The past, present, and future of cancer incidence in the United States: 1975 through 2020
Weir HK , Thompson TD , Soman A , Moller B , Leadbetter S . Cancer 2015 121 (11) 1827-37 BACKGROUND: The overall age-standardized cancer incidence rate continues to decline whereas the number of cases diagnosed each year increases. Predicting cancer incidence can help to anticipate future resource needs, evaluate primary prevention strategies, and inform research. METHODS: Surveillance, Epidemiology, and End Results data were used to estimate the number of cancers (all sites) resulting from changes in population risk, age, and size. The authors projected to 2020 nationwide age-standardized incidence rates and cases (including the top 23 cancers). RESULTS: Since 1975, incident cases increased among white individuals, primarily caused by an aging white population, and among black individuals, primarily caused by an increasing black population. Between 2010 and 2020, it is expected that overall incidence rates (proxy for risk) will decrease slightly among black men and stabilize in other groups. By 2020, the authors predict annual cancer cases (all races, all sites) to increase among men by 24.1% (-3.2% risk and 27.3% age/growth) to >1 million cases, and by 20.6% among women (1.2% risk and 19.4% age/growth) to >900,000 cases. The largest increases are expected for melanoma (white individuals); cancers of the prostate, kidney, liver, and urinary bladder in males; and the lung, breast, uterus, and thyroid in females. CONCLUSIONS: Overall, the authors predict cancer incidence rates/risk to stabilize for the majority of the population; however, they expect the number of cancer cases to increase by >20%. A greater emphasis on primary prevention and early detection is needed to counter the effect of an aging and growing population on the burden of cancer. |
Prevalence of taking actions to control blood pressure among adults with self-reported hypertension in 18 states and the District of Columbia, 2009
Ayala C , Fang J , Yuan K . J Clin Hypertens (Greenwich) 2015 17 (3) 172-82 The authors used 2009 Behavioral Risk Factor Surveillance System data to assess the prevalence of taking actions to control hypertension among adults with self-reported hypertension. Differences by descriptive characteristics (sex, age, race/ethnicity, access to health care, medication adherence), presence of other health risk factors (overweight/obesity, smoking, heavy drinking, inadequate fruit/vegetable intake, and physical inactivity), and comorbidities (diabetes, high cholesterol, coronary heart disease, and stroke) were compared. The prevalence of hypertension was 29.6%, and 75.0% of these patients reported taking antihypertensive medications, 73.1% changed eating habits, 72.8% decreased the use of salt, 78.8% reduced alcohol consumption, and 69.9% increased their physical activity. Overall, 87.2% reported taking two or more actions to reduce blood pressure. Patients taking antihypertensive medications were more likely to take two or more actions than their counterparts (90.6% vs 79.4%, P<.01). Those with at least one other health risk factor were 1.85 times as likely to take two or more actions as their counterparts (95% confidence interval, 1.18-2.92 times). More than 80% of hypertensive adults reported taking two or more actions to control blood pressure. The prevalence of taking actions differed significantly by descriptive characteristics, the presence health risk factors, and comorbidities. |
Primary care providers' recommendations for hypertension prevention, DocStyles Survey, 2012
Fang J , Ayala C , Loustalot F . J Prim Care Community Health 2015 6 (3) 170-6 BACKGROUND: Healthy behaviors, including maintaining an ideal body weight, eating a healthy diet, being physically active, limiting alcohol intake, and not smoking, can help prevent hypertension. The objective of this study was to determine the prevalence of recommending these behaviors to patients by primary care providers (PCPs) and to assess what PCP characteristics, if any, were associated with making the recommendations. METHODS: DocStyles 2012, a Web-based panel survey, was used to assess PCPs' demographic characteristics, health-related behaviors, practice setting, and prevalence of making selected recommendations to prevent hypertension. Logistic regression was used to calculate the odds of making all 6 recommendations, by demographic, professional, or personal health behavior characteristics. RESULTS: Overall, 1253 PCPs responded to the survey (537 family physicians, 464 internists, and 252 nurse practitioners). To prevent hypertension, 89.4% recommended a healthy diet, 89.9% recommended lower salt intake, 90.3% recommended maintaining a healthy weight, 69.4% recommended limiting alcohol intake, 95.1% recommended being physically active, and 90.4% recommended smoking cessation for their patients who smoked. More than half (56.1%) of PCPs recommended all 6 healthy behaviors. PCPs' demographic characteristics and practice setting were not associated with recommending all 6. PCPs who reported participating in regular physical activity (odds ratio [OR] 1.68, 95% confidence interval [CI] 1.05-2.67) and eating healthy diet (OR 1.68, 95% CI 1.11-2.56) were more likely to offer all 6 healthy behavior recommendations than those without these behaviors. CONCLUSION: Most PCPs recommended healthy behaviors to their adult patients to prevent hypertension. PCPs' own healthy behaviors were associated with their recommendations. Preventing hypertension is a multifactorial effort, and in the clinical environment, PCPs have frequent opportunities to model and promote healthy lifestyles to their patients. |
Early menopause and other gynecologic risk indicators for chronic fatigue syndrome in women
Boneva RS , Lin JM , Unger ER . Menopause 2015 22 (8) 826-34 OBJECTIVE: This study aims to examine whether gynecologic conditions are associated with chronic fatigue syndrome (CFS). METHODS: This study includes a subset of 157 women from a population-based case-control study in Georgia, United States, conducted in 2004-2009. Gynecologic history was collected using a self-administered questionnaire. Crude odds ratios (ORs) with 95% CIs and ORs adjusted for body mass index and other covariates, where relevant, were estimated for gynecologic conditions between 84 CFS cases and 73 healthy controls. RESULTS: Cases and controls were of similar age. Women with CFS reported significantly more gynecologic conditions and surgical operations than controls: menopause status (61.9% vs 37.0%; OR, 2.37; 95% CI, 1.21-4.66), earlier mean age at menopause onset (37.6 vs 48.6 y; adjusted OR, 1.22; 95% CI, 1.09-1.36), excessive menstrual bleeding (73.8% vs 42.5%; adjusted OR, 3.33; 95% CI, 1.66-6.70), bleeding between periods (48.8% vs 23.3%; adjusted OR, 3.31; 95% CI, 1.60-6.86), endometriosis (29.8% vs 12.3%; adjusted OR, 3.67; 95% CI, 1.53-8.84), use of noncontraceptive hormonal preparations (57.1% vs 26.0%; adjusted OR, 2.95; 95% CI, 1.36-6.38), nonmenstrual pelvic pain (26.2% vs 2.7%; adjusted OR, 11.98; 95% CI, 2.57-55.81), and gynecologic surgical operation (65.5% vs 31.5%; adjusted OR, 3.33; 95% CI, 1.66-6.67), especially hysterectomy (54.8% vs 19.2%; adjusted OR, 3.23; 95% CI, 1.46-7.17). Hysterectomy and oophorectomy occurred at a significantly younger mean age in the CFS group than in controls and occurred before CFS onset in 71% of women with records of date of surgical operation and date of CFS onset. CONCLUSIONS: Menstrual abnormalities, endometriosis, pelvic pain, hysterectomy, and early/surgical menopause are all associated with CFS. Clinicians should be aware of the association between common gynecologic problems and CFS in women. Further work is warranted to determine whether these conditions contribute to the development and/or perpetuation of CFS in some women. |
Metabolic syndrome is associated with increased breast cancer risk: a systematic review with meta-analysis
Bhandari R , Kelley GA , Hartley TA , Rockett IR . Int J Breast Cancer 2014 2014 189384 BACKGROUND: Although individual metabolic risk factors are reported to be associated with breast cancer risk, controversy surrounds risk of breast cancer from metabolic syndrome (MS). We report the first systematic review and meta-analysis of the association between MS and breast cancer risk in all adult females. METHODS: Studies were retrieved by searching four electronic reference databases [PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Web of Science, and ProQuest through June 30, 2012] and cross-referencing retrieved articles. Eligible for inclusion were longitudinal studies reporting associations between MS and breast cancer risk among females aged 18 years and older. Relative risks and 95% confidence intervals were calculated for each study and pooled using random-effects models. Publication bias was assessed quantitatively (Trim and Fill) and qualitatively (funnel plots). Heterogeneity was examined using Q and I (2) statistics. RESULTS: Representing nine independent cohorts and 97,277 adult females, eight studies met the inclusion criteria. A modest, positive association was observed between MS and breast cancer risk (RR: 1.47, 95% CI, 1.15-1.87; z = 3.13; p = 0.002; Q = 26.28, p = 0.001; I (2) = 69.55%). No publication bias was observed. CONCLUSIONS: MS is associated with increased breast cancer risk in adult women. |
The population distribution of the sagittal abdominal diameter (SAD) and SAD/height ratio among Finnish adults
Kahn HS , Rissanen H , Bullard KM , Knekt P . Clin Obes 2014 4 (6) 333-341 Sagittal abdominal diameter (SAD; 'abdominal height' measured in supine position) may improve upon conventional anthropometry for predicting incident cardiometabolic diseases. However, the SAD is used infrequently by practitioners and epidemiologists. A representative survey of Finnish adults in 2000-2001 collected body measurements including SAD (by sliding-beam calliper) using standardized protocols. Sampled non-pregnant adults (ages 30+ years; 79% participation) provided 6123 SAD measurements from 80 health centre districts. Through stratified, complex survey design, these data represented 2.86 million adults at ages 30+ years. SAD ranged from 13.5 to 38.0cm, with a population mean (standard error) of 21.7 (0.05) cm and median (interquartile range) of 21.0 (19.1-23.4). Median SAD was higher at ages 50+ years compared with ages 30-49 both for men (22.4 [20.5-24.6] vs. 20.8 [19.3-22.7]) and women (21.7 [19.6-23.9] vs. 19.4 [17.8-21.4]). The SAD/height ratio was similar (0.118) for both sexes at 30-39 years, rising more steeply with age for women than men. Attaining only a basic education, compared with a high level, was associated with increased mean (95% confidence interval) SADs for men (22.6 [22.3-22.8] vs. 22.0 [21.7-22.2]) and women (21.8 [21.5-22.0] vs. 20.6 [20.4-20.8]). Finland's early experience with nationally representative SAD measurements provides normative reference values and physiological insights useful for investigations of cardiometabolic risk. |
Microbiota that affect risk for shigellosis in children in low-income countries.
Lindsay B , Oundo J , Hossain MA , Antonio M , Tamboura B , Walker AW , Paulson JN , Parkhill J , Omore R , Faruque AS , Das SK , Ikumapayi UN , Adeyemi M , Sanogo D , Saha D , Sow S , Farag TH , Nasrin D , Li S , Panchalingam S , Levine MM , Kotloff K , Magder LS , Hungerford L , Sommerfelt H , Pop M , Nataro JP , Stine OC . Emerg Infect Dis 2015 21 (2) 242-50 Pathogens in the gastrointestinal tract exist within a vast population of microbes. We examined associations between pathogens and composition of gut microbiota as they relate to Shigella spp./enteroinvasive Escherichia coli infection. We analyzed 3,035 stool specimens (1,735 nondiarrheal and 1,300 moderate-to-severe diarrheal) from the Global Enteric Multicenter Study for 9 enteropathogens. Diarrheal specimens had a higher number of enteropathogens (diarrheal mean 1.4, nondiarrheal mean 0.95; p<0.0001). Rotavirus showed a negative association with Shigella spp. in cases of diarrhea (odds ratio 0.31, 95% CI 0.17-0.55) and had a large combined effect on moderate-to-severe diarrhea (odds ratio 29, 95% CI 3.8-220). In 4 Lactobacillus taxa identified by 16S rRNA gene sequencing, the association between pathogen and disease was decreased, which is consistent with the possibility that Lactobacillus spp. are protective against Shigella spp.-induced diarrhea. Bacterial diversity of gut microbiota was associated with diarrhea status, not high levels of the Shigella spp. ipaH gene. |
Timing of influenza A(H5N1) in poultry and humans and seasonal influenza activity worldwide, 2004-2013
Durand LO , Glew P , Gross D , Kasper M , Trock S , Kim IK , Bresee JS , Donis R , Uyeki TM , Widdowson MA , Azziz-Baumgartner E . Emerg Infect Dis 2015 21 (2) 202-8 Co-circulation of influenza A(H5N1) and seasonal influenza viruses among humans and animals could lead to co-infections, reassortment, and emergence of novel viruses with pandemic potential. We assessed the timing of subtype H5N1 outbreaks among poultry, human H5N1 cases, and human seasonal influenza in 8 countries that reported 97% of all human H5N1 cases and 90% of all poultry H5N1 outbreaks. In these countries, most outbreaks among poultry (7,001/11,331, 62%) and half of human cases (313/625, 50%) occurred during January-March. Human H5N1 cases occurred in 167 (45%) of 372 months during which outbreaks among poultry occurred, compared with 59 (10%) of 574 months that had no outbreaks among poultry. Human H5N1 cases also occurred in 59 (22%) of 267 months during seasonal influenza periods. To reduce risk for co-infection, surveillance and control of H5N1 should be enhanced during January-March, when H5N1 outbreaks typically occur and overlap with seasonal influenza virus circulation. |
Tissue and cellular tropism, pathology and pathogenesis of Ebola and Marburg viruses
Martines RB , Ng DL , Greer PW , Rollin PE , Zaki SR . J Pathol 2015 235 (2) 153-74 Ebola viruses and Marburg viruses include some of the most virulent and fatal pathogens known to humans. These viruses cause severe haemorrhagic fevers, with case fatality rates in the range 25-90%. The diagnosis of filovirus using formalin-fixed tissues from fatal cases poses a significant challenge. The most characteristic histopathological findings are seen in the liver; however, the findings overlap with many other viral and non-viral haemorrhagic diseases. The need to distinguish filovirus infections from other haemorrhagic fevers, particularly in areas with multiple endemic viral haemorrhagic agents, is of paramount importance. In this review we discuss the current state of knowledge of filovirus infections and their pathogenesis, including histopathological findings, epidemiology, modes of transmission and filovirus entry and spread within host organisms. The pathogenesis of filovirus infections is complex and involves activation of the mononuclear phagocytic system, with release of pro-inflammatory cytokines, chemokines and growth factors, endothelial dysfunction, alterations of the innate and adaptive immune systems, direct organ and endothelial damage from unrestricted viral replication late in infection, and coagulopathy. Although our understanding of the pathogenesis of filovirus infections has rapidly increased in the past few years, many questions remain unanswered. |
Trends in disease and complications of hepatitis A virus infection in the United States, 1999-2011: a new concern for adults
Ly KN , Klevens RM . J Infect Dis 2015 212 (2) 176-82 BACKGROUND: In recent years, few US adults have had exposure and resultant immunity to hepatitis A virus (HAV). Further, persons with liver disease have an increased risk of adverse consequences if they are infected with HAV. METHODS: This study used 1999-2011 National Notifiable Diseases Surveillance System and Multiple Cause of Death data to assess trends in the incidence of HAV infection, HAV-related hospitalization, and HAV-related mortality. RESULTS: During 1999-2011, the incidence of HAV infection declined from 6.0 cases/100 000 to 0.4 cases/100 000. Similar declines were seen by sex and age, but persons aged ≥80 years had the highest incidence of HAV infection in 2011 (0.22 cases/100 000). HAV-related hospitalizations increased from 7.3% in 1999 to 24.5% in 2011. The mean age of hospitalized cases increased from 36.0 years in 1999 to 45.1 years in 2011. While HAV-related mortality declined, the mean age at death among decedents with HAV infection increased from 48.0 years in 1999 to 76.2 years in 2011. The median age range of decedents who had HAV infection and a liver-related condition was 51.0 to 68.0 years. CONCLUSIONS: Although vaccine-preventable, HAV-related hospitalizations increased greatly, mostly among adults, and liver-related conditions were frequently reported among HAV-infected individuals who died. Public health efforts should focus on the need to assess protection from hepatitis A among adults, including those with liver disease. |
Update on the epidemiology of Middle East respiratory syndrome coronavirus (MERS-CoV) infection, and guidance for the public, clinicians, and public health authorities - January 2015
Rha B , Rudd J , Feikin D , Watson J , Curns AT , Swerdlow DL , Pallansch MA , Gerber SI . MMWR Morb Mortal Wkly Rep 2015 64 (3) 61-2 CDC continues to work with the World Health Organization (WHO) and other partners to closely monitor Middle East respiratory syndrome coronavirus (MERS-CoV) infections globally and to better understand the risks to public health. The purpose of this report is to provide a brief update on MERS-CoV epidemiology and to notify health care providers, public health officials, and others to maintain awareness of the need to consider MERS-CoV infection in persons who have recently traveled from countries in or near the Arabian Peninsula. |
