferring higher risk of prolonged viral replication and severe illness and died on symptom day 34. Further investigations are needed to determine the significance of infection with strains possessing NA-H275Y and HA-D222G. |
Pertussis Pseudo-outbreak linked to specimens contaminated by Bordetella pertussis DNA From clinic surfaces.
Mandal S , Tatti KM , Woods-Stout D , Cassiday PK , Faulkner AE , Griffith MM , Jackson ML , Pawloski LC , Wagner B , Barnes M , Cohn AC , Gershman KA , Messonnier NE , Clark TA , Tondella ML , Martin SW . Pediatrics 2012 129 (2) e424-30 BACKGROUND AND OBJECTIVES: We investigated a pertussis outbreak characterized by atypical cases, confirmed by polymerase chain reaction (PCR) alone at a single laboratory, which persisted despite high vaccine coverage and routine control measures. We aimed to determine whether Bordetella pertussis was the causative agent and advise on control interventions. METHODS: We conducted case ascertainment, confirmatory testing for pertussis and other pathogens, and an assessment for possible sources of specimen contamination, including a survey of clinic practices, sampling clinics for B pertussis DNA, and review of laboratory quality indicators. RESULTS: Between November 28, 2008, and September 4, 2009, 125 cases were reported, of which 92 (74%) were PCR positive. Cases occurring after April 2009 (n = 79; 63%) had fewer classic pertussis symptoms (63% vs 98%; P < .01), smaller amounts of B pertussis DNA (mean PCR cycle threshold value: 40.9 vs 33.1; P < .01), and a greater proportion of PCR-positive results (34% vs 6%; P < .01). Cultures and serology for B pertussis were negative. Other common respiratory pathogens were detected. We identified factors that likely resulted in specimen contamination at the point of collection: environmentally present B pertussis DNA in clinics from vaccine, clinic standard specimen collection practices, use of liquid transport medium, and lack of clinically relevant PCR cutoffs. CONCLUSIONS: A summer pertussis pseudo-outbreak, multifactorial in cause, likely occurred. Recommendations beyond standard practice were made to providers on specimen collection and environmental cleaning, and to laboratories on standardizing PCR protocols and reporting results, to minimize false-positive results from contaminated clinical specimens. |
Use of a human influenza challenge model to assess person-to-person transmission: proof-of-concept study
Killingley B , Enstone JE , Greatorex J , Gilbert AS , Lambkin-Williams R , Cauchemez S , Katz JM , Booy R , Hayward A , Oxford J , Bridges CB , Ferguson NM , Nguyen Van-Tam JS . J Infect Dis 2012 205 (1) 35-43 BACKGROUND: Influenza transmission in humans remains poorly understood. In particular, the relative contribution of contact, large droplet, and aerosol transmission is unknown. The aims of this proof-of-concept study were to determine whether an experimentally induced influenza infection is transmissible between humans and whether this would form a viable platform for future studies. METHODS: In a quarantine facility, healthy volunteers ("donors") were inoculated with A/Wisconsin/67/2005 (H3N2) influenza virus via intranasal drops. On study days 2 and 3 "recipient" volunteers were exposed to donors under close living conditions. Volunteers socialized for 30 hours during a 2-day period. Infection was confirmed by ≥1 positive results from polymerase chain reaction, virus culture, or serology. RESULTS: After inoculation, 4 of 9 donors developed symptoms consistent an influenza-like illness (ILI) and 7 of 9 were proven to be influenza-infected. After exposure, 4 of 15 recipients developed symptoms of ILI and 3 of 15 were proven to be infected. Serum collected within 2 days of study initiation indicated that 1 donor and 3 recipients were seropositive at study initiation. After adjustment for preexposure immunity, the overall secondary attack rate was 25% (3 of 12). CONCLUSIONS: Experimental human exposure studies offer an attractive potential method for answering outstanding questions related to influenza transmission and the evaluation of interventions to reduce it. |
A multivariable model to classify methicillin-resistant staphylococcus aureus infections as health care or community associated
Sievert DM , Boulton ML , Wilson ML , Wilkins MJ , Gillespie BW . Infect Dis Clin Pract (Baltim Md) 2012 20 (1) 42-48 BACKGROUND: Methicillin-resistant Staphylococcus aureus (MRSA) infections are often defined as health care (HA) or community-associated (CA) using common classification schemes involving health care risk factor, infection type, susceptibility pattern, or molecular typing. This investigation compared pulsed-field gel electrophoresis (PFGE) molecular typing results (dichotomized as HA or CA) with our new MRSA infection classification method. The goal was to develop an improved predictive model for PFGE-type based primarily on the other 3 classification variables. METHODS: Methicillin-resistant S. aureus infections reported to the Michigan Department of Community Health from October 2004 to December 2005 were analyzed. Patients' demographics, risk factors, infection information, and susceptibility results were collected for 2151 cases. A subset of 244 MRSA infections with available PFGE results was analyzed. Results of logistic regression are presented using a receiver operating characteristic curve analysis. RESULTS: The multivariable models predicted the PFGE classification as HA or CA (Max-rescaled R = 61%) better than health care risk factor, infection type, or susceptibility pattern alone (max-rescaled R = 21%, 34%, and 46%, respectively). The best model included infection type, susceptibility pattern, age, and hospitalized during infection. CONCLUSIONS: This model provides a simpler, more accurate prediction of HA or CA status, thus enhancing efforts to control MRSA infections. (Copyright 2011 Lippincott Williams &Wilkins.) |
Prevalence and risk factors associated with herpes simplex virus-2 infection in a contemporary cohort of HIV-infected persons in the United States
Patel P , Bush T , Mayer KH , Desai S , Henry K , Overton ET , Conley L , Hammer J , Brooks JT . Sex Transm Dis 2012 39 (2) 154-160 BACKGROUND: We compared the herpes simplex virus type 2 (HSV-2) seroprevalence in a contemporary HIV cohort with the general US population and determined risk factors for HSV-2 infection among HIV-infected persons. METHODS: The Study to Understand the Natural History of HIV and AIDS in the Era of Effective Therapy (SUN) Study is a prospective observational cohort of 700 HIV-infected adults enrolled in 4 US cities between 2004 and 2006. At baseline, participants completed a behavioral risk questionnaire and provided specimens for HSV-2 serology. We calculated HSV-2 seroprevalence, standardized by age, gender, and race among HIV-infected persons compared with the general US adult population, using data from the National Health and Nutrition Examination Survey from 2003 to 2006. We examined risk factors associated with HSV-2 infection among HIV-infected persons using multivariate logistic regression. RESULTS: Among 660 (94%) SUN participants with adequate specimens for HSV-2 serologic testing, 548 (83%) were 20 to 49 years old (median age, 39 years; 77% male; 59% non-Hispanic white; median CD4 count, 470 cells/mm; 74% with HIV RNA viral loads <400 copies/mL). HSV-2 seroprevalence was significantly higher among HIV-infected adults (59.7%, 95% confidence interval: 55.8-63.6) compared with the general US population (19.2%, 95% confidence interval: 17.5-21.1). In multivariate analysis, we found that older age, female gender, black non-Hispanic race/ethnicity, being currently unemployed, high-risk anal HPV infection, and longer duration since HIV diagnosis were associated with significantly higher odds of HSV-2 infection. CONCLUSION: HSV-2 seroprevalence is 3 times as high among HIV-infected adults as in the general US population. Clinicians should be aware that increased risk for HSV-2 infection was distributed broadly among HIV-infected persons and not limited to those with high-risk sexual behaviors. |
Preventing deaths in persons with HIV/hepatitis B virus coinfection: a call to accelerate prevention and treatment efforts
Peters PJ , Marston BJ . J Infect Dis 2012 205 (2) 166-8 The prognosis associated with a new diagnosis of human immunodeficiency virus (HIV) infection has improved dramatically since the virus was first recognized [1]. However, the remarkable increases in survival have been attenuated in some groups because of the presence of comorbid infectious diseases and other illnesses. Globally, an estimated 5%–10% of the 33.3 million people living with HIV are coinfected with the hepatitis B virus (HBV). This double-whammy of HIV/HBV coinfection has translated into poorer outcomes. For instance, in settings where expanded access to antiretroviral therapy (ART) has reduced deaths from HIV, liver-related death (from any of a variety of etiologies) has emerged as an important cause for the remaining mortality [2]. Infection with HIV increases the rate of replication of HBV, thereby accelerating progression to cirrhosis, hepatocellular carcinoma, and other liver-related morbidity [3]. There is not clear evidence that HBV impacts the progression of HIV disease, but it has been speculated that HBV infection increases susceptibility to liver toxicity from ART and impairs the immunological response (eg, CD4 cell–count recovery) to HIV treatment. Evaluating whether HIV progression is an important element of the increased mortality seen in coinfected patients has been challenging because of the heterogeneity of available HIV and HBV data in studies reported to date. |
