Measuring the prevalence of diagnosed chronic obstructive pulmonary disease in the United States using data from the 2012-2014 National Health Interview Survey
Ward BW , Nugent CN , Blumberg SJ , Vahratian A . Public Health Rep 2017 132 (2) 33354916688197 OBJECTIVES: This study, measuring the prevalence of chronic obstructive pulmonary disease (COPD), examined (1) whether a single survey question asking explicitly about diagnosed COPD is sufficient to identify US adults with COPD and (2) how this measure compares with estimating COPD prevalence using survey questions on diagnosed emphysema and/or chronic bronchitis and all 3 survey questions together. METHODS: We used data from the 2012-2014 National Health Interview Survey to examine different measures of prevalence among 7211 US adults who reported a diagnosed respiratory condition (ie, emphysema, chronic bronchitis, and/or COPD). RESULTS: We estimated a significantly higher prevalence of COPD by using a measure accounting for all 3 diagnoses (6.1%; 95% CI, 5.9%-6.3%) than by using a measure of COPD diagnosis only (3.0%; 95% CI, 2.8%-3.1%) or a measure of emphysema and/or chronic bronchitis diagnoses (4.7%; 95% CI, 4.6%-4.9%). This pattern was significant among all subgroups examined except for non-Hispanic Asian adults. The percentage difference between measures of COPD was larger among certain subgroups (adults aged 18-39, Hispanic adults, and never smokers); additional analyses showed that this difference resulted from a large proportion of adults in these subgroups reporting a diagnosis of chronic bronchitis only. CONCLUSIONS: With the use of self- or patient-reported health survey data such as the National Health Interview Survey, it is recommended that a measure asking respondents only about COPD diagnosis is not adequate for estimating the prevalence of COPD. Instead, a measure accounting for diagnoses of emphysema, chronic bronchitis, and/or COPD may be a better measure. Additional analyses should explore the reliability and validation of survey questions related to COPD, with special attention toward questions on chronic bronchitis. |
Predictors of dyslipidemia over time in youth with type 1 diabetes: For the SEARCH for Diabetes in Youth Study
Shah AS , Maahs DM , Stafford JM , Dolan LM , Lang W , Imperatore G , Bell RA , Liese AD , Reynolds K , Pihoker C , Marcovina S , D'Agostino RB Jr , Dabelea D . Diabetes Care 2017 40 (4) 607-613 OBJECTIVE: Understanding the risk factors associated with progression and regression of dyslipidemia in youth with type 1 diabetes may guide treatments. RESEARCH DESIGN AND METHODS: We studied 1,478 youth with type 1 diabetes (age 10.8 +/- 3.9 years, 50% male, 77% non-Hispanic white, not on lipid-lowering medications) at baseline and at a mean follow-up of 7.1 +/- 1.9 years in the SEARCH for Diabetes in Youth (SEARCH) study. Progression to dyslipidemia was defined as normal lipid concentrations at baseline and abnormal at follow-up (non-HDL-cholesterol [C] >130 mg/dL or HDL-C <35 mg/dL). Regression was defined as abnormal lipids at baseline and normal at follow-up. Multivariable logistic regression was used to evaluate factors associated with progression and regression compared with stable normal and stable abnormal, respectively. An area under the curve (AUC) variable was used for the time-varying covariates A1C and waist-to-height ratio (WHtR). RESULTS: Non-HDL-C progressed, regressed, was stable normal, and stable abnormal in 19%, 5%, 69%, and 7% of youth with type 1 diabetes, respectively. Corresponding percentages for HDL-C were 3%, 3%, 94%, and 1%, respectively. Factors associated with non-HDL-C progression were higher A1C AUC and higher WHtR AUC in males. Non-HDL-C regression was associated with lower WHtR AUC, and HDL-C progression was associated with male sex and higher WHtR AUC. HDL-C regression was not modeled due to small numbers. CONCLUSIONS: A1C and WHtR are modifiable risk factors associated with change in dyslipidemia over time in youth with type 1 diabetes. |
Estimation of the incidence of hepatocellular carcinoma and cholangiocarcinoma in Songkhla, Thailand, 1989-2013, using multiple imputation method
Yeesoonsang S , Bilheem S , McNeil E , Iamsirithaworn S , Jiraphongsa C , Sriplung H . Cancer Res Treat 2017 49 (1) 54-60 PURPOSE: Histological specimens are not required for diagnosis of liver and bile duct (LBD) cancer, resulting in a high percentage of unknown histologies. We compared estimates of hepatocellular carcinoma (HCC) and cholangiocarcinoma (CCA) incidences by imputing these unknown histologies. MATERIALS AND METHODS: A retrospective study was conducted using data from the Songkhla Cancer Registry, southern Thailand, from 1989 to 2013. Multivariate imputation by chained equations (mice) was used in re-classification of the unknown histologies. Age-standardized rates (ASR) of HCC and CCA by sex were calculated and the trends were compared. RESULTS: Of 2,387 LBD cases, 61% had unknown histology. After imputation, the ASR of HCC in males during 1989 to 2007 increased from 4 to 10 per 100,000 and then decreased after 2007. The ASR of CCA increased from 2 to 5.5 per 100,000, and the ASR of HCC in females decreased from 1.5 in 2009 to 1.3 in 2013 and that of CCA increased from less than 1 to 1.9 per 100,000 by 2013. RESULTS: of complete case analysis showed somewhat similar, although less dramatic, trends. CONCLUSION: In Songkhla, the incidence of CCA appears to be stable after increasing for 20 years whereas the incidence of HCC is now declining. The decline in incidence of HCC among males since 2007 is probably due to implementation of the hepatitis B virus vaccine in the 1990s. The rise in incidence of CCA is a concern and highlights the need for case control studies to elucidate the risk factors. |
Bone mineral density and the risk of hip and knee osteoarthritis: The Johnston County Osteoarthritis Project
Barbour KE , Murphy LB , Helmick CG , Hootman JM , Renner JB , Jordan JM . Arthritis Care Res (Hoboken) 2017 69 (12) 1863-1870 OBJECTIVES: To address knowledge gaps regarding the relationship between bone mineral density (BMD) and incident hip or knee osteoarthritis (OA); specifically, lack of information regarding hip OA or symptomatic outcomes. METHODS: Using data (N=1,474) from the Johnston County Osteoarthritis (JoCo OA) Project's first (1999-2004) and second follow-up (2005-2010) of participants aged ≥45 years we examined the association between total hip BMD and both hip and knee OA. Total hip BMD was measured using dual-energy X-ray absorptiometry, and participants were classified into sex-specific quartiles (low, intermediate low, intermediate high, and high). Radiographic osteoarthritis (ROA) was defined as development of Kellgren-Lawrence grade ≥2. Symptomatic ROA (sROA) was defined as onset of both ROA and symptoms. Weibull regression modeling was used to estimate hazard ratios (HR) and 95% confidence intervals (95% CIs). RESULTS: Median follow-up time was 6.5 (range=4.0-10.2) years. In multivariate models, and compared with participants with low BMD, those with intermediate high and high BMD were less likely to develop hip sROA (HR (95% CIs) 0.52 (0.31- 0.86) and 0.56 (0.31 - 0.86), respectively; p-trend = 0.024); high BMD was not associated (0.69 (0.45-1.06)) with risk of hip ROA. Compared with participants with low BMD, those with intermediate low and intermediate high total hip BMD were more likely to develop knee sROA (2.15 (1.40-3.30) and 1.65 (1.02-2.67), respectively; p-trend=0.325); similar associations were seen with knee ROA. CONCLUSIONS: Our findings suggest that higher BMD may reduce the risk hip sROA, while intermediate levels may increase the risk of both knee sROA and ROA. |
Dementia and co-occurring chronic conditions: a systematic literature review to identify what is known and where are the gaps in the evidence?