Update: Ebola virus disease epidemic - West Africa, January 2015
CDC Incident Management System Ebola Epidemiology Team , Guinea Interministerial Committee for Response Against the Ebola Virus , World Health Organization , CDC Guinea Response Team , Liberia Ministry of Health and Social Welfare , CDC Liberia Response Team , Sierra Leone Ministry of Health and Sanitation , CDC Sierra Leone Response Team , CDC NCEZID Viral Special Pathogens Branch . MMWR Morb Mortal Wkly Rep 2015 64 (4) 109-110 CDC is assisting ministries of health and working with other organizations to end the ongoing epidemic of Ebola virus disease (Ebola) in West Africa. The updated data in this report were compiled from situation reports from the Guinea Interministerial Committee for Response Against the Ebola Virus, the Liberia Ministry of Health and Social Welfare, the Sierra Leone Ministry of Health and Sanitation, and the World Health Organization. |
Longitudinal analysis of key HIV-risk behavior patterns and predictors in men who have sex with men, Bangkok, Thailand
Holtz TH , Pattanasin S , Chonwattana W , Tongtoyai J , Chaikummao S , Varangrat A , Mock PA . Arch Sex Behav 2015 44 (2) 341-8 The HIV incidence among Thai men who have sex with men (MSM) enrolled in the Bangkok MSM Cohort Study (BMCS) has remained high since its inception in 2006. The purpose of this BMCS analysis was to determine: (1) changes in three HIV-risk behaviors (unprotected anal intercourse (UAI), recreational drug use, and multiple sexual partners i.e., more than four male/transgender partner) over time; and (2) factors associated with each one separately. Thai MSM aged 18 years or older and living in Bangkok were eligible to participate in the BMCS. At each follow-up visit, participants were asked to report their sexual and drug behaviors in the previous 4 months. We conducted a longitudinal analysis using generalized estimating equations logistic regression that included 1,569 MSM who were enrolled from 2006 to 2010 and contributed at least one follow-up visit. For each four-month visit increase, we found a 2, 1, and 1 % decrease in odds for reported UAI, recreational drug use, and multiple sexual partners, respectively. We found significant predictors associated with three HIV-risk behaviors such as binge drinking, participation in group sex, and use of erectile dysfunction drugs. The statistically significant decrease in odds of HIV-risk behaviors among the participants is encouraging; however, continued vigilance is required to address the factors associated with HIV-risk behaviors through currently available interventions reaching MSM. |
Low HIV-1 transmitted drug resistance in Bulgaria against a background of high clade diversity
Alexiev I , Shankar A , Wensing AM , Beshkov D , Elenkov I , Stoycheva M , Nikolova D , Nikolova M , Switzer WM . J Antimicrob Chemother 2015 70 (6) 1874-80 OBJECTIVES: To determine transmitted drug resistance (TDR) and HIV-1 genetic diversity in Bulgaria. METHODS: The prevalence of TDR and HIV-1 subtypes was determined in 305/1446 (21.1%) persons newly diagnosed with HIV/AIDS from 1988 to 2011. TDR mutations (TDRMs) in protease and reverse transcriptase were defined using the WHO HIV drug mutation list. Phylogenetic analysis was used to infer polymerase (pol) genotype. RESULTS: TDRMs were found in 16/305 (5.2%) persons, 11 (3.6%) with resistance to NRTIs, 5 (1.6%) with resistance to NNRTIs and 3 (0.9%) with resistance to PIs. Dual-class TDRMs were found in three (1.0%) patients and one statistically supported cluster of TDRMs comprising two individuals with subtype B infection. TDRMs were found in 10 heterosexuals, 4 MSM and two intravenous drug users. Phylogenetic analyses identified high HIV-1 diversity consisting of mostly subtype B (44.6%), subtype C (3.3%), sub-subtype A1 (2.6%), sub-subtype F1 (2.3%), sub-subtype A-like (3.6%), subtype G (0.3%), CRF14_BG (1.6%), CRF05_DF (1.3%), CRF03_AB (0.3%) and unique recombinant forms (1.3%). CONCLUSIONS: We found a low prevalence of TDR against a background of high HIV-1 genetic diversity among antiretroviral-naive patients in Bulgaria. Our results provide baseline data on TDR and support continued surveillance of high-risk populations in Bulgaria to better target treatment and prevention efforts. |
Melioidosis Diagnostic Workshop, 2013
Hoffmaster AR , AuCoin D , Baccam P , Baggett HC , Baird R , Bhengsri S , Blaney DD , Brett PJ , Brooks TJ , Brown KA , Chantratita N , Cheng AC , Dance DA , Decuypere S , Defenbaugh D , Gee JE , Houghton R , Jorakate P , Lertmemongkolchai G , Limmathurotsakul D , Merlin TL , Mukhopadhyay C , Norton R , Peacock SJ , Rolim DB , Simpson AJ , Steinmetz I , Stoddard RA , Stokes MM , Sue D , Tuanyok A , Whistler T , Wuthiekanun V , Walke HT . Emerg Infect Dis 2015 21 (2) Melioidosis is a severe disease that can be difficult to diagnose because of its diverse clinical manifestations and a lack of adequate diagnostic capabilities for suspected cases. There is broad interest in improving detection and diagnosis of this disease not only in melioidosis-endemic regions but also outside these regions because melioidosis may be underreported and poses a potential bioterrorism challenge for public health authorities. Therefore, a workshop of academic, government, and private sector personnel from around the world was convened to discuss the current state of melioidosis diagnostics, diagnostic needs, and future directions. |
Mortality among blacks or African Americans with HIV infection - United States, 2008-2012
Siddiqi AE , Hu X , Hall HI . MMWR Morb Mortal Wkly Rep 2015 64 (4) 81-86 A primary goal of the National HIV/AIDS Strategy is to reduce HIV-related health disparities, including HIV-related mortality in communities at high risk for human immunodeficiency virus (HIV) infection. As a group, persons who self-identify as blacks or African Americans (referred to as blacks in this report), have been affected by HIV more than any other racial/ethnic population. Forty-seven percent of persons who received an HIV diagnosis in the United States in 2012 and 43% of all persons living with diagnosed HIV infection in 2011 were black. Blacks also experienced a low 3-year survival rate among persons with HIV infection diagnosed during 2003-2008. CDC and its partners have been pursuing a high-impact prevention approach and supporting projects focusing on minorities to improve diagnosis, linkage to care, and retention in care, and to reduce disparities in HIV-related health outcomes. To measure trends in disparities in mortality among blacks, CDC analyzed data from the National HIV Surveillance System. The results of that analysis indicated that among blacks aged ≥13 years the death rate per 1,000 persons living with diagnosed HIV decreased from 28.4 in 2008 to 20.5 in 2012. Despite this improvement, in 2012 the death rate per 1,000 persons living with HIV among blacks was 13% higher than the rate for whites and 47% higher than the rate for Hispanics or Latinos. These data demonstrate the need for implementation of interventions and public health strategies to further reduce disparities in deaths. |
A plan for community event-based surveillance to reduce Ebola transmission - Sierra Leone, 2014-2015
Crowe S , Hertz D , Maenner M , Ratnayake R , Baker P , Lash R , Klena J , Lee-Kwan SH , Williams C , Jonnie GT , Gorina Y , Anderson A , Saffa G , Carr D , Tuma J , Miller L , Turay A , Belay E . MMWR Morb Mortal Wkly Rep 2015 64 (3) 70-3 Ebola virus disease (Ebola) was first detected in Sierra Leone in May 2014 and was likely introduced into the eastern part of the country from Guinea. The disease spread westward, eventually affecting Freetown, Sierra Leone's densely populated capital. By December 2014, Sierra Leone had more Ebola cases than Guinea and Liberia, the other two West African countries that have experienced widespread transmission. As the epidemic intensified through the summer and fall, an increasing number of infected persons were not being detected by the county's surveillance system until they had died. Instead of being found early in the disease course and quickly isolated, these persons remained in their communities throughout their illness, likely spreading the disease. |
Preparation of at-risk West African countries for Ebola
Vora NM , Arthur RR , Swerdlow DL , Angulo FJ . Lancet 2015 385 (9965) 329-330 The ongoing Ebola epidemic in west Africa is an unprecedented health and humanitarian crisis. So far, more than 20 000 cases have been reported1 in Guinea, Liberia, and Sierra Leone, and transmission models developed during this epidemic have predicted spread of Ebola into neighbouring west African countries.2 These predictions have already been realised in Nigeria and Senegal, but public health authorities in both countries acted swiftly to limit secondary transmission.3, 4 The experiences in Nigeria and Senegal attest to the effectiveness of conventional epidemiological methods—particularly, case isolation and contact tracing—in containing Ebola outside the three countries with widespread transmission.5 Mali became the latest west African country to report an Ebola introduction in October, 2014, followed by another independent introduction in November, 2014, and the country's public health authorities responded efficiently such that the outbreaks have now been contained. Improvement of Ebola preparedness and response capacity in neighbouring at-risk west African countries should therefore be prioritised so that public health responses can be rapidly initiated elsewhere if the need arises. |
Prospective comparison of infective endocarditis in Khon Kaen, Thailand and Rennes, France
Watt G , Lacroix A , Pachirat O , Baggett HC , Raoult D , Fournier PE , Tattevin P . Am J Trop Med Hyg 2015 92 (4) 871-4 Prospectively collected, contemporary data are lacking on how the features of infective endocarditis (IE) vary according to region. We, therefore, compared IE in Rennes, France and Khon Kaen, Thailand. Fifty-eight patients with confirmed IE were enrolled at each site during 2011 and 2012 using a common protocol. Compared with French patients, Thais had a lower median age (47 versus 70 years old; P < 0.001) and reported more animal contact (86% versus 21%; P < 0.001). There were more zoonotic infections among Thai than France patients (6 and 1 cases; P = 0.017) and fewer staphylococcal infections (4 versus 15 cases; P = 0.011). Among Thai patients, IE in patients with prosthetic heart valves was less prevalent (9% and 35%; P = 0.001), whereas underlying rheumatic heart disease (RHD) was more prevalent (31% and 4%; P = 0.001). Our data strengthen previous observations that IE in the tropics has distinctive demographic characteristics, risk factors, and etiologies and underscore the need for improved prevention and control strategies. |
Public health response to commercial airline travel of a person with Ebola virus infection - United States, 2014
Regan JJ , Jungerman R , Montiel SH , Newsome K , Objio T , Washburn F , Roland E , Petersen E , Twentyman E , Olaiya O , Naughton M , Alvarado-Ramy F , Lippold SA , Tabony L , McCarty CL , Kinsey CB , Barnes M , Black S , Azzam I , Stanek D , Sweitzer J , Valiani A , Kohl KS , Brown C , Pesik N . MMWR Morb Mortal Wkly Rep 2015 64 (3) 63-6 Before the current Ebola epidemic in West Africa, there were few documented cases of symptomatic Ebola patients traveling by commercial airline, and no evidence of transmission to passengers or crew members during airline travel. In July 2014 two persons with confirmed Ebola virus infection who were infected early in the Nigeria outbreak traveled by commercial airline while symptomatic, involving a total of four flights (two international flights and two Nigeria domestic flights). It is not clear what symptoms either of these two passengers experienced during flight; however, one collapsed in the airport shortly after landing, and the other was documented to have fever, vomiting, and diarrhea on the day the flight arrived. Neither infected passenger transmitted Ebola to other passengers or crew on these flights. In October 2014, another airline passenger, a U.S. health care worker who had traveled domestically on two commercial flights, was confirmed to have Ebola virus infection. Given that the time of onset of symptoms was uncertain, an Ebola airline contact investigation in the United States was conducted. In total, follow-up was conducted for 268 contacts in nine states, including all 247 passengers from both flights, 12 flight crew members, eight cleaning crew members, and one federal airport worker (81 of these contacts were documented in a report published previously). All contacts were accounted for by state and local jurisdictions and followed until completion of their 21-day incubation periods. No secondary cases of Ebola were identified in this investigation, confirming that transmission of Ebola during commercial air travel did not occur. |
Effectiveness of Ebola treatment units and community care centers - Liberia, September 23-October 31, 2014
Washington ML , Meltzer ML . MMWR Morb Mortal Wkly Rep 2015 64 (3) 67-9 Previous reports have shown that an Ebola outbreak can be slowed, and eventually stopped, by placing Ebola patients into settings where there is reduced risk for onward Ebola transmission, such as Ebola treatment units (ETUs) and community care centers (CCCs) or equivalent community settings that encourage changes in human behaviors to reduce transmission risk, such as making burials safe and reducing contact with Ebola patients. Using cumulative case count data from Liberia up to August 28, 2014, the EbolaResponse model previously estimated that without any additional interventions or further changes in human behavior, there would have been approximately 23,000 reported Ebola cases by October 31, 2014. In actuality, there were 6,525 reported cases by that date. To estimate the effectiveness of ETUs and CCCs or equivalent community settings in preventing greater Ebola transmission, CDC applied the EbolaResponse model to the period September 23-October 31, 2014, in Liberia. The results showed that admitting Ebola patients to ETUs alone prevented an estimated 2,244 Ebola cases. Having patients receive care in CCCs or equivalent community settings with a reduced risk for Ebola transmission prevented an estimated 4,487 cases. Having patients receive care in either ETUs or CCCs or in equivalent community settings, prevented an estimated 9,100 cases, apparently as the result of a synergistic effect in which the impact of the combined interventions was greater than the sum of the two interventions. Caring for patients in ETUs, CCCs, or in equivalent community settings with reduced risk for transmission can be important components of a successful public health response to an Ebola epidemic. |
HIV testing and service delivery among blacks or African Americans - 61 health department jurisdictions, United States, 2013
Seth P , Walker T , Hollis N , Figueroa A , Belcher L . MMWR Morb Mortal Wkly Rep 2015 64 (4) 87-90 In the United States, approximately 1.2 million persons are living with human immunodeficiency virus (HIV), of whom approximately 14.0% have not received a diagnosis. Some groups are disproportionately affected by HIV, such as persons who self-identify as blacks or African Americans (in this report referred to as blacks). Blacks accounted for 12.0% of the United States' population but accounted for 41.0% of persons living with HIV in 2011. HIV testing is critical to identify those who are infected and link them to HIV medical care for their own health and to reduce transmission to partners. To assess progress toward increasing HIV testing and service delivery among blacks in 2013, CDC analyzed national-level program data submitted by 61 health departments and 151 directly funded community-based organizations through the National HIV Prevention Program Monitoring and Evaluation system. This report describes the results of that analysis, which found that, in 2013, blacks accounted for 45.0% of CDC-funded HIV testing events (TEs) and more than half (54.9%) of all newly identified HIV-positive persons (in this report referred to as new positives). Among blacks, gay, bisexual, and other men who have sex with men (collectively referred to as MSM) had the highest percentage of new positives (9.6%). Broader implementation of routine HIV screening and HIV testing targeted towards populations at high risk can help identify persons with undiagnosed HIV infection and link these persons to HIV medical care and prevention services. Linkage to medical care and referrals to HIV partner services and HIV prevention services among blacks could be improved. |
Increased risk and mortality of invasive pneumococcal disease in HIV-exposed-uninfected infants <1 year of age in South Africa, 2009-2013