Health related quality of life among patients with tuberculosis and HIV in Thailand
Kittikraisak W , Kingkaew P , Teerawattananon Y , Yothasamut J , Natesuwan S , Manosuthi W , Chongsuvivatwong V , Whitehead SJ . PLoS One 2012 7 (1) e29775 INTRODUCTION: Health utilities of tuberculosis (TB) patients may be diminished by side effects from medication, prolonged treatment duration, physical effects of the disease itself, and social stigma attached to the disease. METHODS: We collected health utility data from Thai patients who were on TB treatment or had been successfully treated for TB for the purpose of economic modeling. Structured questionnaire and EuroQol (EQ-5D) and EuroQol visual analog scale (EQ-VAS) instruments were used as data collection tools. We compared utility of patients with two co-morbidities calculated using multiplicative model (U(CAL)) with the direct measures and fitted Tobit regression models to examine factors predictive of health utility and to assess difference in health utilities of patients in various medical conditions. RESULTS: Of 222 patients analyzed, 138 (62%) were male; median age at enrollment was 40 years (interquartile range [IQR], 35-47). Median monthly household income was 6,000 Baht (187 US$; IQR, 4,000-15,000 Baht [125-469 US$]). Concordance correlation coefficient between utilities measured using EQ-5D and EQ-VAS (U(EQ-5D) and U(VAS), respectively) was 0.6. U(CAL) for HIV-infected TB patients was statistically different from the measured U(EQ-5D) (p-value<0.01) and U(VAS) (p-value<0.01). In tobit regression analysis, factors independently predictive of U(EQ-5D) included age and monthly household income. Patients aged ≥40 years old rated U(EQ-5D) significantly lower than younger persons. Higher U(EQ-5D) was significantly associated with higher monthly household income in a dose response fashion. The median U(EQ-5D) was highest among patients who had been successfully treated for TB and lowest among multi-drug resistant TB (MDR-TB) patients who were on treatment. CONCLUSIONS: U(CAL) of patients with two co-morbidities overestimated the measured utilities, warranting further research of how best to estimate utilities of patients with such conditions. TB and MDR-TB treatments impacted on patients' self perceived health status. This effect diminished after successful treatment. |
HIV risk-related behaviors in the United States household population aged 15-44 years: data from the National Survey of Family Growth, 2002 and 2006-2010
Chandra A , Billioux VG , Copen CE , Sionean C . Natl Health Stat Report 2012 (46) 1-19 OBJECTIVE: This report presents national estimates of selected HIV risk-related behaviors among men and women 15-44 years of age in the United States, based on the 2006-2010 National Survey of Family Growth (NSFG). Data from the 2006-2010 NSFG are compared with data from the 2002 NSFG. METHODS: Data for 2006-2010 were collected through in-person interviews with a national sample of 22,682 men and women aged 15-44 years in the household population of the United States. The measures presented in this report were collected using audio computer-assisted self-interviewing (ACASI), in which the respondent enters his or her own answers into the computer without telling them to an interviewer. The response rate for the 2006-2010 NSFG was 77%, 78% for women and 75% for men. HIV risk-related behavioral measures examined in this report include sexual risk, drug risk, and recent STD treatment. REPORTS: Approximately 10% of men and 8% of women in 2006-2010 reported at least one of the HIV risk-related behavioral measures examined in this report, representing 6.5 million men and 4.9 million women in the general U.S. household population. This represents a decline from the 13% of men and 11% of women who reported one or more of these measures in 2002. This decline appears to be due to a decrease in sexual risk behaviors reported in 2006-2010, however further analysis as well as comparisons with other household surveys are needed to fully understand and describe trends over time. Significant variations were seen by demographic and socioeconomic characteristics including age, race and Hispanic origin, sex, education, and poverty level income. Among men, those with recent prison experience were more likely than other men to report one or more HIV risk-related behaviors in the past year. |
Immune reconstitution inflammatory syndrome (IRIS) in the HIV outpatient study (HOPS): incidence and implications for mortality
Novak RM , Richardson JT , Buchacz K , Chmiel JS , Durham MD , Palella FJ , Wendrow A , Wood K , Young B , Brooks JT . AIDS 2012 26 (6) 721-30 OBJECTIVE: To describe incidence of IRIS and its association with mortality in a large multi-site U.S. HIV-infected cohort applying an objective, comprehensive definition. DESIGN: We studied 2 610 patients seen during 1996-2007 who initiated or resumed highly active combination antiretroviral therapy (cART) and, during the next six months, demonstrated a decline in plasma HIV RNA viral load (VL) ≥ 0.5 log10 copies/mL or ≥ 50% increase in CD4 cell count/mm (CD4). We defined IRIS as the diagnosis of a Type B or Type C condition (per the CDC 1993 AIDS case definition) or any new mucocutaneous disorder during this same time period. METHODS: We assessed the incidence of IRIS, evaluated risk factors for IRIS using conditional logistic regression, and for all-cause mortality using proportional hazards models. RESULTS: We identified 370 cases of IRIS (in 276 patients). Median and nadir CD4 at cART initiation were 90 and 43 cells/mm, respectively; median VL was 2.7 log10 copies/mL. The most common IRIS-defining diagnoses were candidiasis (all forms), cytomegalovirus (CMV) infection, disseminated Mycobacterium avium intracellulare, Pneumocystis pneumonia, varicella zoster, Kaposi's sarcoma and non-Hodgkin lymphoma. Only one case of Mycobacterium tuberculosis was observed. IRIS was independently associated with CD4 < 50 cells/mm vs. ≥ 200 cells/mm (odds ratio [OR] 5.0) and VL ≥ 5.0 log10 copies vs. < 4.0 log10 copies (OR, 2.3). IRIS with a Type B or C-defining diagnosis approximately doubled the risk for all-cause mortality. CONCLUSION: In this large U.S.-based HIV-infected cohort, IRIS occurred in 10.6% of patients who responded to effective antiretroviral therapy, and contributed to increased mortality. |
Antiviral treatment of influenza in children
Garg S , Fry AM , Patton M , Fiore AE , Finelli L . Pediatr Infect Dis J 2012 31 (2) e43-51 Influenza causes substantial morbidity in children in the United States each year. The 2009 influenza A (H1N1) pandemic disproportionately affected the pediatric population and resulted in a substantially increased number of hospitalizations and deaths among children. Early influenza antiviral treatment reduces the duration of illness, frequency of complications, antibiotic use, and health care utilization costs attributable to influenza. A comprehensive strategy to reduce influenza-associated hospitalizations and deaths among children should include empiric antiviral treatment for suspected or confirmed influenza of any severity in children who are hospitalized; who have severe, complicated, or progressive illness; or who are at high risk for influenza complications. Here, we summarize data on the burden of influenza among children in the United States, the indications for influenza antiviral treatment among children, the available evidence for influenza antiviral treatment, and antiviral treatment considerations, including resistance and adverse events. |
Cervical pap screening cytological abnormalities among HIV-infected adolescents in the LEGACY cohort