Snowden MB , Steinman LE , Bryant LL , Cherrier MM , Greenlund KJ , Leith KH , Levy C , Logsdon RG , Copeland C , Vogel M , Anderson LA , Atkins DC , Bell JF , Fitzpatrick AL . Int J Geriatr Psychiatry 2017 32 (4) 357-371 OBJECTIVE: The challenges posed by people living with multiple chronic conditions are unique for people with dementia and other significant cognitive impairment. There have been recent calls to action to review the existing literature on co-occurring chronic conditions and dementia in order to better understand the effect of cognitive impairment on disease management, mobility, and mortality. METHODS: This systematic literature review searched PubMed databases through 2011 (updated in 2016) using key constructs of older adults, moderate-to-severe cognitive impairment (both diagnosed and undiagnosed dementia), and chronic conditions. Reviewers assessed papers for eligibility and extracted key data from each included manuscript. An independent expert panel rated the strength and quality of evidence and prioritized gaps for future study. RESULTS: Four thousand thirty-three articles were identified, of which 147 met criteria for review. We found that moderate-to-severe cognitive impairment increased risks of mortality, was associated with prolonged institutional stays, and decreased function in persons with multiple chronic conditions. There was no relationship between significant cognitive impairment and use of cardiovascular or hypertensive medications for persons with these comorbidities. Prioritized areas for future research include hospitalizations, disease-specific outcomes, diabetes, chronic pain, cardiovascular disease, depression, falls, stroke, and multiple chronic conditions. CONCLUSIONS: This review summarizes that living with significant cognitive impairment or dementia negatively impacts mortality, institutionalization, and functional outcomes for people living with multiple chronic conditions. Our findings suggest that chronic-disease management interventions will need to address co-occurring cognitive impairment. |
A Large Community Outbreak of Legionnaires' Disease Associated With a Cooling Tower in New York City, 2015.
Weiss D , Boyd C , Rakeman JL , Greene SK , Fitzhenry R , McProud T , Musser K , Huang L , Kornblum J , Nazarian EJ , Fine AD , Braunstein SL , Kass D , Landman K , Lapierre P , Hughes S , Tran A , Taylor J , Baker D , Jones L , Kornstein L , Liu B , Perez R , Lucero DE , Peterson E , Benowitz I , Lee KF , Ngai S , Stripling M , Varma JK . Public Health Rep 2017 132 (2) 33354916689620 OBJECTIVES: Infections caused by Legionella are the leading cause of waterborne disease outbreaks in the United States. We investigated a large outbreak of Legionnaires' disease in New York City in summer 2015 to characterize patients, risk factors for mortality, and environmental exposures. METHODS: We defined cases as patients with pneumonia and laboratory evidence of Legionella infection from July 2 through August 3, 2015, and with a history of residing in or visiting 1 of several South Bronx neighborhoods of New York City. We describe the epidemiologic, environmental, and laboratory investigation that identified the source of the outbreak. RESULTS: We identified 138 patients with outbreak-related Legionnaires' disease, 16 of whom died. The median age of patients was 55. A total of 107 patients had a chronic health condition, including 43 with diabetes, 40 with alcoholism, and 24 with HIV infection. We tested 55 cooling towers for Legionella, and 2 had a strain indistinguishable by pulsed-field gel electrophoresis from 26 patient isolates. Whole-genome sequencing and epidemiologic evidence implicated 1 cooling tower as the source of the outbreak. CONCLUSIONS: A large outbreak of Legionnaires' disease caused by a cooling tower occurred in a medically vulnerable community. The outbreak prompted enactment of a new city law on the operation and maintenance of cooling towers. Ongoing surveillance and evaluation of cooling tower process controls will determine if the new law reduces the incidence of Legionnaires' disease in New York City. |
A large outbreak of acute gastroenteritis caused by the human norovirus GII.17 strain at a university in Henan Province, China.
Huang XY , Su J , Lu QC , Li SZ , Zhao JY , Li ML , Li Y , Shen XJ , Zhang BF , Wang HF , Mu YJ , Wu SY , Du YH , Liu LC , Chen WJ , Klena JD , Xu BL . Infect Dis Poverty 2017 6 (1) 6 BACKGROUND: Human noroviruses are a major cause of viral gastroenteritis and are the main etiological agents of acute gastroenteritis outbreaks. An increasing number of outbreaks and sporadic cases of norovirus have been reported in China in recent years. There was a large acute gastroenteritis outbreak at a university in Henan Province, China in the past five years. We want to identify the source, transmission routes of the outbreak by epidemiological investigation and laboratory testing in order to provide the effective control measures. METHODS: The clinical cases were investigated, and analysed by descriptive epidemiological methods according to factors such as time, department, grade and so on. Samples were collected from clinical cases, healthy persons, the environment, water, and food at the university. These samples were tested for potential bacteria and viruses. The samples that tested positive for norovirus were selected for whole genome sequencing and the sequences were then analysed. RESULTS: From 4 March to 3 April 2015, a total of 753 acute diarrhoea cases were reported at the university; the attack rate was 3.29%. The epidemic curve showed two peaks, with the main peak occurring between 10 and 20 March, accounting for 85.26% of reported cases. The rates of norovirus detection in samples from confirmed cases, people without symptoms, and environmental samples were 32.72%, 17.39%, and 9.17%, respectively. The phylogenetic analysis showed that the norovirus belonged to the genotype GII.17. CONCLUSIONS: This is the largest and most severe outbreak caused by genotype GII.17 norovirus in recent years in China. The GII.17 viruses displayed high epidemic activity and have become a dominant strain in China since the winter of 2014, having replaced the previously dominant GII.4 Sydney 2012 strain. |
Detection of macrolide resistance genes in culture-negative specimens from Bangladeshi children with invasive pneumococcal diseases.
Hasanuzzaman M , Malaker R , Islam M , Baqui AH , Darmstadt GL , Whitney CG , Saha SK . J Glob Antimicrob Resist 2017 8 131-134 OBJECTIVES: In recent years, an increasing prevalence of macrolide resistance among pneumococci in Bangladesh has been observed. However, the scenario remains incomplete, as few isolates (<1%) are available from pneumonia cases and most pneumococcal meningitis cases (>80%) are culture-negative. This study optimised a triplex PCR method to detect macrolide resistance genes (MRGs) (mefA and ermB) and cpsA from culture-negative pneumococcal cases to predict the prevalence and level of macrolide resistance. METHODS: The presence of MRGs among pneumococcal strains (n=153) with a wide range of erythromycin MICs (<0.5 to ≥256mg/L) was determined by PCR. Triplex PCR was validated by simultaneous detection of MRG(s) and cpsA in culture-negative clinical specimens and corresponding isolates. The known impact of the presence of specific MRG(s) on MICs of strains was used to predict the MICs of non-culturable strains based on the presence/absence of MRG(s) in the specimens. RESULTS: None of the erythromycin-susceptible isolates possessed any of the MRGs, and all non-susceptible strains had ≥1 MRG. MICs were 2-16mg/L and ≥256mg/L for 93% of strains with mefA and ermB, respectively, whereas 100% of isolates with both genes had MICs≥256mg/L. PCR for body fluids showed 100% concordance with corresponding isolates when tested for MRG(s) in parallel. CONCLUSIONS: Erythromycin MICs can be predicted for non-culturable strains with 93-100% precision based on detection of ermB and/or mefA. This method will be useful for establishing comprehensive surveillance for macrolide resistance among pneumococci, specifically in the population with prior antibiotic use. |
Seroprevalence of hepatitis E among Boston area travelers, 2009-2010
Barbre KA , Jentes ES , Drobeniuc J , Kamili S , Hamer DH , Barnett ED . Am J Trop Med Hyg 2017 96 (4) 929-934 We determined the prevalence of IgG antibodies to hepatitis E virus (anti-HEV IgG) among travelers attending Boston-area travel health clinics from 2009 to 2010. Pre-travel samples were available for 1,356 travelers, with paired pre- and post-travel samples for 450 (33%). Eighty of 1,356 (6%) pre-travel samples were positive for anti-HEV IgG. Compared with participants who had never lived in nor traveled to a highly endemic country, the pre-travel prevalence odds ratio (POR) of anti-HEV IgG among participants born in or with a history of previous travel to a highly endemic country was increased (POR = 4.8, 95% CI = 2.3-10.3 and POR = 2.6, 95% CI = 1.4-5.0, respectively). Among participants with previous travel to a highly endemic country, anti-HEV IgG was associated with age > 40 years (POR = 3.7, 95% CI = 1.3-10.2) and travel history to ≥ 3 highly endemic countries (POR = 2.7, 95% CI = 1.2-5.9). Two participants may have contracted HEV infection during their 2009-2010 trip. |