von Mollendorf C , von Gottberg A , Tempia S , Meiring S , de Gouveia L , Quan V , Lengana S , Avenant T , du Plessis N , Eley B , Finlayson H , Reubenson G , Moshe M , O'Brien KL , Klugman KP , Whitney CG , Cohen C . Clin Infect Dis 2015 60 (9) 1346-56 BACKGROUND: High antenatal HIV seroprevalence rates ( reverse similar30%) with low perinatal HIV transmission rates (2.5%) due to HIV prevention of mother-to-child transmission program improvements in South Africa, has resulted in increasing numbers of HIV-exposed-uninfected (HEU) children. We aimed to describe the epidemiology of invasive pneumococcal disease (IPD) in HEU infants. METHODS: We conducted a cross-sectional study of infants aged <1 year with IPD enrolled in a national, laboratory-based surveillance program for incidence estimations. Incidence was reported for two time points, 2009 and 2013. At enhanced sites we collected additional data including HIV status and in-hospital outcome. RESULTS: We identified 2099 IPD cases in infants from 2009-2013 from all sites. In infants from enhanced sites (n=1015), 92% had known HIV exposure status and 86% had known outcomes. IPD incidence was highest in HIV-infected infants, ranging from 272-654/100,000 population between time points (2013 and 2009), followed by HEU (33-88/100,000) and HIV-unexposed-uninfected (HUU) infants (18-28/100,000). Case fatality rate in HEU (29%, 74/253) was intermediate between HUU (25%, 94/377) and HIV-infected infants (34%, 81/242). When restricted to cases <6 months of age, HEU infants (37%, 59/175) were at significantly higher risk of dying than HUU infants (32%, 51/228; Adjusted relative risk ratio=1.76 [95% confidence interval 1.09-2.85]). DISCUSSION: HEU infants are at increased risk of IPD and mortality from IPD compared with HUU children, especially as young infants. HEU infants, whose numbers will likely continue to increase, should be prioritized for interventions such as pneumococcal vaccination along with HIV-infected infants and children. |
Influenza virus surveillance by the Instituto Adolfo Lutz, influenza season 2014: antiviral resistance
Santos KC , Silva DB , Benega MA , Paulino Rde S , ESilva ER Jr , Pereira Ddos S , Mussi AD , Silva VC , Gubareva L V , Paiva TM . Rev Inst Med Trop Sao Paulo 2015 57 (1) 92 Neuraminidase (NA) inhibitors (NAIs) are the only antivirals that are effective for prophylaxis and the treatment of seasonal influenza A and B infections. There are currently two NAIs approved in most countries: oseltamivir (Tamiflu; F. Hoffmann - La Roche) and zanamivir (Relenza; GlaxoSmithKline plc.). The development of drug resistance is a major drawback for any antiviral therapy, and these specific anti-influenza drugs are not excluded from this rule. Thus, the proper use of NAIs and worldwide monitoring for the presence and spread of drug resistant influenza viruses are of the utmost importance. The existence of a global surveillance network for influenza, underpinning vaccine strain selection, is a valuable asset when seeking to track the emergence of antiviral resistance. | The Instituto Adolfo Lutz, São Paulo, SP, Brazil, plays a role in national and global influenza surveillance. The objective of the present study was to monitor antiviral resistance to assist public health authorities with decisions regarding prophylaxis and treatment strategies. | Using the real time polymerase chain reaction assay (rRT-PCR), influenza viruses of type A, subtype H1N1pdm09 and H3N2, as well as type B viruses, were identified and antiviral resistance testing was conducted using pyrosequencing2 and Sanger dideoxy sequence analysis5. | Prior to the emergence of the pandemic virus in 2009, the presence of the oseltamivir resistance-conferring marker, H275Y, was identified in seasonal influenza A (H1N1). In 2014, influenza virus surveillance identified the same marker, H275Y, in an influenza A (H1N1) pdm09 strain isolated from a 20 year-old pregnant woman living in Mato Grosso/Cuiabá, the Midwest region of Brazil. The virus was collected in March 2014. In addition, two permissive secondary NA mutations; V241I and N369K were detected in the virus isolated in the Midwest region of Brazil1. These mutations are known to negate the impact of the NA H275Y oseltamivir resistance mutation on viral replicative fitness. This patient was treated with oseltamivir, rocephin, azithromycin and made a full recovery from the respiratory disease. | The choice of assay for assessing the susceptibility of the influenza virus to NAIs depends on factors pertaining to appropriateness of the setting, cost, sustainability, speed in obtaining valid results, reliability in terms of predictive values, and accessibility. The high sensitivity of genotypic assays allows for testing of clinical specimens, thus eliminating the need for virus propagation in cell culture. In addition, rapid genotypic testing facilitates more appropriate patient management and can significantly advance and assist in large-scale epidemiological studies of drug-resistant variants4. | |
Care of the child with Ebola virus disease
Eriksson CO , Uyeki TM , Christian MD , King MA , Braner DA , Kanter RK , Kissoon N . Pediatr Crit Care Med 2015 16 (2) 97-103 OBJECTIVES: To provide clinicians with practical considerations for care of children with Ebola virus disease in resource-rich settings. DATA SOURCES: Review of the published medical literature, World Health Organization and government documents, and expert opinion. DATA SYNTHESIS: There are limited data regarding Ebola virus disease in children; however, reported case-fatality proportions in children are high. Ebola virus may affect immune regulation and endothelial function differently in children than adults. Considerations for care of children with Ebola virus disease are presented. CONCLUSIONS: Ebola virus disease is a severe multisystem disease with high mortality in children and adults. Hospitals and clinicians must prepare to provide care for patients with Ebola virus disease before such patients present for care, with particular attention to rigorous infection control to limit secondary cases. Although there is no proven specific treatment for Ebola virus disease, meticulous supportive care offers patients the best chance of survival. |
A cluster of acute flaccid paralysis and cranial nerve dysfunction temporally associated with an outbreak of enterovirus D68 in children in Colorado, USA
Messacar K , Schreiner TL , Maloney JA , Wallace A , Ludke J , Oberste MS , Nix WA , Robinson CC , Glode MP , Abzug MJ , Dominguez SR . Lancet 2015 385 (9978) 1662-71 BACKGROUND: Clusters of acute flaccid paralysis or cranial nerve dysfunction in children are uncommon. We aimed to assess a cluster of children with acute flaccid paralysis and cranial nerve dysfunction geographically and temporally associated with an outbreak of enterovirus-D68 respiratory disease. METHODS: We defined a case of neurological disease as any child admitted to Children's Hospital Colorado (Aurora, CO, USA) with acute flaccid paralysis with spinal-cord lesions involving mainly grey matter on imaging, or acute cranial nerve dysfunction with brainstem lesions on imaging, who had onset of neurological symptoms between Aug 1, 2014, and Oct 31, 2014. We used Poisson regression to assess whether the numbers of cases during the outbreak period were significantly greater than baseline case numbers from a historical control period (July 31, 2010, to July 31, 2014). FINDINGS: 12 children met the case definition (median age 11.5 years [IQR 6.75-15]). All had a prodromal febrile illness preceding neurological symptoms by a median of 7 days (IQR 5.75-8). Neurological deficits included flaccid limb weakness (n=10; asymmetric n=7), bulbar weakness (n=6), and cranial nerve VI (n=3) and VII (n=2) dysfunction. Ten (83%) children had confluent, longitudinally extensive spinal-cord lesions of the central grey matter, with predominant anterior horn-cell involvement, and nine (75%) children had brainstem lesions. Ten (91%) of 11 children had cerebrospinal fluid pleocytosis. Nasopharyngeal specimens from eight (73%) of 11 children were positive for rhinovirus or enterovirus. Viruses from five (45%) of 11 children were typed as enterovirus D68. Enterovirus PCR of cerebrospinal fluid, blood, and rectal swabs, and tests for other causes, were negative. Improvement of cranial nerve dysfunction has been noted in three (30%) of ten children. All ten children with limb weakness have residual deficits. INTERPRETATION: We report the first geographically and temporally defined cluster of acute flaccid paralysis and cranial nerve dysfunction in children associated with an outbreak of enterovirus-D68 respiratory illness. Our findings suggest the possibility of an association between enterovirus D68 and neurological disease in children. If enterovirus-D68 infections continue to happen in an endemic or epidemic pattern, development of effective antiviral or immunomodulatory therapies and vaccines should become scientific priorities. FUNDING: National Center for Advancing Translational Sciences, National Institutes of Health. |
A cross-sectional study of 'yaws' in districts of Ghana which have previously undertaken azithromycin mass drug administration for trachoma control
Ghinai R , El-Duah P , Chi KH , Pillay A , Solomon AW , Bailey RL , Agana N , Mabey DC , Chen CY , Adu-Sarkodie Y , Marks M . PLoS Negl Trop Dis 2015 9 (1) e0003496 Yaws, caused by Treponema pallidum ssp. pertenue, is reportedly endemic in Ghana. Mass distribution of azithromycin is now the cornerstone of the WHO yaws eradication campaign. Mass distribution of azithromycin at a lower target dose was previously undertaken in two regions of Ghana for the control of trachoma. Ongoing reporting of yaws raises the possibility that resistance may have emerged in T. pallidum pertenue, or that alternative infections may be responsible for some of the reported cases. We conducted a cross-sectional survey in thirty communities in two districts of Ghana where MDA for trachoma had previously been conducted. Children aged 5-17 years with ulcerative lesions compatible with yaws were enrolled. Samples for treponemal serology and lesion PCR were collected from all children. 90 children with 98 lesions were enrolled. Syphilis serology was negative in all of them. PCR for T. pallidum ssp pertenue was negative in all children, but Haemophilus ducreyi DNA was detected in 9 lesions. In these communities, previously treated for trachoma, we found no evidence of ongoing transmission of yaws. H. ducreyi was associated with a proportion of skin lesions, but the majority of lesions remain unexplained. Integration of diagnostic testing into both pre and post-MDA surveillance systems is required to better inform yaws control programmes. |
Diverse HIV epidemics among people who inject drugs in Thailand: evidence from respondent-driven sampling surveys in Bangkok and Chiang Mai
Prybylski D , Manopaiboon C , Visavakum P , Yongvanitjit K , Aramrattana A , Manomaipiboon P , Tanpradech S , Suksripanich O , Pattanasin S , Wolfe M , Whitehead SJ . Drug Alcohol Depend 2015 148 126-35 BACKGROUND: Thailand's long-standing HIV sero-sentinel surveillance system for people who inject drugs (PWID) is confined to those in methadone-based drug treatment clinics and representative data are scarce, especially outside of Bangkok. METHODS: We conducted probability-based respondent-driven sampling (RDS) surveys in Bangkok (n=738) and Chiang Mai (n=309) to increase understanding of local HIV epidemics and to better inform the planning of evidence-based interventions. RESULTS: PWID had different epidemiological profiles in these two cities. Overall HIV prevalence was higher in Bangkok (23.6% vs. 10.9%, p<0.001) but PWID in Bangkok are older and appear to have long-standing HIV infections. In Chiang Mai, HIV infections appear to be more recently acquired and PWID were younger and had higher levels of recent injecting and sexual risk behaviors with lower levels of intervention exposure. Methamphetamine was the predominant drug injected in both sites and polydrug use was common although levels and patterns of the specific drugs injected varied significantly between the sites. In multivariate analysis, recent midazolam injection was significantly associated with HIV infection in Chiang Mai (adjusted odds ratio=8.1; 95% confidence interval: 1.2-54.5) whereas in Bangkok HIV status was not associated with recent risk behaviors as infections had likely been acquired in the past. CONCLUSION: PWID epidemics in Thailand are heterogeneous and driven by local factors. There is a need to customize intervention strategies for PWID in different settings and to integrate population-based survey methods such as RDS into routine surveillance to monitor the national response. |
Rollout of Xpert MTB/RIF in northwest Cambodia for the diagnosis of tuberculosis among PLHA
Auld SC , Moore BK , Killam WP , Eng B , Nong K , Pevzner EC , Eam KK , Eang MT , Warren D , Whitehead SJ . Public Health Action 2014 4 (4) 216-221 OBJECTIVE: To describe the implementation and utilization of the Xpert MTB/RIF (Xpert) assay to diagnose tuberculosis (TB) among people living with the human immunodeficiency virus/acquired immune-deficiency syndrome (HIV/AIDS, PLHA) in Cambodia. DESIGN: Following the rollout of Xpert, an evaluation was conducted in four provinces of Cambodia from March to December 2012 to determine the utilization, performance, and turnaround time (TAT) of Xpert among PLHA. Data were collected from paper-based patient registers. RESULTS: Of 497 PLHA with a positive TB symptom screen, 357 (72%) were tested with smear microscopy, and 250 (50%) with Xpert; 25 (10%) PLHA tested with Xpert were positive for TB and none were rifampicin-resistant. The utilization of Xpert increased from 23% to 75%, with a median TAT of 1 day. Across districts, utilization ranged from zero to 85%, while the TAT ranged from zero to 22 days. CONCLUSION: While early data show increasing utilization of Xpert for PLHA with a positive symptom screen, most patients underwent smear microscopy as an initial diagnostic test. Training delays and challenges associated with specimen referral may have contributed to variability in Xpert uptake and TAT, particularly for sites without onsite Xpert testing. Enhanced programmatic support, particularly for specimen referral and results reporting, may facilitate appropriate utilization. |
Use of insecticide-treated house screens to reduce infestations of dengue virus vectors, Mexico
Manrique-Saide P , Che-Mendoza A , Barrera-Perez M , Guillermo-May G , Herrera-Bojorquez J , Dzul-Manzanilla F , Gutierrez-Castro C , Lenhart A , Vazquez-Prokopec G , Sommerfeld J , McCall PJ , Kroeger A , Arredondo-Jimenez JI . Emerg Infect Dis 2015 21 (2) 308-11 Dengue prevention efforts rely on control of virus vectors. We investigated use of insecticide-treated screens permanently affixed to windows and doors in Mexico and found that the screens significantly reduced infestations of Aedes aegypti mosquitoes in treated houses. Our findings demonstrate the value of this method for dengue virus vector control. |
A review of nonoccupational pathways for pesticide exposure in women living in agricultural areas
Deziel NC , Friesen MC , Hoppin JA , Hines CJ , Thomas K , Beane Freeman LE . Environ Health Perspect 2015 123 (6) 515-24 BACKGROUND: Women living in agricultural areas may experience high pesticide exposures compared to women in urban or suburban areas due to their proximity to farm activities. OBJECTIVE: Our objective was to review the evidence in the published literature for the contribution of nonoccupational pathways of pesticide exposure in women living in North American agricultural areas. METHODS: We evaluated the following nonoccupational exposure pathways: para-occupational (i.e., take-home or bystander exposure), agricultural drift, residential pesticide use, and dietary ingestion. We also evaluated the role of hygiene factors (e.g., house cleaning; shoe removal). RESULTS: Among 35 publications identified (published 1995-2013), several reported significant or suggestive (p<0.1) associations between para-occupational (n=19) and agricultural drift (n=10) pathways and pesticide dust or biomarker levels, while three observed that residential use was associated with pesticide concentrations in dust. The four studies related to ingestion reported low detection rates of most pesticides in water; additional studies are needed to draw conclusions about this pathway's importance. Hygiene factors were not consistently linked to exposure among the 18 relevant publications identified. CONCLUSIONS: Evidence supported the importance of para-occupational, drift, and residential use pathways. Disentangling exposure pathways was difficult because agricultural populations are concurrently exposed to pesticides via multiple pathways. Most evidence was based on measurements of pesticides in residential dust, which are applicable to any household member and are not specific to women. An improved understanding of nonoccupational pesticide exposure pathways in women living in agricultural areas is critical for studying health effects in women and for designing effective exposure-reduction strategies. |
Observational scores of dampness and mold associated with measurements of microbial agents and moisture in three public schools
Cho SJ , Cox-Ganser JM , Park JH . Indoor Air 2015 26 (2) 168-78 We examined associations between observational dampness scores and measurements of microbial agents and moisture in three public schools. A dampness score was created for each room from 4-point-scale scores (0-3) of water damage, water stains, visible mold, moldy odor, and wetness for each of 8 room components (ceiling, walls, windows, floor, ventilation, furniture, floor trench, and pipes), when present. We created mixed microbial exposure indices (MMEIs) for each of 121 rooms by summing decile ranks of 8 analytes (total culturable fungi; total, Gram-negative, and Gram-positive culturable bacteria; ergosterol; (1-->3)-beta-D-glucan; muramic acid; and endotoxin) in floor dust. We found significant (p ≤ 0.01) linear associations between the dampness score and culturable bacteria (total, Gram-positive, and Gram-negative) and the MMEIs. Rooms with dampness scores greater than 0.25 (median) had significantly (p < 0.05) higher levels of most microbial agents, MMEIs, and relative moisture content than those with lower scores (≤ 0.25). Rooms with reported recent water leaks had significantly (p < 0.05) higher dampness scores than those with historical or no reported water leaks. This study suggests that observational assessment of dampness/mold using a standardized form may be valuable for identifying and documenting water damage and associated microbial contamination. |
