Nonadherence to Antihypertensive Medication Among Hypertensive Adults in the United States─HealthStyles, 2010
Tong X , Chu EK , Fang J , Wall HK , Ayala C . J Clin Hypertens (Greenwich) 2016 Nonadherence, or not taking medications as prescribed, to antihypertensive medications has been associated with uncontrolled hypertension. The authors analyzed data from HealthStyles 2010 to assess medication nonadherence among adults with hypertension. The overall prevalence of hypertension was 27.4% and the prevalence of nonadherence was 30.5% among hypertensive adult respondents. Nonadherence rates were highest among younger adults (aged 18-44 years), Hispanics, those who reported lowest annual income (<$25,000), and those who reported depression. The most common reason stated for nonadherence was "I cannot afford the medication" (35.1%). A multivariate logistic regression model showed age, race, and household income to be associated with nonadherence. These findings suggest that certain subgroups are more likely to report barriers to adherence. Interventions to support the management of hypertension should consider the identification of certain at-risk subgroups and utilize community and clinical evidenced-based resources to improve long-term control. |
Applying the social ecological model to creating Asthma-Friendly Schools in Louisiana
Nuss HJ , Hester LL , Perry MA , Stewart-Briley C , Reagon VM , Collins P . J Sch Health 2016 86 (3) 225-32 BACKGROUND: In 2010, the Louisiana Asthma Management and Prevention Program (LAMP) implemented the Asthma-Friendly Schools Initiative in high-risk Louisiana populations. The social ecological model (SEM) was used as a framework for an asthma program implemented in 70 state K-12 public schools over 2 years. METHODS: Activities included a needs assessment, identification of students with asthma, individualized asthma action plans (AAP), staff trainings, environmental quality improvement, and school system policy changes to address the asthma burden. RESULTS: There were 522 new or existing asthma cases recognized. Asthma knowledge/awareness was measurably improved among school personnel. School indoor air quality was improved across all locations. School-level polices were adopted that improved AAP collection, compliance to bus-idling restrictions, and asthma medication self-carry. CONCLUSIONS: The SEM framework can be used for school-based programs to address successfully and improve asthma-related issues from the individual through policy levels. |
Respiratory viruses associated hospitalization among children aged <5 years in Bangladesh: 2010-2014
Homaira N , Luby SP , Hossain K , Islam K , Ahmed M , Rahman M , Rahman Z , Paul RC , Bhuiyan MU , Brooks WA , Sohel BM , Banik KC , Widdowson MA , Willby M , Rahman M , Bresee J , Ramirez KS , Azziz-Baumgartner E . PLoS One 2016 11 (2) e0147982 BACKGROUND: We combined hospital-based surveillance and health utilization survey data to estimate the incidence of respiratory viral infections associated hospitalization among children aged < 5 years in Bangladesh. METHODS: Surveillance physicians collected respiratory specimens from children aged <5 years hospitalized with respiratory illness and residing in the primary hospital catchment areas. We tested respiratory specimens for respiratory syncytial virus, parainfluenza viruses, human metapneumovirus, influenza, adenovirus and rhinoviruses using rRT-PCR. During 2013, we conducted a health utilization survey in the primary catchment areas of the hospitals to determine the proportion of all hospitalizations for respiratory illness among children aged <5 years at the surveillance hospitals during the preceding 12 months. We estimated the respiratory virus-specific incidence of hospitalization by dividing the estimated number of hospitalized children with a laboratory confirmed infection with a respiratory virus by the population aged <5 years of the catchment areas and adjusted for the proportion of children who were hospitalized at the surveillance hospitals. RESULTS: We estimated that the annual incidence per 1000 children (95% CI) of all cause associated respiratory hospitalization was 11.5 (10-12). The incidences per 1000 children (95% CI) per year for respiratory syncytial virus, parainfluenza, adenovirus, human metapneumovirus and influenza infections were 3(2-3), 0.5(0.4-0.8), 0.4 (0.3-0.6), 0.4 (0.3-0.6), and 0.4 (0.3-0.6) respectively. The incidences per 1000 children (95%CI) of rhinovirus-associated infections among hospitalized children were 5 (3-7), 2 (1-3), 1 (0.6-2), and 3 (2-4) in 2010, 2011, 2012 and 2013, respectively. CONCLUSION: Our data suggest that respiratory viruses are associated with a substantial burden of hospitalization in children aged <5 years in Bangladesh. |
Uveitis and systemic inflammatory markers in convalescent phase of Ebola virus disease
Chancellor JR , Padmanabhan SP , Greenough TC , Sacra R , Ellison RT 3rd , Madoff LC , Droms RJ , Hinkle DM , Asdourian GK , Finberg RW , Stroher U , Uyeki TM , Ceron OM . Emerg Infect Dis 2016 22 (2) 295-7 We report a case of probable Zaire Ebola virus-related ophthalmologic complications in a physician from the United States who contracted Ebola virus disease in Liberia. Uveitis, immune activation, and nonspecific increase in antibody titers developed during convalescence. This case highlights immune phenomena that could complicate management of Ebola virus disease-related uveitis during convalescence. |
Prognostic indicators for Ebola patient survival
Crowe SJ , Maenner MJ , Kuah S , Erickson BR , Coffee M , Knust B , Klena J , Foday J , Hertz D , Hermans V , Achar J , Caleo GM , Van Herp M , Albarino CG , Amman B , Basile AJ , Bearden S , Belser JA , Bergeron E , Blau D , Brault AC , Campbell S , Flint M , Gibbons A , Goodman C , McMullan L , Paddock C , Russell B , Salzer JS , Sanchez A , Sealy T , Wang D , Saffa G , Turay A , Nichol ST , Towner JS . Emerg Infect Dis 2016 22 (2) 217-23 To determine whether 2 readily available indicators predicted survival among patients with Ebola virus disease in Sierra Leone, we evaluated information for 216 of the 227 patients in Bo District during a 4-month period. The indicators were time from symptom onset to healthcare facility admission and quantitative real-time reverse transcription PCR cycle threshold (Ct), a surrogate for viral load, in first Ebola virus-positive blood sample tested. Of these patients, 151 were alive when detected and had reported healthcare facility admission dates and Ct values available. Time from symptom onset to healthcare facility admission was not associated with survival, but viral load in the first Ebola virus-positive blood sample was inversely associated with survival: 52 (87%) of 60 patients with a Ct of >24 survived and 20 (22%) of 91 with a Ct of <24 survived. Ct values may be useful for clinicians making treatment decisions or managing patient or family expectations. |
Ebola and its control in Liberia, 2014-2015
Nyenswah TG , Kateh F , Bawo L , Massaquoi M , Gbanyan M , Fallah M , Nagbe TK , Karsor KK , Wesseh CS , Sieh S , Gasasira A , Graaff P , Hensley L , Rosling H , Lo T , Pillai SK , Gupta N , Montgomery JM , Ransom RL , Williams D , Laney AS , Lindblade KA , Slutsker L , Telfer JL , Christie A , Mahoney F , De Cock KM . Emerg Infect Dis 2016 22 (2) 169-77 The severe epidemic of Ebola virus disease in Liberia started in March 2014. On May 9, 2015, the World Health Organization declared Liberia free of Ebola, 42 days after safe burial of the last known case-patient. However, another 6 cases occurred during June-July; on September 3, 2015, the country was again declared free of Ebola. Liberia had by then reported 10,672 cases of Ebola and 4,808 deaths, 37.0% and 42.6%, respectively, of the 28,103 cases and 11,290 deaths reported from the 3 countries that were heavily affected at that time. Essential components of the response included government leadership and sense of urgency, coordinated international assistance, sound technical work, flexibility guided by epidemiologic data, transparency and effective communication, and efforts by communities themselves. Priorities after the epidemic include surveillance in case of resurgence, restoration of health services, infection control in healthcare settings, and strengthening of basic public health systems. |
Epidemiology of epidemic ebola virus disease in Conakry and surrounding prefectures, Guinea, 2014-2015
Rico A , Brody D , Coronado F , Rondy M , Fiebig L , Carcelen A , Deyde VM , Mesfin S , Retzer KD , Bilivogui P , Keita S , Dahl BA . Emerg Infect Dis 2016 22 (2) 178-83 In 2014, Ebola virus disease (EVD) in West Africa was first reported during March in 3 southeastern prefectures in Guinea; from there, the disease rapidly spread across West Africa. We describe the epidemiology of EVD cases reported in Guinea's capital, Conakry, and 4 surrounding prefectures (Coyah, Dubreka, Forecariah, and Kindia), encompassing a full year of the epidemic. A total of 1,355 EVD cases, representing approximately 40% of cases reported in Guinea, originated from these areas. Overall, Forecariah had the highest cumulative incidence (4x higher than that in Conakry). Case-fatality percentage ranged from 40% in Conakry to 60% in Kindia. Cumulative incidence was slightly higher among male than female residents, although incidences by prefecture and commune differed by sex. Over the course of the year, Conakry and neighboring prefectures became the EVD epicenter in Guinea. |
Epidemiology of human leptospirosis in Malaysia, 2004-2012
Benacer D , Thong KL , Min NC , Verasahib KB , Galloway RL , Hartskeerl RA , Souris M , Zain SN . Acta Trop 2016 157 162-8 Leptospirosis is an emerging disease, especially in countries with a tropical climate such as Malaysia. A dramatic increase in the number of cases has been reported over the last decade; however, information on the epidemiological trends of this disease is lacking. The objective of this study is to provide an epidemiological description of human leptospirosis cases over a 9-year period (2004-2012) and disease relationship with meteorological, geographical, and demographical information. A retrospective study was undertaken to describe the patterns of human leptospirosis cases and their association with intrinsic (sex, age, and ethnicity) and extrinsic (location, rainfall, and temperature) factors. Data was grouped according to age, sex, ethnicity, seasonality and geographical distribution, and analyzed using statistical tools to understand the influence of all the different factors on disease incidence. A total of 12,325 cases of leptospirosis were reported between 2004 and 2012 with an upward trend in disease incidence, with the highest in 2012. Three hundred thirty-eight deaths were reported with an overall case fatality rate of 2.74%, with higher incidence in males (9696; 78.7%) compared with female patients (2629; 21.3%), and overall male to female ratio of 3.69:1. Patients aged cohorts between 30 to 39 years old (16.22 per 100,000 population) had the highest disease incidence while the lowest incidence occurred between <1 to 9 years old (3.44 per 100,000 population). The average incidence was highest amongst Malays (10.97 per 100,000 population), followed by Indians (7.95 per 100,000 population). Stratification according to geographical distribution showed that the state of Malacca had the highest average disease incidence (11.12 per 100,000 population) followed by Pahang (10.08 per 100,000 population). The states of Terengganu, Kelantan, and Perak recorded similar rates of incidence ( approximately 8.00 per 100,000 population), while Johor with the least number of reported cases (1.80 per 100,000 population). Positive relationships were recorded between the number of reported cases with the number of raining days per month and monthly average temperature (p-value < 0.05). However, no significant association was noted between rainfall volume and number of reported Leptospirosis cases. This collaborative efforts between medical, academic and governmental institutions has enabled the construction of this comprehensive database that is essential to understand the disease trends in Malaysia and add insights into the prevention and control of this disease. |