Tuberculosis outbreaks in the United States, 2009-2015
Mindra G , Wortham JM , Haddad MB , Powell KM . Public Health Rep 2017 132 (2) 33354916688270 OBJECTIVES: The Centers for Disease Control and Prevention provides on-site epidemiologic assistance for outbreak response when the health capacity of state, tribal, local, and territorial health departments has been exceeded. We examined recent outbreaks of tuberculosis (TB) for which health departments needed assistance. METHODS: We defined a TB outbreak as detection of ≥3 TB cases related by transmission, as suggested by routine genotyping and epidemiologic linkages. We conducted retrospective reviews of documentation from all 21 TB outbreak investigations in the United States for which the Centers for Disease Control and Prevention provided on-site assistance during 2009-2015. We abstracted data on patients' demographic characteristics and TB risk factors, as well as factors contributing to the outbreak from trip reports written by on-site investigators, and we compared these with outbreaks investigated during 2002-2008. RESULTS: The 21 TB outbreaks during 2009-2015 involved 457 outbreak patients (range, 3-99 patients per outbreak). Of the 21 outbreaks, 16 were first identified through genotype data. In sum, 118 (26%) patients were identified through contact investigations of other patients in the outbreak. Most outbreak patients (n = 363, 79%) were US born. Ninety-two (26%) patients had a mental illness, 204 (45%) had been homeless in the year before diagnosis, and 379 (83%) used alcohol excessively or used illicit substances. The proportion of patients experiencing homelessness doubled between 2002-2008 and 2009-2015; other characteristics were similar between the 2 periods. Delayed TB diagnosis contributed to unmitigated transmission in all but 1 outbreak. CONCLUSIONS: TB outbreaks challenge frontline public health resources. Genotyping and contact investigations are important strategies for detecting and controlling TB outbreaks, particularly among people experiencing homelessness or those with mental illness. |
Looking for fungi in all the right places: screening for cryptococcal disease and other AIDS-related mycoses among patients with advanced HIV disease
Greene G , Sriruttan C , Le T , Chiller T , Govender NP . Curr Opin HIV AIDS 2017 12 (2) 139-147 PURPOSE OF REVIEW: As HIV treatment programmes scale up to meet the UNAIDS 90-90-90 goals, care must be taken to start antiretroviral treatment safely in patients with advanced disease (CD4 counts <200 cells/mul) who are simultaneously at risk for opportunistic infections and immune reconstitution inflammatory syndrome. Invasive fungal diseases pose a great threat at this critical time point, though the development of inexpensive and highly accurate rapid diagnostic tests has changed the approach HIV programmes are taking to reduce the high mortality associated with these opportunistic infections. This article summarizes recent advances and findings in fungal opportunistic infection diagnostics with a focus on screening to prevent cryptococcal meningitis. RECENT FINDINGS: Cryptococcal antigen (CrAg) screening using a lateral flow assay platform is cost-effective and feasible to implement as either a laboratory reflex or point-of-care test. Recent CrAg screening pilots have elucidated the varying prevalence of cryptococcal antigenemia across geographic regions, which may aid programme planning. Evidence from recently completed clinical trials provides a strong motivation for the use of CrAg titer to refine treatment options for patients with subclinical cryptococcal disease. SUMMARY: Although several operational barriers to programme effectiveness still need to be addressed, the utility of CrAg screening using inexpensive and accurate antigen assays has been demonstrated in real-world HIV programmes, paving the way for development and testing of other fungal opportunistic infection screening strategies and for an integrated advanced HIV disease testing package to reduce AIDS mortality and ensure safe antiretroviral treatment initiation. |
Pregnancy and linkage to care among women diagnosed with HIV infection in 61 CDC-funded health departments in the United States, 2013
FitzHarris LF , Hollis ND , Nesheim SR , Greenspan JL , Dunbar EK . AIDS Care 2017 29 (7) 1-8 Timely linkage to HIV care (LTC) following an HIV diagnosis is especially important for pregnant women with HIV to prevent perinatal transmission and improve maternal health. However, limited data are available on LTC among U.S. pregnant women. Our analysis aimed to identify HIV diagnoses among childbearing age (CBA) women (15-44 years old) by pregnancy status and to compare LTC of HIV-infected pregnant women to HIV-infected non-pregnant women. We analyzed 2013 CDC-funded HIV testing data from 61 health departments and 151 directly funded community-based organizations among CBA women. LTC includes linkage at any time after an HIV diagnosis and within 90 days after HIV diagnosis. Pearson's chi-square was used to compare LTC of pregnant and non-pregnant women. Data were analyzed using SAS v9.3. Among the 1,379,860 HIV testing events among CBA women in 2013, 0.3% (n = 3690) were HIV-positive. Among all HIV-positive diagnoses with an available pregnancy status (n = 1987), 7%, (n = 138) were pregnant. Among women with pregnancy status data, LTC any time after an HIV-positive diagnosis was 73.2% for pregnant women and 60.7% for non-pregnant women. LTC within 90 days was 71.7% for pregnant women and 56.2% for non-pregnant women. Pregnancy was associated with LTC any time (p < 0.01) and within 90 days of diagnosis (p < 0.01). Compared with non-pregnant women, a higher proportion of pregnant women with HIV were linked to care overall, and linked within 90 days. Pregnancy appears to facilitate better LTC, but improvements are needed for women overall and pregnant women specifically. |
HIV and sexually transmitted disease testing behavior among adolescent sexual minority males: Analysis of pooled Youth Risk Behavior Survey Data, 2005-2013
Sharma A , Wang LY , Dunville R , Valencia RK , Rosenberg ES , Sullivan PS . LGBT Health 2017 4 (2) 130-140 PURPOSE: Adolescent sexual minority males (ASMM) comprise a high-risk group that may benefit from expanded human immunodeficiency virus (HIV) and sexually transmitted disease (STD) prevention services. The purpose of this study was to estimate the prevalence of HIV and STD testing among ASMM from pooled high school Youth Risk Behavior Surveys (YRBSs). METHODS: Data came from 26 YRBSs from 2005 to 2013, which included questions on sexual identity and/or sex of sexual contacts and questions on ever being tested for HIV and/or STDs. Multivariable logistic regression was used to identify factors independently associated with lifetime HIV testing among sexually experienced ASMM. RESULTS: Overall, 3027 of 43,037 (6.3%, 95% confidence interval [CI]: 5.8%-6.8%) males were categorized as ASMM. Among 1229 sexually experienced ASMM, 413 (26.6%, 95% CI: 21.8%-31.4%) reported ever being tested for HIV, and among 571 ASMM who reported not using a condom during last intercourse, 192 (29.4%, 95% CI: 21.3%-37.6%) reported testing. A longer duration since first intercourse (≥3 vs. ≤1 year: adjusted prevalence ratio [aPR]: 1.6, 95% CI: 1.0-2.6) and recent intercourse (within the past 3 months vs. earlier: aPR: 2.2, 95% CI: 1.4-3.4) was associated with a higher adjusted prevalence of HIV testing. Sixty-four of 252 (30.2%, 95% CI: 20.0%-40.4%) sexually experienced ASMM reported ever being tested for STDs. CONCLUSION: Low levels of testing among sexually experienced ASMM, particularly those who reported sex without a condom at last intercourse, highlight the exigency of improving age-appropriate HIV and STD prevention services. Educating healthcare providers to better assess adolescent sexual histories is essential to increasing testing. |
Incidence of norovirus-associated diarrhea, Shanghai, China, 2012-2013
Yu J , Ye C , Lai S , Zhu W , Zhang Z , Geng Q , Xue C , Yang W , Wu S , Hall AJ , Sun Q , Li Z . Emerg Infect Dis 2017 23 (2) 312-315 We conducted sentinel-based surveillance for norovirus in the Pudong area of Shanghai, China, during 2012-2013, by analyzing 5,324 community surveys, 408,024 medical records, and 771 laboratory-confirmed norovirus infections among 3,877 diarrhea cases. Our analysis indicated an outpatient incidence of 1.5/100 person-years and a community incidence of 8.9/100 person-years for norovirus-associated diarrhea. |
Increase in urgent care center visits for sexually transmitted infections, United States, 2010-2014
Pearson WS , Tao G , Kroeger K , Peterman TA . Emerg Infect Dis 2017 23 (2) 367-369 During 2010-2014, urgent care centers saw a approximately 2-fold increase in the number of visits for chlamydia and gonorrhea testing and a >3-fold increase in visits by persons with diagnosed sexually transmitted infections. As urgent care becomes more popular, vigilance is required to ensure proper management of these diseases. |