Distribution and determinants of urinary biomarkers of exposure to organophosphate insecticides in Puerto Rican pregnant women
Lewis RC , Cantonwine DE , Anzalota Del Toro LV , Calafat AM , Valentin-Blasini L , Davis MD , Montesano MA , Alshawabkeh AN , Cordero JF , Meeker JD . Sci Total Environ 2015 512-513c 337-344 Globally, human exposures to organophosphate (OP) insecticides may pose a significant burden to the health of mothers and their developing fetuses. Unfortunately, relevant data is limited in certain areas of the world concerning sources of exposure to OP insecticides in pregnant populations. To begin to address this gap in information for Puerto Rico, we studied repeated measures of urinary concentrations of 10 OP insecticide metabolites among 54 pregnant women from the northern karst region of the island. We also collected demographic data and self-reported information on the consumption of fruits, vegetables, and legumes in the past 48h before urine collection and home pest-related issues. We calculated the distributions of the urinary biomarkers and compared them to women of reproductive age from the general U.S. population. We also used statistical models accounting for correlated data to assess within-subject temporal variability of the urinary biomarkers and to identify predictors of exposure. We found that for all but two metabolites (para-nitrophenol [PNP], diethylthiophosphate [DETP]), 50th or 95th percentile urinary concentrations (the metric that was used for comparison was based on the biomarker's detection frequency) of the other eight metabolites (3,5,6-trichloro-2-pyridinol [TCPY], 2-isopropyl-4-methyl-6-hydroxy-pyrimidine, malathion dicarboxylic acid, diethylphosphate, diethyldithiophosphate, dimethylphosphate, dimethylthiophosphate [DMTP], dimethyldithiophosphate) were somewhat lower in our cohort compared with similarly aged women from the continental United States. TCPY, PNP, DETP, and DMTP, which were the only urinary metabolites detected in greater than 50% of the samples, had poor reproducibility (intraclass correlation coefficient range: 0.19-0.28) during pregnancy. Positive predictors of OP insecticide exposure included: age; marital or employment status; consumption of cherries, grape juice, peanuts, peanut butter, or raisins; and residential application of pesticides. Further research is needed to understand what aspects of the predictors identified influence OP insecticide exposure during pregnancy. |
More than half of US youth consume seafood and most have blood mercury concentrations below the EPA reference level, 2009-2012
Nielsen SJ , Aoki Y , Kit BK , Ogden CL . J Nutr 2015 145 (2) 322-7 BACKGROUND: Consuming seafood has health benefits, but seafood can also contain methylmercury, a neurotoxicant. Exposure to methylmercury affects children at different stages of brain development, including during adolescence. OBJECTIVE: The objective was to examine seafood consumption and blood mercury concentrations in US youth. METHODS: In the 2009-2012 NHANES, a cross-sectional nationally representative sample of the US population, seafood consumption in the past 30 d and blood mercury concentrations on the day of examination were collected from 5656 youth aged 1-19 y. Log-linear regression was used to examine the association between frequency of specific seafood consumption and blood mercury concentration, adjusting for race/Hispanic origin, sex, and age. RESULTS: In 2009-2012, 62.4% +/- 1.4% (percent +/- SE) of youth consumed any seafood in the preceding month; 38.4% +/- 1.4% and 48.5% +/- 1.5% reported consuming shellfish and fish, respectively. In 2009-2012, the geometric mean blood mercury concentration was 0.50 +/- 0.02 mug/L among seafood consumers and 0.27 +/- 0.01 mug/L among those who did not consume seafood. Less than 0.5% of youth had blood mercury concentrations ≥5.8 mug/L. In adjusted log-linear regression analysis, no significant associations were observed between frequency of breaded fish or catfish consumption and blood mercury concentrations, but frequency of consuming certain seafood types had significant positive association with blood mercury concentrations: high-mercury fish (swordfish and shark) [exponentiated beta coefficient (expbeta): 2.40; 95% CI: 1.23, 4.68]; salmon (expbeta: 1.41; 95% CI: 1.26, 1.55); tuna (expbeta: 1.38; 95% CI: 1.29, 1.45); crabs (expbeta: 1.35; 95% CI: 1.17, 1.55); shrimp (expbeta: 1.12; 95% CI: 1.05, 1.20), and all other seafood (expbeta: 1.23; 95% CI: 1.17, 1.32). Age-stratified log-linear regression analyses produced similar results. CONCLUSION: Few US youth have blood mercury concentrations ≥5.8 mug/L, although more than half of US youth consumed seafood in the past month. |
Outbreaks of unexplained neurologic illness - Muzaffarpur, India, 2013-2014
Shrivastava A , Srikantiah P , Kumar A , Bhushan G , Goel K , Kumar S , Kumar T , Mohankumar R , Pandey R , Pathan P , Pappanna M , Pasi A , Pradhan A , Singh P , Somashekar D , Velayudhan A , Yadav R , Chhabra M , Mittal V , Khare S , Sejvar JJ , Dwivedi M , Laserson K , Earhart KC , Sivaperumal P , Kumar AR , Chakrabarti A , Thomas J , Schier J , Singh R , Singh RS , Dhariwal AC , Chauhan LS . MMWR Morb Mortal Wkly Rep 2015 64 (3) 49-53 Outbreaks of an unexplained acute neurologic illness affecting young children and associated with high case-fatality rates have been reported in the Muzaffarpur district of Bihar state in India since 1995. The outbreaks generally peak in June and decline weeks later with the onset of monsoon rains. There have been multiple epidemiologic and laboratory investigations of this syndrome, leading to a wide spectrum of proposed causes for the illness, including infectious encephalitis and exposure to pesticides. An association between illness and litchi fruit has been postulated because Muzaffarpur is a litchi fruit-producing region. To better characterize clinical and epidemiologic features of the illness that might suggest its cause and how it can be prevented, the Indian National Centre for Disease Control (NCDC) and CDC investigated outbreaks in 2013 and 2014. Clinical and laboratory findings in 2013 suggested a noninflammatory encephalopathy, possibly caused by a toxin. A common laboratory finding was low blood glucose (<70 mg/dL) on admission, a finding associated with a poorer outcome; 44% of all cases were fatal. An ongoing 2014 investigation has found no evidence of any infectious etiology and supports the possibility that exposure to a toxin might be the cause. The outbreak period coincides with the month-long litchi harvesting season in Muzaffarpur. Although a specific etiology has not yet been determined, the 2014 investigation has identified the illness as a hypoglycemic encephalopathy and confirmed the importance of ongoing laboratory evaluation of environmental toxins to identify a potential causative agent, including markers for methylenecyclopropylglycine (MCPG), a compound found in litchi seeds known to cause hypoglycemia in animal studies. Current public health recommendations are focused on reducing mortality by urging affected families to seek prompt medical care, and ensuring rapid assessment and correction of hypoglycemia in ill children. |
An assessment of the human health impact of seven leading foodborne pathogens in the United States using disability adjusted life years
Scallan E , Hoekstra RM , Mahon BE , Jones TF , Griffin PM . Epidemiol Infect 2015 143 (13) 1-10 We explored the overall impact of foodborne disease caused by seven leading foodborne pathogens in the United States using the disability adjusted life year (DALY). We defined health states for each pathogen (acute illness and sequelae) and estimated the average annual incidence of each health state using data from public health surveillance and previously published estimates from studies in the United States, Canada and Europe. These pathogens caused about 112 000 DALYs annually due to foodborne illnesses acquired in the United States. Non-typhoidal Salmonella (32 900) and Toxoplasma (32 700) caused the most DALYs, followed by Campylobacter (22 500), norovirus (9900), Listeria monocytogenes (8800), Clostridium perfringens (4000), and Escherichia coli O157 (1200). These estimates can be used to prioritize food safety interventions. Future estimates of the burden of foodborne disease in DALYs would be improved by addressing important data gaps and by the development and validation of US-specific disability weights for foodborne diseases. |
Classification of Bartonella strains associated with straw-colored fruit bats (Eidolon helvum) across Africa using a multi-locus sequence typing platform.
Bai Y , Hayman DT , McKee CD , Kosoy MY . PLoS Negl Trop Dis 2015 9 (1) e0003478 Bartonellae are facultative intracellular bacteria and are highly adapted to their mammalian host cell niches. Straw-colored fruit bats (Eidolon helvum) are commonly infected with several bartonella strains. To elucidate the genetic diversity of these bartonella strains, we analyzed 79 bartonella isolates from straw-colored fruit bats in seven countries across Africa (Cameroon, Annobon island of Equatorial Guinea, Ghana, Kenya, Nigeria, Tanzania, and Uganda) using a multi-locus sequencing typing (MLST) approach based on nucleotide sequences of eight loci (ftsZ, gltA, nuoG, ribC, rpoB, ssrA, ITS, and 16S rRNA). The analysis of each locus but ribC demonstrated clustering of the isolates into six genogroups (E1 - E5 and Ew), while ribC was absent in the isolates belonging to the genogroup Ew. In general, grouping of all isolates by each locus was mutually supportive; however, nuoG, gltA, and rpoB showed some incongruity with other loci in several strains, suggesting a possibility of recombination events, which were confirmed by network analyses and recombination/mutation rate ratio (r/m) estimations. The MLST scheme revealed 45 unique sequence types (ST1 - 45) among the analyzed bartonella isolates. Phylogenetic analysis of concatenated sequences supported the discrimination of six phylogenetic lineages (E1 - E5 and Ew) corresponding to separate and unique Bartonella species. One of the defined lineages, Ew, consisted of only two STs (ST1 and ST2), and comprised more than one-quarter of the analyzed isolates, while other lineages contained higher numbers of STs with a smaller number of isolates belonging to each lineage. The low number of allelic polymorphisms of isolates belonging to Ew suggests a more recent origin for this species. Our findings suggest that at least six Bartonella species are associated with straw-colored fruit bats, and that distinct STs can be found across the distribution of this bat species, including in populations of bats which are genetically distinct. |
Novel gentamicin resistance genes in Campylobacter isolated from humans and retail meats in the USA.
Zhao S , Mukherjee S , Chen Y , Li C , Young S , Warren M , Abbott J , Friedman S , Kabera C , Karlsson M , McDermott PF . J Antimicrob Chemother 2015 70 (5) 1314-21 OBJECTIVES: To understand the molecular epidemiology of gentamicin-resistant Campylobacter and investigate aminoglycoside resistance mechanisms. METHODS: One-hundred-and-fifty-one gentamicin-resistant Campylobacter isolates from humans (n = 38 Campylobacter jejuni; n = 41, Campylobacter coli) and retail chickens (n = 72 C. coli), were screened for the presence of gentamicin resistance genes by PCR and subtyped using PFGE. A subset of the isolates (n = 41) was analysed using WGS. RESULTS: Nine variants of gentamicin resistance genes were identified: aph(2'')-Ib, Ic, Ig, If, If1, If3, Ih, aac(6')-Ie/aph(2'')-Ia and aac(6')-Ie/aph(2'')-If2. The aph(2'')-Ib, Ic, If1, If3, Ih and aac(6')-Ie/aph(2'')-If2 variants were identified for the first time in Campylobacter. Human isolates showed more diverse aminoglycoside resistance genes than did retail chicken isolates, in which only aph(2'')-Ic and -Ig were identified. The aph(2'')-Ig gene was only gene shared by C. coli isolates from human (n = 27) and retail chicken (n = 69). These isolates displayed the same resistance profile and similar PFGE patterns, suggesting that contaminated retail chicken was probably the source of human C. coli infections. Human isolates were genetically diverse and generally more resistant than the retail chicken isolates. The most frequent co-resistance was to tetracycline (78/79, 98.7%), followed by ciprofloxacin/nalidixic acid (46/79, 58.2%), erythromycin and azithromycin (36/79, 45.6%), telithromycin (32/79, 40.5%) and clindamycin (18/79, 22.8%). All human and retail meat isolates were susceptible to florfenicol. CONCLUSIONS: This study demonstrated that several new aminoglycoside resistance genes underlie the recent emergence of gentamicin-resistant Campylobacter, and that, in addition to contaminated retail chicken, other sources have also contributed to gentamicin-resistant Campylobacter infections in humans. |
Surgical site infection surveillance following ambulatory surgery
Rhee C , Huang SS , Berrios-Torres SI , Kaganov R , Bruce C , Lankiewicz J , Platt R , Yokoe DS . Infect Control Hosp Epidemiol 2015 36 (2) 225-8 We assessed 4045 ambulatory surgery patients for surgical site infection (SSI) using claims-based triggers for medical chart review. Of 98 patients flagged by codes suggestive of SSI, 35 had confirmed SSIs. SSI rates ranged from 0 to 3.2% for common procedures. Claims may be useful for SSI surveillance following ambulatory surgery. Infect Control Hosp Epidemiol 2014;00(0):1-4. |
Precautionary practices of healthcare workers who disinfect medical and dental devices using high-level disinfectants
Henn SA , Boiano JM , Steege AL . Infect Control Hosp Epidemiol 2015 36 (2) 180-5 BACKGROUND: High-level disinfectants (HLDs) are used throughout the healthcare industry to chemically disinfect reusable, semicritical medical and dental devices to control and prevent healthcare-associated infections among patient populations. Workers who use HLDs are at risk of exposure to these chemicals, some of which are respiratory and skin irritants and sensitizers. OBJECTIVE: To evaluate exposure controls used and to better understand impediments to healthcare workers using personal protective equipment while handling HLDs. DESIGN: Web-based survey. PARTICIPANTS: A targeted sample of members of professional practice organizations representing nurses, technologists/technicians, dental professionals, respiratory therapists, and others who reported handling HLDs in the previous 7 calendar days. Participating organizations invited either all or a random sample of members via email, which included a hyperlink to the survey. METHODS: Descriptive analyses were conducted including simple frequencies and prevalences. RESULTS: A total of 4,657 respondents completed the survey. The HLDs used most often were glutaraldehyde (59%), peracetic acid (16%), and ortho-phthalaldehyde (15%). Examples of work practices or events that could increase exposure risk included failure to wear water-resistant gowns (44%); absence of standard procedures for minimizing exposure (19%); lack of safe handling training (17%); failure to wear protective gloves (9%); and a spill/leak of HLD during handling (5%). Among all respondents, 12% reported skin contact with HLDs, and 33% of these respondents reported that they did not always wear gloves. CONCLUSION: Findings indicated that precautionary practices were not always used, underscoring the importance of improved employer and worker training and education regarding HLD hazards. |
Clinical relevance of the Hevea brasiliensis lipid transfer protein Hev b 12
Faber MA , Sabato V , Bridts CH , Nayak A , Beezhold DH , Ebo DG . J Allergy Clin Immunol 2015 135 (6) 1645-8 Natural rubber latex (NRL) from Hevea brasiliensis (Euphorbiaceae) constitutes an important cause of allergy with distinct phenotypes depending on the sensitization route and profile of the patient.1 In health care workers NRL allergy is dominated by sensitization to the proteins Hev b 5, 6.01, 6.02, and 6.03.2 Because of the ubiquity of these proteins in the plant kingdom, patients frequently display cross-reactivity to various fruits and vegetables. In patients who have undergone multiple operations, such as those with spina bifida, cross-reactivity is rare because NRL allergy mainly results from sensitization to components without homologues in edible plants, namely Hev b 1 and Hev b 3.1 | However, NRL allergy has recently been confirmed in patients without clear sensitization to the components Hev b 1, 3, 5, 6, 7, 8, 9, 10, and 11.1 The exact explanation for this observation probably relates to the fact that the panel of recombinant proteins currently available for diagnostics does not cover the entire NRL IgE response. Although Beezhold et al3 identified the nonspecific lipid transfer protein (nsLTP) Hev b 12 from NRL as a potential cross-reactive panallergen more than a decade ago, literature about the clinical significance of Hev b 12 sensitization is limited, and no Hev b 12 sensitization was demonstrable in 25 children with latex allergy.4 Rihs et al5 observed Hev b 12–specific IgE (sIgE) reactivity in only 6 (12.5%) of 48 patients with fruit allergy but without symptoms on latex exposure. In these patients Hev b 12 sensitization seemed attributable to cross-reactive nsLTPs from different fruits and apparently of limited role in NRL allergy. |
Adverse Events Following Measles, Mumps, and Rubella Vaccine in Adults Reported to the Vaccine Adverse Event Reporting System (VAERS), 2003-2013.