HIV testing and service delivery among black females - 61 health department jurisdictions, United States, 2012-2014
Stein R , Pierce T , Hollis N , Smith J . MMWR Morb Mortal Wkly Rep 2016 65 (4) 83-85 A primary goal of the national human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) Strategy is to reduce HIV-related health disparities (1). Among all HIV diagnoses among women in the United States in 2014, non-Hispanic black or African American (black) women accounted for an estimated 62% of diagnoses, despite constituting only 13% of the female population (2,3). Although HIV diagnoses continue to occur disproportionately among black women, HIV surveillance data indicate a 13.5% decrease in diagnoses from 2012 to 2014 (2,4). However, widespread HIV testing and early linkage to care are critical for persons with HIV to achieve viral suppression and improved health outcomes, and to reduce transmission of HIV to others (5). Analysis of CDC-funded program data on HIV testing services provided to black females and submitted by 61 state and local health departments during 2012-2014 revealed that the number of new HIV diagnoses among black females decreased 17% from 2,177 in 2012 to 1,806 in 2014. Among black females with newly diagnosed HIV infection, the percentage who were linked to HIV medical care within 90 days of diagnosis increased 48.2%, from 33.8% in 2012 to 50.1% in 2014. However, in 2010 the National HIV/AIDS Strategy established a goal to link 85% of persons with newly diagnosed HIV infection to HIV medical care (1). Enhanced efforts to diagnose HIV infection among black females and link them to HIV medical care are critical to address HIV infections in the United States. |
Impact of HIV on mortality among patients treated for tuberculosis in Lima, Peru: a prospective cohort study
Velasquez GE , Cegielski JP , Murray MB , Yagui MJ , Asencios LL , Bayona JN , Bonilla CA , Jave HO , Yale G , Suarez CZ , Sanchez E , Rojas C , Atwood SS , Contreras CC , Cruz JS , Shin SS . BMC Infect Dis 2016 16 (1) 45 BACKGROUND: Human immunodeficiency virus (HIV)-associated tuberculosis deaths have decreased worldwide over the past decade. We sought to evaluate the effect of HIV status on tuberculosis mortality among patients undergoing treatment for tuberculosis in Lima, Peru, a low HIV prevalence setting. METHODS: We conducted a prospective cohort study of patients treated for tuberculosis between 2005 and 2008 in two adjacent health regions in Lima, Peru (Lima Ciudad and Lima Este). We constructed a multivariate Cox proportional hazards model to evaluate the effect of HIV status on mortality during tuberculosis treatment. RESULTS: Of 1701 participants treated for tuberculosis, 136 (8.0 %) died during tuberculosis treatment. HIV-positive patients constituted 11.0 % of the cohort and contributed to 34.6 % of all deaths. HIV-positive patients were significantly more likely to die (25.1 vs. 5.9 %, P < 0.001) and less likely to be cured (28.3 vs. 39.4 %, P = 0.003). On multivariate analysis, positive HIV status (hazard ratio [HR] = 6.06; 95 % confidence interval [CI], 3.96-9.27), unemployment (HR = 2.24; 95 % CI, 1.55-3.25), and sputum acid-fast bacilli smear positivity (HR = 1.91; 95 % CI, 1.10-3.31) were significantly associated with a higher hazard of death. CONCLUSIONS: We demonstrate that positive HIV status was a strong predictor of mortality among patients treated for tuberculosis in the early years after Peru started providing free antiretroviral therapy. As HIV diagnosis and antiretroviral therapy provision are more widely implemented for tuberculosis patients in Peru, future operational research should document the changing profile of HIV-associated tuberculosis mortality. |
Disparities in consistent retention in HIV care - 11 states and the District of Columbia, 2011-2013
Dasgupta S , Oster AM , Li J , Hall HI . MMWR Morb Mortal Wkly Rep 2016 65 (4) 77-82 In 2013, 45% of new human immunodeficiency virus (HIV) infection diagnoses occurred in non-Hispanic blacks/African Americans (blacks) (1), who represent 12% of the U.S. POPULATION: * Antiretroviral therapy (ART) improves clinical outcomes and reduces transmission of HIV, which causes acquired immunodeficiency syndrome (AIDS) (2). Racial/ethnic disparities in HIV care limit access to ART, perpetuating disparities in survival and reduced HIV transmission. National HIV Surveillance System (NHSS) data are used to monitor progress toward reaching the National HIV/AIDS Strategy goals to improve care among persons living with HIV and to reduce HIV-related disparities.dagger CDC used NHSS data to describe retention in HIV care over 3 years and describe differences by race/ethnicity. Among persons with HIV infection diagnosed in 2010 who were alive in December 2013, 38% of blacks with HIV infection were consistently retained in care during 2011-2013, compared with 50% of Hispanics/Latinos (Hispanics) and 49% of non-Hispanic whites (whites). Differences in consistent retention in care by race/ethnicity persisted when groups were stratified by sex or transmission category. Among blacks, 35% of males were consistently retained in care compared with 44% of females. Differences in HIV care retention by race/ethnicity were established during the first year after diagnosis. Efforts to establish early HIV care among blacks are needed to mitigate racial/ethnic disparities in HIV outcomes over time. |
Dual contraceptive method use and pregnancy intention among people living with HIV receiving HIV care at six hospitals in Thailand
Munsakul W , Lolekha R , Kowadisaiburana B , Roongpisuthipong A , Jirajariyavej S , Asavapiriyanont S , Hancharoenkit U , Baipluthong B , Pattanasin S , Martin M . Reprod Health 2016 13 (1) 8 BACKGROUND: Describe dual contraceptive method use and the intention to become pregnant of people living with HIV (PLHIV) and their partners in Thailand. METHODS: From January 2008-March 2009, we systematically selected a cohort of PLHIV from PLHIV seeking care at five tertiary care hospitals and one community hospital to complete a questionnaire assessing sexual activity, intention to become pregnant, and contraceptive practices at baseline and 12 months after enrollment. Participants received short family planning messages every 2-3 months to promote the use of dual contraceptives and were offered family planning services. RESULTS: A total of 1,388 PLHIV enrolled, their median age was 37 years (IQR 33-43), 898 (64.7 %) had a steady partner, and 737 (53.1 %) were male. Among those with a steady partner, 862 (96.0 %) did not intend to become pregnant; 709 (82.3 %) had sex during the previous 3 months, 683 (96.3 %) used at least one contraceptive method, and 202 (29.6 %) used dual contraceptive methods. Of the 317 PLHIV who used a single contraceptive method at baseline, 66 (20.8 %) reported using dual methods at 12 months. Participants at two tertiary care hospitals where coordinators facilitated PLHIV referral between HIV and OB/GYN clinics were more likely than participants at the other hospitals to change from single method to dual method (p ≤ 0.03). CONCLUSION: Few PLHIV in this study intended to become pregnant; however, only one-fourth used dual contraceptive methods. Integrating an assessment of the intention to become pregnant and strengthening the PLHIV referral systems in family planning services may contribute to higher rates of dual contraceptive use. |
Maternal tenofovir disoproxil fumarate use in pregnancy and growth outcomes among HIV-exposed uninfected infants in Kenya
Pintye J , Langat A , Singa B , Kinuthia J , Odeny B , Katana A , Nganga L , John-Stewart G , McGrath CJ . Infect Dis Obstet Gynecol 2015 2015 276851 BACKGROUND: Tenofovir disoproxil fumarate (TDF) is commonly used in antiretroviral treatment (ART) and preexposure prophylaxis regimens. We evaluated the relationship of prenatal TDF use and growth outcomes among Kenyan HIV-exposed uninfected (HEU) infants. Materials and Methods: We included PCR-confirmed HEU infants enrolled in a cross-sectional survey of mother-infant pairs conducted between July and December 2013 in Kenya. Maternal ART regimen during pregnancy was determined by self-report and clinic records. Six-week and 9-month z-scores for weight-for-age (WAZ), weight-for-length (WLZ), length-for-age (LAZ), and head circumference-for-age (HCAZ) were compared among HEU infants with and without TDF exposure using t-tests and multivariate linear regression models. RESULTS: 277 mothers who received ART during pregnancy, 63% initiated ART before pregnancy, of which 89 (32%) used TDF. No differences in birth weight (3.0 kg versus 3.1 kg, p = 0.21) or gestational age (38 weeks versus 38 weeks, p = 0.16) were detected between TDF-exposed and TDF-unexposed infants. At 6 weeks, unadjusted mean WAZ was lower among TDF-exposed infants (-0.8 versus -0.4, p = 0.03), with a trend towards association in adjusted analyses (p = 0.06). There were no associations between prenatal TDF use and WLZ, LAZ, and HCAZ in 6-week or 9-month infant cohorts. CONCLUSION: Maternal TDF use did not adversely affect infant growth compared to other regimens. |
Co-feeding transmission of the Ehrlichia muris-like agent (EMLA) to mice (Mus musculus)
Karpathy SE , Allerdice ME , Sheth M , Dasch GA , Levin ML . Vector Borne Zoonotic Dis 2016 16 (3) 145-50 The Ehrlichia muris-like agent (EMLA) is a newly recognized human pathogen found in Wisconsin and Minnesota. Ecological investigations have implicated both the blacklegged tick, Ixodes scapularis, and the white-footed mouse, Peromyscus leucopus, as playing roles in the maintenance of EMLA in nature. The work presented here shows that I. scapularis is an efficient vector of EMLA in a laboratory mouse model, but that Dermacentor variabilis, another frequent human biting tick found in EMLA endemic areas, is not. Additionally, I. scapularis larvae are able to acquire EMLA through co-feeding with infected nymphs. As EMLA only persists in mouse blood for a relatively short period of time, co-feeding transmission may play an important role in the maintenance of EMLA in ticks, and subsequently may play a role in limiting the geographic distribution of this pathogen in areas where co-feeding of larvae and nymphs is less common. |
Prevalence of probiotic use among inpatients: a descriptive study of 145 U.S. hospitals
Yi SH , Jernigan JA , McDonald LC . Am J Infect Control 2016 44 (5) 548-53 BACKGROUND: To inform clinical guidance, public health efforts, and research directions, probiotic use in U.S. health care needs to be better understood. This work aimed to assess the prevalence of inpatient probiotic use in a sample of U.S. hospitals. METHODS: Probiotic use among patients discharged in 2012 was estimated using the MarketScan Hospital Drug Database. In addition, the annual trend in probiotic use (2006-2012) was assessed among a subset of hospitals. RESULTS: Among 145 hospitals with 1,976,167 discharges in 2012, probiotics were used in 51,723 (2.6%) of hospitalizations occurring in 139 (96%) hospitals. Patients receiving probiotics were 9 times more likely to receive antimicrobials (P < .0001) and 21 times more likely to have a Clostridium difficile infection diagnosis (P < .0001). The most common probiotic formulations were Saccharomyces boulardii (32% of patients receiving probiotics), Lactobacillus acidophilus and Lactobacillus bulgaricus (30%), L acidophilus (28%), and Lactobacillus rhamnosus (11%). Probiotic use increased from 1.0% of 1,090,373 discharges in 2006 to 2.9% of 1,006,051 discharges in 2012 (P < .0001). CONCLUSIONS: In this sample of U.S. hospitals, a sizable and growing number of inpatients received probiotics as part of their care despite inadequate evidence to support their use in this population. Additional research is needed to guide probiotic use in the hospital setting. |