Increasing antibiotic resistance in Shigella spp. from infected New York City Residents, New York, USA
Murray K , Reddy V , Kornblum JS , Waechter H , Chicaiza LF , Rubinstein I , Balter S , Greene SK , Braunstein SL , Rakeman JL , Dentinger CM . Emerg Infect Dis 2017 23 (2) 332-335 Approximately 20% of Shigella isolates tested in New York City, New York, USA, during 2013-2015 displayed decreased azithromycin susceptibility. Case-patients were older and more frequently male and HIV infected than those with azithromycin-susceptible Shigella infection; 90% identified as men who have sex with men. Clinical interpretation guidelines for azithromycin resistance and outcome studies are needed. |
Alcohol use and immune reconstitution among HIV-infected patients on antiretroviral therapy in Nairobi, Kenya
Cagle A , McGrath C , Richardson BA , Donovan D , Sakr S , Yatich N , Ngomoa R , Chepngeno Langat A , John-Stewart G , Chung MH . AIDS Care 2017 29 (9) 1-6 Studies on the effects of alcohol use on HIV disease progression have been contradictory, with at least one study finding a positive effect of low alcohol consumption on CD4 count. In addition, most such studies have taken place in the developed West. We investigated the association between alcohol use and immune reconstitution through CD4 count response among HIV-infected individuals on antiretroviral therapy (ART) at an urban sub-Saharan African clinic. This was a retrospective cohort study of treatment-naive HIV-infected adults initiating ART in Nairobi, Kenya and followed for 12 months between January 2009 and December 2012. At enrollment, a standardized questionnaire was used to collect data on sociodemographic variables and alcohol consumption. CD4 count was measured every six months. Linear regression models assessed the association between CD4 count and alcohol consumption, categorized as abstinent, moderate, or hazardous. Overall, 854 participants were included, 522 of which were women, with 85 (25.6%) men and 50 (9.6%) women reporting any alcohol use, and 8 (2.4%) men and 7 (1.3%) women reporting hazardous drinking. At baseline, alcohol use was associated with higher education and socioeconomic status. Median CD4 count was higher among alcohol users compared to those who abstained at baseline and at 6 and 12 months post-ART initiation, although this was only significant at 6 months. There were no differences in adherence between abstainers and drinkers. While overall alcohol use was significantly associated with higher CD4 counts, moderate and hazardous use treated separately were not. We conclude that, while alcohol use was associated with higher CD4 counts at 12 months post-ART, the mechanism for this association is unclear but may reflect unmeasured socioeconomic or nutritional differences. Additional research is required on the specific drinking patterns of this population and the types of alcoholic beverages consumed to clarify this relationship. |
Cluster of HIV infections associated with unsafe injection practices in a rural village in Cambodia
Saphonn V , Fujita M , Samreth S , Chan S , Rouet F , Khol V , Mam S , Mom C , Tuot S , Le LV , Ly PS , Ferradini L , Mean CV . J Acquir Immune Defic Syndr 2017 75 (3) e82-e86 In late 2014 in a rural village in Cambodia, a surge in HIV infections was reported and a rapid investigation identified 114 among 915 (12.4%) Roka commune residents being HIV infected, with 65% women and age ranging between 3 and 87 years. As a comparison, between January and November 2014, only 4 among 271 people in Roka commune (1.5%) were found HIV-positive. With only 1 public health care center for all villages in the commune, health services are largely shared by private health service providers including unlicensed informal health practitioners who conduct home visits and administer medical procedures, including medical injection, intravenous infusion, and blood draw. A case–control study was performed in December 2014, led by the National Center for HIV/AIDS, Dermatology and STDs (NCHADS) and the University of Health Sciences (UHS), to identify risk factors associated with recently diagnosed HIV-positive cases in Roka commune. |
County-level vulnerability assessment for rapid dissemination of HIV or HCV infections among persons who inject drugs, United States
Van Handel MM , Rose CE , Hallisey EJ , Kolling JL , Zibbell JE , Lewis B , Bohm MK , Jones CM , Flanagan BE , Siddiqi AE , Iqbal K , Dent AL , Mermin JH , McCray E , Ward JW , Brooks JT . J Acquir Immune Defic Syndr 2016 73 (3) 323-331 OBJECTIVE: A recent HIV outbreak in a rural network of persons who inject drugs (PWID) underscored the intersection of the expanding epidemics of opioid abuse, unsterile injection drug use (IDU), and associated increases in hepatitis C virus (HCV) infections. We sought to identify US communities potentially vulnerable to rapid spread of HIV, if introduced, and new or continuing high rates of HCV infections among PWID. DESIGN: We conducted a multistep analysis to identify indicator variables highly associated with IDU. We then used these indicator values to calculate vulnerability scores for each county to identify which were most vulnerable. METHODS: We used confirmed cases of acute HCV infection reported to the National Notifiable Disease Surveillance System, 2012-2013, as a proxy outcome for IDU, and 15 county-level indicators available nationally in Poisson regression models to identify indicators associated with higher county acute HCV infection rates. Using these indicators, we calculated composite index scores to rank each county's vulnerability. RESULTS: A parsimonious set of 6 indicators were associated with acute HCV infection rates (proxy for IDU): drug-overdose deaths, prescription opioid sales, per capita income, white, non-Hispanic race/ethnicity, unemployment, and buprenorphine prescribing potential by waiver. Based on these indicators, we identified 220 counties in 26 states within the 95th percentile of most vulnerable. CONCLUSIONS: Our analysis highlights US counties potentially vulnerable to HIV and HCV infections among PWID in the context of the national opioid epidemic. State and local health departments will need to further explore vulnerability and target interventions to prevent transmission. |
Molecular Survey of Bacterial Zoonotic Agents in Bats from the Country of Georgia (Caucasus).
Bai Y , Urushadze L , Osikowicz L , McKee C , Kuzmin I , Kandaurov A , Babuadze G , Natradze I , Imnadze P , Kosoy M . PLoS One 2017 12 (1) e0171175 Bats are important reservoirs for many zoonotic pathogens. However, no surveys of bacterial pathogens in bats have been performed in the Caucasus region. To understand the occurrence and distribution of bacterial infections in these mammals, 218 bats belonging to eight species collected from four regions of Georgia were examined for Bartonella, Brucella, Leptospira, and Yersinia using molecular approaches. Bartonella DNA was detected in 77 (35%) bats from all eight species and was distributed in all four regions. The prevalence ranged 6-50% per bat species. The Bartonella DNA represented 25 unique genetic variants that clustered into 21 lineages. Brucella DNA was detected in two Miniopterus schreibersii bats and in two Myotis blythii bats, all of which were from Imereti (west-central region). Leptospira DNA was detected in 25 (13%) bats that included four M. schreibersii bats and 21 M. blythii bats collected from two regions. The Leptospira sequences represented five genetic variants with one of them being closely related to the zoonotic pathogen L. interrogans (98.6% genetic identity). No Yersinia DNA was detected in the bats. Mixed infections were observed in several cases. One M. blythii bat and one M. schreibersii bat were co-infected with Bartonella, Brucella, and Leptospira; one M. blythii bat and one M. schreibersii bat were co-infected with Bartonella and Brucella; 15 M. blythii bats and three M. schreibersii bats were co-infected with Bartonella and Leptospira. Our results suggest that bats in Georgia are exposed to multiple bacterial infections. Further studies are needed to evaluate pathogenicity of these agents to bats and their zoonotic potential. |
Rickettsia amblyommatis sp. nov., a spotted fever group Rickettsia associated with multiple species of Amblyomma ticks in North, Central and South America