Setse R , Siberry GK , Moss WJ , Gravitt P , Wheeling T , Bohannon B , Dominguez K . J Pediatr Adolesc Gynecol 2012 25 (1) 27-34 OBJECTIVES: To determine the prevalence of cervical Pap screening (CPAP-S), identify factors associated with CPAP-S, and explore risk factors for abnormal cervical cytology in female adolescents with perinatally and behaviorally acquired HIV infection. DESIGN: Cross-sectional. SETTING: LEGACY is a national observational cohort chart review study of 1478 HIV-infected persons (<age 24 years) managed in 22 HIV specialty clinics in the United States. PARTICIPANTS: Sexually active females aged 13-24 years in the LEGACY cohort. MAIN OUTCOME MEASURES: CPAP-S and abnormal cervical cytology. RESULTS: Of 231 sexually active female LEGACY participants 13-24 years of age 49% had documentation of CPAP-S between 2001 and 2006. Fifty-eight percent of 113 cervical tests were abnormal (2% high-grade). In multivariable analysis, perinatal HIV infection and black race were associated with decreased likelihood of CPAP-S (adjusted prevalence ratio [APR] 0.66, 95% CI 0.45-0.96 and APR 0.74, 95% CI 0.56-0.96, respectively). Presence of any sexually transmitted infection (STI) was independently associated with increased likelihood of CPAP-S (APR 1.56, 95% CI 1.21, 2.02). CD4+ T-lymphocyte count <200 cells/mL and previous STI diagnosis were independently associated with increased likelihood of abnormal cervical cytology (APR 2.19, 95% CI 1.26-3.78 and APR 1.94, 95% CI 1.29-2.92, respectively). CONCLUSIONS: Among sexually active HIV-infected adolescent females, prevalence of CPAP-S was low and cytology was abnormal in more than half of Pap smears. Perinatally HIV-infected, sexually active females were less likely to undergo CPAP-S than their behaviorally HIV-infected counterparts. Interventions targeted at HIV-infected adolescents and care providers are needed to improve CPAP-S in HIV-infected young women, especially those with perinatally acquired HIV infection. |
Chlamydia trachomatis trends in the United States among persons 14 to 39 years of age, 1999-2008
Datta SD , Torrone E , Kruszon-Moran D , Berman S , Johnson R , Satterwhite CL , Papp J , Weinstock H . Sex Transm Dis 2012 39 (2) 92-6 BACKGROUND: We report the first population-based assessment of national trends in chlamydia prevalence in the United States. METHODS: We investigated trends in chlamydia prevalence in representative samples of the US population aged 14 to 39 years using data from five 2-year survey cycles of the National Health and Nutrition Examination Survey from 1999 to 2008. Prevalence estimates and 95% confidence intervals (CI) are reported stratified by age, gender, and race/ethnicity. Percent change in prevalence over this time period was estimated from regression models. RESULTS: In the 2007-2008 cycle, chlamydia prevalence among participants aged 14 to 39 years was 1.6% (95% CI: 1.1%-2.4%). Prevalence was higher among females (2.2%, 95% CI: 1.4%-3.4%) than males (1.1%, 95% CI: 0.7%-1.7%). Prevalence among non-Hispanic black persons was 6.7% (95% CI: 4.6%-9.9%) and was 2.5% (95% CI: 1.6%-3.8%) among adolescents aged 14 to 19 years. Over the five 2-year cycles, there was an estimated 40% reduction (95% CI: 8%-61%) in prevalence among participants aged 14 to 39 years. Decreases in prevalence were notable in men (53% reduction, 95% CI: 19%-72%), adolescents aged 14 to 19 years (48% reduction, 95% CI: 11%-70%), and adolescent non-Hispanic black persons (45%, reduction, 95% CI: 4%-70%). There was no change in prevalence among females aged 14 to 25 years, the population targeted for routine annual screening. CONCLUSIONS: On the basis of population estimates of chlamydia prevalence, the overall chlamydia burden in the United States decreased from 1999 to 2008. However, there remains a need to reduce prevalence in populations most at risk and to reduce racial disparities. |
Cytomegalovirus survival on common environmental surfaces: opportunities for viral transmission
Stowell JD , Forlin-Passoni D , Din E , Radford K , Brown D , White A , Bate SL , Dollard SC , Bialek SR , Cannon MJ , Schmid DS . J Infect Dis 2012 205 (2) 211-4 Congenital cytomegalovirus (CMV) affects approximately 1 of 150 births and is a leading cause of hearing loss and intellectual disability. It has been suggested that transmission may occur via contaminated surfaces. CMV AD169 in filtered human saliva, applied to environmental surfaces, was recovered at various time points. Samples were evaluated by culture and real-time polymerase chain reaction. CMV was found viable on metal and wood to 1 hour, glass and plastic to 3 hours, and rubber, cloth, and cracker to 6 hours. CMV was cultured from 83 of 90 wet and 5 of 40 dry surfaces. CMV was more likely to be isolated from wet, highly absorbent surfaces at earlier time points. |
Dynamic patterns of circulating seasonal and pandemic A(H1N1)pdm09 influenza viruses from 2007-2010 in and around Delhi, India
Broor S , Krishnan A , Roy DS , Dhakad S , Kaushik S , Mir MA , Singh Y , Moen A , Chadha M , Mishra AC , Lal RB . PLoS One 2012 7 (1) e29129 Influenza surveillance was carried out in a subset of patients with influenza-like illness (ILI) presenting at an Employee Health Clinic (EHS) at All India Institute of Medical Sciences (AIIMS), New Delhi (urban) and pediatric out patients department of civil hospital at Ballabhgarh (peri-urban), under the Comprehensive Rural Health Services Project (CRHSP) of AIIMS, in Delhi region from January 2007 to December 2010. Of the 3264 samples tested, 541 (17%) were positive for influenza viruses, of which 221 (41%) were pandemic Influenza A(H1N1)pdm09, 168 (31%) were seasonal influenza A, and 152 (28%) were influenza B. While the Influenza viruses were detected year-round, their types/subtypes varied remarkably. While there was an equal distribution of seasonal A(H1N1) and influenza B in 2007, predominance of influenza B was observed in 2008. At the beginning of 2009, circulation of influenza A(H3N2) viruses was observed, followed later by emergence of Influenza A(H1N1)pdm09 with co-circulation of influenza B viruses. Influenza B was dominant subtype in early 2010, with second wave of Influenza A(H1N1)pdm09 in August-September, 2010. With the exception of pandemic H1N1 emergence in 2009, the peaks of influenza activity coincided primarily with monsoon season, followed by minor peak in winter at both urban and rural sites. Age group analysis of influenza positivity revealed that the percent positivity of Influenza A(H1N1)pdm09 influenza virus was highest in >5-18 years age groups (OR 2.5; CI = 1.2-5.0; p = 0.009) when compared to seasonal influenza. Phylogenetic analysis of Influenza A(H1N1)pdm09 from urban and rural sites did not reveal any major divergence from other Indian strains or viruses circulating worldwide. Continued surveillance globally will help define regional differences in influenza seasonality, as well as, to determine optimal periods to implement influenza vaccination programs among priority populations. |
Trends in the treatment of anemia using recombinant human erythropoietin in patients with HIV infection
Sullivan PS , Hanson DL , Richardson JT , Brooks JT . Open AIDS J 2011 5 113-8 BACKGROUND: Treating anemia with erythropoietin (EPO) to hemoglobin (Hb) endpoints >11 g/dL may increase risk of serious adverse cardiovascular events. METHODS: We used medical records data (1996-2003 from the Adolescent Spectrum of HIV Disease Project [ASD] and 1996-2006 from the HIV Outpatient Study [HOPS]) to describe EPO prescription patterns for mildly, moderately, or severely anemic HIV-infected patients. We calculated proportions prescribed EPO and treated to Hb>12 g/dL, and tested for trends over time. We calculated median hemoglobin at first EPO prescription, and described temporal changes using linear regression. RESULTS: Among 37,395 patients in ASD and 7,005 patients in HOPS, EPO prescription increased over time for moderately anemic patients; for patients with severe anemia, EPO prescription increased only among ASD patients. Hb at EPO prescription decreased over time in ASD patients (median=8.5 g/dL), but not in HOPS patients (median 9.5 g/dL). Percentage of EPO-treated patients with post-treatment Hb>12 g/dL was 18.3% in ASD and stable, and was 56.7% in HOPS and increased over time (p = 0.03). CONCLUSIONS: Through 2006, EPO prescription increased over time for patients with moderate or severe anemia. Many patients treated with EPO had post-treatment Hb>12 g/dL. Based on 2011 FDA recommendations, changes in previous prescription practices will be needed. |
"The anticipation alone could kill you": past and potential clients' perspectives on HIV testing in non-health care settings
Joseph HA , Fasula AM , Morgan RL , Stuckey A , Alvarez ME , Margolis A , Stratford D , Dooley SW . AIDS Educ Prev 2011 23 (6) 577-94 HIV testing in non-health care settings is an effective strategy for increasing the proportion of persons aware of their infection. We conducted 21 focus groups with 186 past and potential clients in five U.S. cities to explore attitudes and experiences related to HIV counseling and testing in non-health care settings. Qualitative analysis yielded several key themes. HIV-related stigma and fear emerged as a main theme throughout the discussions. Knowing one's HIV status quickly and accurately was of primary importance; HIV prevention counseling was secondary. Participants prioritized a supportive, nonjudgmental environment with adequate privacy and confidentiality. Provision of immediate emotional support, medical information, and linkage services to HIV-infected clients were considered essential. Staff with HIV-specific skills to address clients' emotional and informational needs was considered a strength of non-health care testing programs. Frequently, however, participants compared non-health care settings unfavorably to health care settings regarding privacy, competency, confidentiality, and test accuracy. Recommendations for enhancing counseling and testing services in non-health care settings are discussed. |