User perspectives of characteristics of improved cookstoves from a field evaluation in Western Kenya
Loo JD , Hyseni L , Ouda R , Koske S , Nyagol R , Sadumah I , Bashin M , Sage M , Bruce N , Pilishvili T , Stanistreet D . Int J Environ Res Public Health 2016 13 (2) 167 Over half of the world's population uses biomass fuels; these households cook on open fires indoors, increasing their risk of adverse health effects due to household air pollution (HAP) from biomass combustion. This study evaluated six improved cookstoves (ICS) for effectiveness and acceptability in a rural community in Western Kenya. This paper describes women's views on each ICS compared to the traditional three-stone fire. Views on stove characteristics, fuel consumption, health effects and acceptability were assessed through structured interviews and focus group discussions. Data were coded and analyzed using a thematic approach. In total, 262 interviews and 11 focus groups were conducted from 43 women. Overall, women preferred the ICS over the traditional three-stone fire for various reasons including ease of use, efficiency, fuel efficiency and perceived reduction in smoke and improved health. However, there were clear preferences for specific ICS with almost half of women preferring a Philips stove. Despite acceptance and use of ICS, women used multiple stoves to meet their daily needs. Qualitative studies are essential to field evaluations to provide insight into user perspectives and acceptability of ICS and to inform research and development of technologies that are both effective in reducing HAP and practical in use. |
Prenatal polybrominated diphenyl ether and perfluoroalkyl substance exposures and executive function in school-age children
Vuong AM , Yolton K , Webster GM , Sjodin A , Calafat AM , Braun JM , Dietrich KN , Lanphear BP , Chen A . Environ Res 2016 147 556-64 Executive function is a critical behavioral trait rarely studied in relation to potential neurotoxicants. Prenatal exposure to polybrominated diphenyl ethers (PBDEs) and perfluoroalkyl substances (PFASs) has been associated with adverse neurodevelopment, but there is limited research on executive function. Data from 256 mother-child pairs in the Health Outcomes and Measures of the Environment Study, a prospective birth cohort (2003-2006, Cincinnati, OH), was used to examine maternal serum PBDEs and PFASs and executive function in children ages 5 and 8 years. Maternal serum PBDEs and PFASs were measured at 16+/-3 weeks gestation. Executive function was assessed with the parent-rated Behavior Rating Inventory of Executive Function (BRIEF), which yields composite measures: behavioral regulation index, metacognition index, and global executive composite. Higher BRIEF scores indicate executive function impairments. Linear mixed models and generalized estimating equations were used to estimate covariate-adjusted associations between PBDEs and PFASs and executive function. A 10-fold increase in BDE-153 was associated with poorer behavior regulation (beta=3.23, 95% CI 0.60, 5.86). Higher odds of having a score ≥60 in behavior regulation (OR=3.92, 95% CI 1.76, 8.73) or global executive functioning (OR=2.34, 95% CI 1.05, 5.23) was observed with increased BDE-153. Each ln-unit increase in perfluorooctane sulfonate (PFOS) was associated with poorer behavior regulation (beta=3.14, 95% CI 0.68, 5.61), metacognition (beta=3.10, 95% CI 0.62, 5.58), and global executive functioning (beta=3.38, 95% CI 0.86, 5.90). However, no association was observed between perfluorooctanoate (PFOA) and executive function. Prenatal exposures to BDE-153 and PFOS may be associated with executive function deficits in school-age children. |
Impact of providing in-home water service on the rates of infectious diseases: results from four communities in Western Alaska
Thomas TK , Ritter T , Bruden D , Bruce M , Byrd K , Goldberger R , Dobson J , Hickel K , Smith J , Hennessy T . J Water Health 2016 14 (1) 132-41 Approximately 20% of rural Alaskan homes lack in-home piped water; residents haul water to their homes. The limited quantity of water impacts the ability to meet basic hygiene needs. We assessed rates of infections impacted by water quality (waterborne, e.g. gastrointestinal infections) and quantity (water-washed, e.g. skin and respiratory infections) in communities transitioning to in-home piped water. Residents of four communities consented to a review of medical records 3 years before and after their community received piped water. We selected health encounters with ICD-9CM codes for respiratory, skin and gastrointestinal infections. We calculated annual illness episodes for each infection category after adjusting for age. We obtained 5,477 person-years of observation from 1032 individuals. There were 9,840 illness episodes with at least one ICD-9CM code of interest; 8,155 (83%) respiratory, 1,666 (17%) skin, 241 (2%) gastrointestinal. Water use increased from an average 1.5 gallons/capita/day (g/c/d) to 25.7 g/c/d. There were significant (P-value < 0.05) declines in respiratory (16, 95% confidence interval (CI): 11-21%), skin (20, 95%CI: 10-30%), and gastrointestinal infections (38, 95%CI: 13-55%). We demonstrated significant declines in respiratory, skin and gastrointestinal infections among individuals who received in-home piped water. This study reinforces the importance of adequate quantities of water for health. |
Regional variation in human exposure to persistent organic pollutants in the United States, NHANES
Wattigney WA , Irvin-Barnwell E , Pavuk M , Ragin-Wilson A . J Environ Public Health 2015 2015 571839 We examined serum levels of persistent organic pollutants (POPs) among geographical regions of the United States as defined by the US Census Bureau. National Health and Nutrition Examination Survey (NHANES) data for adults aged 20 years and older are presented for selected survey periods between 1999 and 2010. From NHANES 1999 through 2004, dichlorodiphenyldichloroethylene (DDE) concentration levels were consistently higher among people living in the West than in the Midwest, Northeast, or South. In 2003-2010, perfluorinated compound concentrations tended to be highest in the South. The sum of 35 polychlorinated biphenyls (PCBs) congeners was significantly higher in the Northeast [GM: 189; 95% CI: 173-204 ng/g lipid] than the remaining regions. The regional differences in higher body burdens of exposure to particular POPs could be attributed to a variety of activities, including region-specific patterns of land use and industrial and agricultural chemical applications, as well as different levels of regulatory activity. |
Optimum allocation for a dual-frame telephone survey
Wolter KM , Tao X , Montgomery R , Smith PJ . Surv Methodol 2015 41 (2) 389-401 Careful design of a dual-frame random digit dial (RDD) telephone survey requires selecting from among many options that have varying impacts on cost, precision, and coverage in order to obtain the best possible implementation of the study goals. One such consideration is whether to screen cell-phone households in order to interview cell-phone only (CPO) households and exclude dual-user household, or to take all interviews obtained via the cell-phone sample. We present a framework in which to consider the tradeoffs between these two options and a method to select the optimal design. We derive and discuss the optimum allocation of sample size between the two sampling frames and explore the choice of optimum p, the mixing parameter for the dualuser domain. We illustrate our methods using the National Immunization Survey, sponsored by the Centers for Disease Control and Prevention. |
Attribution of Salmonella enterica serotype Hadar infections using antimicrobial resistance data from two points in the food supply system
Vieira AR , Grass J , Fedorka-Cray PJ , Plumblee JR , Tate H , Cole DJ . Epidemiol Infect 2016 144 (9) 1-8 A challenge to the development of foodborne illness prevention measures is determining the sources of enteric illness. Microbial subtyping source-attribution models attribute illnesses to various sources, requiring data characterizing bacterial isolate subtypes collected from human and food sources. We evaluated the use of antimicrobial resistance data on isolates of Salmonella enterica serotype Hadar, collected from ill humans, food animals, and from retail meats, in two microbial subtyping attribution models. We also compared model results when either antimicrobial resistance or pulsed-field gel electrophoresis (PFGE) patterns were used to subtype isolates. Depending on the subtyping model used, 68-96% of the human infections were attributed to meat and poultry food products. All models yielded similar outcomes, with 86% [95% confidence interval (CI) 80-91] to 91% (95% CI 88-96) of the attributable infections attributed to turkey, and 6% (95% CI 2-10) to 14% (95% CI 8-20) to chicken. Few illnesses (<3%) were attributed to cattle or swine. Results were similar whether the isolates were obtained from food animals during processing or from retail meat products. Our results support the view that microbial subtyping models are a flexible and robust approach for attributing Salmonella Hadar. |
Gene integrated set profile analysis: a context-based approach for inferring biological endpoints.
Kowalski J , Dwivedi B , Newman S , Switchenko JM , Pauly R , Gutman DA , Arora J , Gandhi K , Ainslie K , Doho G , Qin Z , Moreno CS , Rossi MR , Vertino PM , Lonial S , Bernal-Mizrachi L , Boise LH . Nucleic Acids Res 2016 44 (7) e69 The identification of genes with specific patterns of change (e.g. down-regulated and methylated) as phenotype drivers or samples with similar profiles for a given gene set as drivers of clinical outcome, requires the integration of several genomic data types for which an 'integrate by intersection' (IBI) approach is often applied. In this approach, results from separate analyses of each data type are intersected, which has the limitation of a smaller intersection with more data types. We introduce a new method, GISPA (Gene Integrated Set Profile Analysis) for integrated genomic analysis and its variation, SISPA (Sample Integrated Set Profile Analysis) for defining respective genes and samples with the context of similar, a priori specified molecular profiles. With GISPA, the user defines a molecular profile that is compared among several classes and obtains ranked gene sets that satisfy the profile as drivers of each class. With SISPA, the user defines a gene set that satisfies a profile and obtains sample groups of profile activity. Our results from applying GISPA to human multiple myeloma (MM) cell lines contained genes of known profiles and importance, along with several novel targets, and their further SISPA application to MM coMMpass trial data showed clinical relevance. |
From genomic medicine to precision medicine: highlights of 2015.
Auffray C , Caulfield T , Griffin JL , Khoury MJ , Lupski JR , Schwab M . Genome Med 2016 8 (1) 12 2015 has been an exciting year for genomic medicine. We asked our Section Editors to discuss the breakthroughs in their fields of expertise, and what these might mean for the future. As in previous years, exome and whole-genome sequencing are leading the way in our understanding of disease mechanisms, their diagnosis and treatment, while information about the protein products of the genome has also grown, driven by novel technological advances. Precision medicine is now taking off as an important topic in the public health sphere and in education, and no discussion of 2015 would be complete without a mention of the huge advances in gene editing technologies, the implications of which have dominated ethics and policy debate. |
Gene expression profiling of rubella virus infected primary endothelial cells of fetal and adult origin.