Sukumaran L , McNeil MM , Moro PL , Lewis PW , Winiecki SK , Shimabukuro TT . Clin Infect Dis 2015 60 (10) e58-65 BACKGROUND: Limited data exists on the safety of MMR vaccine in adults. We reviewed reports of adverse events (AEs) to the Vaccine Adverse Event Reporting System (VAERS) to assess safety in this previously under-studied group. METHODS: VAERS is the national spontaneous vaccine safety surveillance system co-administered by CDC and the FDA. We searched the VAERS database for US reports of adults aged 19 years and older who received MMR vaccine from January 1, 2003 to July 31, 2013. We clinically reviewed reports and available medical records for serious AEs, pregnancy reports, and reports for selected pre-specified outcomes. RESULTS: During this period, VAERS received 3,175 US reports after MMR vaccine in adults. Of these, 168 (5%) were classified as serious, including 7 reports of death. Females accounted for 77% of reports. The most common signs and symptoms for all reports were pyrexia (19%), rash (17%), pain (13%) and arthralgia (13%). We did not detect any new safety findings in empirical Bayesian data mining. We identified 131 reports of MMR vaccine administered to a pregnant woman; the majority of these vaccinations were in the first trimester and in 83 (62%), no AE was reported. CONCLUSIONS: In our review of VAERS data, we did not detect any new or unexpected safety concerns for MMR vaccination in adults. We identified reports of pregnant women exposed to MMR which is a group in whom the vaccine is contraindicated, suggesting the need for continued provider education on vaccine recommendations and screening. |
Response to challenge dose among young adults vaccinated for hepatitis B as infants: importance of detectable residual antibody to hepatitis B surface antigen
Spradling PR , Kamili S , Xing J , Drobeniuc J , Hu DJ , Middleman AB . Infect Control Hosp Epidemiol 2015 36 (5) 1-5 OBJECTIVE: To determine whether a difference in antibody to hepatitis B surface antigen (anti-HBs) response to a hepatitis B vaccine challenge dose existed among persons with a baseline anti-HBs level of 0 mIU/mL (group 1) and those with "non-zero" levels of 0.1-4.9 (group 2) and 5.0-9.9 (group 3) mIU/mL, according to the VITROS ECi anti-HBs assay. DESIGN: Subanalysis of randomized clinical trial. Response was defined as a postchallenge anti-HBs level of at least 10 mIU/mL and 4-fold rise in anti-HBs level 2 weeks after a single challenge dose of 10 vs 20 microg Engerix-B. Baseline was defined as the anti-HBs level immediately before administration of the challenge dose. SETTING: Pediatric integrated healthcare system near Houston, Texas. PARTICIPANTS: Three hundred nineteen US-born 16-19-year-olds who completed the hepatitis B vaccine series during the first year of life. RESULTS: One hundred seventy-eight persons had zero (group 1) and 141 (114 group 2 and 27 group 3) had non-zero anti-HBs levels at baseline. Response to the challenge dose was significantly higher among those with non-zero vs zero anti-HBs levels, irrespective of challenge dosage; only 1 person with a non-zero anti-HBs level failed to respond to the challenge dose (group 3, 27/27 [100%] vs group 2, 113/114 [99%] vs group 1, 145/178 [82%]; P<.0001). CONCLUSIONS: Among participants with residual anti-HBs levels less than 10 mIU/mL 16-19 years after primary hepatitis B vaccination during infancy, non-zero anti-HBs levels, with rare exception, indicated persistence of immune memory to HBsAg. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT01341275. |
Serogroup A meningococcal conjugate (PsA-TT) vaccine coverage and measles vaccine coverage in Burkina Faso - implications for introduction of PsA-TT into the Expanded Programme on Immunization
Meyer SA , Kambou JL , Cohn A , Goodson JL , Flannery B , Medah I , Messonnier N , Novak R , Diomande F , Djingarey MH , Clark TA , Yameogo I , Fall A , Wannemuehler K . Vaccine 2015 33 (12) 1492-8 BACKGROUND: A new serogroup A meningococcal conjugate vaccine (PsA-TT, MenAfriVac) has been developed to combat devastating serogroup A Neisseria meningitis (MenA) epidemics in Africa. A mass immunization campaign targeting 1-29 year olds was conducted in Burkina Faso in December 2010. Protection of subsequent infant cohorts will be necessary through either introduction of PsA-TT into the routine Expanded Programme on Immunization (EPI) or periodic repeat mass vaccination campaigns. OBJECTIVES: To inform future immunization policy for PsA-TT vaccination of infants through a comparison of PsA-TT campaign vaccination coverage and routine measles-containing vaccine (MCV) coverage in Burkina Faso. METHODS: A national survey was conducted in Burkina Faso during December 17-27, 2011 using stratified cluster sampling to assess PsA-TT vaccine coverage achieved by the 2010 nationwide immunization campaign among 2-30 year olds and routine MCV coverage among 12-23 month olds. Coverage estimates and 95% Confidence Intervals (CI) were calculated, reasons for non-vaccination and methods of campaign communication were described, and a multivariable analysis for factors associated with vaccination was conducted. RESULTS: National overall PsA-TT campaign coverage was 95.9% (95% CI: 95.0-96.7) with coverage greater than 90% all 13 regions of Burkina Faso. National overall routine MCV coverage was 92.5% (95% CI: 90.5-94.1), but ranged from 75.3% to 95.3% by region. The primary predictor for PsA-TT vaccination among all age groups was a head of household informed of the campaign. PsA-TT vaccination was more likely in residents of rural settings, whereas MCV vaccination was more likely in residents of urban settings. CONCLUSION: Overall national vaccination rates in Burkina Faso were similar for PsA-TT and MCV vaccine. The regions with MCV coverage below targets may be at risk for sub-optimal vaccination coverage if PsA-TT is introduced in EPI. These results highlight the need for assessments of routine vaccination coverage to guide PsA-TT immunization policy in meningitis belt countries. |
Strengthening routine immunization systems to improve global vaccination coverage
Sodha SV , Dietz V . Br Med Bull 2015 113 (1) 5-14 BACKGROUND: Global coverage with the third dose of diphtheria-tetanus-pertussis vaccine among children under 1 year of age stagnated at approximately 83-84% during 2008-13. SOURCES OF DATA: Annual World Health Organization and UNICEF-derived national vaccination coverage estimates. AREAS OF AGREEMENT: Incomplete vaccination is associated with poor socioeconomic status, lower education, non-use of maternal-child health services, living in conflict-affected areas, missed immunization opportunities and cancelled vaccination sessions. AREAS OF CONTROVERSY: Vaccination platforms must expand to include older ages including the second year of life. Immunization programmes, including eradication and elimination initiatives such as those for polio and measles, must integrate within the broader health system. GROWING POINTS: The Global Vaccine Action Plan (GVAP) 2011-20 is a framework for strengthening immunization systems, emphasizing country ownership, shared responsibility, equity, integration, sustainability and innovation. AREAS TIMELY FOR DEVELOPING RESEARCH: Immunization programmes should identify, monitor and evaluate gaps and interventions within the GVAP framework. |
Vaccination coverage among adults, excluding influenza vaccination - United States, 2013
Williams WW , Lu PJ , O'Halloran A , Bridges CB , Kim DK , Pilishvili T , Hales CM , Markowitz LE . MMWR Morb Mortal Wkly Rep 2015 64 (4) 95-102 Vaccinations are recommended throughout life to prevent vaccine-preventable diseases and their sequelae. Adult vaccination coverage, however, remains low for most routinely recommended vaccines and below Healthy People 2020 targets. In October 2014, the Advisory Committee on Immunization Practices (ACIP) approved the adult immunization schedule for 2015. With the exception of influenza vaccination, which is recommended for all adults each year, other adult vaccinations are recommended for specific populations based on a person's age, health conditions, behavioral risk factors (e.g., injection drug use), occupation, travel, and other indications. To assess vaccination coverage among adults aged ≥19 years for selected vaccines, CDC analyzed data from the 2013 National Health Interview Survey (NHIS). This report highlights results of that analysis for pneumococcal, tetanus toxoid-containing (tetanus and diphtheria vaccine [Td] or tetanus and diphtheria with acellular pertussis vaccine [Tdap]), hepatitis A, hepatitis B, herpes zoster (shingles), and human papillomavirus (HPV) vaccines by selected characteristics (age, race/ethnicity,dagger and vaccination indication). Influenza vaccination coverage estimates for the 2013-14 influenza season have been published separately. Compared with 2012, only modest increases occurred in Tdap vaccination among adults aged ≥19 years (a 2.9 percentage point increase to 17.2%), herpes zoster vaccination among adults aged ≥60 years (a 4.1 percentage point increase to 24.2%), and HPV vaccination among males aged 19-26 years (a 3.6 percentage point increase to 5.9%); coverage among adults in the United States for the other vaccines did not improve. Racial/ethnic disparities in coverage persisted for all six vaccines and widened for Tdap and herpes zoster vaccination. Increases in vaccination coverage are needed to reduce the occurrence of vaccine-preventable diseases among adults. Awareness of the need for vaccines for adults is low among the general population, and adult patients largely rely on health care provider recommendations for vaccination. The Community Preventive Services Task Force and the National Vaccine Advisory Committee have recommended that health care providers incorporate vaccination needs assessment, recommendation, and offer of vaccination into every clinical encounter with adult patients to improve vaccination rates and to narrow the widening racial/ethnic disparities in vaccination coverage. |
Vaccination policies among health professional schools: evidence of immunity and allowance of vaccination exemptions
Dolan SB , Libby TE , Lindley MC , Ahmed F , Stevenson J , Strikas RA . Infect Control Hosp Epidemiol 2015 36 (2) 186-91 OBJECTIVE: To characterize health professional schools by their vaccination policies for acceptable forms of evidence of immunity and exemptions permitted. METHODS: Data were collected between September 2011 and April 2012 using an Internet-based survey e-mailed to selected types of accredited health professional programs. Schools were identified through accrediting associations for each type of health professional program. Analysis was limited to schools requiring ≥1 vaccine recommended by the Advisory Committee on Immunization Practices (ACIP): measles, mumps, rubella, hepatitis B, varicella, pertussis, and influenza. Weighted bivariate frequencies were generated using SAS 9.3. RESULTS: Of 2,775 schools surveyed, 75% (n=2,077) responded; of responding schools, 93% (1947) required ≥1 ACIP-recommended vaccination. The proportion of schools accepting ≥1 non-ACIP-recommended form of evidence of immunity varied by vaccine: 42% for pertussis, 37% for influenza, 30% for rubella, 22% for hepatitis B, 18% for varicella, and 9% for measles and mumps. Among schools with ≥1 vaccination requirement, medical exemptions were permitted for ≥1 vaccine by 75% of schools; 54% permitted religious exemptions; 35% permitted personal belief exemptions; 58% permitted any nonmedical exemption. CONCLUSIONS: Many schools accept non-ACIP-recommended forms of evidence of immunity which could lead some students to believe they are protected from vaccine preventable diseases when they may be susceptible. Additional efforts are needed to better educate school officials about current ACIP recommendations for acceptable forms of evidence of immunity so school policies can be revised as needed. |
Naturally acquired antibodies against Haemophilus influenzae type a in Aboriginal adults, Canada
Nix EB , Williams K , Cox AD , St Michael F , Romero-Steiner S , Schmidt DS , McCready WG , Ulanova M . Emerg Infect Dis 2015 21 (2) 273-9 In the post-Haemophilus influenzae type b (Hib) vaccine era that began in the 1980's, H. influenzae type a (Hia) emerged as a prominent cause of invasive disease in North American Aboriginal populations. To test whether a lack of naturally acquired antibodies may underlie increased rates of invasive Hia disease, we compared serum bactericidal activity against Hia and Hib and IgG and IgM against capsular polysaccharide between Canadian Aboriginal and non-Aboriginal healthy and immunocompromised adults. Both healthy and immunocompromised Aboriginal adults exhibited significantly higher bactericidal antibody titers against Hia than did non-Aboriginal adults (p = 0.042 and 0.045 respectively), with no difference in functional antibody activity against Hib. IgM concentrations against Hia were higher than IgG in most study groups; the inverse was true for antibody concentrations against Hib. Our results indicate that Aboriginal adults possess substantial serum bactericidal activity against Hia that is mostly due to IgM antibodies. The presence of sustained IgM against Hia suggests recent Hia exposure. |
Effectiveness of a monovalent rotavirus vaccine in infants in Malawi after programmatic roll-out: an observational and case-control study
Bar-Zeev N , Kapanda L , Tate JE , Jere KC , Iturriza-Gomara M , Nakagomi O , Mwansambo C , Costello A , Parashar UD , Heyderman RS , French N , Cunliffe NA . Lancet Infect Dis 2015 15 (4) 422-8 BACKGROUND: Rotavirus is the main cause of severe acute gastroenteritis in children in Africa. Monovalent human rotavirus vaccine (RV1) was added into Malawi's infant immunisation schedule on Oct 29, 2012. We aimed to assess the impact and effectiveness of RV1 on rotavirus gastroenteritis in the 2 years after introduction. METHODS: From Jan 1, 2012, to June 30, 2014, we recruited children younger than 5 years who were admitted into Queen Elizabeth Central Hospital, Blantyre, Malawi, with acute gastroenteritis. We assessed stool samples from these children for presence of rotavirus with use of ELISA and we genotyped rotaviruses with use of RT-PCR. We compared rotavirus detection rates in stool samples and incidence of hospital admittance for rotavirus in children from Jan 1 to June 30, in the year before vaccination (2012) with the same months in the 2 years after vaccination was introduced (2013 and 2014). In the case-control portion of our study, we recruited eligible rotavirus-positive children from the surveillance platform and calculated vaccine effectiveness (one minus the odds ratio of vaccination) by comparing infants with rotavirus gastroenteritis with infants who tested negative for rotavirus, and with community age-matched and neighbourhood-matched controls. FINDINGS: We enrolled 1431 children, from whom we obtained 1417 stool samples (99%). We detected rotavirus in 79 of 157 infants (50%) before the vaccine, compared with 57 of 219 (40%) and 52 of 170 (31%) in successive calendar years after vaccine introduction (p=0.0002). In the first half of 2012, incidence of rotavirus hospital admission was 269 per 100 000 infants compared with 284 in the same months of 2013 (rise of 5.8%, 95% CI -23.1 to 45.4; p=0.73) and 153 in these months in 2014 (a reduction from the prevaccine period of 43.2%, 18.0-60.7; p=0.003). We recruited 118 vaccine-eligible rotavirus cases (median age 8.9 months; IQR 6.6-11.1), 317 rotavirus-test-negative controls (9.4 months; 6.9-11.9), and 380 community controls (8.8 months; 6.5-11.1). Vaccine effectiveness for two doses of RV1 in rotavirus-negative individuals was 64% (95% CI 24-83) and community controls was 63% (23-83). The point estimate of effectiveness was higher against genotype G1 than against G2 and G12. INTERPRETATION: Routine use of RV1 reduced hospital admissions for several genotypes of rotavirus in children younger than 5 years, especially in infants younger than 1 year. Our data support introduction of rotavirus vaccination at the WHO recommended schedule, with continuing surveillance in high-mortality countries. FUNDING: Wellcome Trust, GlaxoSmithKline Biologicals. |
Hepatitis B vaccination is effective by subcutaneous route in children with bleeding disorders: a universal data collection database analysis
Carpenter SL , Soucie JM , Presley RJ , Ragni MV , Wicklund BM , Silvey M , Davidson H . Haemophilia 2015 21 (1) e39-43 Subcutaneous (SQ) vs. intramuscular (IM) vaccination may cause fewer injection site complications in children with bleeding disorders, but little is known about comparative immunogenicity. To compare immunogenicity of hepatitis B virus (HBV) vaccination administered SQ or IM to individuals <2 years old with bleeding disorders, we performed a retrospective analysis of HBV surface antibody titres among patients enrolled in the universal data collection database who had received three doses of HBV vaccine solely by one route (SQ or IM). Data reviewed were from an initial visit before 24 months of age, until time of hepatitis antibody titre testing. The SQ and IM study groups did not differ in demographics, haemophilia type or severity or bleeding history. The mean age at the time of HBV surface antibody (anti-HBs) testing was 56.9 +/- 20.3 months. Eighty-five of 92 subjects (92.4%) who received vaccine SQ developed a positive antibody titre (>12 IU/L), compared to 101/114 (88.6%) who received IM (P = 0.30). There was no statistically significant difference in distribution of titre values. The average age of the subjects at time of testing was 53 +/- 20 months in the SQ group vs. 60 +/- 20 months in the IM group (P = 0.02). The average time between the last dose of vaccine and anti-HBs testing was 47.6 +/- 18.5 months among SQ vaccinated subjects vs. 51.6 +/- 20.5 months in the IM group (P = 0.2). Immunogenicity to hepatitis B vaccination by the SQ and IM routes is similar. |
Introducing seasonal influenza vaccine in low-income countries: an adverse events following immunization survey in the Lao People's Democratic Republic
Phengxay M , Mirza SA , Reyburn R , Xeuatvongsa A , Winter C , Lewis H , Olsen SJ , Tsuyuoka R , Khanthamaly V , Palomeque FS , Bresee JS , Moen AC , Corwin AL . Influenza Other Respir Viruses 2015 9 (2) 94-8 OBJECTIVE: In 2012, Lao PDR introduced seasonal influenza vaccine in pregnant women, persons aged ≥50 years, persons with chronic diseases, and healthcare personnel. We assessed adverse events following immunization (AEFI). METHODS: We used a multistage randomized cluster sample design to interview vaccine recipients. FINDINGS: Between April and May 2012, 355 902 were vaccinated. Of 2089 persons interviewed, 261 (12.5%) reported one or more AEFI. The most commonly reported AEFIs were local reactions. No hospitalizations or deaths were reported; 16% sought medical care. Acceptance and awareness of vaccination were high. CONCLUSIONS: Following the introduction of seasonal influenza vaccine in Lao PDR, self-reported adverse events were mild. |
Advisory Committee on Immunization Practices recommended immunization schedule for adults aged 19 years or older - United States, 2015
Kim DK , Bridges CB , Harriman KH , Advisory Committee on Immunization Practices , Adult Immunization Work Group . MMWR Morb Mortal Wkly Rep 2015 64 (4) 91-92 In October 2014, the Advisory Committee on Immunization Practices (ACIP) approved the Recommended Immunization Schedule for Adults Aged 19 Years or Older, United States, 2015. 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. Changes in the 2015 adult immunization schedule from the 2014 schedule included the August 2014 recommendation for routine administration of the 13-valent pneumococcal conjugate vaccine (PCV13) in series with the 23-valent pneumococcal polysaccharide vaccine (PPSV23) for all adults aged 65 years or older, the August 2014 revision on contraindications and precautions for the live attenuated influenza vaccine (LAIV), and the October 2014 approval by the Food and Drug Administration to expand the approved age for use of recombinant influenza vaccine (RIV). These revisions were also reviewed and approved by the American College of Physicians, American Academy of Family Physicians, American College of Obstetricians and Gynecologists, and American College of Nurse-Midwives. |
Advisory Committee on Immunization Practices recommended immunization schedules for persons aged 0 through 18 years - United States, 2015
Strikas RA , Advisory Committee on Immunization Practices , ACIP Child/Adolescent Immunization Work Group . MMWR Morb Mortal Wkly Rep 2015 64 (4) 93-94 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 2014, ACIP approved the recommended immunization schedules for persons aged 0 through 18 years for 2015, which include several changes from the 2014 immunization schedules. For 2015, the figures, footnotes, and tables are being 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 2015 immunization schedules for persons aged 0 through 18 years also are available at the website in several formats, including portrait, landscape, and pocket-sized versions. Ordering instructions for laminated versions and "parent-friendly" schedules also are available at the immunization schedule website. |
Trauma center staffing, infrastructure, and patient characteristics that influence trauma center need
Faul M , Sasser SM , Lairet J , Mould-Millman NK , Sugerman D . West J Emerg Med 2015 16 (1) 98-106 INTRODUCTION: The most effective use of trauma center resources helps reduce morbidity and mortality, while saving costs. Identifying critical infrastructure characteristics, patient characteristics and staffing components of a trauma center associated with the proportion of patients needing major trauma care will help planners create better systems for patient care. METHODS: We used the 2009 National Trauma Data Bank-Research Dataset to determine the proportion of critically injured patients requiring the resources of a trauma center within each Level I-IV trauma center (n=443). The outcome variable was defined as the portion of treated patients who were critically injured. We defined the need for critical trauma resources and interventions ("trauma center need") as death prior to hospital discharge, admission to the intensive care unit, or admission to the operating room from the emergency department as a result of acute traumatic injury. Generalized Linear Modeling (GLM) was used to determine how hospital infrastructure, staffing Levels, and patient characteristics contributed to trauma center need. RESULTS: Nonprofit Level I and II trauma centers were significantly associated with higher levels of trauma center need. Trauma centers that had a higher percentage of transferred patients or a lower percentage of insured patients were associated with a higher proportion of trauma center need. Hospital infrastructure characteristics, such as bed capacity and intensive care unit capacity, were not associated with trauma center need. A GLM for Level III and IV trauma centers showed that the number of trauma surgeons on staff was associated with trauma center need. CONCLUSION: Because the proportion of trauma center need is predominantly influenced by hospital type, transfer frequency, and insurance status, it is important for administrators to consider patient population characteristics of the catchment area when planning the construction of new trauma centers or when coordinating care within state or regional trauma systems. |
Understanding Bhutanese refugee suicide through the interpersonal-psychological theory of suicidal behavior
Ellis BH , Lankau EW , Ao T , Benson MA , Miller AB , Shetty S , Lopes Cardozo B , Geltman PL , Cochran J . Am J Orthopsychiatry 2015 85 (1) 43-55 Attention has been drawn to high rates of suicide among refugees after resettlement and in particular among the Bhutanese refugees. This study sought to understand the apparent high rates of suicide among resettled Bhutanese refugees in the context of the Interpersonal-Psychological Theory of Suicidal Behavior (IPTS). Expanding on a larger investigation of suicide in a randomly selected sample of Bhutanese men and women resettled in Arizona, Georgia, New York, and Texas (Ao et al., 2012), the current study focused on 2 factors, thwarted belongingness and perceived burdensomeness, examined individual and postmigration variables associated with these factors, and explored how they differed by gender. Overall, factors such as poor health were associated with perceived burdensomeness and thwarted belongingness. For men, stressors related to employment and providing for their families were related to feeling burdensome and/or alienated from family and friends, whereas for women, stressors such as illiteracy, family conflict, and being separated from family members were more associated. IPTS holds promise in understanding suicide in the resettled Bhutanese community. |
Application of a Seven-Target Pyrosequencing Assay To Improve the Detection of Neuraminidase Inhibitor-Resistant Influenza A(H3N2) Viruses.