Correlates of HIV infection among sexually active adults in Kenya: a national population-based survey
Oluoch T , Mohammed I , Bunnell R , Kaiser R , Kim AA , Gichangi A , Mwangi M , Dadabhai S , Marum L , Orago A , Mermin J . Open AIDS J 2011 5 125-34 OBJECTIVE: To identify factors associated with prevalent HIV in a national HIV survey in Kenya. METHODS: The Kenya AIDS Indicator Survey was a nationally representative population-based sero-survey that examined demographic and behavioral factors and serologic testing for HIV, HSV-2 and syphilis in adults aged 15-64 years. We analyzed questionnaire and blood testing data to identify significant correlates of HIV infection among sexually active adults. RESULTS: Of 10,957 eligible women and 8,883 men, we interviewed 10,239 (93%) women and 7,731 (87%) men. We collected blood specimens from 9,049 women and 6,804 men of which 6,447 women and 5,112 men were sexually active during the 12 months prior to the survey. HIV prevalence among sexually active adults was 7.4%. Factors independently associated with HIV among women were region (Nyanza vs Nairobi: adjusted OR [AOR] 1.6, 95%CI 1.1-2.3), number of lifetime sex partners (6-9 vs 0-1 partners: AOR 3.0, 95%CI 1.6-5.9), HSV-2 (AOR 6.5, 95%CI 4.9-8.8), marital status (widowed vs never married: AOR 2.7, 95%CI 1.5-4.8) and consistent condom use with last sex partner (AOR 2.3, 95%CI 1.6-3.4). Among men, correlates of HIV infection were 30-to-39-year-old age group (AOR 5.2, 95%CI 2.6-10.5), number of lifetime sex partners (10+ vs 0-1 partners, AOR 3.5, 95%CI 1.4-9.0), HSV-2 (AOR 4.7, 95%CI 3.2-6.8), syphilis (AOR 2.4, 95%CI 1.4-4.0), consistent condom use with last sex partner (AOR 2.1, 95% CI 1.5-3.1) and lack of circumcision (AOR 4.0, 95%CI 2.8 - 5.5). CONCLUSION: Kenya's heterogeneous epidemic will require regional and gender-specific prevention approaches. |
Lead poisoning in United States-bound refugee children: Thailand-Burma border, 2009
Mitchell T , Jentes E , Ortega L , Scalia Sucosky M , Jefferies T , Bajcevic P , Parr V , Jones W , Brown MJ , Painter J . Pediatrics 2012 129 (2) e392-9 BACKGROUND: Elevated blood lead levels lead to permanent neurocognitive sequelae in children. Resettled refugee children in the United States are considered at high risk for elevated blood lead levels, but the prevalence of and risk factors for elevated blood lead levels before resettlement have not been described. METHODS: Blood samples from children aged 6 months to 14 years from refugee camps in Thailand were tested for lead and hemoglobin. Sixty-seven children with elevated blood lead levels (venous ≥10 microg/dL) or undetectable (capillary <3.3 microg/dL) blood lead levels participated in a case-control study. RESULTS: Of 642 children tested, 33 (5.1%) had elevated blood lead levels. Children aged <2 years had the highest prevalence (14.5%). Among children aged <2 years included in a case-control study, elevated blood lead levels risk factors included hemoglobin <10 g/dL, exposure to car batteries, and taking traditional medicines. CONCLUSIONS: The prevalence of elevated blood lead levels among tested US-bound Burmese refugee children was higher than the current US prevalence, and was especially high among children <2 years old. Refugee children may arrive in the United States with elevated blood lead levels. A population-specific understanding of preexisting lead exposures can enhance postarrival lead-poisoning prevention efforts, based on Centers for Disease Control and Prevention recommendations for resettled refugee children, and can lead to remediation efforts overseas. |
Adhering to fundamental principles of biomonitoring, BPA pharmacokinetics, and mass balance is no "flaw"
Teeguarden JG , Calafat AM , Doerge DR . Toxicol Sci 2012 125 (1) 321-5 In their letter to the editor of Toxicological Sciences, vom Saal et al. (2011) declare that we have misrepresented or omitted relevant details and used “numerous” flawed assumptions to conclude that humans exposed to high dietary levels of bisphenol A (BPA) have undetectable internal levels of the bioactive form of BPA, levels that are expected to be substantially lower than effect levels in sensitized test animals. Their comments demand a thoughtful and critical review to either substantiate the criticisms and rectify them or refute them, ensuring that unsubstantiated criticisms do not discredit the original work. | Three major claims are made by vom Saal et al. We review each and then turn our attention to eight additional claims, using peer-reviewed findings, emphasizing the fundamental concepts concerning BPA pharmacokinetics and biomonitoring along with basic concepts of mass balance or statistics. We are concerned that many of criticisms of vom Saal et al. were made with disregard for these fundamental principles. | The three most important claims made by vom Saal et al. focus on their contention that daily exposure in our study was not high. These claims are addressed first. |
Prostate cancer treatment ascertained from several sources: analysis of disagreement and error
Goodman M , Steenland NK , Almon ML , Liff JS , Dilorio CK , Butler SO , Ekwueme DU , Hall IJ , Smith JL , Master VA , Roberts PL . Ann Oncol 2012 23 (1) 256-63 BACKGROUND: Treatment data for prostate cancer can be obtained from a variety of sources. Each of these sources has its own strengths and weaknesses and is subject to error. MATERIALS AND METHODS: In a population-based cohort of 319 prostate cancer patients, data on treatment were obtained from five sources: two patient interviews at 6 and 12 months after diagnosis, primary caregiver interviews, physician questionnaires, and medical records. Inter-reporting agreement and accuracy of reporting (compared with medical records) were assessed. Multivariate analyses examined patient, caregiver, and physician characteristics as determinants of reporting error. RESULTS: The agreement among different reporting methods was generally good to excellent for prostatectomy and brachytherapy (kappa range 0.70-0.90) and fair to good (kappa range 0.35-0.75) for external beam radiation and hormonal treatment. Compared with medical records, the interview- and questionnaire-based data collection methods were more accurate for prostatectomy and brachytherapy than for external beam radiation and hormonal therapy. Using medical records as the 'gold standard', patient and caregiver interviews at 6 months after the diagnosis had higher sensitivity and specificity than other reporting sources. CONCLUSION: Interviews of prostate cancer patients and caregivers are useful alternatives to medical record abstraction, particularly if carried out during, or soon after, treatment. |
Estimating the prevalence of chronic hepatitis B virus infection - New York City, 2008
France AM , Bornschlegel K , Lazaroff J , Kennedy J , Balter S . J Urban Health 2012 89 (2) 373-83 Chronic hepatitis B virus (HBV) infection is a preventable cause of liver failure, cirrhosis, and liver cancer; estimated chronic HBV infection prevalence is 0.3-0.5% in the USA. Prevalence in New York City (NYC) is likely higher because foreign-born persons, who represent 36% of NYC's population versus 11% nationwide, bear a disproportionate burden of chronic HBV infection. However, because no comprehensive, population-based survey of chronic HBV infection has been conducted in NYC, a reliable prevalence estimate is unavailable. We used two approaches to estimate chronic HBV infection prevalence in NYC: (1) a census-based estimate, combining local and national prevalence data for specific populations, and (2) a surveillance-based estimate, using data from NYC's Department of Health and Mental Hygiene Hepatitis B Surveillance Registry and adjusting for out-migration and deaths. Results from both the census-based estimate and the surveillance-based estimate were similar, with an estimated prevalence of chronic HBV in NYC of 1.2%. This estimate is two to four times the estimated prevalence for the USA as a whole. According to the census-based estimate, >93% of all cases in NYC are among persons who are foreign-born, and approximately half of those are among persons born in China. These findings underscore the importance of local data for tailoring programmatic efforts to specific foreign-born populations in NYC. In particular, Chinese-language programs and health education materials are critical. Reliable estimates are important for policymakers in local jurisdictions to better understand their own population's needs and can help target primary care services, prevention materials, and education. |