Geyer H , Bauer M , Neumann J , Ludde A , Rennert P , Friedrich N , Claus C , Perelygina L , Mankertz A . Virol J 2016 13 (1) 21 BACKGROUND: Rubella virus (RV) infection is usually a mild illness in children and adults. However, maternal infection during the first trimester of pregnancy can lead to congenital rubella syndrome (CRS) in the infant. Fetuses with CRS show damage to the endothelium of the heart and blood vessels; thus, it has been speculated that the clinical manifestations associated with CRS may be a result of endothelial cells persistently infected with RV. Here, we compared the effects of RV infection on gene expression in primary endothelial cells of fetal (HUVEC) and of adult (HSaVEC) origin by transcriptional profiling. RESULTS: More than 75 % of the genes differentially regulated following RV infection were identical in both cell types. Gene Ontology (GO) analysis of these commonly regulated genes showed an enrichment of terms involved in cytokine production and cytokine regulation. Increased accumulation of inflammatory cytokines following RV infection was verified by protein microarray. Interestingly, the chemokine CCL14, which is implicated in supporting embryo implantation at the fetal-maternal interface, was down-regulated following RV infection only in HUVEC. Most noticeably, when analyzing the uniquely regulated transcripts for each cell type, GO term-based cluster analysis of the down-regulated genes of HUVEC revealed an enrichment of the GO terms "sensory organ development", "ear development" and "eye development". CONCLUSION: Since impairment in vision and hearing are the most prominent clinical manifestations observed in CRS patients, the here detected down-regulated genes involved in the development of sensory organs sheds light on the molecular mechanisms that may contribute to the teratogenic effect of RV. |
The critical role of communications in a multilevel obesity-prevention intervention: Lessons learned for alcohol educators
Hatfield DP , Sliwa SA , Folta SC , Economos CD , Goldberg JP . Patient Educ Couns 2016 100 Suppl 1 S3-S10 OBJECTIVE: Multilevel interventions to prevent underage drinking are more effective than individual-level strategies, and messaging campaigns are key to such approaches. Recognizing the benefits of translating best practices across public health domains, this paper details the communications campaign from Shape Up Somerville (SUS), an exemplar for multilevel community-based approaches to address pediatric obesity, highlighting lessons learned for alcohol educators. METHODS: All elements of SUS, including the communications strategy, were developed collaboratively with local partners. Communication initiatives included community-engaged brand development to unify diverse intervention components; school-based communications to promote new opportunities for healthy eating and physical activity; and media partnerships to promote healthy behaviors community-wide. RESULTS: The overall SUS intervention was effective in reducing prevalence of overweight/obesity among first- to third-graders in Somerville relative to control communities. Process evaluation showed that communications successfully reached diverse community segments and raised awareness of and receptivity to changes. CONCLUSIONS AND PRACTICE IMPLICATIONS: Communications campaigns are essential components of multilevel interventions addressing public health challenges including obesity and underage drinking. Such communications should be developed collaboratively with the target audience and stakeholders, designed to engage community members at multiple levels through multiple channels within a systems framework, and sustained through local partnerships. |
Evaluation of a novel intervention to reduce unnecessary urine cultures in intensive care units at a tertiary care hospital in Maryland, 2011-2014
Epstein L , Edwards JR , Halpin AL , Preas MA , Blythe D , Harris AD , Hunt D , Johnson JK , Filippell M , Gould CV , Leekha S . Infect Control Hosp Epidemiol 2016 37 (5) 1-4 We assessed the impact of a reflex urine culture protocol, an intervention aimed to reduce unnecessary urine culturing, in intensive care units at a tertiary care hospital. Significant decreases in urine culturing rates and reported rates of catheter-associated urinary tract infection followed implementation of the protocol. |
A randomized controlled trial of the impact of alternative dosing schedules on the immune response to human rotavirus vaccine in rural Ghanaian infants
Armah G , Lewis KD , Cortese MM , Parashar UD , Ansah A , Gazley L , Victor JC , McNeal MM , Binka F , Steele AD . J Infect Dis 2016 213 (11) 1678-85 BACKGROUND: The 2-dose Human Rotavirus Vaccine (HRV) recommended schedule is at DPT1 and DPT2 (6/10 weeks of age). Alternative schedules and additional doses of HRV have been proposed and may improve vaccine performance in low-income countries (LIC). METHODS: In this randomized trial in rural Ghana, HRV was administered at ages 6/10 (Group 1), 10/14 (Group 2), or 6/10/14 weeks (Group 3). We compared serum anti-rotavirus IgA seroconversion (≥20 U/mL) and geometric mean concentrations (GMCs) between Group 1 and Groups 2 and 3. RESULTS: Ninety-three percent (424/456) of participants completed the study per protocol. In Groups 1, 2, and 3, respectively, the IgA seroconversion rate among participants with IgA levels <20 U/mL at baseline was 28.9%, 37.4%, and 43.4% (Group 1: versus 3 p=0.014; versus 2: p=0.163). Post-vaccination IgA GMCs were 22.1 U/mL, 26.5 U/mL, and 32.6 U/mL (Group 1: versus 3 p=0.038; versus 2: p=0.304). CONCLUSIONS: A third dose of HRV resulted in increased seroconversion and GMCs as compared to two doses administered at 6/10 weeks of age. Since there is no correlate of protection, a post-marketing effectiveness study is required to determine whether the improvement in immune response translates into a public health benefit in LICs. CLINICALTRIALSGOV IDENTIFIER: clinicaltrials.gov; NCT015751. |
Surveillance of vaccination coverage among adult populations - United States, 2014
Williams WW , Lu PJ , O'Halloran A , Kim DK , Grohskopf LA , Pilishvili T , Skoff TH , Nelson NP , Harpaz R , Markowitz LE , Rodriguez-Lainz A , Bridges CB . MMWR Surveill Summ 2016 65 (1) 1-36 PROBLEM/CONDITION: Overall, the prevalence of illness attributable to vaccine-preventable diseases is greater among adults than among children. Adults are recommended to receive vaccinations based on their age, underlying medical conditions, lifestyle, prior vaccinations, and other considerations. Updated vaccination recommendations from CDC are published annually in the U.S. Adult Immunization Schedule. Despite longstanding recommendations for use of many vaccines, vaccination coverage among U.S. adults is low. REPORTING PERIOD: August 2013-June 2014 (for influenza vaccination) and January-December 2014 (for pneumococcal, tetanus and diphtheria [Td] and tetanus and diphtheria with acellular pertussis [Tdap], hepatitis A, hepatitis B, herpes zoster, and human papillomavirus [HPV] vaccination). DESCRIPTION OF SYSTEM: The National Health Interview Survey (NHIS) is a continuous, cross-sectional national household survey of the noninstitutionalized U.S. civilian population. In-person interviews are conducted throughout the year in a probability sample of households, and NHIS data are compiled and released annually. The survey objective is to monitor the health of the U.S. population and provide estimates of health indicators, health care use and access, and health-related behaviors. RESULTS: Compared with data from the 2013 NHIS, increases in vaccination coverage occurred for Tdap vaccine among adults aged ≥19 years (a 2.9 percentage point increase to 20.1%) and herpes zoster vaccine among adults aged ≥60 years (a 3.6 percentage point increase to 27.9%). Aside from these modest improvements, vaccination coverage among adults in 2014 was similar to estimates from 2013 (for influenza coverage, similar to the 2012-13 season). Influenza vaccination coverage among adults aged ≥19 years was 43.2%. Pneumococcal vaccination coverage among high-risk persons aged 19-64 years was 20.3% and among adults aged ≥65 years was 61.3%. Td vaccination coverage among adults aged ≥19 years was 62.2%. Hepatitis A vaccination coverage among adults aged ≥19 years was 9.0%. Hepatitis B vaccination coverage among adults aged ≥19 years was 24.5%. HPV vaccination coverage among adults aged 19-26 years was 40.2% for females and 8.2% for males. Racial/ethnic differences in coverage persisted for all seven vaccines, with higher coverage generally for whites compared with most other groups. Adults without health insurance were significantly less likely than those with health insurance to report receipt of influenza vaccine (aged ≥19 years), pneumococcal vaccine (aged 19-64 years with high-risk conditions and aged ≥65 years), Td vaccine (aged ≥19 years), Tdap vaccine (aged ≥19 years and 19-64 years), hepatitis A vaccine (aged ≥19 years overall and among travelers), hepatitis B vaccine (aged ≥19 years, 19-49 years, and 19-59 years with diabetes), herpes zoster vaccine (aged ≥60 years and 60-64 years), and HPV vaccine (females aged 19-26 years and males aged 19-26 years). Adults who reported having a usual place for health care generally were more likely to receive recommended vaccinations than those who did not have a usual place for health care, regardless of whether they had health insurance. Vaccination coverage was significantly higher among those reporting one or more physician contacts in the past year compared with those who had not visited a physician in the past year, regardless of whether they had health insurance. Even among adults who had health insurance and ≥10 physician contacts within the past year, 23.8%-88.8% reported not having received vaccinations that were recommended either for all persons or for those with some specific indication. Overall, vaccination coverage among U.S.-born respondents was significantly higher than that of foreign-born respondents with few exceptions (influenza vaccination [adults aged 19-49 years], hepatitis A vaccination [adults aged ≥19 years], hepatitis B vaccination [adults with diabetes aged ≥60 years], and HPV vaccination [males aged 19-26 years]). INTERPRETATION: Overall, increases in adult vaccination coverage are needed. Although modest gains occurred in Tdap vaccination coverage among adults aged ≥19 years and herpes zoster vaccination coverage among adults aged ≥60 years, coverage for other vaccines and risk groups did not improve, and racial/ethnic disparities persisted for routinely recommended adult vaccines. Coverage for all vaccines for adults remained low, and missed opportunities to vaccinate adults continued. Although having health insurance coverage and a usual place for health care are associated with higher vaccination coverage, these factors alone do not assure optimal adult vaccination coverage. PUBLIC HEALTH ACTIONS: Assessing associations with vaccination is important for understanding factors that contribute to low coverage rates and to disparities in vaccination, and for implementing strategies to improve vaccination coverage. Practices that have been demonstrated to improve vaccination coverage should be used. These practices include assessment of patients' vaccination indications by health care providers and routine recommendation and offer of needed vaccines to adults, implementation of reminder-recall systems, use of standing-order programs for vaccination, and assessment of practice-level vaccination rates with feedback to staff members. For vaccination to be improved among those least likely to be up-to-date on recommended adult vaccines, efforts also are needed to identify adults who do not have a regular provider or insurance and who report fewer health care visits. |
Sustained transmission of pertussis in vaccinated, 1-5-year-old children in a preschool, Florida, USA
Matthias J , Pritchard PS , Martin SW , Dusek C , Cathey E , D'Alessio R , Kirsch M . Emerg Infect Dis 2016 22 (2) 242-6 In September 2013, local county health officials in Tallahassee, Florida, USA, were notified of a laboratory-confirmed pertussis case in a 1-year-old preschool attendee. During a 5-month period, 26 (22%) students 1-5 years of age, 2 staff from the same preschool, and 11 family members met the national case definition for pertussis. Four persons during this outbreak were hospitalized for clinical management of pertussis symptoms. Only 5 students, including 2 students with pertussis, had not received the complete series of vaccinations for pertussis. Attack rates in 1 classroom for all students who received the complete series of vaccinations for pertussis approached 50%. This outbreak raises concerns about vaccine effectiveness in this preschool age group and reinforces the idea that recent pertussis vaccination should not dissuade physicians from diagnosing, testing, or treating persons with compatible illness for pertussis. | Monitoring of vaccine performance is necessary to identify outbreaks or emerging epidemiologic trends. | eng |
Varicella immunization requirements for US colleges: 2014-2015 academic year
Leung J , Marin M , Leino V , Even S , Bialek SR . J Am Coll Health 2016 64 (6) 0 OBJECTIVE: To obtain information on varicella pre-matriculation requirements in US colleges for undergraduate students during the 2014-2015 academic year. PARTICIPANTS: Healthcare professionals and member-schools of the American College Health Association (ACHA). METHODS: An electronic survey was sent to ACHA members regarding school characteristics and whether schools had policies in place requiring that students show proof of 2-doses of varicella vaccination for school attendance. RESULTS: Only 27% (101/370) of schools had a varicella pre-matriculation requirement for undergraduate students. Only 68% of schools always enforced this requirement. Private schools, 4-year schools, Northeastern schools, those with <5,000 students, and schools located in a state with a 2-dose varicella vaccine mandate were significantly more likely to have a varicella pre-matriculation requirement. CONCLUSIONS: A small proportion of US colleges have a varicella pre-matriculation requirement for varicella immunity. College vaccination requirements are an important tool for controlling varicella in these settings. |
White Paper on studying the safety of the childhood immunization schedule in the Vaccine Safety Datalink
Glanz JM , Newcomer SR , Jackson ML , Omer SB , Bednarczyk RA , Shoup JA , DeStefano F , Daley MF . Vaccine 2016 34 Suppl 1 A1-a29 While the large majority of parents in the U.S. vaccinate their children according to the recommended immunization schedule, some parents have refused or delayed vaccinating, often citing safety concerns. In response to public concern, the U.S. Institute of Medicine (IOM) evaluated existing research regarding the safety of the recommended immunization schedule. The IOM concluded that although available evidence strongly supported the safety of the currently recommended schedule as a whole, additional observational research was warranted to compare health outcomes between fully vaccinated children and those on a delayed or alternative schedule. In addition, the IOM identified the Vaccine Safety Datalink (VSD) as an important resource for conducting this research. Guided by the IOM findings, the Centers for Disease Control and Prevention (CDC) commissioned a White Paper to assess how the VSD could be used to study the safety of the childhood immunization schedule. Guided by subject matter expert engagement, the resulting White Paper outlines a 4 stage approach for identifying exposure groups of undervaccinated children, presents a list of health outcomes of highest priority to examine in this context, and describes various study designs and statistical methods that could be used to analyze the safety of the schedule. While it appears feasible to study the safety of the recommended immunization schedule in settings such as the VSD, these studies will be inherently complex, and as with all observational studies, will need to carefully address issues of confounding and bias. In light of these considerations, decisions about conducting studies of the safety of the schedule will also need to assess epidemiological evidence of potential adverse events that could be related to the schedule, the biological plausibility of an association between an adverse event and the schedule, and public concern about the safety of the schedule. |