Tamura D , Okomo-Adhiambo M , Mishin VP , Guo Z , Xu X , Villanueva J , Fry AM , Stevens J , Gubareva LV . Antimicrob Agents Chemother 2015 59 (4) 2374-9 National U.S. influenza antiviral surveillance incorporates data generated by neuraminidase (NA) inhibition (NI) testing of isolates supplemented with NA sequence analysis; and pyrosequencing analysis of clinical specimens. Lack of established correlates for clinically relevant resistance to NA inhibitors (NAIs) hinders interpretation of NI assay data. Nonetheless, A(H3N2) viruses are commonly monitored for highly reduced or reduced inhibition in the NI assay and/or presence of NA markers, E119V, R292K and N294S. In 2012-2013, three drug resistant A(H3N2) viruses were detected by NI assay among isolates (n=1424); all showed highly reduced inhibition by oseltamivir and had E119V. In addition, one R292K variant was detected among clinical samples (n=1024) by a 3-target pyrosequencing assay. Overall, frequency of NAI resistance was low, 0.16% (4 of 2448). To screen for additional NA markers previously identified in viruses from NAI-treated patients, the pyrosequencing assay was modified to include Q136K, I222V, del245-248 and del247-250. The 7-target pyrosequencing assay detected NA variants carrying E119V, Q136 and del245-248 in an isolate from an oseltamivir-treated patient. Next, this assay was applied to clinical specimens collected from hospitalized patients and submitted for NI testing, but failed cell culture propagation. Of the 27 clinical specimens tested, 4 (15%) contained NA changes: R292K (n=2), E119V (n=1) and del247-250 (n=1). Recombinant NAs with del247-250 and del245-248, respectively, conferred highly reduced inhibition by oseltamivir, reduced inhibition by zanamivir, and normal inhibition by peramivir and laninamivir. Our results demonstrated the benefits of the 7-target pyrosequencing assay in conducting A(H3N2) antiviral surveillance and testing for clinical care. |
Pooled PCR testing strategy and prevalence estimation of submicroscopic infections using Bayesian latent class models in pregnant women receiving intermittent preventive treatment at Machinga District Hospital, Malawi, 2010.
Zhou Z , Mitchell RM , Gutman J , Wiegand RE , Mwandama DA , Mathanga DP , Skarbinski J , Shi YP . Malar J 2014 13 (1) 509 BACKGROUND: Low malaria parasite densities in pregnancy are a diagnostic challenge. PCR provides high sensitivity and specificity in detecting low density of parasites, but cost and technical requirements limit its application in resources-limited settings. Pooling samples for PCR detection was explored to estimate prevalence of submicroscopic malaria infection in pregnant women at delivery. Previous work uses gold-standard based methods to calculate sensitivity and specificity of tests, creating a challenge when newer methodologies are substantially more sensitive than the gold standard. Thus prevalence was estimated using Bayesian latent class models (LCMs) in this study. METHODS: Nested PCR (nPCR) for the 18S rRNA gene subunit of Plasmodium falciparum was conducted to detect malaria infection in microscopy-negative Malawian women on IPTp. Two-step sample pooling used dried blood spot samples (DBSs) collected from placenta or periphery at delivery. Results from nPCR and histology as well as previously published data were used to construct LCMs to estimate assay sensitivity and specificity. Theoretical confidence intervals for prevalence of infection were calculated for two-step and one-step pooling strategies. RESULTS: Of 617 microscopy-negative Malawian women, 39 (6.3%) were identified as actively infected by histology while 52 (8.4%) were positive by nPCR. One hundred forty (22.7%) individuals had past infection assessed by histology. With histology as a reference, 72% of women in the active infection group, 7.1% in the past infection group and 3.2% in histology-negative group were nPCR positive. Using latent class models without a gold standard, histology had a median sensitivity of 49.7% and specificity of 97.6% for active infection while PCR had a median sensitivity of 96.0% and specificity of 99.1%. The true prevalence of active infection was estimated at 8.0% (CI: 5.8-10.5%) from PCR. PCR also had similar sensitivity for detecting either peripheral or placental malaria for submicroscopic infections. One-step pooling would give similar confidence intervals for pool sizes less than 20 while reducing the number of tests performed. CONCLUSIONS: Pooled nPCR testing was a sensitive and resource-efficient strategy and LCMs provided precise prevalence estimates of submicroscopic infections. Compared to two-step pooling, one-step pooling could provide similar prevalence estimates at population levels with many fewer tests required. |
A smartphone dongle for diagnosis of infectious diseases at the point of care
Laksanasopin T , Guo TW , Nayak S , Sridhara AA , Xie S , Olowookere OO , Cadinu P , Meng F , Chee NH , Kim J , Chin CD , Munyazesa E , Mugwaneza P , Rai AJ , Mugisha V , Castro AR , Steinmiller D , Linder V , Justman JE , Nsanzimana S , Sia SK . Sci Transl Med 2015 7 (273) 273re1 This work demonstrates that a full laboratory-quality immunoassay can be run on a smartphone accessory. This low-cost dongle replicates all mechanical, optical, and electronic functions of a laboratory-based enzyme-linked immunosorbent assay (ELISA) without requiring any stored energy; all necessary power is drawn from a smartphone. Rwandan health care workers used the dongle to test whole blood obtained via fingerprick from 96 patients enrolling into care at prevention of mother-to-child transmission clinics or voluntary counseling and testing centers. The dongle performed a triplexed immunoassay not currently available in a single test format: HIV antibody, treponemal-specific antibody for syphilis, and nontreponemal antibody for active syphilis infection. In a blinded experiment, health care workers obtained diagnostic results in 15 min from our triplex test that rivaled the gold standard of laboratory-based HIV ELISA and rapid plasma reagin (a screening test for syphilis), with sensitivity of 92 to 100% and specificity of 79 to 100%, consistent with needs of current clinical algorithms. Patient preference for the dongle was 97% compared to laboratory-based tests, with most pointing to the convenience of obtaining quick results with a single fingerprick. This work suggests that coupling microfluidics with recent advances in consumer electronics can make certain laboratory-based diagnostics accessible to almost any population with access to smartphones. |
A high throughput method for estimating mouth-level intake of mainstream cigarette smoke
Yan X , Zhang L , Hearn BA , Valentin-Blasini L , Polzin GM , Watson CH . Nicotine Tob Res 2015 17 (11) 1324-30 INTRODUCTION: We developed a high throughput method for estimating smoker's mainstream smoke intake on a per-cigarette basis by analyzing discarded cigarette butts. This new method utilizes ultraviolet/visible (UV-Vis) spectrophotometric analysis of isopropanol-soluble smoke particulate matter extracted from discarded cigarette filters. METHODS: When measured under a wide range of smoking conditions for a given brand variant, smoking machine delivery of nicotine, benzene, polycyclic aromatic hydrocarbons, and tobacco-specific nitrosamines can be related to the overall filter extract absorbance at 360nm. Once this relationship has been established, UV-Vis analysis of a discarded cigarette filter butt gives a quantitative measure of a smoker's exposure to these analytes. RESULTS: The measured mainstream smoke constituents correlated closely (correlation coefficients from 0.9303 to 0.9941) with the filter extract absorbance. These high correlations held over a wide range of smoking conditions for 2R4F research cigarettes as well as popular domestic cigarette brands sold in the United States. CONCLUSIONS: This low cost, high throughput method is suitable for high volume analyses (hundreds of samples per day) because UV-Vis spectrophotometry, rather than mass spectrometry, is used for the cigarette filter butt analysis. This method provides a stable and noninvasive means for estimating mouth-level delivery of many mainstream smoke constituents. The ability to gauge the mouth-level intake of harmful chemicals and total mainstream smoke for cigarette smokers in a natural setting on a cigarette-by-cigarette basis can provide insights on factors contributing to morbidity and mortality from cigarette smoking, as well as insights on strategies related to smoking cessation. |
Carcinogenicity of fluoro-edenite, silicon carbide fibres and whiskers, and carbon nanotubes
Grosse Y , Loomis D , Guyton KZ , Lauby-Secretan B , El Ghissassi F , Bouvard V , Benbrahim-Tallaa L , Guha N , Scoccianti C , Mattock H , Straif K , Kane AB , Debia M , Dion C , Moller P , Savolainen K , Canu IG , Jaurand MC , Comba P , Kobayashi N , Morimoto Y , Tsuda H , Yu IJ , Vermeulen R , Bugge MD , Bateson TF , Kuempel ED , Morgan DL , Pinkerton KE , Sargent LM , Stayner L . Lancet Oncol 2014 15 (13) 1427-8 In October, 2014, 21 experts from ten countries met at the International Agency for Research on Cancer (IARC; Lyon, France) to assess the carcinogenicity of fluoro-edenite, silicon carbide (SiC) fibres and whiskers, and carbon nanotubes (CNTs) including single-walled (SWCNTs) and multi-walled (MWCNTs) types. These assessments will be published as Volume 111 of the IARC Monographs.1 | Fluoro-edenite was first identified around the Etna volcano near Biancavilla, Italy; a similar mineral was also reported from the Kimpo volcano in Japan. Fluoro-edenite can occur as asbestiform fibres. Unpaved roads made from local quarry products from Biancavilla, used since the 1950s, are a source for airborne fluoro-edenite fibres; additionally indoor air was also contaminated from the use of the quarry's products in building materials. Several surveillance studies reported an excess of mesothelioma incidence and mortality in the regional population of Biancavilla.2 Since the rate ratios for mesothelioma were large and stable, chance was unlikely to explain these findings. The excess was similar in men and women, and most prominent in young adults, suggesting an environmental rather than occupational cause. Moreover, most of the cases had no history of occupational exposure to asbestos. Fluoro-edenite fibrous amphibole was classified as carcinogenic to humans (Group 1) on the basis of sufficient evidence in humans that exposure to fluoro-edenite causes mesothelioma. Sufficient evidence of carcinogenicity was also reported in experimental animals, with increased incidences of mesotheliomas observed in one study in male and female rats given fibrous fluoro-edenite by intraperitoneal or intrapleural injection.3 The results of the few available mechanistic studies were consistent with proposed mechanisms of fibre carcinogenicity.4 |
Racial/ethnic differences in survival of United States children with birth defects: a population-based study
Wang Y , Liu G , Canfield MA , Mai CT , Gilboa SM , Meyer RE , Anderka M , Copeland GE , Kucik JE , Nembhard WN , Kirby RS . J Pediatr 2015 166 (4) 819-26 e1-2 OBJECTIVES: To examine racial/ethnic-specific survival of children with major birth defects in the US. STUDY DESIGN: We pooled data on live births delivered during 1999-2007 with any of 21 birth defects from 12 population-based birth defects surveillance programs. We used the Kaplan-Meier method to calculate cumulative survival probabilities and Cox proportional hazards models to estimate mortality risk. RESULTS: For most birth defects, there were small-to-moderate differences in neonatal (<28 days) survival among racial/ethnic groups. However, compared with children born to non-Hispanic white mothers, postneonatal infant (28 days to <1 year) mortality risk was significantly greater among children born to non-Hispanic black mothers for 13 of 21 defects (hazard ratios [HRs] 1.3-2.8) and among children born to Hispanic mothers for 10 of 21 defects (HRs 1.3-1.7). Compared with children born to non-Hispanic white mothers, a significantly increased childhood (≤8 years) mortality risk was found among children born to Asian/Pacific Islander mothers for encephalocele (HR 2.6), tetralogy of Fallot, and atrioventricular septal defect (HRs 1.6-1.8) and among children born to American Indian/Alaska Native mothers for encephalocele (HR 2.8), whereas a significantly decreased childhood mortality risk was found among children born to Asian/Pacific Islander mothers for cleft lip with or without cleft palate (HR 0.6). CONCLUSION: Children with birth defects born to non-Hispanic black and Hispanic mothers carry a greater risk of mortality well into childhood, especially children with congenital heart defect. Understanding survival differences among racial/ethnic groups provides important information for policy development and service planning. |
Service and treatment use among children diagnosed with autism spectrum disorders
Zablotsky B , Pringle BA , Colpe LJ , Kogan MD , Rice C , Blumberg SJ . J Dev Behav Pediatr 2015 36 (2) 98-105 OBJECTIVE: Children diagnosed with autism spectrum disorder (ASD) require substantial support to address not only core ASD symptoms but also a range of co-occurring conditions. This study explores treatment and service use among children with ASD with and without intellectual disability (ID) and parents' perception of unmet needs from these treatments. METHODS: Data were retrieved from a probability-based national sample of 2077 children diagnosed with ASD, ID, or both (ASD and ID). Weighted multivariate logistic regressions examined differences between diagnostic groups for current medication and service utilization with a subanalysis exploring differences among those with co-occurring psychiatric conditions. Additional modeling examined parents' perception of unmet needs. RESULTS: Children diagnosed with ASD and ID were significantly more likely to be receiving current medication and services when compared with children with ID only or ASD only. Children with a co-occurring psychiatric diagnosis, from all 3 diagnostic groups, were more likely to be receiving a current medication, but not more likely to be receiving a current service when compared with children without a co-occurring psychiatric diagnosis. Children with ASD and a co-occurring psychiatric diagnosis were significantly more likely to have parents who reported unmet needs when compared with parents of children with ASD without a co-occurring psychiatric diagnosis. CONCLUSIONS: Children diagnosed with ASD and ID, especially those with a comorbid psychiatric condition, represent a vulnerable population with substantial rates of current service (98%) and medication (67%) usage, but despite these high rates, approximately 30% of parents report that their child's developmental needs are still not being met by their current treatment and services. |
Trends in gestational weight gain: the Pregnancy Risk Assessment Monitoring System, 2000-2009
Johnson JL , Farr SL , Dietz PM , Sharma AJ , Barfield WD , Robbins CL . Am J Obstet Gynecol 2015 212 (6) 806 e1-8 OBJECTIVE: Achieving adequate gestational weight gain is important for optimal health of the infant and mother. We estimate current population-based trends of gestational weight gain. STUDY DESIGN: We analyzed data from the Pregnancy Risk Assessment Monitoring System for 124,348 women who delivered live infants in 14 states during 2000-2009. We examined prevalence and trends in gestational weight gain in pounds as a continuous variable, and within 1990 Institute of Medicine recommendations (yes/no) as a dichotomous variable. We examined adjusted trends in mean gestational weight gain using multivariable linear regression and gestational weight gain within recommendations using multivariable multinomial logistic regression. RESULTS: During 2000-2009, 35.8% of women gained within Institute of Medicine gestational weight gain recommendations, 44.4% gained above, and 19.8% gained below. From 2000-2009, there was a biennial 1.0 percentage point decrease in women gaining within Institute of Medicine gestational weight gain recommendations (P-trend <.01) and a biennial 0.8 percentage point increase in women gaining above Institute of Medicine recommendations (P-trend <.01). The percentage of women gaining weight below Institute of Medicine recommendations remained relatively constant from 2000-2009 (P-trend= .14). The adjusted odds of gaining within Institute of Medicine recommendations were lower in 2006-2007 (aOR= 0.90, 95% CI: 0.85-0.96) and 2008-2009 (aOR=0.90, 95% CI: 0.85-0.96) relative to 2000-2001. CONCLUSION: Overall, from 2000-2009 the percentage of women gaining within Institute of Medicine recommendations slightly decreased while mean gestational weight gain slightly increased. Efforts are needed to develop and implement strategies to ensure that women achieve gestational weight gain within recommendations. |
Pregnancy-related mortality in the United States, 2006-2010
Creanga AA , Berg CJ , Syverson C , Seed K , Bruce FC , Callaghan WM . Obstet Gynecol 2015 125 (1) 5-12 OBJECTIVE: To update national population-level pregnancy-related mortality estimates and examine characteristics and causes of pregnancy-related deaths in the United States during 2006-2010. METHODS: We used data from the Pregnancy Mortality Surveillance System and calculated pregnancy-related mortality ratios by year and age group for four race-ethnicity groups: non-Hispanic white, non-Hispanic black, Hispanic, and other. We examined causes of pregnancy-related deaths by pregnancy outcome during 2006-2010 and compared causes of pregnancy-related deaths since 1987. RESULTS: The 2006-2010 pregnancy-related mortality ratio was 16.0 deaths per 100,000 live births (20,959,533 total live births). Specific race-ethnicity pregnancy-related mortality ratios were 12.0, 38.9, 11.7, and 14.2 deaths per 100,000 live births for non-Hispanic white, non-Hispanic black, Hispanic, and other race women, respectively. Pregnancy-related mortality ratios increased with maternal age for all women and within all age groups, non-Hispanic black women had the highest risk of dying from pregnancy complications. Over time, the contribution to pregnancy-related deaths of hemorrhage, hypertensive disorders of pregnancy, embolism, and anesthesia complications continued to decline, whereas the contribution of cardiovascular conditions and infection increased. Seven of 10 categories of causes of death each contributed from 9.4% to 14.6% of all 2006-2010 pregnancy-related deaths; cardiovascular conditions ranked first. CONCLUSION: Relative to previous years, during 2006-2010, the U.S. pregnancy-related mortality ratio increased as did the contribution of cardiovascular conditions and infection to pregnancy-related mortality. Although the identification of pregnancy-related deaths may be improving in the United States, the increasing contribution of chronic diseases to pregnancy-related mortality suggests a change in risk profile of the birthing population. LEVEL OF EVIDENCE: II. |