Improving surveillance definitions for ventilator-associated pneumonia in an era of public reporting and performance measurement
Magill SS , Fridkin SK . Clin Infect Dis 2012 54 (3) 378-80 Healthcare providers have at their disposal an arsenal of tools to prevent healthcare-associated infections (HAIs), including infection prevention bundles, provider education, hand hygiene monitoring and feedback, and the ability to track HAI events and provide feedback of HAI infection rates to providers and hospital administration. Participation in long-term surveillance efforts as part of a regional or national program provides critical data that healthcare facilities can use to develop and implement local prevention efforts and achieve reductions in infection rates [1–3]. Historically, many infections that met HAI surveillance definitions were not considered by clinicians to be preventable, and the consequences of their detection were limited to debates among providers and healthcare epidemiology personnel within the facility and internal decisions about how best to use the data. These internal discussions often fueled improvements in surveillance and situational awareness of the preventability of HAIs within individual healthcare facilities. However, the consequences have changed with the advent of required reporting of HAI data through the National Healthcare Safety Network (NHSN). This reporting is necessary to comply with state-based mandates for HAI reporting and public availability of facility-specific HAI data, as well as federal HAI reporting requirements. |
Temporal trend and climate factors of hemorrhagic fever with renal syndrome epidemic in Shenyang City, China
Liu X , Jiang B , Gu W , Liu Q . BMC Infect Dis 2011 11 331 BACKGROUND: Hemorrhagic fever with renal syndrome (HFRS) is an important infectious disease caused by different species of hantaviruses. As a rodent-borne disease with a seasonal distribution, external environmental factors including climate factors may play a significant role in its transmission. The city of Shenyang is one of the most seriously endemic areas for HFRS. Here, we characterized the dynamic temporal trend of HFRS, and identified climate-related risk factors and their roles in HFRS transmission in Shenyang, China. METHODS: The annual and monthly cumulative numbers of HFRS cases from 2004 to 2009 were calculated and plotted to show the annual and seasonal fluctuation in Shenyang. Cross-correlation and autocorrelation analyses were performed to detect the lagged effect of climate factors on HFRS transmission and the autocorrelation of monthly HFRS cases. Principal component analysis was constructed by using climate data from 2004 to 2009 to extract principal components of climate factors to reduce co-linearity. The extracted principal components and autocorrelation terms of monthly HFRS cases were added into a multiple regression model called principal components regression model (PCR) to quantify the relationship between climate factors, autocorrelation terms and transmission of HFRS. The PCR model was compared to a general multiple regression model conducted only with climate factors as independent variables. RESULTS: A distinctly declining temporal trend of annual HFRS incidence was identified. HFRS cases were reported every month, and the two peak periods occurred in spring (March to May) and winter (November to January), during which, nearly 75% of the HFRS cases were reported. Three principal components were extracted with a cumulative contribution rate of 86.06%. Component 1 represented MinRH0, MT1, RH1, and MWV1; component 2 represented RH2, MaxT3, and MAP3; and component 3 represented MaxT2, MAP2, and MWV2. The PCR model was composed of three principal components and two autocorrelation terms. The association between HFRS epidemics and climate factors was better explained in the PCR model (F = 446.452, P < 0.001, adjusted R2 = 0.75) than in the general multiple regression model (F = 223.670, P < 0.000, adjusted R2 = 0.51). CONCLUSION: The temporal distribution of HFRS in Shenyang varied in different years with a distinctly declining trend. The monthly trends of HFRS were significantly associated with local temperature, relative humidity, precipitation, air pressure, and wind velocity of the different previous months. The model conducted in this study will make HFRS surveillance simpler and the control of HFRS more targeted in Shenyang. |
Networking for applied field epidemiology - Eastern Mediterranean Public Health Network (EMPHNET) conference 2011
Al Nsour M , Kaiser R . East Mediterr Health J 2011 17 (12) 990-993 On the occasion of the second Eastern Mediterranean Public Health Network (EMPHNET) conference that was held from 6-9 December 2011 in Sharm Al Sheikh, Egypt, this article introduces EMPHNET and its role to link Field Epidemiology Training Programs (FETP) in the region. The paper briefly describes the changing epidemiology situation in the region to illustrate the urgent need to strengthen public health systems and to build up the epidemiologist workforce. |
Estimating the burden of malaria: the need for improved surveillance
Mueller I , Slutsker L , Tanner M . PLoS Med 2011 8 (12) e1001144 Ivo Mueller, Laurence Slutsker, and Marcel Tanner highlight the importance of using complementary methods to estimate the burden of malaria and call for a renewed focus on efficient malaria surveillance. |
Enhancing HIV communication between parents and children: efficacy of the Parents Matter! Program
Miller KS , Lin CY , Poulsen MN , Fasula A , Wyckoff SC , Forehand R , Long N , Armistead L . AIDS Educ Prev 2011 23 (6) 550-63 We examine efficacy of the Parents Matter! Program (PMP), a program to teach African-American parents of preadolescents sexual communication and HIV-prevention skills, through a multicenter, randomized control trial. A total of 1115 parent-child participants were randomized to one of three intervention arms (enhanced, brief, control). Percentages and 95% confidence intervals compare parents' perception of child readiness to learn about sexual issues, communication effectiveness, and dyad concordance from baseline to 12 months postintervention. Wilcoxon rank sum tests compare the changes in scores measuring communication content in HIV/AIDS, abstinence, and condom use. Compared to control, parents in the enhanced arm increased perception of child readiness to learn about sex (16% vs. 29%; p < .001), and a greater proportion of parent-child dyads reported concordant responses on communication topics: HIV/AIDS (15%, 95% CI = 8-21%; p < .001), abstinence (13%, 95% CI = 7-20%; p < .001), condoms (15%, 95% CI = 9-22%; p < .001). Increases in communication scores in HIV/AIDS, abstinence, and condom use were greater in the enhanced arm than control (p < 0.01). We conclude that the enhanced PMP can help parents educate children about HIV and prepare children to avoid sexual risk. |
Persistence of long-term immunity to hepatitis B among adolescents immunized at birth
Chaves SS , Fischer G , Groeger J , Patel PR , Thompson ND , Teshale EH , Stevenson K , Yano VM , Armstrong GL , Samandari T , Kamili S , Drobeniuc J , Hu DJ . Vaccine 2012 30 (9) 1644-9 The long-term duration of recombinant hepatitis B vaccine-induced immunity among persons vaccinated starting at birth is still not well understood. Waning of vaccine-induced immunity could leave young adults at risk of hepatitis B virus infection due to behavioral or occupational exposures. We followed a cohort of children immunized starting at birth with a 3-dose regimen of recombinant hepatitis B vaccine (5mcg, 2.5mcg, 2.5mcg). They were challenged with a booster dose of the hepatitis B vaccine 10 and 15 years after vaccination to assess anamnestic response as a measure of persistence of protection. Among 108 participants who had lost protective antibody levels against hepatitis B, the majority (>70%) had an anamnestic response to the booster dose; response rates did not decline significantly between 10 and 15 years follow-up periods. A high antibody concentration following primary vaccination was independently associated with an anamnestic response later on in life. Nonetheless, approximately 20-30% of participants were unable to mount an immune response after boosting. Hepatitis B revaccination might be required for persons vaccinated starting at birth if opportunities for hepatitis B virus exposure exist. Future vaccine recommendations should be based on studies ascertaining protection against clinically significant disease. |
Human vaccines and their importance to public health