Non-interference of rotavirus vaccine with measles-rubella vaccine at 9 months and improvements in anti-rotavirus immunity: a randomized trial
Zaman K , Fleming JA , Victor JC , Yunus M , Bari TI , Azim T , Rahman M , Mowla SM , Bellini WJ , McNeal M , Icenogle JP , Lopman B , Parashar U , Cortese MM , Steele AD , Neuzil KM . J Infect Dis 2016 BACKGROUND: The burden of rotavirus morbidity and mortality is high in children under 5 years in developing countries and evaluations indicate waning protection from rotavirus immunization in the second year. An additional dose of rotavirus vaccine may enhance the immune response and lengthen the period of protection against disease, however co-administration should not interfere with immune responses to concurrently given vaccines. METHODS: Enrolling 480 9-month old participants from Matlab, Bangladesh, the primary objective was to establish non-inferiority of concomitant administration of measles-rubella (MR) vaccine and a 3rd dose of human monovalent rotavirus vaccine (HRV) [MR+HRV] compared to MR vaccine given alone [MR]. Secondary objectives included non-inferiority of rubella antibody seroconversion and evaluating rotavirus IgA/IgG seroresponses in MR+HRV participants. RESULTS: Two months post-vaccination, 75.3% and 74.3% of MR+HRV and MR group infants, respectively, had seroprotective levels of measles virus antibodies. 100.0% and 99.6%, respectively, showed anti-rubella IgG seroprotection. In the MR+HRV group, pre-vaccination anti-rotavirus IgA and IgG seropositivities (52.7% and 66.3%, respectively) increased to 69.6% and 88.3% post-vaccination. CONCLUSIONS: Vaccine-induced measles and rubella antibody responses are not negatively affected by concomitant administration of HRV. The HRV dose increases anti-rotavirus serum antibody titres and the proportion of infants with detectable anti-rotavirus antibody. |
The PARADIGM of influenza vaccination in heart failure patients
Acharya D , Uyeki TM . JACC Heart Fail 2016 4 (2) 159-61 Annual seasonal influenza epidemics of variable severity are associated with substantial morbidity and mortality worldwide, with influenza activity peaking during corresponding winter months in temperate climates of the northern and southern hemispheres (1). In the tropics and subtropics, influenza activity occurs year-round, with differences in peak periods. Most influenza disease burden estimates are derived from studies conducted in developed countries. Certain populations are considered to be at increased risk for influenza complications, including infants, the elderly, immuno-suppressed persons, pregnant women, and persons with chronic conditions including pulmonary and cardiac disease (2). Prevention of influenza in the United States is focused upon annual influenza vaccination of all persons ≥6 months of age, although recommended target populations and different kinds of vaccines and their availability and uses differ worldwide (3). Influenza vaccine effectiveness varies by age group, immune status, and antigenic similarities between circulating influenza virus strains and vaccine strains. | The World Health Organization has estimated that an estimated 3 to 5 million cases of severe influenza and approximately 250,000 to 500,000 deaths occur each year (4). Heart failure (HF) is an independent prognostic factor for influenza- associated hospitalization or death (5). In the United States, hospitalizations for HF peak during the winter and are lowest during the summer (6). Influenza vaccination has been associated with reductions in HF hospitalization and death in multiple community-based observational studies of patients ≥65 years of age and studies of younger adults with high-risk medical conditions (7,8). The U.S. Centers for Disease Control and Prevention, American Heart Association, and European Society of Cardiology recommend annual influenza vaccinations in patients with HF. |
Effect of pentavalent rotavirus vaccine introduction on hospital admissions for diarrhoea and rotavirus in children in Rwanda: a time-series analysis
Ngabo F , Tate JE , Gatera M , Rugambwa C , Donnen P , Lepage P , Mwenda JM , Binagwaho A , Parashar UD . Lancet Glob Health 2016 4 (2) e129-36 BACKGROUND: In May, 2012, Rwanda became the first low-income African country to introduce pentavalent rotavirus vaccine into its routine national immunisation programme. Although the potential health benefits of rotavirus vaccination are huge in low-income African countries that account for more than half the global deaths from rotavirus, concerns remain about the performance of oral rotavirus vaccines in these challenging settings. METHODS: We conducted a time-series analysis to examine trends in admissions to hospital for non-bloody diarrhoea in children younger than 5 years in Rwanda between Jan 1, 2009, and Dec 31, 2014, using monthly discharge data from the Health Management Information System. Additionally, we reviewed the registries in the paediatric wards at six hospitals from 2009 to 2014 and abstracted the number of total admissions and admissions for diarrhoea in children younger than 5 years by admission month and age group. We studied trends in admissions specific to rotavirus at one hospital that had undertaken active rotavirus surveillance from 2011 to 2014. We assessed changes in rotavirus epidemiology by use of data from eight active surveillance hospitals. FINDINGS: Compared with the 2009-11 prevaccine baseline, hospital admissions for non-bloody diarrhoea captured by the Health Management Information System fell by 17-29% from a pre-vaccine median of 4051 to 2881 in 2013 and 3371 in 2014, admissions for acute gastroenteritis captured in paediatric ward registries decreased by 48-49%, and admissions specific to rotavirus captured by active surveillance fell by 61-70%. The greatest effect was recorded in children age-eligible to be vaccinated, but we noted a decrease in the proportion of children with diarrhoea testing positive for rotavirus in almost every age group. INTERPRETATION: The number of admissions to hospital for diarrhoea and rotavirus in Rwanda fell substantially after rotavirus vaccine implementation, including among older children age-ineligible for vaccination, suggesting indirect protection through reduced transmission of rotavirus. These data highlight the benefits of routine vaccination against rotavirus in low-income settings. FUNDING: Gavi, the Vaccine Alliance and the Government of Rwanda. |
Interventions to increase HPV vaccination coverage: a systematic review
Smulian EA , Mitchell KR , Stokley S . Hum Vaccin Immunother 2016 12 (6) 0 We reviewed intervention studies designed to increase human papillomavirus (HPV) vaccination coverage to further understand the impact interventions can have on HPV vaccination coverage. We searched 5 databases for intervention studies published from June 2006 to May 2015. Studies were included if they quantitatively measured HPV vaccination coverage as an outcome and were conducted in the United States. We abstracted outcomes, methods, and results from each study and classified by type of intervention conducted. Findings from 34 studies suggest many types of intervention strategies can increase HPV vaccination coverage in different settings, and with modest cost. Interventions were effective especially when implemented in combination at both provider and community levels. However, not all interventions showed significant effects on coverage. More research is needed to identify the best methods for widespread implementation of effective strategies. |
Advisory Committee on Immunization Practices Recommended Immunization Schedule for Adults Aged 19 Years or Older - United States, 2016
Kim DK , Bridges CB , Harriman KH . MMWR Morb Mortal Wkly Rep 2016 65 (4) 88-90 In October 2015, the Advisory Committee on Immunization Practices (ACIP)* approved the Recommended Immunization Schedule for Adults Aged 19 Years or Older, United States, 2016. This schedule provides a summary of ACIP recommendations for the use of vaccines routinely recommended for adults aged 19 years or older in two figures, footnotes for each vaccine, and a table that describes primary contraindications and precautions for commonly used vaccines for adults. Although the figures in the adult immunization schedule illustrate recommended vaccinations that begin at age 19 years, the footnotes contain information on vaccines that are recommended for adults that may begin at age younger than age 19 years. The footnotes also contain vaccine dosing, intervals between doses, and other important information and should be read with the figures. |
Advisory Committee on Immunization Practices recommended immunization schedules for persons aged 0 Through 18 Years - United States, 2016
Robinson CL . MMWR Morb Mortal Wkly Rep 2016 65 (4) 86-87 Each year, the Advisory Committee on Immunization Practices (ACIP)* reviews the recommended immunization schedules for persons aged 0 through 18 years to ensure that the schedules reflect current recommendations for Food and Drug Administration-licensed vaccines. In October 2015, ACIP approved the recommended immunization schedules for persons aged 0 through 18 years for 2016; the 2016 schedules include several changes from the 2015 immunization schedules. For 2016, the figures, footnotes, and tables will be published on the CDC immunization schedule website (http://www.cdc.gov/vaccines/schedules/index.html). This provides readers electronic access to the most current version of the schedules and footnotes on the CDC website. Health care providers are advised to use figures, tables, and the combined footnotes together. Printable versions of the 2016 immunization schedules for persons aged 0 through 18 years in several formats (e.g., portrait, landscape, and pocket-sized versions) and ordering instructions for laminated versions and "parent-friendly" schedules are available at the immunization schedule website. |
Evaluation of rotavirus disease burden and vaccine effectiveness in India
Kang G , Tate JE , Parashar UD . Vaccine 2015 33 (51) 7143 Measurement of the burden of disease for common childhood conditions can be challenging, particularly when most healthcare data capture systems are based in hospitals. There are few ways to estimate the burden of milder disease, which might be managed at home and the most severe disease, which might result in death before a child reaches a healthcare facility. Among study designs, observational cohorts measuring the incidence and the severity of disease could be considered best suited for estimating disease burden but are resource intensive. Within the context of a clinical trial, particularly one that is placebo-controlled, research teams have the responsibility of provision of appropriate care for children, which can alter the natural progression of disease. The design of a clinical trial, the frequency of contact and the resources available and utilized to manage ill children can all affect the severity of disease, as has been highlighted in an important comparison of rotavirus vaccine trials in developing countries [1]. | We are fortunate that in India, unlike most other developing country settings, there have been several observational cohorts, as well as hospital based studies, from which burden of disease has been estimated as described in John et al. [2]. It is reassuring to note that despite the differences in study designs and geographic locations of the observational studies the estimates are similar, and in line with that reported from South Africa. It is revealing that the intensity of monitoring and the prompt provision of care within the context of a clinical trial, resulted in a >30% reduction in the incidence of severe rotavirus gastroenteritis, even though the trial was conducted in the same location as the observational studies from which disease burden estimates were derived [3]. |
Dating violence and injury among youth exposed to violence
Reidy DE , Kearns MC , Houry D , Valle LA , Holland KM , Marshall KJ . Pediatrics 2016 137 (2) e20152627 OBJECTIVES: To assess gender differences in the proportion of adolescents reporting teen dating violence (TDV) and the frequency of TDV at multiple age points across adolescence in a high-risk sample of youth with previous exposure to violence. METHODS: A cross-sectional, high-risk sample of boys and girls (n = 1149) ages 11 to 17 years completed surveys assessing TDV and self-defense. Indices of TDV included perpetration and victimization scales of controlling behaviors, psychological TDV, physical TDV, sexual TDV, fear/intimidation, and injury. RESULTS: More girls reported perpetrating psychological and physical TDV, whereas twice as many boys reported sexual TDV perpetration. More girls reported fear/intimidation victimization than boys. When comparing the frequency of TDV across adolescence, boys reported more sexual TDV victimization at younger ages, and girls demonstrated a trend toward more victimization at older ages. Likewise, younger boys reported more fear/intimidation and injury perpetration and injury victimization than younger girls. However, by age 17, girls reported more injury perpetration than boys, and reports of injury victimization and use of self-defense did not differ. Notably, despite potential parity in injury, girls consistently reported more fear/intimidation victimization associated with TDV. CONCLUSIONS: Contrary to data suggesting that girls experience far more sexual TDV and injury, these data suggest that at specific times during adolescence, boys among high-risk populations may be equally at risk for victimization. However, the psychological consequences (fear) are greater for girls. These findings suggest a need to tailor strategies to prevent TDV based on both age- and gender-specific characteristics in high-risk populations. |
Nanopore Sequencing as a Rapidly Deployable Ebola Outbreak Tool.
Hoenen T , Groseth A , Rosenke K , Fischer RJ , Hoenen A , Judson SD , Martellaro C , Falzarano D , Marzi A , Squires RB , Wollenberg KR , de Wit E , Prescott J , Safronetz D , van Doremalen N , Bushmaker T , Feldmann F , McNally K , Bolay FK , Fields B , Sealy T , Rayfield M , Nichol ST , Zoon KC , Massaquoi M , Munster VJ , Feldmann H . Emerg Infect Dis 2016 22 (2) 331-4 Rapid sequencing of RNA/DNA from pathogen samples obtained during disease outbreaks provides critical scientific and public health information. However, challenges exist for exporting samples to laboratories or establishing conventional sequencers in remote outbreak regions. We successfully used a novel, pocket-sized nanopore sequencer at a field diagnostic laboratory in Liberia during the current Ebola virus outbreak. |
Ebola Virus RNA Stability in Human Blood and Urine in West Africa's Environmental Conditions.
Janvier F , Delaune D , Poyot T , Valade E , Merens A , Rollin PE , Foissaud V . Emerg Infect Dis 2016 22 (2) 292-4 We evaluated RNA stability of Ebola virus in EDTA blood and urine samples collected from infected patients and stored in West Africa's environmental conditions. In blood, RNA was stable for at least 18 days when initial cycle threshold values were <30, but in urine, RNA degradation occurred more quickly. |
Development of Real-Time PCR Methods for the Detection of Bacterial Meningitis Pathogens without DNA Extraction.