Karpathy SE , Slater KS , Goldsmith CS , Nicholson WL , Paddock CD . Int J Syst Evol Microbiol 2016 66 (12) 5236-5243 In 1973, investigators isolated a rickettsial organism, designated strain WB-8-2T, from an adult Amblyomma americanum tick collected at Land Between the Lakes National Recreation Area, TN, USA. This organism is now recognized as highly prevalent in A. americanum, as well as several other Amblyomma species found throughout the Western hemisphere. It has been suggested that cross-reactivity to WB-8-2T and similar strains contributes to the increasing number of spotted fever cases reported in the USA. In 1995, investigators provided preliminary evidence that this strain, as well as another strain from Missouri, represented a distinct taxonomic unit within the genus Rickettsia by evaluating sequences of the 16S rRNA and 17 kDa protein genes. However, the bacterium was never formally named, despite the use of the designation 'Rickettsia amblyommii' and later 'Candidatus Rickettsia amblyommii', for more than 20 years in the scientific literature. Herein, we provide additional molecular evidence to identify strain WB-8-2T as a representative strain of a unique rickettsial species and present a formal description for the species, with the proposed name modified to Rickettsia amblyommatis sp. nov. to conform to the International Code of Nomenclature of Prokaryotes. We also establish a pure culture of strain WB-8-2T and designate it as the type strain for the species. The type strain is WB-8-2T (=CRIRC RAM004T=CSURP2882T). |
Antibiotic prescribing by general dentists in the United States, 2013
Roberts RM , Bartoces M , Thompson SE , Hicks LA . J Am Dent Assoc 2017 148 (3) 172-178 e1 BACKGROUND: Dentists prescribe approximately 10% of outpatient antibiotics, but little is known about dentists' antibiotic prescribing patterns. The authors conducted a study to characterize prescribing by dentists according to antibiotic agent and category, patient demographic characteristics, and geographic region in the United States. METHODS: The authors identified oral antibiotic prescriptions dispensed during 2013 in the Xponent (QuintilesIMS) database. The authors used the total number of prescriptions and county-level census population denominators to calculate prescribing rates. In addition, the authors analyzed prescribing according to individual agent, drug category, and patient demographic characteristics and the total number of prescriptions calculated for general dentists overall. RESULTS: Dentists prescribed 24.5 million courses of antibiotics in 2013, a prescribing rate of 77.5 prescriptions per 1,000 people. Penicillins were the most commonly prescribed antibiotic category. Dentists prescribed most antibiotics for adults older than 19 years. The Northeast census region had the highest prescribing rate per 1,000 people. The District of Columbia had the highest prescribing rate of 99.5 per 1,000 people, and Delaware had the lowest prescribing rate of 50.7 per 1,000 people. CONCLUSIONS: Dentists prescribe large quantities of antibiotics in outpatient settings, and there is considerable geographic variability. Additional study is needed to better understand the reasons for this variability and identify areas of possible intervention and improvement. PRACTICAL IMPLICATIONS: Continued efforts to combat antibiotic resistance will require all prescribers, including dentists, to examine prescribing behaviors for appropriateness and the effectiveness of guidelines to identify opportunities to optimize antibiotic use. |
Prenatal exposure to perfluoroalkyl substances and body fatness in girls
Hartman TJ , Calafat AM , Holmes AK , Marcus M , Northstone K , Flanders WD , Kato K , Taylor EV . Child Obes 2017 13 (3) 222-230 BACKGROUND: Perfluoroalkyl substances (PFASs) are used in surface coatings that resist stains, grease, and water. METHODS: The association between in utero PFAS exposure and girls' body fatness at age 9 was analyzed in The Avon Longitudinal Study of Parents and Children (UK). Maternal serum [median 15 weeks: interquartile range (IQR) 10 and 28 weeks of gestation] was analyzed for perfluorooctane sulfonate (PFOS), perfluorooctanoate (PFOA), perfluorohexane sulfonate (PFHxS), and perfluorononanoate (PFNA). Body composition was measured by dual X-ray emission absorptiometry, and percent total body fat (%BF) was calculated. Associations between PFASs and body fatness were modeled by multivariable linear regression. RESULTS: Among 359 girls, median (IQR) %BF was 27.5 (IQR 21.7-34.6). Median (IQR) concentrations (all ng/mL) were 3.7 (2.9-4.8) for PFOA, 19.8 (15.0-25.3) for PFOS, 1.6 (1.3-2.2) for PFHxS, and 0.5 (0.4-0.7) for PFNA. Maternal PFAS concentrations were not significantly associated with daughters' total %BF overall. Mothers' educational status modified associations for PFOA and PFOS with %BF (P-interactions: 0.005 and 0.02, respectively). %BF was higher [1.4%; 95% confidence interval (95% CI): 0.3 to 2.5] for each one unit (ng/mL) higher PFOA among girls with mothers in the middle education group, but lower (-0.6%; 95% CI: -1.12 to -0.04) for the corresponding comparison among girls with mothers with the highest education. %BF was lower (-0.2%; 95% CI: -0.3 to -0.1) for each one unit higher PFOS among girls with the most educated mothers. CONCLUSIONS: Prenatal exposure to PFOA and PFOS was associated with girls' %BF within some strata of maternal education status. PFHxS and PFNA were not associated with %BF. |
Anti-bacterial efficacy of alcoholic hand rubs in the Kenyan market, 2015
Ochwoto M , Muita L , Talaam K , Wanjala C , Ogeto F , Wachira F , Osman S , Kimotho J , Ndegwa L . Antimicrob Resist Infect Control 2017 6 17 BACKGROUND: Hand hygiene is known to be effective in preventing hospital and community-acquired infections. The increasing number of hand sanitizer brands in Kenyan hospitals and consumer outlets is of concern. Thus the main aim of this study was to evaluate the anti-bacterial efficacy and organoleptic properties of these hand sanitizers in Kenya. METHODS: This was an experimental, laboratory-based study of 14 different brands of hand sanitizers (coded HS1-14) available in various retail outlets and hospitals in Kenya. Efficacy was evaluated using standard non-pathogenic Escherichia coli (ATCC 25922), Staphylococcus aureus (ATCC 25923) and Pseudomonas aeruginosa (ATCC 27853) as per the European Standard (EN). The logarithmic reduction factors (RF) were assessed at baseline and after treatment, and log reduction then calculated. Ten and 25 healthy volunteers participated in the efficacy and organoleptic studies respectively. RESULTS: Four (28.6%) hand sanitizers (HS12, HS9, HS13 and HS14) showed a 5.9 reduction factor on all the three bacteria strains. Seven (50%) hand sanitizers had efficacies of <3 against all the three bacteria strains used. Efficacy on E. Coli was higher compared to the other pathogens. Three hand sanitizers were efficacious on one of the pathogens and not the other. In terms of organoleptic properties, gel-based formulations were rated far higher than the liquid based formulations brands. CONCLUSION: Fifty percent (50%) of the selected hand sanitizers in the Kenyan market have efficacy that falls below the World Health Organization (WHO) and DIN EN 1500:2013. Of the 14 hand sanitizers found in the Kenyan market, only four showed efficacies that were comparable to the WHO-formulation. There is a need to evaluate how many of these products with <3 efficacy that have been incorporated into the health system for hand hygiene and the country's policy on regulations on their usage. |
Improving the selection and development of influenza vaccine viruses - Report of a WHO informal consultation on improving influenza vaccine virus selection, Hong Kong SAR, China, 18-20 November 2015.
Hampson A , Barr I , Cox N , Donis RO , Hirve S , Jernigan D , Katz J , McCauley J , Motta F , Odagiri T , Tami JS , Waddell A , Webby R , Ziegler T , Zhang W . Vaccine 2017 35 (8) 1104-1109 Since 2010 the WHO has held a series of informal consultations to explore ways of improving the currently highly complex and time-pressured influenza vaccine virus selection and development process. In November 2015 experts from around the world met to review the current status of efforts in this field. Discussion topics included strengthening influenza surveillance activities to increase the availability of candidate vaccine viruses and improve the extent, timeliness and quality of surveillance data. Consideration was also given to the development and potential application of newer laboratory assays to better characterize candidate vaccine viruses, the potential importance of antibodies directed against influenza virus neuraminidase, and the role of vaccine effectiveness studies. Advances in next generation sequencing and whole genome sequencing of influenza viruses were also discussed, along with associated developments in synthetic genomics technologies, evolutionary analysis and predictive mathematical modelling. Discussions were also held on the late emergence of an antigenic variant influenza A(H3N2) virus in mid-2014 that could not be incorporated in time into the 2014-15 northern hemisphere vaccine. There was broad recognition that given the current highly constrained influenza vaccine development and production timeline it would remain impossible to incorporate any variant virus which emerged significantly long after the relevant WHO biannual influenza vaccine composition meetings. Discussions were also held on the development of pandemic and broadly protective vaccines, and on associated regulatory and manufacturing requirements and constraints. With increasing awareness of the health and economic burdens caused by seasonal influenza, the ever-present threat posed by zoonotic influenza viruses, and the significant impact of the 2014-15 northern hemisphere seasonal influenza vaccine mismatch, this consultation provided a very timely opportunity to share developments and exchange views. In all areas, a renewed and strengthened emphasis was placed on developing concrete and measurable actions and identifying the key stakeholders responsible for their implementation. |