Schuchat A . Procedia Vaccinol 2011 5 (1) 120-126 Few medical interventions compete with vaccines for their cumulative impact on health and well-being of entire populations. Routine immunization of children in the United States now targets 16 vaccine-preventable diseases; and vaccines are now routinely given across the lifespan. Immunization efforts achieved the global eradication of smallpox, as well as the elimination of polio, measles, and rubella from the Americas. The childhood vaccine series including DTP, polio, MMR, Hib, hepatitis B, and varicella vaccines is estimated to prevent 14 million infections, avoid 33,000 premature deaths, and save $9.9 billion in direct medical costs as well as $33 billion in indirect costs for each U.S. birth cohort fully vaccinated. Newer vaccines such as pneumococcal conjugate, rotavirus, and hepatitis A vaccines have also reduced illness and hospitalizations among the target populations but also have amplified benefits beyond their direct effects through reduced transmission from those immunized to other groups. Although for most of the 20th century there was a substantial delay between a vaccine's introduction in developed countries and its broad use in poor countries, newer global public-private partnerships and advocacy are leading to accelerated uptake of new and underutilized vaccines. Since the Measles Initiative was established in 2001, more than 700 million children worldwide have received a measles vaccination and an estimated 4.3 million childhood measles deaths have been averted. The full impact of increasing routine immunization further and implementing new vaccines against pneumonia and diarrhea agents in the poorest countries could prevent more than 2 million additional childhood deaths each year. |
A rapid method for capture and identification of immunogenic proteins in Bordetella pertussis enriched membranes fractions: a fast-track strategy applicable to other microorganisms
West R , Whitmon J , Williamson YM , Moura H , Nelson M , Melnick N , Tondella ML , Schieltz D , Rees J , Woolfitt AR , Barr JR , Ades EW , Carlone GM , Sampson JS . J Proteomics 2012 75 (6) 1966-72 Mass spectrometry (MS) coupled with 1-D and 2-D electrophoresis can be utilized to detect and identify immunogenic proteins, but these methods are laborious and time-consuming. We describe an alternative, simple, rapid gel-free strategy to identify multiple immunogenic proteins from Bordetella pertussis (Bp). It couples immunoprecipitation to nano liquid chromatography- tandem mass spectrometry (IP-nLC-MS/MS) and is significantly both time- and labor-saving. We developed a gel-free magnetic bead-based immunoprecipitation (IP) method using different NP-40/PBS concentrations in which solubilized proteins of Bp Tohama I membrane fractions were precipitated with polyclonal rabbit anti-Bp whole cell immune sera. Immune complexes were analyzed by MS and Scaffold analysis (>95% protein identification probability). Total immunoproteins identified were 50, 63 and 49 for 0.90%, 0.45% and 0.22% NP-40/PBS buffer concentrations respectively. Known Bp proteins identified included pertactin, serotype 2 fimbrial subunit and filamentous hemagglutinin. As proof of concept that this gel-free protein immunoprecipitation method enabled the capture of multiple immunogenic proteins, IP samples were also analyzed by SDS-PAGE and immunoblotting. Bypassing gels and subjecting immunoprecipitated proteins directly to MS is a simple and rapid antigen identification method with relatively high throughput. IP-nLC-MS/MS provides a novel alternative approach for current methods used for the identification of immunogenic proteins. |
Nanoparticle filtration performance of NIOSH-certified particulate air-purifying filtering facepiece respirators: evaluation by light scattering photometric and particle number-based test methods
Rengasamy S , Eimer BC . J Occup Environ Hyg 2012 9 (2) 99-109 National Institute for Occupational Safety and Health (NIOSH) certification test methods employ charge neutralized NaCl or dioctyl phthalate (DOP) aerosols to measure filter penetration levels of air-purifying particulate respirators photometrically using a TSI 8130 automated filter tester at 85 L/min. A previous study in our laboratory found that widely different filter penetration levels were measured for nanoparticles depending on whether a particle number (count)-based detector or a photometric detector was used. The purpose of this study was to better understand the influence of key test parameters, including filter media type, challenge aerosol size range, and detector system. Initial penetration levels for 17 models of NIOSH-approved N-, R-, and P-series filtering facepiece respirators were measured using the TSI 8130 photometric method and compared with the particle number-based penetration (obtained using two ultrafine condensation particle counters) for the same challenge aerosols generated by the TSI 8130. In general, the penetration obtained by the photometric method was less than the penetration obtained with the number-based method. Filter penetration was also measured for ambient room aerosols. Penetration measured by the TSI 8130 photometric method was lower than the number-based ambient aerosol penetration values. Number-based monodisperse NaCl aerosol penetration measurements showed that the most penetrating particle size was in the 50 nm range for all respirator models tested, with the exception of one model at approximately 200 nm size. Respirator models containing electrostatic filter media also showed lower penetration values with the TSI 8130 photometric method than the number-based penetration obtained for the most penetrating monodisperse particles. Results suggest that to provide a more challenging respirator filter test method than what is currently used for respirators containing electrostatic media, the test method should utilize a sufficient number of particles <100 nm and a count (particle number)-based detector. |
Identification of potential biomarkers of exposure to di(isononyl)cyclohexane-1,2-dicarboxylate (DINCH), an alternative for phthalate plasticizers
Silva MJ , Furr J , Preau JL Jr , Samandar E , Gray LE , Calafat AM . J Expo Sci Environ Epidemiol 2012 22 (2) 204-11 Di(isononyl)cyclohexane-1,2-dicarboxylate (DINCH) is used as an alternative for some phthalate plasticizers. In rats, DINCH mostly eliminates in feces as cyclohexane-1,2-dicarboxylic acid (CHDA), mono isononyl ester (MINCH) or in urine as CHDA. However, CHDA is not a specific biomarker of DINCH and measuring MINCH in feces is impractical. To identify additional potential biomarkers, we administered DINCH (500 mg/kg body weight) in a single subcutaneous (SC) or oral dose to four adult female Sprague-Dawley rats. We collected 24-h urine samples before dosing (to be used as controls) and 24-h and 48-h after dosing, and serum at necropsy after 48 h. We positively identified and accurately quantified CHDA and cyclohexane-1,4-dicarboxylic acid, mono hydroxyisononyl ester (MHNCH) using authentic standards. Moreover, we tentatively identified MINCH and 12 oxidative metabolites, including 4 cyclohexane ring oxidation products, based on their mass spectrometric-fragmentation patterns. CHDA and MHNCH levels were higher in the urine collected 24 h after oral than SC administration. By contrast, 48-h after dosing, CHDA urinary levels were similar regardless of the exposure route. We detected all but two of the urine metabolites also in serum. Levels of CHDA and MHNCH in serum were lower than in the two post-dose urine collections. Our results suggest that several urinary oxidative metabolites, specifically CHDA, mono oxoisononyl ester and MHNCH may be used as specific biomarkers of DINCH exposure in humans. |
Automated on-line column-switching HPLC-MS/MS method for the quantification of triclocarban and its oxidative metabolites in human urine and serum
Zhou X , Ye X , Calafat AM . J Chromatogr B Analyt Technol Biomed Life Sci 2012 881-882 27-33 3,4,4'-Trichlorocarbanilide (triclocarban, TCC) is widely used as an antimicrobial agent in a variety of consumer and personal care products. Because of its widespread use, the potential for human exposure to TCC is high. Human exposure to TCC may be assessed by measuring the concentrations of conjugated or free species of TCC and its two oxidative metabolites, 2'-hydroxy-TCC (2'-OH-TCC) and 3'-hydroxy-TCC (3'-OH-TCC), in urine or serum. To assess human exposure to TCC, we developed a method that uses restricted access materials (RAM) on-line solid phase extraction (SPE) coupled to high performance liquid chromatography-isotope dilution tandem mass spectrometry with peak focusing (HPLC-MS/MS). Sample clean-up by RAM relies on both size exclusion chromatography, to remove the high-molecular matrix components, and reversed phase partition, to extract and pre-concentrate the target analytes. TCC, 2'-OH-TCC and 3'-OH-TCC present in urine or serum were concentrated on the RAM SPE column, back-eluted from the SPE column, diluted through a mixing tee for peak focusing, separated by HPLC, and detected by isotope dilution-MS/MS. The method required a small amount of sample (50mcL) and minimal sample pretreatment. The limits of detection (LOD) ranged from 0.01 to 0.1ng/mL. The method was applied to measure TCC and its metabolites in 158 urine and 16 serum samples collected from adults with no known exposure to TCC. TCC was detected in 35.4% of the urine samples (range: <LOD to 401ng/mL). This sensitive method is rugged as well as labor- and cost-effective, and allows for the analysis of a large number of samples for epidemiological studies. |