Vuong J , Collard JM , Whaley MJ , Bassira I , Seidou I , Diarra S , Ouedraogo RT , Kambire D , Taylor TH Jr , Sacchi C , Mayer LW , Wang X . PLoS One 2016 11 (2) e0147765 Neisseria meningitidis (Nm), Haemophilus influenzae (Hi), and Streptococcus pneumoniae (Sp) are the lead causes of bacterial meningitis. Detection of these pathogens from clinical specimens using traditional real-time PCR (rt-PCR) requires DNA extraction to remove the PCR inhibitors prior to testing, which is time consuming and labor intensive. In this study, five species-specific (Nm-sodC and -ctrA, Hi-hpd#1 and -hpd#3 and Sp-lytA) and six serogroup-specific rt-PCR tests (A, B, C, W, X, Y) targeting Nm capsular genes were evaluated in the two direct rt-PCR methods using PerfeCTa and 5x Omni that do not require DNA extraction. The sensitivity and specify of the two direct rt-PCR methods were compared to TaqMan traditional rt-PCR, the current standard rt-PCR method for the detection of meningitis pathogens. The LLD for all 11 rt-PCR tests ranged from 6,227 to 272,229 CFU/ml for TaqMan, 1,824-135,982 for 5x Omni, and 168-6,836 CFU/ml for PerfeCTa. The diagnostic sensitivity using TaqMan ranged from 89.2%-99.6%, except for NmB-csb, which was 69.7%. For 5x Omni, the sensitivity varied from 67.1% to 99.8%, with three tests below 90%. The sensitivity of these tests using PerfeCTa varied from 89.4% to 99.8%. The specificity ranges of the 11 tests were 98.0-99.9%, 97.5-99.9%, and 92.9-99.9% for TaqMan, 5x Omni, and PerfeCTa, respectively. PerfeCTa direct rt-PCR demonstrated similar or better sensitivity compared to 5x Omni direct rt-PCR or TaqMan traditional rt-PCR. Since the direct rt-PCR method does not require DNA extraction, it reduces the time and cost for processing CSF specimens, increases testing throughput, decreases the risk of cross-contamination, and conserves precious CSF. The direct rt-PCR method will be beneficial to laboratories with high testing volume. |
One-step multiplex real-time RT-PCR assay for detecting and genotyping wild-type group A rotavirus strains and vaccine strains (Rotarix® and RotaTeq®) in stool samples.
Gautam R , Mijatovic-Rustempasic S , Esona MD , Tam KI , Quaye O , Bowen MD . PeerJ 2016 4 e1560 BACKGROUND: Group A rotavirus (RVA) infection is the major cause of acute gastroenteritis (AGE) in young children worldwide. Introduction of two live-attenuated rotavirus vaccines, RotaTeq(R) and Rotarix(R), has dramatically reduced RVA associated AGE and mortality in developed as well as in many developing countries. High-throughput methods are needed to genotype rotavirus wild-type strains and to identify vaccine strains in stool samples. Quantitative RT-PCR assays (qRT-PCR) offer several advantages including increased sensitivity, higher throughput, and faster turnaround time. METHODS: In this study, a one-step multiplex qRT-PCR assay was developed to detect and genotype wild-type strains and vaccine (Rotarix(R) and RotaTeq(R)) rotavirus strains along with an internal processing control (Xeno or MS2 RNA). Real-time RT-PCR assays were designed for VP7 (G1, G2, G3, G4, G9, G12) and VP4 (P[4], P[6] and P[8]) genotypes. The multiplex qRT-PCR assay also included previously published NSP3 qRT-PCR for rotavirus detection and Rotarix(R) NSP2 and RotaTeq(R) VP6 qRT-PCRs for detection of Rotarix(R) and RotaTeq(R) vaccine strains respectively. The multiplex qRT-PCR assay was validated using 853 sequence confirmed stool samples and 24 lab cultured strains of different rotavirus genotypes. By using thermostable rTth polymerase enzyme, dsRNA denaturation, reverse transcription (RT) and amplification (PCR) steps were performed in single tube by uninterrupted thermocycling profile to reduce chances of sample cross contamination and for rapid generation of results. For quantification, standard curves were generated using dsRNA transcripts derived from RVA gene segments. RESULTS: The VP7 qRT-PCRs exhibited 98.8-100% sensitivity, 99.7-100% specificity, 85-95% efficiency and a limit of detection of 4-60 copies per singleplex reaction. The VP7 qRT-PCRs exhibited 81-92% efficiency and limit of detection of 150-600 copies in multiplex reactions. The VP4 qRT-PCRs exhibited 98.8-100% sensitivity, 100% specificity, 86-89% efficiency and a limit of detection of 12-400 copies per singleplex reactions. The VP4 qRT-PCRs exhibited 82-90% efficiency and limit of detection of 120-4000 copies in multiplex reaction. DISCUSSION: The one-step multiplex qRT-PCR assay will facilitate high-throughput rotavirus genotype characterization for monitoring circulating rotavirus wild-type strains causing rotavirus infections, determining the frequency of Rotarix(R) and RotaTeq(R) vaccine strains and vaccine-derived reassortants associated with AGE, and help to identify novel rotavirus strains derived by reassortment between vaccine and wild-type strains. |
Epidemiology of serotype 1 invasive pneumococcal disease, South Africa, 2003-2013
von Mollendorf C , Cohen C , Tempia S , Meiring S , de Gouveia L , Quan V , Lengana S , Karstaedt A , Dawood H , Seetharam S , Lekalakala R , Madhi SA , Klugman KP , von Gottberg A . Emerg Infect Dis 2016 22 (2) 261-70 In South Africa, 7-valent pneumococcal conjugate vaccine (PCV) was introduced in April 2009 and replaced with 13-valent PCV in April 2011. We describe the epidemiology of serotype 1 Streptococcus pneumoniae disease during the pre- and post-PCV eras (2003-2013). Using laboratory-based invasive pneumococcal disease (IPD) surveillance, we calculated annual incidences, identified IPD clusters, and determined serotype 1-associated factors. Of 46,483 IPD cases, 4,544 (10%) were caused by serotype 1. Two clusters of serotype 1 infection were detected during 2003-2004 and 2008-2012, but incidence decreased after 2011. Among children <5 years of age, those who had non-serotype 1 IPD had shorter hospital stays, fewer cases of penicillin-nonsusceptible disease, and lower HIV prevalence and in-hospital death rates than did those with serotype 1 IPD; similar factors were noted for older patients. Serotype 1 IPD had distinctive clinical features in South Africa, and annual incidences fluctuated, with decreases noted after the introduction of PCV13. |
Evaluation of a dust control for a small slab-riding dowel drill for concrete pavement
Echt A , Mead K . Ann Occup Hyg 2016 60 (4) 519-24 PURPOSE: To assess the effectiveness of local exhaust ventilation to control respirable crystalline silica exposures to acceptable levels during concrete dowel drilling. APPROACH: Personal breathing zone samples for respirable dust and crystalline silica were collected while laborers drilled holes 3.5cm diameter by 36cm deep in a concrete slab using a single-drill slab-riding dowel drill equipped with local exhaust ventilation. Data were collected on air flow, weather, and productivity. RESULTS: All respirable dust samples were below the 90 microg detection limit which, when combined with the largest sample volume, resulted in a minimum detectable concentration of 0.31mg m-3. This occurred in a 32-min sample collected when 27 holes were drilled. Quartz was only detected in one air sample; 0.09mg m-3 of quartz was found on an 8-min sample collected during a drill maintenance task. The minimum detectable concentration for quartz in personal air samples collected while drilling was performed was 0.02mg m-3. The average number of holes drilled during each drilling sample was 23. Over the course of the 2-day study, air flow measured at the dust collector decreased from 2.2 to 1.7 m3 s-1. CONCLUSIONS: The dust control performed well under the conditions of this test. The initial duct velocity with a clean filter was sufficient to prevent settling, but gradually fell below the recommended value to prevent dust from settling in the duct. The practice of raising the drill between each hole may have prevented the dust from settling in the duct. A slightly higher flow rate and an improved duct design would prevent settling without regard to the position of the drill. |
Evaluation of Xpert MTB/RIF to identify pulmonary tuberculosis in tuberculosis suspects from low and higher prevalence settings compared to acid fast smear and culture
Firnhaber C , Kendall MA , Wu X , Mazurek GH , Benator DA , Arduino R , Fernandez M , Guy E , Johnson P , Metchock B , Sattler F , Telzak E , Wang YF , Weiner M , Swindells S , Sanne IM , Havlir DV , Grinsztejn B , Alland D . Clin Infect Dis 2016 62 (9) 1081-8 BACKGROUND: Xpert MTB/RIF(Xpert) is a rapid nucleic acid amplification test widely used in high tuberculosis(TB) prevalence settings to detect tuberculosis as well as rpoB mutations associated with rifampin resistance. Data are needed on the diagnostic performance of Xpert in lower prevalence settings to inform appropriate use for both tuberculosis detection and the need for respiratory isolation. METHODS: Xpert was compared to two sputa, each evaluated with AFB smear and mycobacterial culture using liquid and solid culture media, from participants with suspected pulmonary TB from the US, Brazil, and South Africa. RESULTS: Of 992 participants enrolled with evaluable results, 22% had culture-confirmed TB. In 638(64%) US participants, one Xpert demonstrated sensitivity of 85.2%(96.7% in participants with AFB smear-positive(AFB+) sputum, 59.3% with AFB- sputum),specificity of 99.2%, NPV 97.6%, and PPV 94.9%. Results did not differ between higher and low prevalence settings. A second Xpert increased overall sensitivity to 91.1%(100% if AFB+, 71.4% if AFB-), with specificity of 98.9%. In US participants, a single negative Xpert predicted the absence of AFB+/culture+ tuberculosis with an NPV of 99.7%; NPV of two Xperts was 100%, suggesting a role in removing patients from airborne infection isolation. Xpert detected TB DNA and mutations associated with rifampin resistance in five of seven participants with rifampin-resistant, culture+ tuberculosis. Specificity for rifampin resistance was 99.5%,NPV was 98.9%. CONCLUSIONS: In the US, Xpert testing performed comparably to two higher TB prevalence settings. These data support the use of Xpert in the initial evaluation of TB suspects and in algorithms assessing need for respiratory isolation. |
In situ derivatization and quantification of seven carbonyls in cigarette mainstream smoke
Ding YS , Yan X , Wong J , Chan M , Watson CH . Chem Res Toxicol 2016 29 (1) 125-31 Carbonyls, especially aldehydes, are a group of harmful volatile organic compounds that are found in tobacco smoke. Seven carbonyls are listed on the FDA's harmful and potential harmful constituents list for tobacco or tobacco smoke. Carbonyls have reactive functional groups and thus are challenging to quantitatively measure in cigarette smoke. The traditional method of measuring carbonyls in smoke involves solvent-filled impinger trapping and derivatization. This procedure is labor-intensive and generates significant volumes of hazardous waste. We have developed a new method to efficiently derivatize and trap carbonyls from mainstream smoke in situ on Cambridge filter pads. The derivatized carbonyls are extracted from the pads and subsequently quantified by ultra-high-pressure liquid chromatography coupled with tandem mass spectrometry. The new method has been validated and applied to research and commercial cigarettes. Carbonyl yields from research cigarettes are comparable to those from other published literature data. With a convenient smoke collection apparatus, a 4 min sample analysis time, and a low- or submicrogram detection limit, this new method not only simplifies and speeds the detection of an important class of chemical constituents in mainstream smoke but also reduces reactive losses and provides a more accurate assessment of carbonyl levels in smoke. Excellent accuracy (average 98%) and precision (14% average relative standard deviation in research cigarettes) ensure this new method's sufficient fidelity to characterize conventional combusted tobacco products, with potential application toward new or emerging products. |
Carbon nanotube and asbestos exposures induce overlapping but distinct profiles of lung pathology in non-Swiss albino CF-1 mice
Frank EA , Carreira VS , Birch ME , Yadav JS . Toxicol Pathol 2016 44 (2) 211-25 Carbon nanotubes (CNTs) are emerging as important occupational and environmental toxicants owing to their increasing prevalence and potential to be inhaled as airborne particles. CNTs are a concern because of their similarities to asbestos, which include fibrous morphology, high aspect ratio, and biopersistence. Limitations in research models have made it difficult to experimentally ascertain the risk of CNT exposures to humans and whether these may lead to lung diseases classically associated with asbestos, such as mesothelioma and fibrosis. In this study, we sought to comprehensively compare profiles of lung pathology in mice following repeated exposures to multiwall CNTs or crocidolite asbestos (CA). We show that both exposures resulted in granulomatous inflammation and increased interstitial collagen; CA exposures caused predominantly bronchoalveolar hyperplasia, whereas CNT exposures caused alveolar hyperplasia of type II pneumocytes (T2Ps). T2Ps isolated from CNT-exposed lungs were found to have upregulated proinflammatory genes, including interleukin 1ss (IL-1ss), in contrast to those from CA exposed. Immunostaining in tissue showed that while both toxicants increased IL-1ss protein expression in lung cells, T2P-specific IL-1ss increases were greater following CNT exposure. These results suggest related but distinct mechanisms of action by CNTs versus asbestos which may lead to different outcomes in the 2 exposure types. |