Fetal alcohol syndrome among children aged 7-9 years - Arizona, Colorado, and New York, 2010
Fox DJ , Pettygrove S , Cunniff C , O'Leary LA , Gilboa SM , Bertrand J , Druschel CM , Breen A , Robinson L , Ortiz L , Frias JL , Ruttenber M , Klumb D , Meaney FJ . MMWR Morb Mortal Wkly Rep 2015 64 (3) 54-7 Fetal alcohol syndrome (FAS) is a serious birth defect and developmental disorder caused by in utero exposure to alcohol. Assessment of the public health burden of FAS through surveillance has proven difficult; there is wide variation in reported prevalence depending on the study population and surveillance method. Generally, records-based birth prevalence studies report estimates of 0.2-1.5 per 1,000 live births, whereas studies that use in-person, expert assessment of school-aged children in a community report estimates of 6-9 per 1,000 population. The Fetal Alcohol Syndrome Surveillance Network II addressed some of the challenges in records-based ascertainment by assessing a period prevalence of FAS among children aged 79 years in Arizona, Colorado, and New York. The prevalence across sites ranged from 0.3 to 0.8 per 1,000 children. Prevalence of FAS was highest among American Indian/Alaska Native children and lowest among Hispanic children. These estimates continue to be much lower than those obtained from studies using in-person, expert assessment. Factors that might contribute to this discrepancy include 1) inadequate recognition of the physical and behavioral characteristics of FAS by clinical care providers; 2) insufficient documentation of those characteristics in the medical record; and 3) failure to consider prenatal alcohol exposure with diagnoses of behavioral and learning problems. Addressing these factors through training of medical and allied health providers can lead to practice changes, ultimately increasing recognition and documentation of the characteristics of FAS. |
Associations of gestational weight gain with preterm birth among underweight and normal weight women
Sharma AJ , Vesco KK , Bulkley J , Callaghan WM , Bruce FC , Staab J , Hornbrook MC , Berg CJ . Matern Child Health J 2015 19 (9) 2066-73 Studies report increased risk of preterm birth (PTB) among underweight and normal weight women with low gestational weight gain (GWG). However, most studies examined GWG over gestational periods that differ by term and preterm which may have biased associations because GWG rate changes over the course of pregnancy. Furthermore, few studies have specifically examined the amount and pattern of GWG early in pregnancy as a predictor of PTB. Within one integrated health care delivery system, we examined 12,526 singleton pregnancies between 2000 and 2008 among women with a body mass index <25 kg/m2, who began prenatal care in the first trimester and delivered a live-birth >28 weeks gestation. Using self-reported pregravid weight and serial measured antenatal weights, we estimated GWG and the area under the GWG curve (AUC; an index of pattern of GWG) during the first and second trimesters of pregnancy (≤28 weeks). Using logistic regression adjusted for covariates, we examined associations between each GWG measure, categorized into quartiles, and PTB (<37 weeks gestation). We additionally examined associations according to the reason for PTB by developing a novel algorithm using diagnoses and procedure codes. Low GWG in the first and second trimesters was not associated with PTB [aOR 1.11, (95 % CI 0.90, 1.38) with GWG <8.2 kg by 28 weeks compared to pregnancies with GWG >12.9]. Similarly, pattern of GWG was not associated with PTB. Our findings do not support an association between GWG in the first and second trimester and PTB among underweight and normal weight women. |
Sodium and sugar in complementary infant and toddler foods sold in the United States
Cogswell ME , Gunn JP , Yuan K , Park S , Merritt R . Pediatrics 2015 135 (3) 416-23 OBJECTIVES: To evaluate the sodium and sugar content of US commercial infant and toddler foods. METHODS: We used a 2012 nutrient database of 1074 US infant and toddler foods and drinks developed from a commercial database, manufacturer Web sites, and major grocery stores. Products were categorized on the basis of their main ingredients and the US Food and Drug Administration's reference amounts customarily consumed per eating occasion (RACC). Sodium and sugar contents and presence of added sugars were determined. RESULTS: All but 2 of the 657 infant vegetables, dinners, fruits, dry cereals, and ready-to-serve mixed grains and fruits were low sodium (≤140 mg/RACC). The majority of these foods did not contain added sugars; however, 41 of 79 infant mixed grains and fruits contained ≥1 added sugar, and 35 also contained >35% calories from sugar. Seventy-two percent of 72 toddler dinners were high in sodium content (>210 mg/RACC). Toddler dinners contained an average of 2295 mg of sodium per 1000 kcal (sodium 212 mg/100 g). Savory infant/toddler snacks (n = 34) contained an average of sodium 1382 mg/1000 kcal (sodium 486 mg/100 g); 1 was high sodium. Thirty-two percent of toddler dinners and the majority of toddler cereal bars/breakfast pastries, fruit, and infant/toddler snacks, desserts, and juices contained ≥1 added sugar. CONCLUSIONS: Commercial toddler foods and infant or toddler snacks, desserts, and juice drinks are of potential concern due to sodium or sugar content. Pediatricians should advise parents to look carefully at labels when selecting commercial toddler foods and to limit salty snacks, sweet desserts, and juice drinks. |
Sodium content in major brands of US packaged foods, 2009
Gillespie C , Maalouf J , Yuan K , Cogswell ME , Gunn JP , Levings J , Moshfegh A , Ahuja JK , Merritt R . Am J Clin Nutr 2015 101 (2) 344-53 BACKGROUND: Most Americans consume more sodium than is recommended, the vast majority of which comes from commercially packaged and restaurant foods. In 2010 the Institute of Medicine recommended that manufacturers reduce the amount of sodium in their products. OBJECTIVE: The aim was to assess the sodium content in commercially packaged food products sold in US grocery stores in 2009. DESIGN: With the use of sales and nutrition data from commercial sources, we created a database with nearly 8000 packaged food products sold in major US grocery stores in 2009. We estimated the sales-weighted mean and distribution of sodium content (mg/serving, mg/100 g, and mg/kcal) of foods within food groups that contribute the most dietary sodium to the US diet. We estimated the proportion of products within each category that exceed 1) the Food and Drug Administration's (FDA's) limits for sodium in foods that use a "healthy" label claim and 2) 1150 mg/serving or 50% of the maximum daily intake recommended in the 2010 Dietary Guidelines for Americans. RESULTS: Products in the meat mixed dishes category had the highest mean and median sodium contents per serving (966 and 970 mg, respectively). Products in the salad dressing and vegetable oils category had the highest mean and median concentrations per 100 g (1072 and 1067 mg, respectively). Sodium density was highest in the soup category (18.4 mg/kcal). More than half of the products sold in 11 of the 20 food categories analyzed exceeded the FDA limits for products with a "healthy" label claim. In 4 categories, >10% of the products sold exceeded 1150 mg/serving. CONCLUSIONS: The sodium content in packaged foods sold in major US grocery stores varied widely, and a large proportion of top-selling products exceeded limits, indicating the potential for reduction. Ongoing monitoring is necessary to evaluate the progress in sodium reduction. |
Difference between 24-h diet recall and urine excretion for assessing population sodium and potassium intake in adults aged 18-39 y
Mercado CI , Cogswell ME , Valderrama AL , Wang CY , Loria CM , Moshfegh AJ , Rhodes DG , Carriquiry AL . Am J Clin Nutr 2015 101 (2) 376-86 BACKGROUND: Limited data are available on the accuracy of 24-h dietary recalls used to monitor US sodium and potassium intakes. OBJECTIVE: We examined the difference in usual sodium and potassium intakes estimated from 24-h dietary recalls and urine collections. DESIGN: We used data from a cross-sectional study in 402 participants aged 18-39 y ( approximately 50% African American) in the Washington, DC, metropolitan area in 2011. We estimated means and percentiles of usual intakes of daily dietary sodium (dNa) and potassium (dK) and 24-h urine excretion of sodium (uNa) and potassium (uK). We examined Spearman's correlations and differences between estimates from dietary and urine measures. Multiple linear regressions were used to evaluate the factors associated with the difference between dietary and urine measures. RESULTS: Mean differences between diet and urine estimates were higher in men [dNa - uNa (95% CI) = 936.8 (787.1, 1086.5) mg/d and dK - uK = 571.3 (448.3, 694.3) mg/d] than in women [dNa - uNa (95% CI) = 108.3 (11.1, 205.4) mg/d and dK - uK = 163.4 (85.3, 241.5 mg/d)]. Percentile distributions of diet and urine estimates for sodium and potassium differed for men. Spearman's correlations between measures were 0.16 for men and 0.25 for women for sodium and 0.39 for men and 0.29 for women for potassium. Urinary creatinine, total caloric intake, and percentages of nutrient intake from mixed dishes were independently and consistently associated with the differences between diet and urine estimates of sodium and potassium intake. For men, body mass index was also associated. Race was associated with differences in estimates of potassium intake. CONCLUSIONS: Low correlations and differences between dietary and urinary sodium or potassium may be due to measurement error in one or both estimates. Future analyses using these methods to assess sodium and potassium intake in relation to health outcomes may consider stratifying by factors associated with the differences in estimates from these methods. This trial was registered at clinicaltrials.gov as NCT01631240. |
Use of acetochlor and cancer incidence in the Agricultural Health Study
Lerro CC , Koutros S , Andreotti G , Hines CJ , Blair A , Lubin J , Ma X , Zhang Y , Beane Freeman LE . Int J Cancer 2015 137 (5) 1167-75 Since its registration in 1994 acetochlor has become a commonly used herbicide in the US, yet no epidemiologic study has evaluated its carcinogenicity in humans. We evaluated the use of acetochlor and cancer incidence among licensed pesticide applicators in the Agricultural Health Study. In telephone interviews administered during 1999-2005, participants provided information on acetochlor use, use of other pesticides and additional potential confounders. We used Poisson regression to estimate relative risks (RR) and 95% confidence intervals (95% CI) for cancers that occurred from the time of interview through 2011 in Iowa and 2010 in North Carolina. Among 33,484 men, there were 4,026 applicators who used acetochlor and 3,234 incident cancers, with 304 acetochlor-exposed cases. Increased risk of lung cancer was observed among acetochlor users (RR = 1.74; 95% CI: 1.07-2.84) compared to nonusers, and among individuals who reported using acetochlor/atrazine product mixtures (RR = 2.33; 95% CI: 1.30-4.17), compared to nonusers of acetochlor. Colorectal cancer risk was significantly elevated among the highest category of acetochlor users (RR = 1.75; 95% CI: 1.08-2.83) compared to never users. Additionally, borderline significantly increased risk of melanoma (RR = 1.61; 95% CI: 0.98-2.66) and pancreatic cancer (RR = 2.36; 95% CI: 0.98-5.65) were observed among acetochlor users. The associations between acetochlor use and lung cancer, colorectal cancer, melanoma and pancreatic cancer are suggestive, however the lack of exposure-response trends, small number of exposed cases and relatively short time between acetochlor use and cancer development prohibit definitive conclusions. |
Work schedule and physically demanding work in relation to menstrual function: the Nurses' Health Study 3
Lawson CC , Johnson CY , Chavarro JE , Lividoti Hibert EN , Whelan EA , Rocheleau CM , Grajewski B , Schernhammer ES , Rich-Edwards JW . Scand J Work Environ Health 2015 41 (2) 194-203 OBJECTIVES: This study aimed to evaluate occupational exposures and menstrual cycle characteristics among nurses. METHODS: Using cross-sectional data collected in 2010-2012 from 6309 nurses aged 21-45 years, we investigated nurses' menstrual function in the Nurses' Health Study 3. We used multivariable regression modeling to analyze the associations between occupational exposures and prevalence of irregular cycles and long and short cycle lengths. RESULTS: The cohort reported cycle length as <21 (1.5%), 21-25 (15.6%), 26-31 (69.7%), and 32-50 (13.2%) days. In addition, 19% of participants reported irregular cycles. Working ≥41 hours/week was associated with a 16% [95% confidence interval (95% CI): 4-29%] higher prevalence of irregular cycles and a higher prevalence of very short (<21-day) cycles [prevalence odds ratio (OR) 1.93, 95% CI 1.24-3.01] in adjusted models. Irregular menstrual cycles were more prevalent among women working nights only (32% higher; 95% CI 15-51%) or rotating nights (27% higher, 95% CI 10-47%), and was associated with the number of night shifts per month (P for trend <0.0001). Rotating night schedule was associated with long (32-50 day) cycles (OR 1.28, 95% CI 1.03-1.61). Heavy lifting was associated with a higher prevalence of irregular cycles (34% higher), and the prevalence of cycles <21 days and 21-25 day cycles increased with increasing heavy lifting at work (P for trend <0.02 for each endpoint). CONCLUSION: Night work, long hours, and physically demanding work might relate to menstrual disturbances. |
National Survey of US Long-Haul Truck Driver Health and Injury: health behaviors
Birdsey J , Sieber WK , Chen GX , Hitchcock EM , Lincoln JE , Nakata A , Robinson CF , Sweeney MH . J Occup Environ Med 2015 57 (2) 210-216 OBJECTIVE: To compare selected health behaviors and body mass index (modifiable risk factors) of US long-haul truck drivers to the US working population by sex. METHODS: The National Survey of US Long-Haul Truck Driver Health and Injury interviewed a nationally representative sample of long-haul truck drivers (n = 1265) at truck stops. Age-adjusted results were compared with national health surveys. RESULTS: Compared with US workers, drivers had significantly higher body mass index, current cigarette use, and pack-years of smoking; lower prevalence of annual influenza vaccination; and generally lower alcohol consumption. Physical activity level was low for most drivers, and 25% had never had their cholesterol levels tested. CONCLUSIONS: Working conditions common to long-haul trucking may create significant barriers to certain healthy behaviors; thus, transportation and health professionals should address the unique work environment when developing interventions for long-haul drivers. |
Personal and workplace factors and median nerve function in a pooled study of 2396 US workers
Rempel D , Gerr F , Harris-Adamson C , Hegmann KT , Thiese MS , Kapellusch J , Garg A , Burt S , Bao S , Silverstein B , Merlino L , Dale AM , Evanoff B . J Occup Environ Med 2015 57 (1) 98-104 OBJECTIVE: Evaluate associations between personal and workplace factors and median nerve conduction latency at the wrist. METHODS: Baseline data on workplace psychosocial and physical exposures were pooled from four prospective studies of production and service workers (N = 2396). During the follow-up period, electrophysiologic measures of median nerve function were collected at regular intervals. RESULTS: Significant adjusted associations were observed between age, body mass index, sex, peak hand force, duration of forceful hand exertions, Threshold Limit Value for Hand Activity Limit, forceful repetition rate, wrist extension, and decision latitude on median nerve latencies. CONCLUSIONS: Occupational and nonoccupational factors have adverse effects on median nerve function. Measuring median nerve function eliminates possible reporting bias that may affect symptom-based carpal tunnel syndrome case definitions. These results suggest that previously observed associations between carpal tunnel syndrome and occupational factors are not the result of such reporting bias. |
Isocyanates and human health: multistakeholder information needs and research priorities
Lockey JE , Redlich CA , Streicher R , Pfahles-Hutchens A , Hakkinen PB , Ellison GL , Harber P , Utell M , Holland J , Comai A , White M . J Occup Environ Med 2015 57 (1) 44-51 OBJECTIVES: To outline the knowledge gaps and research priorities identified by a broad base of stakeholders involved in the planning and participation of an international conference and research agenda workshop on isocyanates and human health held in Potomac, Maryland, in April 2013. METHODS: A multimodal iterative approach was used for data collection including preconference surveys, review of a 2001 consensus conference on isocyanates, oral and poster presentations, focused break-out sessions, panel discussions, and postconference research agenda workshop. RESULTS: Participants included representatives of consumer and worker health, health professionals, regulatory agencies, academic and industry scientists, labor, and trade associations. CONCLUSIONS: Recommendations were summarized regarding knowledge gaps and research priorities in the following areas: worker and consumer exposures; toxicology, animal models, and biomarkers; human cancer risk; environmental exposure and monitoring; and respiratory epidemiology and disease, and occupational health surveillance. |
Cryptosporidium huwi n. sp. (Apicomplexa: Eimeriidae) from the guppy (Poecilia reticulata).