Development and application of a high-throughput microneutralization assay: lack of xenotropic murine leukemia virus-related virus and/or murine leukemia virus detection in blood donors
Zhou Y , Steffen I , Montalvo L , Lee TH , Zemel R , Switzer WM , Tang S , Jia H , Heneine W , Winkelman V , Tailor CS , Ikeda Y , Simmons G . Transfusion 2012 52 (2) 332-42 BACKGROUND: Xenotropic murine leukemia virus (MLV)-related virus (XMRV) and other related MLVs have been described with chronic fatigue syndrome and certain types of prostate cancer. In addition, prevalence rates as high as 7% have been reported in blood donors, raising the risk of transfusion-related transmission. Several laboratories have utilized microneutralization assays as a surrogate marker for detection of anti-MLV serologic responses-with up to 25% of prostate cancer patients reported to harbor neutralizing antibody responses. STUDY DESIGN AND METHODS: We developed a high-throughput microneutralization assay for research studies on blood donors using retroviral vectors pseudotyped with XMRV-specific envelopes. Infection with these pseudotypes was neutralized by sera from both macaques and mice challenged with XMRV, but not preimmune serum. A total of 354 plasma samples from blood donors in the Reno/Tahoe area were screened for neutralization. RESULTS: A total of 6.5% of donor samples gave moderate neutralization of XMRV, but not control pseudotypes. However, further testing by Western blot revealed no evidence of antibodies against MLVs in any of these samples. Furthermore, no evidence of infectious virus or viral nucleic acid was observed. CONCLUSION: A microneutralization assay was developed for detection of XMRV and can be applied in a high-throughput format for large-scale studies. Although a proportion of blood donors demonstrated the ability to block XMRV envelope-mediated infection, we found no evidence that this inhibition was mediated by specific antibodies elicited by exposure to XMRV or MLV. It is likely that this moderate neutralization is mediated through another, nonspecific mechanism. |
Measuring surface area of airborne titanium dioxide powder agglomerates: relationships between gas adsorption, diffusion and mobility-based methods
LeBouf RF , Ku BK , Chen BT , Frazer DG , Cumpston JL , Stefaniak AB . J Nanopart Res 2011 13 (12) 7029-7039 Inhalation toxicology studies generally use the Brunauer, Emmett, and Teller (BET) gas adsorption method to measure total surface area of particles whereas occupational exposures are more readily measured by real-time mobility-based surface areas or active surface area measured with diffusion charger-based instruments. Three surface area measurement methods were studied: filter-based inert gas adsorption (BET method), diffusion charging, and mobility-based methods. The goal of the project was to investigate and develop a correlation between the measurement methods. The experimental design consisted of measuring surface area in a series of five trials for each of two powder types, fine and ultrafine titanium dioxide with primary particle sizes of 440 and 20 nm, respectively, and two aerosol concentrations. Diffusion charger instruments tended to underestimate the total particle surface area measured by the BET, but were well correlated with mobility-based surface areas obtained from a scanning mobility particle sizer. Filter-based gas adsorption methods and diffusion charging methods provide different but valuable information on total and active surface areas of particles, respectively. Results indicate they should not be used as predictors of one another. |
Molecular identification of Enterocytozoon bieneusi isolates from Nigerian children
Ayinmode AB , Ojuromi OT , Xiao L . J Parasitol Res 2011 2011 129542 A study was conducted to detect and identify enteric microsporidian species in 43 children from Oyo state, Nigeria. Using nested polymerase chain reaction, 9.3% of the children were identified as positive for Enterocytozoon bieneusi. DNA sequencing of the PCR products showed the presence of three known genotypes (two isolates of genotype D and one of genotype K) and one new genotype. This study suggests that either human or animal (or both) could be the infection source for the children, since identified genotypes D and K have been previously detected in both immunocompromised and immunocompetent patients and domestic animals. The identification of high diversity also suggests intensive transmission of microsporidiosis in the studied area. |
Dispersal state of multiwalled carbon nanotubes elicits profibrogenic cellular responses that correlate with fibrogenesis biomarkers and fibrosis in the murine lung
Wang X , Xia T , Addo Ntim S , Ji Z , Lin S , Meng H , Chung CH , George S , Zhang H , Wang M , Li N , Yang Y , Castranova V , Mitra S , Bonner JC , Nel AE . ACS Nano 2011 5 (12) 9772-9787 We developed a dispersal method for multiwalled carbon nanotubes (MWCNTs) that allows quantitative assessment of dispersion on profibrogenic responses in tissue culture cells and in mouse lung. We demonstrate that the dispersal of as-prepared (AP), purified (PD), and carboxylated (COOH) MWCNTs by bovine serum albumin (BSA) and dipalmitoylphosphatidylcholine (DPPC) influences TGF-1, PDGF-AA, and IL-1 production in vitro and in vivo. These biomarkers were chosen based on their synergy in promoting fibrogenesis and cellular communication in the epithelial-mesenchymal cell trophic unit in the lung. The effect of dispersal was most noticeable in AP- and PD-MWCNTs, which are more hydrophobic and unstable in aqueous buffers than hydrophilic COOH-MWCNTs. Well-dispersed AP- and PD-MWCNTs were readily taken up by BEAS-2B, THP-1 cells, and alveolar macrophages (AM) and induced more prominent TGF-1 and IL-1 production in vitro and TGF-1, IL-1, and PDGF-AA production in vivo than nondispersed tubes. Moreover, there was good agreement between the profibrogenic responses in vitro and in vivo as well as the ability of dispersed tubes to generate granulomatous inflammation and fibrosis in airways. Tube dispersal also elicited more robust IL-1 production in THP-1 cells. While COOH-MWCNTs were poorly taken up in BEAS-2B and induced little TGF-1 production, they were bioprocessed by AM and induced less prominent collagen deposition at sites of nongranulomatous inflammation in the alveolar region. Taken together, these results indicate that the dispersal state of MWCNTs affects profibrogenic cellular responses that correlate with the extent of pulmonary fibrosis and are of potential use to predict pulmonary toxicity. (2011 American Chemical Society.) |
Spina bifida subtypes and sub-phenotypes by maternal race/ethnicity in the National Birth Defects Prevention Study
Agopian AJ , Canfield MA , Olney RS , Lupo PJ , Ramadhani T , Mitchell LE , Shaw GM , Moore CA . Am J Med Genet A 2011 158A (1) 109-15 Spina bifida refers to a collection of neural tube defects, including myelomeningocele, meningocele, and myelocele (SB(M) ), as well as lipomyelomeningocele and lipomeningocele (SB(L) ). Maternal race/ethnicity has been associated with an increased risk for spina bifida among offspring. To better understand this relationship, we evaluated different spina bifida subtypes (SB(M) vs. SB(L) ) and sub-phenotypes (anatomic level or presence of additional malformations) by maternal race/ethnicity using data from the National Birth Defects Prevention Study. This study is a large, multisite, population-based study of nonsyndromic birth defects. Prevalence estimates were obtained using data from spina bifida cases (live births, fetal deaths, and elective terminations) and total live births in the study regions. From October 1997 through December 2005, 1,046 infants/fetuses with spina bifida were delivered, yielding a prevalence of 3.06 per 10,000 live births. Differences in the prevalences of SB(M) vs. SB(L) , isolated versus non-isolated SB(M) , and lesion level in isolated SB(M) among case offspring were observed by maternal race/ethnicity. Compared to non-Hispanic (NH) White mothers, offspring of Hispanic mothers had higher prevalences of each subtype and most sub-phenotypes, while offspring of NH Black mothers generally had lower prevalences. Furthermore, differences in race/ethnicity among those with isolated SB(M) were more pronounced by sex. For instance, among male offspring, the prevalence of isolated SB(M) was significantly higher for those with Hispanic mothers compared to NH White mothers [prevalence ratio (PR): 1.55, 95% confidence interval: 1.23-1.95]. These findings provide evidence that certain spina bifida subtypes and sub-phenotypes may be etiologically distinct. ((c) 2011 Wiley Periodicals, Inc.) |