Vital Signs: Alcohol-exposed pregnancies - United States, 2011-2013
Green PP , McKnight-Eily LR , Tan CH , Mejia R , Denny CH . MMWR Morb Mortal Wkly Rep 2016 65 (4) 91-97 BACKGROUND: Alcohol is a teratogen.* Prenatal alcohol exposure is associated with a range of adverse reproductive outcomes and can cause fetal alcohol spectrum disorders (FASDs) characterized by lifelong physical, behavioral, and intellectual disabilities. FASDs are completely preventable if a woman does not drink alcohol while pregnant. METHODS: CDC analyzed data from the 2011-2013 National Survey of Family Growth to generate U.S. prevalence estimates of risk for an alcohol-exposed pregnancy for 4,303 nonpregnant, nonsterile women aged 15-44 years, by selected demographic and behavioral factors. A woman was considered at risk for an alcohol-exposed pregnancy during the past month if she had sex with a male, drank any alcohol, and did not (and her partner did not with her) use contraception in the past month; was not sterile; and had a partner (or partners) not known to be sterile. RESULTS: The weighted prevalence of alcohol-exposed pregnancy risk among U.S. women aged 15-44 years was 7.3%. During a 1-month period, approximately 3.3 million women in the United States were at risk for an alcohol-exposed pregnancy. CONCLUSIONS AND IMPLICATIONS FOR PUBLIC HEALTH PRACTICE: Alcohol use in pregnancy is associated with low birthweight, preterm birth, birth defects, and developmental disabilities. Women of reproductive age should be informed of the risks of alcohol use during pregnancy, and contraception should be recommended, as appropriate, for women who do not want to become pregnant. Women wanting a pregnancy should be advised to stop drinking at the same time contraception is discontinued. Health care providers should advise women not to drink at all if they are pregnant or there is any chance they might be pregnant. Alcohol misuse screening and behavioral counseling (also known as alcohol screening and brief intervention) is recommended for all adults in primary care, including reproductive-aged and pregnant women, as an evidenced-based approach to reducing alcohol consumption among persons who consume alcohol in excess of the recommended guidelines. |
Modifying effects of maternal Hb concentration on infant birth weight in women receiving prenatal iron-containing supplements: a randomised controlled trial
Wang L , Mei Z , Li H , Zhang Y , Liu J , Serdula MK . Br J Nutr 2016 115 (4) 644-9 Concerns have been raised about the benefits of Fe-containing supplements on infant birth weight among women with normal/high Hb levels at baseline. Thus far, no clinical trials have examined whether the effects of prenatal Fe-containing supplements on birth weight vary by maternal Hb levels. We compared the effects of Fe-folic acid (IFA) or multiple micronutrients (MMN) with folic acid (FA) supplements on birth weight among pregnant women with mild/no anaemia or high Hb levels. A double-blind randomised controlled trial was conducted in 2006-2009. In total, 18 775 pregnant women with mild/no anaemia (145 g/l) baseline Hb levels, IFA and MMN supplements increased birth weight by 91.44 (95 % CI 3.37, 179.51) g and 107.63 (95 % CI 21.98, 193.28) g (P<0.05), respectively, compared with the FA group. No differences were found between the IFA and the MMN group, regardless of maternal Hb concentration. In conclusion, the effects of Fe-containing supplements on birth weight depended on baseline Hb concentrations. The Fe-containing supplements improved birth weight in women with very high Hb levels before 20 weeks of gestation. |
Evaluating harms in the assessment of net benefit: A framework for newborn screening condition review
Goldenberg AJ , Comeau AM , Grosse SD , Tanksley S , Prosser LA , Ojodu J , Botkin JR , Kemper AR , Green NS . Matern Child Health J 2016 20 (3) 693-700 BACKGROUND: The Department of Health and Human Services (HHS) Advisory Committee on Heritable Disorders in Newborns and Children ("Advisory Committee") makes recommendations to the HHS Secretary regarding addition of new conditions to the national Recommended Uniform Screening Panel for newborns. The Advisory Committee's decision-making process includes assessing the net benefit of screening for nominated conditions, informed by systematic evidence reviews generated by an independent Condition Review Workgroup. The evidence base regarding harms associated with screening for specific conditions is often more limited than that for benefits. PROCEDURES: The process for defining potential harms from newborn screening reviewed the frameworks from other public health evidence-based review processes, adapted to newborn screening by experts in systematic review, newborn screening programs and bioethics, with input from and approval by the Advisory Committee. MAIN FINDINGS: To support the Advisory Committee's review of nominated conditions, the Workgroup has developed a standardized approach to evaluation of harms and relevant gaps in the evidence. Types of harms include the physical burden to infants; psychosocial and logistic burdens to families from screening or diagnostic evaluation; increased risk of medical treatment for infants diagnosed earlier than children with clinical presentation; delayed diagnosis from false negative results; psychosocial harm from false positive results; uncertainty of clinical diagnosis, age of onset or clinical spectrum; and disparities in access to diagnosis or therapy. CONCLUSIONS: Estimating the numbers of children at risk, the magnitude, timing and likelihood of harms will be integrated into Workgroup reports to the Advisory Committee. |
Features in grocery stores that motivate shoppers to buy healthier foods, ConsumerStyles 2014
Moore LV , Pinard CA , Yaroch AL . J Community Health 2016 41 (4) 812-7 We examined nine features in grocery stores shoppers reported motivated them to purchase more healthful foods in the past month. Features were compiled from common supermarket practices for each of the 4 Ps of marketing: pricing, placement, promotion, and product. We examined percentages of the features overall and by shopping frequency using Chi square tests from a 2014 cross sectional web-based health attitudes and behaviors survey, ConsumerStyles. The survey was fielded from June to July in 2014. Participants were part of a market research consumer panel that were randomly recruited by probability-based sampling using address-based sampling methods to achieve a sample representative of the U.S. POPULATION: Data from 4242 adults ages 18 and older were analyzed. About 44 % of respondents indicated at least one feature motivated them to purchase more healthful foods. Top choices included in-store coupons or specials (20.1 %), availability of convenient, ready-to-eat more healthful foods (18.8 %), product labels or advertising on packages (15.2 %), and labels or signs on shelves that highlighted more healthful options (14.6 %). Frequent shoppers reported being motivated to purchase more healthful foods by in-store tastings/recipe demonstrations and coupons/specials more often than infrequent shoppers. Enhancing the visibility and appeal of more healthful food items in grocery stores may help improve dietary choices in some populations but additional research is needed to identify the most effective strategies for interventions. |
Accounting for the influence of inflammation on retinol-binding protein in a population survey of Liberian preschool-age children
Larson LM , Addo OY , Sandalinas F , Faigao K , Kupka R , Flores-Ayala R , Suchdev PS . Matern Child Nutr 2016 13 (2) Vitamin A deficiency (VAD) is an important contributor to child morbidity and mortality. The prevalence of VAD, measured by retinol-binding protein (RBP) or retinol, is overestimated in populations with a high prevalence of inflammation. We aimed to quantify and adjust for the effect of inflammation on VAD prevalence in a nationally representative survey of Liberian children 6 to 35 months of age. We compared five approaches to adjust RBP for inflammation and estimate VAD prevalence (defined as RBP < 0.7 micromol/L): (1) ignoring inflammation; (2) excluding individuals with inflammation (C-reactive protein (CRP) >5 mg/L or alpha1-acid glycoprotein (AGP) >1 g/)L; (3) multiplying each individual's RBP by an internal correction factor; (4) by an external correction factor; and (5) using regression (corrected RBP = exp(InRBP - beta1 (lnCRPobs -lnCRPref ) - beta2 (lnAGPobs -lnAGPref )). Corrected RBP was based on a regression model where reference lnCRP and lnAGP were set to the maximum of the lowest decile. The unadjusted prevalence of VAD was 24.7%. Children with elevated CRP and/or AGP had significantly lower RBP concentrations than their apparently healthy peers (geometric mean RBP 0.79 micromol/L (95% CI: 0.76, 0.82) vs. 0.95 micromol/L (95% CI: 0.92, 0.97), P < 0.001). Using approaches 2-5 resulted in a prevalence of VAD of 11.6%, 14.3%, 13.5% and 7.3%, respectively. Depending on the approach, the VAD prevalence is reduced 10-17 percentage points when inflammation is taken into account. Further quantification of the influence of inflammation on biomarkers of vitamin A status from other national surveys is needed to compare and recommend the preferred adjustment approach across populations. |
Auditory risk of air rifles
Lankford JE , Meinke DK , Flamme GA , Finan DS , Stewart M , Tasko S , Murphy WJ . Int J Audiol 2016 55 S51-s58 OBJECTIVE: To characterize the impulse noise exposure and auditory risk for air rifle users for both youth and adults. DESIGN: Acoustic characteristics were examined and the auditory risk estimates were evaluated using contemporary damage-risk criteria for unprotected adult listeners and the 120-dB peak limit and LAeq75 exposure limit suggested by the World Health Organization (1999) for children. STUDY SAMPLE: Impulses were generated by nine pellet air rifles and one BB air rifle. RESULTS: None of the air rifles generated peak levels that exceeded the 140 dB peak limit for adults, and eight (80%) exceeded the 120 dB peak SPL limit for youth. In general, for both adults and youth, there is minimal auditory risk when shooting fewer than 100 unprotected shots with pellet air rifles. Air rifles with suppressors were less hazardous than those without suppressors, and the pellet air rifles with higher velocities were generally more hazardous than those with lower velocities. CONCLUSION: To minimize auditory risk, youth should utilize air rifles with an integrated suppressor and lower velocity ratings. Air rifle shooters are advised to wear hearing protection whenever engaging in shooting activities in order to gain self-efficacy and model appropriate hearing health behaviors necessary for recreational firearm use. |
Instituting a filtration/pressurization system to reduce dust concentrations in a control room at a mineral processing plant
Noll J , Cecala A , Hummer J . Min Eng 2015 67 (12) 42-48 The National Institute for Occupational Safety and Health has observed that many control rooms and operator compartments in the U.S. mining industry do not have filtration systems capable of maintaining low dust concentrations in these areas. In this study at a mineral processing plant, to reduce respirable dust concentrations in a control room that had no cleaning system for intake air, a filtration and pressurization system originally designed for enclosed cabs was modified and installed. This system was composed of two filtering units: one to filter outside air and one to filter and recirculate the air inside the control room. Eighty-seven percent of submicrometer particles were reduced by the system under static conditions. This means that greater than 87 percent of respirable dust particles should be reduced as the particle-size distribution of respirable dust particles is greater than that of submicrometer particles, and filtration systems usually are more efficient in capturing the larger particles. A positive pressure near 0.02 inches of water gauge was produced, which is an important component of an effective system and minimizes the entry of particles, such as dust, into the room. The intake airflow was around 118 cfm, greater than the airflow suggested by the American Society of Heating, Refrigerating, and Air-Conditioning Engineers (ASHRAE) for acceptable indoor air quality. After one year, the loading of the filter caused the airflow to decrease to 80 cfm, which still produces acceptable indoor air quality. Due to the loading of the filters, the reduction efficiency for submicrometer particles under static conditions increased to 94 percent from 87 percent. |
The merits of malaria diagnostics during an Ebola virus disease outbreak