Ryan U , Paparini A , Tong K , Yang R , Gibson-Kueh S , O'Hara A , Lymbery A , Xiao L . Exp Parasitol 2015 150 31-5 The morphological, biological, and molecular characteristics of Cryptosporidium piscine genotype 1 from the guppy (Poecilia reticulata) are described, and the species name Cryptosporidium huwi n. sp. is proposed to reflect its genetic and biological differences from gastric and intestinal Cryptosporidium species. Oocysts of C.huwi n. sp. over-lap in size with Cryptosporidium molnari, measuring approximately 4.4-4.9 microm (mean 4.6) by 4.0-4.8 microm (mean 4.4 microm) with a length to width ratio of 1.04 (0.92-1.35) (n = 50). Similar to C.molnari, C.huwi n. sp. was identified in the stomach only and clusters of oogonial and sporogonial stages were identified deep within the epithelium. However, phylogenetic analysis of 18S rRNA sequences indicated that C. huwi n. sp. exhibited 8.5-9.2% and 3.5% genetic distance from C.molnari isolates and piscine genotype 7 respectively. At the actin locus, the genetic distance between C.huwi n. sp. and C.molnari was 16.6%. The genetic distance between C.huwi n. sp. and other Cryptosporidium species at the 18S locus was 13.2%-17% and at the actin locus was 18.9%-26.3%. Therefore C. huwi n. sp. is genetically distinct from previously described Cryptosporidium species. |
Ascariasis in humans and pigs on small-scale farms, Maine, USA, 2010-2013
Miller LA , Colby K , Manning SE , Hoenig D , McEvoy E , Montgomery S , Mathison B , de Almeida M , Bishop H , Dasilva A , Sears S . Emerg Infect Dis 2015 21 (2) 332-4 Ascaris is a genus of parasitic nematodes that can cause infections in humans and pigs. During 2010-2013, we identified 14 cases of ascariasis in persons who had contact with pigs in Maine, USA. Ascaris spp. are important zoonotic pathogens, and prevention measures are needed, including health education, farming practice improvements, and personal and food hygiene. |
Chikungunya on the move
Johansson MA . Trends Parasitol 2015 31 (2) 43-5 In December 2013, chikungunya virus (CHIKV) transmission was reported for the first time in the Americas. Since then it has spread quickly, with more than 1 million suspected and confirmed cases being reported in one year, where previously there were only sporadic travel-related cases. Transmission patterns suggest that the epidemic in the southern hemisphere is only beginning and that chikungunya will not go away anytime soon. |
Embryo transfer practices and multiple births resulting from assisted reproductive technology: an opportunity for prevention
Kissin DM , Kulkarni AD , Mneimneh A , Warner L , Boulet SL , Crawford S , Jamieson DJ . Fertil Steril 2015 103 (4) 954-61 OBJECTIVE: To evaluate assisted reproductive technology (ART) ET practices in the United States and assess the impact of these practices on multiple births, which pose health risks for both mothers and infants. DESIGN: Retrospective cohort analysis using the National ART Surveillance System data. SETTING: US fertility centers reporting to the National ART Surveillance System. PATIENT(S): Noncanceled ART cycles conducted in the United States in 2012. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Multiple birth (birth of two or more infants, at least one of whom was live-born). RESULT(S): Of 134,381 ART transfer cycles performed in 2012, 51,262 resulted in live births, of which 13,563 (26.5%) were multiple births: 13,123 twin and 440 triplet and higher order births. Almost half (46.1%) of these multiple births resulted from the following four cycle types: two fresh blastocyst transfers among favorable or average prognosis patients less than 35 years (1,931 and 1,341 multiple births, respectively), two fresh blastocyst transfers among donor-oocyte recipients (1,532 multiple births), and two frozen/thawed ETs among patients less than 35 years (1,452 multiple births). More than half of triplet or higher order births resulted from the transfer of two embryos (52.5% of births among fresh autologous transfers, 67.2% of births among donor-oocyte recipient transfers, and 42.9% among frozen/thawed autologous transfers). CONCLUSION(S): A substantial reduction of ART-related multiple (both twin and triplet or higher order) births in the United States could be achieved by single blastocyst transfers among favorable and average prognosis patients less than 35 years of age and donor-oocyte recipients. |
Validating prediction equations for mid-arm circumference measurements in adults: National Health and Nutrition Examination Survey, 2001-2012
Nwankwo T , Ostchega Y , Zhang G , Hughes JP . Blood Press Monit 2015 20 (3) 157-63 BACKGROUND: Accurate measurement of blood pressure (BP) requires choosing an appropriate BP cuff size. OBJECTIVES: The objective of this study was to examine the validity of regression equations to predict mid-arm circumference (mid-AC) using 2001-2012 National Health and Nutrition Examination Survey height and weight data. METHODS: National Health and Nutrition Examination Survey uses a complex multistage probability sample design to represent the civilian, noninstitutionalized US resident population. The sample consisted of 29 745 participants aged 20 years and older. RESULTS: For both men and women, the correlations between the predicted and measured mid-AC values were as follows: r=0.91 and 0.92, P<0.001, respectively. For both sexes, the difference between the predicted and measured mid-AC mean values was less than 1.5 cm. The overall percent agreement for selecting the appropriate BP cuff, using the American Heart Association cuff size criteria and comparing the predicted mid-AC values with measured values, was 83.0% for men and 80.0% for women. The percent agreement for small adult cuff was 10.0% for men and 54.0% for women; for adult cuff it was 87.0% for men and 88.0% for women; for large adult cuff it was 82.0% for men and 80.0% for women; and for thigh cuff it was 84.0% for men and 74.0% for women. All agreement statistics were above chance (for men, gamma=0.96, and Kendall's Tau-b=0.73; for women, gamma=0.97, and Kendall's Tau-b=0.76). CONCLUSION: When possible, mid-AC should be directly measured for appropriate BP cuffing; however, the results of this validation study suggest that the prediction equations for mid-AC estimations were highly correlated and had an overall 80.0% agreement with measured mid-AC. |
Vital Signs: disparities in nonsmokers' exposure to secondhand smoke - United States, 1999-2012
Homa DM , Neff LJ , King BA , Caraballo RS , Bunnell RE , Babb SD , Garrett BE , Sosnoff CS , Wang L . MMWR Morb Mortal Wkly Rep 2015 64 (4) 103-108 BACKGROUND: Exposure to secondhand smoke (SHS) from burning tobacco causes disease and death in nonsmoking children and adults. No risk-free level of SHS exposure exists. METHODS: National Health and Nutrition Examination Survey (NHANES) data from 1999-2012 were used to examine SHS exposure among the nonsmoking population aged ≥3 years. SHS exposure among nonsmokers was defined as a serum cotinine level (a metabolite of nicotine) of 0.05-10 ng/mL. SHS exposure was assessed overall and by age, sex, race/ethnicity, poverty level, education, and whether the respondent owned or rented their housing. RESULTS: Prevalence of SHS exposure in nonsmokers declined from 52.5% during 1999-2000 to 25.3% during 2011-2012. During this period, declines were observed for all population subgroups, but disparities exist. During 2011-2012, SHS was highest among: children aged 3-11 years (40.6%), non-Hispanic blacks (46.8%), persons living below the poverty level (43.2%), and persons living in rental housing (36.8%). Among children aged 3-11 years, 67.9% of non-Hispanic blacks were exposed to SHS compared with 37.2% of non-Hispanic whites and 29.9% of Mexican Americans. CONCLUSION: Overall, SHS exposure in the United States has been reduced by half since 1999-2000. However, 58 million persons were still exposed to SHS during 2011-2012, and exposure remains higher among children, non-Hispanic blacks, those living in poverty, and those who rent their housing. IMPLICATIONS FOR PUBLIC HEALTH PRACTICE: Eliminating smoking in indoor spaces fully protects nonsmokers from SHS exposure; separating smokers from nonsmokers, cleaning the air and ventilating buildings cannot completely eliminate exposure. Continued efforts to promote implementation of comprehensive statewide laws prohibiting smoking in workplaces and public places, smoke-free policies in multiunit housing, and voluntary smoke-free home and vehicle rules are critical to protect nonsmokers from this preventable health hazard in the places they live, work, and gather. |
Chemical composition and evaluation of nicotine, tobacco alkaloids, pH, and selected flavors in e-cigarette cartridges and refill solutions
Lisko JG , Tran H , Stanfill SB , Blount BC , Watson CH . Nicotine Tob Res 2015 17 (10) 1270-8 INTRODUCTION: Electronic cigarette (e-cigarette) use is increasing dramatically in developed countries, but little is known about these rapidly evolving products. This study analyzed and evaluated the chemical composition including nicotine, tobacco alkaloids, pH, and flavors in 36 e-liquids brands from 4 manufacturers. METHODS: We determined the concentrations of nicotine, alkaloids, and select flavors and measured pH in solutions used in e-cigarettes. E-cigarette products were chosen based upon favorable consumer approval ratings from online review websites. Quantitative analyses were performed using strict quality assurance/quality control validated methods previously established by our lab for the measurement of nicotine, alkaloids, pH, and flavors. RESULTS: Three-quarters of the products contained lower measured nicotine levels than the stated label values (6%-42% by concentration). The pH for e-liquids ranged from 5.1-9.1. Minor tobacco alkaloids were found in all samples containing nicotine, and their relative concentrations varied widely among manufacturers. A number of common flavor compounds were analyzed in all e-liquids. CONCLUSIONS: Free nicotine levels calculated from the measurement of pH correlated with total nicotine content. The direct correlation between the total nicotine concentration and pH suggests that the alkalinity of nicotine drives the pH of e-cigarette solutions. A higher percentage of nicotine exists in the more absorbable free form as total nicotine concentration increases. A number of products contained tobacco alkaloids at concentrations that exceed U.S. pharmacopeia limits for impurities in nicotine used in pharmaceutical and food products. |
Telephone quitline use and effectiveness among young adults
Zhang L , Malarcher A , Bombard JM , Rabius V . J Smok Cessat 2014 9 (2) 109-118 INTRODUCTION: Although smoking prevalence has declined dramatically among adults in the past 40 years, 19.3% of adults still smoke, including 20.1% of adults aged 18-24 years. Quitlines are effective, population-based interventions that increase successful cessation. AIMS: This study aims to describe the characteristics of young adult smokers aged 18-24 years who used telephone cessation counselling for assistance with quitting, to assess self-reported quit rates, and to examine predictors of quitting, compared to older adults. METHODS: We examined data from 4,542 young adult smokers aged 18-24 years and 46,094 smokers aged > 25 years who enrolled in the American Cancer Society's quitline services during 2006-2008. RESULTS: Young adult smokers aged 18-24 years who called quitlines differed slightly from older adults in demographics and tobacco-use behaviours. There were no age-related differences in self-reported seven-day quit rates or 30-day quit rates at the seven-month follow-up. Predictors of quitting were mostly similar for the young adults and the older adults, although the odds of quitting were lower among young adults for living with vs. not living with a smoker. CONCLUSIONS: Although young adult smokers under-utilise telephone cessation quitlines for assistance with quitting, those who do use these services have quit rates similar to older adults. |
Microsporidia and Cryptosporidium in horses and donkeys in Algeria: detection of a novel Cryptosporidium hominis subtype family (Ik) in a horse.
Laatamna AE , Wagnerova P , Sak B , Kvetonova D , Xiao L , Rost M , McEvoy J , Saadi AR , Aissi M , Kvac M . Vet Parasitol 2015 208 135-42 A total of 219 and 124 individual fecal samples of horses and donkeys, respectively, were screened for the presence of Cryptosporidium spp., Encephalitozoon spp., and Enterocytozoon bieneusi DNA by genus-specific nested PCR. Isolates were genotyped by sequence analysis of SSU rRNA, GP60, TRAP-C1, COWP, and HSP70 loci in Cryptosporidium, and the ITS region in microsporidia. Cryptosporidium spp. was detected on 3/18 horse farms and 1/15 farms where donkeys were kept. Overall, five (2.3%) horse and two (1.6%) donkey specimens were PCR positive for Cryptosporidium. Genotyping at SSU and GP60 loci revealed that three isolates from horses and donkeys were C. parvum subtype family IIaA16G1R1, one isolate from a horse was, C. muris RN66, and one isolate from a donkey was C. muris TS03. An isolate from a horse shared 99.4% and 99.3% similarity with Cryptosporidium hominis and C. cuniculus, respectively, at the SSU locus. This isolate shared 100% identity with C. hominis at the TRAP-C1, COWP, and HSP70 loci, and it was from the novel gp60 subtype family IkA15G1. Microsporidia were found on 6/18 horse and 2/15 donkey farms. E. bieneusi was identified in 6.8% (15/219) and 1.6% (2/124), and Encephalitozoon cuniculi was identified in 1.8% (4/219) and 1.6% (2/124), of horses and donkeys, respectively. Three genotypes of E. cuniculi (I, II and III) were detected in horses, and E. cuniculi genotype II was detected in donkeys. Four genotypes of E. bieneusi (horse1, horse 2, CZ3, D) were described in horses. An additional five horses and two donkeys were positive for E. bieneusi, but the isolated were not genotyped. Neither Cryptosporidium nor microsporidia prevalence were affected by sex, age, type of breeding, or whether the host was a horse or a donkey. |
How well do birth records serve maternal and child health programs? Birth registration system evaluation, New York City, 2008-2011
Howland RE , Madsen AM , Toprani A , Gambatese M , Mulready-Ward C , Begier E . Matern Child Health J 2015 19 (7) 1559-66 National birth registration guidelines were revised in 2003 to improve data quality; however, few studies have evaluated the impact on local jurisdictions and their data users. In New York City (NYC), approximately 125,000 births are registered annually with the NYC Department of Health and Mental Hygiene, and data are used routinely by the department's maternal and child health (MCH) programs. In order to better meet MCH program needs, we used Centers for Disease Control and Prevention guidelines to assess birth data usefulness, simplicity, data quality, timeliness and representativeness. We interviewed birth registration and MCH program staff, reviewed a 2009 survey of birth registrars (n = 39), and analyzed 2008-2011 birth records for timeliness and completeness (n = 502,274). Thirteen MCH programs use birth registration data for eligibility determination, needs assessment, program evaluation, and surveillance. Demographic variables are used frequently, nearly 100 % complete, and considered the gold standard by programs; in contrast, medical variables' use and validity varies widely. Seventy-seven percent of surveyed birth registrars reported ≥1 problematic items in the system; 64.1 % requested further training. During 2008-2011, the median interval between birth and registration was 5 days (range 0-260 days); 11/13 programs were satisfied with timeliness. The NYC birth registration system provides local MCH programs useful, timely, and representative data. However, some medical items are difficult to collect, of low quality, and rarely used. We recommend enhancing training for birth registrars, continuing quality improvement efforts, increasing collaboration with program users, and removing consistently low-quality and low-use variables. |
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