Shift work and adverse pregnancy outcomes: comments on a recent meta-analysis
Rocheleau C , Lawson C , Whelan E , Rich-Edwards J . BJOG 2012 119 (3) 378 Regarding the recent meta-analysis on shift work and pregnancy outcomes,1 we disagree that ‘any effects of shift work on preterm delivery are likely to be small’. These conclusions were based on a sensitivity analysis in which the authors excluded studies they deemed to be ‘of lower quality’. Some studies were excluded because shift work and preterm delivery were self-reported on the same instrument, assumed to result in recall bias. However, there is little evidence that women inaccurately report gestational age, especially in broad categories. As Gordis said: | Although a potential for recall bias is self-evident in case–control studies, in point of fact, there are few actual examples that demonstrate that recall bias has in fact been a major problem in case–control studies and has led to erroneous conclusions regarding associations.2 Items that are subjective (e.g. pain intensity), that participants pay little attention to (e.g. minor headache), or that are sensitive (e.g. illicit drugs) might be more prone to recall bias.3 Preterm birth and shift work do not meet these conditions. |
An updated algorithm for estimation of pesticide exposure intensity in the Agricultural Health Study
Coble J , Thomas KW , Hines CJ , Hoppin JA , Dosemeci M , Curwin B , Lubin JH , Freeman LEB , Blair A , Sandler DP , Alavanja MCR . Int J Environ Res Public Health 2011 8 (12) 4608-4622 An algorithm developed to estimate pesticide exposure intensity for use in epidemiologic analyses was revised based on data from two exposure monitoring studies. In the first study, we estimated relative exposure intensity based on the results of measurements taken during the application of the herbicide 2,4-dichlorophenoxyacetic acid (2,4-D) (n = 88) and the insecticide chlorpyrifos (n = 17). Modifications to the algorithm weighting factors were based on geometric means (GM) of post-application urine concentrations for applicators grouped by application method and use of chemically-resistant (CR) gloves. Measurement data from a second study were also used to evaluate relative exposure levels associated with airblast as compared to hand spray application methods. Algorithm modifications included an increase in the exposure reduction factor for use of CR gloves from 40% to 60%, an increase in the application method weight for boom spray relative to in-furrow and for air blast relative to hand spray, and a decrease in the weight for mixing relative to the new weights assigned for application methods. The weighting factors for the revised algorithm now incorporate exposure measurements taken on Agricultural Health Study (AHS) participants for the application methods and personal protective equipment (PPE) commonly reported by study participants. |
Development of elastomeric isolators to reduce roof bolting machine drilling noise
Michael R , Yantek D , Johnson D , Ferro E , Swope C . Noise Control Eng J 2011 59 (6) 591-612 Among underground coal miners, hearing loss remains one of the most common occupational illnesses. In response to this problem, the National Institute for Occupational Safety and Health (NIOSH) Office of Mine Safety and Health Research (OMSHR) conducts research to reduce the noise emission of underground coal-mining equipment, an example of which is a roof bolting machine. Field studies show that, on average, drilling noise is the most significant contributor to a roof bolting machine operator's noise exposure. NIOSH OMSHR has determined that the drill steel and chuck are the dominant sources of drilling noise. NIOSH OMSHR, Corry Rubber Corporation, and Kennametal, Inc. have developed a bit isolator that breaks the steel-to-steel link between the drill bit and drill steel and a chuck isolator that breaks the mechanical connection between the drill steel and the chuck, thus reducing the noise radiated by the drill steel and chuck, and the noise exposure of the roof bolter operator. This paper documents the evolution of the bit isolator and chuck isolator including various alternative designs which may enhance performance. Laboratory testing confirms that production bit and chuck isolators reduce the A-weighted sound level generated during drilling by 3.7 to 6.6 dB. Finally, this paper summarizes results of a finite element analysis used to explore the key parameters of the drill bit isolator and chuck isolator to understand the impact these parameters have on noise. (2011 Institute of Noise Control Engineering.) |
A shell-based magnetic field model for magnetic proximity detection systems
Li J , Carr J , Jobes C . Saf Sci 2012 50 (3) 463-471 Several magnetic proximity detection systems have been developed for mining vehicles and mobile machinery to protect nearby workers. Magnetic field generators are often used in these systems to establish magnetic fields around the equipment. A sensor worn by a worker provides a measurement of the magnetic flux density that is used to estimate the proximity to the machine. The proximity detection systems currently available for underground mining equipment are capable of identifying whether a worker is near the machine. However, it is a challenge for these systems to accurately locate the worker. Mining machines, which have fast-moving, articulated parts, present hazards that change depending on the situation at hand as well as the specific location of the worker. In addition, the dynamic nature and confined spaces of the mining environment often demand that the workers be close to the machinery. Therefore, in many cases, simply knowing the proximity of a worker may be inadequate. To provide the most effective protection, it would be advantageous to know the worker’s exact location relative to specific parts of the machine. To lay the foundation for measuring such a location, we have developed a shell-based model of the magnetic flux density distribution for a ferrite-cored generator. This paper will present an analysis of the model along with a model construction process. Also presented are the laboratory test results of a prototype system that implements this model to determine the exact location of a magnetic sensor using the fields from two generators. |
Potential moderating role of seat belt law on the relationship between seat belt use and adverse health behavior
Strine TW , Beck L , Bolen J , Okoro C , Li C . Am J Health Behav 2012 36 (1) 44-55 OBJECTIVE: To determine the potential moderating effect of seat belt law on seat belt compliance among persons who engage in adverse health behaviors. METHODS: Self-reported use of seat belts and adverse health behaviors in a 2008 US state-based population survey. RESULTS: Seat belt law moderates the use of seat belts among males and females who smoked, males who were physically inactive, and males and females who engaged in multiple risk behaviors. CONCLUSION: There is a need to supplement legislative interventions with more focused behavioral approaches to further increase seat belt compliance among persons who engage in adverse risk behaviors. |
Comment on 'Electromagnetic force on a moving dipole'
Hnizdo V . Eur J Phys 2012 33 (1) L3-L6 Using the Lagrangian formalism, the force on a moving dipole derived by Kholmetskii et al (2011 Eur. J. Phys. 32 873-81) is found to be missing some important terms. |
Coxiella burnetii infection of marine mammals in the Pacific Northwest, 1997-2010
Kersh GJ , Lambourn DM , Raverty SA , Fitzpatrick KA , Self JS , Akmajian AM , Jeffries SJ , Huggins J , Drew CP , Zaki SR , Massung RF . J Wildl Dis 2012 48 (1) 201-6 Q fever is a zoonotic disease caused by the bacterium Coxiella burnetii. Humans are commonly exposed via inhalation of aerosolized bacteria derived from the waste products of domesticated sheep and goats, and particularly from products generated during parturition. However, many other species can be infected with C. burnetii, and the host range and full zoonotic potential of C. burnetii is unknown. Two cases of C. burnetii infection in marine mammal placenta have been reported, but it is not known if this infection is common in marine mammals. To address this issue, placenta samples were collected from Pacific harbor seals (Phoca vitulina richardsi), harbor porpoises (Phocoena phocoena), and Steller sea lions (Eumetopias jubatus). Coxiella burnetii was detected by polymerase chain reaction (PCR) in the placentas of Pacific harbor seals (17/27), harbor porpoises (2/6), and Steller sea lions (1/2) collected in the Pacific Northwest. A serosurvey of 215 Pacific harbor seals sampled in inland and outer coastal areas of the Pacific Northwest showed that 34.0% (73/215) had antibodies against either Phase 1 or Phase 2 C. burnetii. These results suggest that C. burnetii infection is common among marine mammals in this region. |
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