de Wit E , Falzarano D , Onyango C , Rosenke K , Marzi A , Ochieng M , Juma B , Fischer RJ , Prescott JB , Safronetz D , Omballa V , Owuor C , Hoenen T , Groseth A , van Doremalen N , Zemtsova G , Self J , Bushmaker T , McNally K , Rowe T , Emery SL , Feldmann F , Williamson B , Nyenswah TG , Grolla A , Strong JE , Kobinger G , Stroeher U , Rayfield M , Bolay FK , Zoon KC , Stassijns J , Tampellini L , de Smet M , Nichol ST , Fields B , Sprecher A , Feldmann H , Massaquoi M , Munster VJ . Emerg Infect Dis 2016 22 (2) 323-6 Malaria is a major public health concern in the countries affected by the Ebola virus disease epidemic in West Africa. We determined the feasibility of using molecular malaria diagnostics during an Ebola virus disease outbreak and report the incidence of Plasmodium spp. parasitemia in persons with suspected Ebola virus infection. |
Multiple causes of an unexpected malaria outbreak in a high-transmission area in Madagascar
Kesteman T , Rafalimanantsoa SA , Razafimandimby H , Rasamimanana HH , Raharimanga V , Ramarosandratana B , Ratsimbasoa A , Ratovonjato J , Elissa N , Randrianasolo L , Finlay A , Rogier C , Randrianarivelojosia M . Malar J 2016 15 (1) 57 BACKGROUND: The malaria burden in Madagascar dropped down last decade, largely due to scale-up of control measures. Nevertheless, a significant rise of malaria cases occurred in 2011-2012 in two regions of the rainy South-Eastern Madagascar, where malaria is considered as mesoendemic and the population is supposed to be protected by its acquired immunity against Plasmodium. A multidisciplinary investigation was conducted in order to identify the causes of the outbreak. METHODS: In March 2012, a cross-sectional study was conducted in 20 randomly selected clusters, involving the rapid diagnostic testing of all ≥6 month-old members of households and a questionnaire about socio-demographic data and exposure to malaria control interventions. Changes in environmental conditions were evaluated by qualitative interview of local authorities, climatic conditions were evaluated by remote-sensing, and stock outs of malaria supplies in health facilities were evaluated by quantitative means. Two long-lasting insecticidal nets (LLINs) were sampled in each cluster in order to evaluate their condition and the remanence of their insecticidal activity. The entomological investigation also encompassed the collection Anopheles vectors in two sites, and the measure of their sensitivity to deltamethrin. RESULTS: The cross-sectional survey included 1615 members of 440 households. The mean Plasmodium infection rate was 25.6 % and the mean bed net use on the day before survey was 71.1 %. The prevalence of Plasmodium infections was higher in 6-14 year-old children (odds ratio (OR) 7.73 [95 % CI 3.58-16.68]), in rural areas (OR 6.25 [4.46-8.76]), in poorest socio-economic tercile (OR 1.54 [1.13-2.08]), and it was lower in individuals sleeping regularly under the bed net (OR 0.51 [0.32-0.82]). Stock outs of anti-malarial drugs in the last 6 months have been reported in two third of health facilities. Rainfalls were increased as compared with the three previous rainy seasons. Vectors collected were sensitive to pyrethroids. Two years after distribution, nearly all LLINs collected showed a loss of physical integrity and insecticide activity, CONCLUSIONS: Increased rainfall, decreasing use and reduced insecticide activity of long-lasting insecticide-treated nets, and drug shortages may have been responsible for, or contributed to, the outbreak observed in South-Eastern Madagascar in 2011-2012. Control interventions for malaria elimination must be sustained at the risk of triggering harmful epidemics, even in zones of high transmission. |
Case 28-2015: a man with febrile symptoms after traveling from Liberia
Tan KR , Cullen KA , Arguin PM . N Engl J Med 2016 374 (3) 293-4; discussion 294 In the Case Record discussed by Biddinger et al. (Sept. 10 issue),1 the authors describe the care of a febrile traveler who was returning from an area in which malaria is highly endemic and who was considered to be in the “low (but not zero) risk category” for Ebola virus disease (EVD).2 Modifications made to safely assess the patient for EVD are reported, including the use of only a rapid diagnostic test to diagnose malaria. The Centers for Disease Control and Prevention (CDC) recommends immediate microscopy of thin and thick blood smears for the diagnosis of malaria, which can be safely performed by observing precautions against the transmission of EVD.3 Diagnosis by means of microscopy allows for the identification of species and the quantification of parasitemia, both of which are needed to determine the most appropriate treatment. Microscopy must always be performed after a rapid diagnostic test in order to confirm the result and obtain this additional information.4 The patient discussed could have had undiagnosed hyperparasitemia, which requires parenteral therapy. In addition, without identifying the species by means of microscopy or polymerasechain-reaction assay, the authors may have missed a mixed infection, which could have been treated with primaquine, thereby preventing a 6-week relapse. Correct determination of the initial infecting species is preferred over the reliance on knowledge of the geographic distribution of species that cause relapsing malaria and the use of empirical therapy with primaquine. |
Tobacco advertising, promotion, and sponsorship (TAPS) exposure, anti-TAPS policies, and students' smoking behavior in Botswana and South Africa
English LM , Hsia J , Malarcher A . Prev Med 2016 91S S28-S34 OBJECTIVE: We examined the change over time in tobacco advertising, promotion and sponsorship (TAPS) exposure and the concurrent changes in cigarette smoking behavior among students age 13 to 15years in two African countries with different anti-TAPS policies. In South Africa, anti-TAPS policies became more comprehensive over time and were more strictly enforced, whereas the partial anti-TAPS policies adopted in Botswana were weakly enforced. METHOD: We analyzed two rounds of Global Youth Tobacco Survey data from South Africa (1999, n=2342; 2011, n=3713) and in Botswana (2001, n=1073; 2008, n=1605). We assessed several indicators of TAPS exposure along with prevalence of current cigarette smoking and smoking susceptibility for each data round. Logistic regression was used to examine changes over time in TAPS exposure and smoking behavior in both countries. RESULTS: Between 1999 and 2011, South African students' exposure to tobacco advertising and sponsorship decreased significantly by 16% (p value, <0.0001) and 14% (p value, <0.0001), respectively. Exposure to tobacco promotion was lower and did not decrease significantly. Botswanan students' TAPS exposure did not change significantly between 2001 and 2008. South African students' prevalence of cigarette smoking decreased over time (OR, 0.68) as did susceptibility to smoking (OR, 0.75), but declines did not remain significant after adjusting for parents' and friends' smoking. In Botswana, students' prevalence of cigarette smoking increased significantly over time (OR, 1.84), as did susceptibility to smoking (OR, 2.71). CONCLUSION: Enforcement of strong anti-TAPS policies is a vital component of effective tobacco control programs in Africa. Such regulations, if effectively implemented, can reduce TAPS exposure among adolescents and may influence cigarette smoking behavior. |
Youth access to cigarettes in six sub-Saharan African countries
Chandora R , Song Y , Chaussard M , Palipudi KM , Lee KA , Ramanandraibe N , Asma S . Prev Med 2016 91S S23-S27 OBJECTIVE: Tobacco smoking is initiated and established mostly during adolescence. The World Health Organization (WHO) Framework Convention on Tobacco Control (FCTC) Article 16 outlines the obligation of parties to prohibit the sale of tobacco products to minors. This study examined where and how student smokers obtain cigarettes. METHODS: We examined Global Youth Tobacco Survey (GYTS) data from 2009 to 2011 on cigarette access among students aged 13-15 in six sub-Saharan African countries. RESULTS: In all countries analyzed, over 20% of student smokers obtained their cigarettes in a store or shop (52.6% in South Africa, 37.7% in Republic of Congo, 28.2% in Swaziland, 27.4% in Cote d'Ivoire, 26.9% in Ghana, and 22.6% in Uganda). In Cote d'Ivoire and South Africa, 68.9% and 68.7% of student cigarette smokers, respectively, were not refused the sale of cigarettes because of age. The percentage of students who were offered free cigarettes by a tobacco company representative ranged from 4.7% in Cote d'Ivoire to 12.1% in South Africa. CONCLUSIONS: The method of obtaining cigarettes and access to cigarettes among students varies among sub-Saharan African countries. Adopting and enforcing interventions that prevent youth from accessing tobacco products could be an effective strategy for reducing smoking initiation among youth in sub-Saharan African countries. |
Perceptions of harm from secondhand smoke exposure among U.S. adults, 2009-2010
Kruger J , Patel R , Kegler M , Babb SD , King BA . Tob Induc Dis 2016 14 3 BACKGROUND: Exposure to secondhand smoke (SHS) causes significant disease and death. We assessed the prevalence and correlates of perceptions about the health harm of SHS among U.S. adults at the national and state level. METHODS: Data came from the 2009-2010 National Adult Tobacco Survey, a national landline and cellular telephone survey. Perceptions about the health harms of SHS were assessed as follows: 'not at all harmful', 'somewhat harmful', and 'very harmful'. Descriptive statistics were used to assess the prevalence of SHS harm perceptions by tobacco use and sociodemographic factors, including sex, age, race/ethnicity, education, marital status, annual household income, region, sexual orientation, children in the household, and smoke-free law coverage. Logistic regression was used to assess odds of perceiving SHS to be "very harmful" (vs. "not at all harmful" or "somewhat harmful"), adjusting for the aforementioned factors. RESULTS: Nationally, 64.5 % of adults perceived SHS as 'very harmful' (state range: 73.5 % [Utah] to 53.7 % [Kentucky]). By tobacco use, the perception that SHS is 'very harmful' was: 76.5 % among nonusers of tobacco; 62.1 % among noncombustible only users; 47.9 % among combustible only users; and 40.8 % among dual combustible and noncombustible users. Following adjustment, the perception that SHS was 'very harmful' was higher among females, non-Hispanic minorities and Hispanics, respondents living with children, and states with 100 % smoke-free law coverage. Among current tobacco users the odds of perceiving SHS to be 'very harmful' was lower in the Midwest than the West. CONCLUSIONS: Almost two-thirds of American adults perceive SHS as 'very harmful'; however, currently only half of all Americans are protected by comprehensive state or local smoke-free laws. These findings underscore the importance of public education campaigns to increase awareness of SHS exposure harm and the benefits of smoke-free environments. Expanding comprehensive smoke-free laws could protect all Americans from SHS. |
Amoebic meningoencephalitis and disseminated infection caused by Balamuthia mandrillaris in a Western lowland gorilla (Gorilla gorilla gorilla)
Gjeltema JL , Troan B , Muehlenbachs A , Liu L , Da Silva AJ , Qvarnstrom Y , Tobias JR , Loomis MR , De Voe RS . J Am Vet Med Assoc 2016 248 (3) 315-21 CASE DESCRIPTION: A 22-year-old male gorilla (Gorilla gorilla gorilla) housed in a zoo was evaluated for signs of lethargy, head-holding, and cervical stiffness followed by development of neurologic abnormalities including signs of depression, lip droop, and tremors. CLINICAL FINDINGS: Physical examination under general anesthesia revealed a tooth root abscess and suboptimal body condition. A CBC and serum biochemical analysis revealed mild anemia, neutrophilia and eosinopenia consistent with a stress leukogram, and signs consistent with dehydration. Subsequent CSF analysis revealed lymphocytic pleocytosis and markedly increased total protein concentration. TREATMENT AND OUTCOME: Despite treatment with antimicrobials, steroids, and additional supportive care measures, the gorilla's condition progressed to an obtunded mentation with grand mal seizures over the course of 10 days. Therefore, the animal was euthanized and necropsy was performed. Multifocal areas of malacia and hemorrhage were scattered throughout the brain; on histologic examination, these areas consisted of necrosis and hemorrhage associated with mixed inflammation, vascular necrosis, and intralesional amoebic trophozoites. Tan foci were also present in the kidneys and pancreas. Immunohistochemical testing positively labeled free-living amoebae within the brain, kidneys, eyes, pancreas, heart, and pulmonary capillaries. Subsequent PCR assay of CSF and frozen kidney samples identified the organism as Balamuthia mandrillaris, confirming a diagnosis of amoebic meningoencephalitis. CLINICAL RELEVANCE: Infection with B mandrillaris has been reported to account for 2.8% of captive gorilla deaths in North America over the past 19 years. Clinicians working with gorillas should have a high index of suspicion for this diagnosis when evaluating and treating animals with signs of centrally localized neurologic disease. |
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