Effectiveness of the 13-valent pneumococcal conjugate vaccine against invasive pneumococcal disease in South African children: a case-control study
Cohen C , von Mollendorf C , de Gouveia L , Lengana S , Meiring S , Quan V , Nguweneza A , Moore DP , Reubenson G , Moshe M , Madhi SA , Eley B , Hallbauer U , Finlayson H , Varughese S , O'Brien KL , Zell ER , Klugman KP , Whitney CG , von Gottberg A . Lancet Glob Health 2017 5 (3) e359-e369 BACKGROUND: The 13-valent pneumococcal conjugate vaccine (PCV13) was designed to include disease-causing serotypes that are important in low-income and middle-income countries. Vaccine effectiveness estimates are scarce in these settings. South Africa replaced PCV7 with PCV13 in 2011 using a 2 + 1 schedule. We aimed to assess the effectiveness of two or more doses of PCV13 against invasive pneumococcal disease in children with HIV infection and in those not infected with HIV. METHODS: Cases of invasive pneumococcal disease in children aged 5 years or younger were identified through national laboratory-based surveillance. Isolates were serotyped with the Quellung reaction or PCR. We sought in-hospital controls for every case, matched for age, HIV status, and study site. We aimed to enrol four controls for every case not infected with HIV and six controls for every case with HIV infection (case-control sets). With conditional logistic regression, we calculated vaccine effectiveness as a percentage, with the equation 1 - [adjusted odds ratio for vaccination] x 100. We included data from an earlier investigation of PCV7 to assess vaccine effectiveness in children exposed to but not infected with HIV and in malnourished children not infected with HIV. FINDINGS: Between January, 2012, and December, 2014, we enrolled children aged 16 weeks or older to our study: 240 were cases not infected with HIV, 75 were cases with HIV infection, 1118 were controls not infected with HIV, and 283 were controls with HIV infection. The effectiveness of two or more doses of PCV13 against PCV13-serotype invasive pneumococcal disease was 85% (95% CI 37 to 96) among 11 case-control sets of children not infected with HIV and 91% (-35 to 100) among three case-control sets of children with HIV infection. PCV13 effectiveness among 26 case-control sets of children not infected with HIV was 52% (95% CI -12 to 79) against all-serotype invasive pneumococcal disease and 94% (44 to 100) for serotype 19A. Vaccine effectiveness against PCV7-serotype invasive pneumococcal disease was 87% (95% CI 38 to 97) in children exposed to HIV but uninfected and 90% (53 to 98) in malnourished children not infected with HIV. INTERPRETATION: Our results indicate that PCV13 in a 2 + 1 schedule is effective for preventing vaccine-type pneumococcal infections in young children not infected with HIV, including those who are malnourished or who have been exposed to HIV. Although the point estimate for PCV13 vaccine effectiveness in children infected with HIV was high, it did not reach significance, possibly because of the small sample size. These findings support recommendations for widespread use of pneumococcal conjugate vaccine in low-income and middle-income countries. FUNDING: Gavi, The Vaccine Alliance. |
Spanking and adult mental health impairment: The case for the designation of spanking as an adverse childhood experience
Afifi TO , Ford D , Gershoff ET , Merrick M , Grogan-Kaylor A , Ports KA , MacMillan HL , Holden GW , Taylor CA , Lee SJ , Peters Bennett R . Child Abuse Negl 2017 71 24-31 Adverse Childhood Experiences (ACEs) such as child abuse are related to poor health outcomes. Spanking has indicated a similar association with health outcomes, but to date has not been considered an ACE. Physical and emotional abuse have been shown in previous research to correlate highly and may be similar in nature to spanking. To determine if spanking should be considered an ACE, this study aimed to examine 1): the grouping of spanking with physical and emotional abuse; and 2) if spanking has similar associations with poor adult health problems and accounts for additional model variance. Adult mental health problems included depressive affect, suicide attempts, moderate to heavy drinking, and street drug use. Data were from the CDC-Kaiser ACE study (N=8316, response rate=65%). Spanking loaded on the same factor as the physical and emotional abuse items. Additionally, spanking was associated with increased odds of suicide attempts (Adjusted Odds Ratios (AOR)=1.37; 95% CI=1.02 to1.86), moderate to heavy drinking (AOR)=1.23; 95% CI=1.07 to 1.41), and the use of street drugs (AOR)=1.32; 95% CI=1.4 to 1.52) in adulthood over and above experiencing physical and emotional abuse. This indicates spanking accounts for additional model variance and improves our understanding of these outcomes. Thus, spanking is empirically similar to physical and emotional abuse and including spanking with abuse adds to our understanding of these mental health problems. Spanking should also be considered an ACE and addressed in efforts to prevent violence. |
Association of a postnatal parent education program for abusive head trauma with subsequent pediatric abusive head trauma hospitalization rates
Dias MS , Rottmund CM , Cappos KM , Reed ME , Wang M , Stetter C , Shaffer ML , Hollenbeak CS , Paul IM , Christian CW , Berger RP , Klevens J . JAMA Pediatr 2017 171 (3) 223-229 Importance: Studies suggest that a postnatal parental intervention may reduce the incidence of abusive head trauma (AHT) of infants and young children. Objective: To assess the effect of statewide universal AHT education for parents on AHT hospitalization rates in Pennsylvania and on parents' self-reported knowledge gains and parenting behaviors. Design, Setting, and Participants: Changes in AHT hospitalization rates in Pennsylvania before and during the intervention were compared with those in 5 other states lacking universal parental AHT education during the same period. Data were collected from maternity units and birthing centers throughout Pennsylvania from the parents of 1593834 infants born on these units from January 1, 2003, to December 31, 2013. Parental behavior and knowledge were assessed through immediate (n = 16111) and 7-month postintervention (n = 146) parent surveys in a per protocol analysis of evaluable parents. Interventions: Parents read a brochure, viewed an 8-minute video about infant crying and AHT, asked questions of the nurse, and signed a commitment statement affirming their participation. Educational posters were displayed on each unit. Main Outcomes and Measures: Changes in AHT hospitalization rates before and during the intervention in Pennsylvania and 5 other states. Secondary outcomes included self-reported knowledge gains and changes in parenting practices. Results: A total of 1180291 parents (74.1%) of children ranging in age from 0 to 23 months signed a commitment statement. Incidence rate ratios for hospitalization for AHT increased in Pennsylvania from 24.1 (95% CI, 22.1-26.3) to 26.6 (95% CI, 24.9-28.4) per 100000 children aged 0 to 23 months during the intervention period; changes in Pennsylvania were not significantly different from aggregate changes in the 5 other states, from 22.4 (95% CI, 21.2-23.6) to 22.0 (95% CI, 21.2-22.8) per 100000 children aged 0 to 23 months. A total of 16111 parents (21.5% men, 78.5% women) completed the postnatal survey. Despite an overall 74.1% adherence with the intervention, only 20.6% of parents saw the brochure and video and only 5.7% were exposed to the entire intervention. Among the respondents answering individual questions on the postnatal surveys, 10958 mothers (91.0%) and 2950 fathers (88.6%) reported learning a lot about understanding infant crying as normal; 11023 mothers (92.2%) and 2923 fathers (88.9%), calming their infant, 11396 mothers (94.6%) and 3035 fathers (91.9%), calming themselves; 10060 mothers (85.1%) and 2688 fathers (83.4%), selecting other infant caregivers; and 11435 mothers (94.8%) and 3201 fathers (95.8%), that the information would decrease the likelihood of shaking an infant. Among the 143 respondents completing the 7-month survey, 109 (76.2%) reported remembering the information while their child was crying. Conclusions and Relevance: This intervention was not associated with a reduction in pediatric AHT hospitalization rates but was associated with self-reported gains in parental knowledge that were retained for 7 months. |
Precision Medicine Requires Precision Laboratories.
Rajeevan MS , Li T , Unger ER . J Mol Diagn 2017 19 (2) 226-229 This commentary highlights the validation study by Lih et al that supports the use of precision medicine for improved clinical trials. |
A rapid Orthopoxvirus purification protocol suitable for high-containment laboratories
Hughes L , Wilkins K , Goldsmith CS , Smith S , Hudson P , Patel N , Karem K , Damon I , Li Y , Olson VA , Satheshkumar PS . J Virol Methods 2017 243 68-73 Virus purification in a high-containment setting provides unique challenges due to barrier precautions and operational safety approaches that are not necessary in lower biosafety level (BSL) 2 environments. The need for high risk group pathogen diagnostic assay development, anti-viral research, pathogenesis and vaccine efficacy research necessitates work in BSL-3 and BSL-4 labs with infectious agents. When this work is performed in accordance with BSL-4 practices, modifications are often required in standard protocols. Classical virus purification techniques are difficult to execute in a BSL-3 or BSL-4 laboratory because of the work practices used in these environments. Orthopoxviruses are a family of viruses that, in some cases, requires work in a high-containment laboratory and due to size do not lend themselves to simpler purification methods. Current CDC purification techniques of orthopoxviruses uses 1,1,2-trichlorotrifluoroethane, commonly known as Genetron(R). Genetron(R) is a chlorofluorocarbon (CFC) that has been shown to be detrimental to the ozone and has been phased out and the limited amount of product makes it no longer a feasible option for poxvirus purification purposes. Here we demonstrate a new orthopoxvirus purification method that is suitable for high-containment laboratories and produces virus that is not only comparable to previous purification methods, but improves on purity and yield. |
Oxidative stress, DNA methylation, and telomere length changes in peripheral blood mononuclear cells after pulmonary exposure to metal-rich welding nanoparticles
Shoeb M , Kodali VK , Farris BY , Bishop LM , Meighan TG , Salmen R , Eye T , Friend S , Schwegler-Berry D , Roberts JR , Zeidler-Erdely PC , Erdely A , Antonini JM . NanoImpact 2017 5 61-69 Welding fume is a complex mixture of different potentially cytotoxic and genotoxic metals, such as chromium (Cr), manganese (Mn), nickel (Ni), and iron (Fe). Documented health effects have been observed in workers exposed to welding fume. The objective of the study was to use an animal model to identify potential biomarkers of epigenetic changes (e.g., changes in telomere length, DNA methylation) in isolated peripheral blood mononuclear cells (PBMCs) after exposure to different welding fumes. Male Sprague-Dawley rats were exposed by intratracheal instillation (ITI) of 2.0 mg/rat of gas metal arc-mild steel (GMA-MS) or manual metal arc-stainless steel (MMA-SS) welding fume. Vehicle controls received sterile saline by ITI. At 4 h, 14 h, 1 d, 3 d, 10 d, and 30 d, bronchoalveolar lavage (BAL) was performed to assess lung inflammation. Whole blood was collected, and PBMCs were isolated. Dihydroethidium (DHE) fluorescence and 4-hydroxylnonenal protein adduct (P-HNE) formation were measured in PBMCs to assess reactive oxygen species production. DNA alterations in PBMCs were determined by evaluating changes in DNA methylation and telomere length. Metal composition of the two fumes was different: MMA-SS (41% Fe, 29% Cr, 17% Mn, 3% Ni) versus GMA-MS (85% Fe, 14% Mn). The more soluble and chemically complex MMA-SS sample induced a more persistent and greater inflammatory response compared to the other groups. Also, oxidative stress markers increased at 24 h in the PBMCs recovered from the MMA-SS group compared to other group. No significant differences were observed when comparing DNA methylation between the welding fume and control groups at any of the time points, whereas the MMA-SS sample significantly increased telomere length at 1 and 30 d after a single exposure compared to the other groups. These findings suggest that genotoxic (e.g., Cr, Ni) and soluble (e.g, Cr, Mn) metals in MMA-SS fume, that are different from the GMA-MS fume, may enhance lung toxicity, as well as induce markers of oxidative stress and increase telomere length in PBMCs. Importantly, the measurement of telomere length in cells isolated from peripheral blood may serve as a potential biomarker of response in the assessment of toxicity associated with welding fumes. |
Targeting parenting in early childhood: A public health approach to improve outcomes for children living in poverty
Morris AS , Robinson LR , Hays-Grudo J , Claussen AH , Hartwig SA , Treat AE . Child Dev 2017 88 (2) 388-397 In this article, the authors posit that programs promoting nurturing parent-child relationships influence outcomes of parents and young children living in poverty through two primary mechanisms: (a) strengthening parents' social support and (b) increasing positive parent-child interactions. The authors discuss evidence for these mechanisms as catalysts for change and provide examples from selected parenting programs that support the influence of nurturing relationships on child and parenting outcomes. The article focuses on prevention programs targeted at children and families living in poverty and closes with a discussion of the potential for widespread implementation and scalability for public health impact. |
Key program findings and insights from the Baby-Friendly Hawaii Project
Kahin SA , McGurk M , Hansen-Smith H , West M , Li R , Melcher CL . J Hum Lact 2017 33 (2) 890334416683675 BACKGROUND: Breastfeeding is the optimal method for infant feeding. In the United States, 81.1% of mothers initiate breastfeeding; however, only 44.4% and 22.3% of mothers are exclusively breastfeeding at 3 and 6 months, respectively. Research aim: The Centers for Disease Control and Prevention provides guidance and funding to state health departments to support strategies to improve breastfeeding policies and practices in the hospital, community, and worksite settings. In 2010, the Hawaii State Department of Health received support from the Centers for Disease Control and Prevention to launch the Baby-Friendly Hawaii Project (BFHP) to increase the number of Hawaii hospitals that provide maternity care consistent with the Ten Steps to Successful Breastfeeding and increase the rate of women who remain exclusively breastfeeding throughout their hospital stay. METHODS: For this article, we examined the BFHP's final evaluation report and Hawaii breastfeeding and maternity care data to identify the role of the BFHP in facilitating improvements in maternity care practices and breastfeeding rates. RESULTS: Since 2010, 52 hospital site visits, 58 trainings, and ongoing technical assistance were administered, and more than 750 staff and health professionals from BFHP hospitals were trained. Hawaii's overall quality composite Maternity Practices in Infant Nutrition and Care score increased from 65 (out of 100) in 2009 to 76 in 2011 and 80 in 2013, and Newborn Screening Data showed an increase in statewide exclusive breastfeeding from 59.7% in 2009 to 77.0% in 2014. CONCLUSION: Implementation and findings from the BFHP can inform future planning at the state and federal levels on maternity care practices that can improve breastfeeding. |
Unanticipated multiple seam stresses from pillar systems behaving as pseudo gob–case histories
Gauna M , Mark C . Int J Min Sci Technol 2017 27 (1) 131-137 Underground coal mining in the U.S. is conducted in numerous regions where previous workings exist above and/or below an actively mined seam. Miners know that overlying or underlying fully extracted coal areas, also known as gob regions, can result in abutment stresses that affect the active mining. If there was no full extraction, and the past mining consists entirely of intact pillars, the stresses on the active seam are usually minimal. However, experience has shown that in some situations there has been sufficient yielding in overlying or underlying pillar systems to cause stress transfer to the adjoining larger pillars or barriers, which in turn, transfer significant stresses onto the workings of the active seam. In other words, the overlying or underlying pillar system behaves as a “pseudo gob.” The presence of a pseudo gob is often unexpected, and the consequences can be severe. This paper presents several case histories, summarized briefly below, that illustrate pseudo gob phenomenon: (1) pillar rib degradation at a West Virginia mine at 335 m depth that contributed to a rib roll fatality, (2) pillar rib deterioration at a Western Kentucky mine at 175 m depth that required pillar size adjustment and installation of supplemental bolting, (3) roof deterioration at an eastern Kentucky mine at 400 m depth that stopped mine advance and required redirecting the section development, (4) coal burst on development at an eastern Kentucky mine at 520 m depth that had no nearby pillar recovery, and (5) coal burst on development at a West Virginia mine at the relatively shallow depth of 335 m that also had no nearby pillar recovery. The paper provides guidance so that when an operation encounters a potential pseudo gob stress interaction the hazard can be mitigated based on an understanding of the mechanism encountered. |
Preventing roof fall fatalities during pillar recovery: A ground control success story
Mark C , Gauna M . Int J Min Sci Technol 2017 27 (1) 107-113 For decades, pillar recovery accounted for a quarter of all roof fall fatalities in underground coal mines. Studies showed that a miner on a pillar recovery section was at least three times more likely to be killed by a roof fall than other coal miners. Since 2007, however, there has been just one fatal roof fall on a pillar line. This paper describes the process that resulted in this historic achievement. It covers both the key research findings and the ways in which those insights, beginning in the early 2000s, were implemented in mining practice. One key finding was that safe pillar recovery requires both global and local stability. Global stability is addressed primarily through proper pillar design, and became a major focus after the 2007 Crandall Canyon mine disaster. But the most significant improvements resulted from detailed studies that showed that local stability, defined as roof control in the immediate work area, could be achieved with three interventions: (1) leaving an engineered final stump, rather than extracting the entire pillar, (2) enhancing roof bolt support, particularly in intersections, and (3) increasing the use of mobile roof supports (MRS). A final component was an emphasis on better management of pillar recovery operations. This included a focus on worker positioning, as well as on the pillar and lift sequences, MRS operations, and hazard identification. As retreat mines have incorporated these elements into their roof control plans, it has become clear that pillar recovery is not “inherently unsafe.” The paper concludes with a discussion of the challenges that remain, including the problems of rib falls and coal bursts. |
Association of neighbourhood food availability with the consumption of processed and ultra-processed food products by children in a city of Brazil: a multilevel analysis
Leite FH , de Carvalho Cremm E , de Abreu DS , Oliveira MA , Budd N , Martins PA . Public Health Nutr 2017 21 (1) 1-12 OBJECTIVE: To investigate the association between neighbourhood food availability and the consumption of ready-to-consume products (RCP), either processed or ultra-processed, and unprocessed/minimally processed foods (UF-MPF) by children. DESIGN: Cross-sectional. 24 h Dietary recalls were collected from children from January 2010 to June 2011. Neighbourhood food availability data were collected from 672 food stores located within 500 m of participants' homes, using an adapted and validated instrument. Neighbourhood-level socio-economic status (SES) was obtained by calculating the mean years of household head's education level in each census tract covered by 500 m buffers. Foods that were consumed by children and/or available in the food stores were classified based on their degree of industrial processing. Multilevel random-effect models examined the association between neighbourhood food availability and children's diets. SETTING: Santos, Brazil. SUBJECTS: Children (n 513) under 10 years old (292 aged <6 years, 221 aged ≥6 years). RESULTS: The availability of RCP in food stores was associated with increased RCP consumption (P<0.001) and decreased UF-MPF consumption (P<0.001). The consumption of UF-MPF was positively associated with neighbourhood-level SES (P<0.01), but not with the availability of UF-MPF in the neighbourhood. CONCLUSIONS: Results suggest that food policies and interventions that aim to reduce RCP consumption in Santos and similar settings should focus on reducing the availability in food stores. The results also suggest that interventions should not only increase the availability of UF-MPF in lower-SES neighbourhoods, but should strive to make UF-MPF accessible within these environments. |
Outbreak investigation of Plasmodium vivax malaria in a region of Guatemala targeted for malaria elimination
Cohen R , Sarceno Cardona J , Solares Navarro E , Padilla N , Reyes L , Javier Pinto Villar R , Masuoka P , Bernart C , Peruski LF , Bryan JP . Am J Trop Med Hyg 2017 96 (4) 819-825 The Department of Santa Rosa, Guatemala, is targeted for malaria elimination. However, compared with 2011, a 13-fold increase in cases was reported in 2012. To describe the epidemiology of malaria in Santa Rosa in the setting of the apparent outbreak, demographic and microscopic data from 2008 to 2013 were analyzed. In April 2012, a new surveillance strategy, funded by the Global Fund to Fight AIDS, Tuberculosis and Malaria, was introduced involving more active case detection, centralized microscopy, increased community engagement, and expanded vector control. Interviews with vector control personnel and site visits were conducted in June 2013. From 2008 to 2013, 337 cases of malaria were reported. The increase in cases occurred largely after the new surveillance strategy was implemented. Most (137/165; 83%) 2012 cases came from one town near a lake. Plasmodium vivax was the malaria species detected in all cases. Cases were detected where malaria was not previously reported. Monthly rainfall or/and temperature did not correlate with cases. Interviews with public health personnel suggested that the new funding, staffing, and strategy were responsible for improved quality of malaria detection and control and thus the increase in reported cases. Improvements in surveillance, case detection, and funding appear responsible for the temporary increase in cases, which thus may paradoxically indicate progress toward elimination. |
Structured mentoring for workforce engagement and professional development in public health settings
Dopson SA , Griffey S , Ghiya N , Laird S , Cyphert A , Iskander J . Health Promot Pract 2017 18 (3) 1524839916686927 Mentoring is commonly used to facilitate professional growth and workforce development in a variety of settings. Organizations can use mentoring to help achieve broader personnel goals including leadership development and succession planning. While mentorship can be incorporated into training programs in public health, there are other examples of structured mentoring, with time commitments ranging from minutes to months or longer. Based on a review of the literature in public health and aggregated personal subject matter expertise of existing programs at the Centers for Disease Control and Prevention, we summarize selected mentoring models that vary primarily by time commitments and meeting frequency and identify specific work situations to which they may be applicable, primarily from the federal job experience point of view. We also suggest specific tasks that mentor-mentee pairs can undertake, including review of writing samples, practice interviews, and development of the mentee's social media presence. The mentor-mentee relationship should be viewed as a reciprocally beneficial one that can be a source of learning and personal growth for individuals at all levels of professional achievement and across the span of their careers. |
Long-acting reversible contraception
Curtis KM , Peipert JF . N Engl J Med 2017 376 (5) 461-468 A 17-year-old high school student who has never been pregnant presents for advice regarding contraception. She has an unremarkable medical history and is planning to become sexually active with her boyfriend in the near future. Her primary concern is an unintended pregnancy, and she inquires about methods of contraception that are highly effective. How would you counsel her about options for contraception? | Unintended pregnancies are a difficult public health problem for clinicians and policy makers. After three decades of minimal change in the rate of unintended pregnancy in the United States among adolescents and women, the rate has decreased in recent years — from 54 unintended pregnancies per 1000 adolescents and women 15 to 44 years of age in 2008 to 45 cases per 1000 adolescents and women in 2011.1 However, the most recent U.S. data still indicate that 45% of all pregnancies in the United States are unintended, as compared with 34% in Western Europe.1,2 Unintended pregnancies are associated with an increased risk of adverse reproductive outcomes and sociodemographic challenges; contraception is a primary means of prevention. Overall, between 2011 and 2013, a total of 62% of all women 15 to 44 years of age reported current use of contraception.3,4 However, the most highly effective, reversible methods — intrauterine devices (IUDs) and hormonal implants — were being used by only a small proportion of the women who reported using contraceptives between 2011 and 2013. A comparison of the use of IUDs and hormonal implants between 2002 and 2011–2013 showed that the use of IUDs increased from 2% to 10% and the use of implants increased from 0.4% to 1% (Fig. S1 in the Supplementary Appendix, available with the full text of this article at NEJM.org).3,4 Increasing access to these most effective, reversible methods of contraception is a key strategy to further decrease the rate of unintended pregnancy in the United States. |
Healthcare provider attitudes regarding contraception for women with obesity
Jatlaoui TC , Zapata LB , Curtis KM , Folger SG , Marchbanks PA , Mandel MG , Jamieson DJ . J Womens Health (Larchmt) 2017 26 (8) 870-877 BACKGROUND: Whether providers who regularly provide family planning services consider contraceptive methods as unsafe for women with obesity is unknown. METHODS: We analyzed questionnaire responses received from December 2009 to March 2010 from 635 office-based physicians and 1323 Title X clinic providers delivering family planning services, who were randomly sampled (response rate 65%) before the release of national evidence-based contraception guidelines. We examined provider and clinical setting characteristics and clinic patient demographics for association with provider misconceptions about safety of combined oral contraceptives (COCs), depot medroxyprogesterone acetate (DMPA), or intrauterine devices (IUDs) for women with obesity. If providers considered methods as unsafe or do not know, we categorized those responses as misconceptions. We used multivariable logistic regression to estimate adjusted odds ratios (aORs) and 95% confidence intervals (CIs). RESULTS: A substantial proportion of respondents had misconceptions about the safety of COCs (31%), DMPA (24%), copper (Cu) (18%), and levonorgestrel (LNG)-IUDs (16%) for women with obesity. Provider type was associated with increased odds of misconceptions for all four methods compared with office-based obstetrician/gynecologists. Not having the method available onsite was associated with safety misconceptions of DMPA (aOR 1.90, 95% CI 1.07-3.36), Cu-IUD (aOR 4.19, 95% CI 1.51-11.61), and LNG-IUD (aOR 5.25, 95% CI 1.67-16.49). CONCLUSION: While the majority of providers considered all four contraceptive methods safe for women with obesity, substantial proportions had misconceptions about safety of COCs, DMPA, and IUDs. Provider education, particularly among certain specialties, is needed to increase knowledge regarding moderate and highly effective contraceptive methods among this patient population. |
Characteristics of US travelers to Zika virus-affected countries in the Americas, March 2015-October 2016
Lammert S , Walker AT , Erskine S , Rao SR , Esposito DH , Ryan ET , Robbins GK , LaRocque RC . Emerg Infect Dis 2017 23 (2) 324-327 Zika virus has recently been introduced to the Americas and is spreading rapidly. We evaluated the characteristics of US travelers to Zika virus-affected countries who were seen at Global TravEpiNet sites during March 2015-October 2016. Nearly three quarters of travelers were men or women of reproductive age. |
Clinician survey to determine knowledge of dengue and clinical management practices, Texas, 2014
Adam JK , Abeyta R , Smith B , Gaul L , Thomas DL , Han G , Sharp TM , Waterman SH , Tomashek KM . Am J Trop Med Hyg 2017 96 (3) 708-714 Dengue, a mosquito-borne viral disease, is increasingly being identified as a cause of outbreaks in the United States. During July-December 2013, a total of three south Texas counties reported 53 laboratory-confirmed dengue cases; 26 were locally acquired, constituting the largest outbreak in Texas since 2005. Because dengue outbreaks are expected to continue in south Texas and early case identification and timely treatment can reduce mortality, we sought to determine clinicians' knowledge of dengue and its clinical management. A survey was sent to 2,375 south Texas clinicians; 217 (9%) completed the survey. Approximately half of participants demonstrated knowledge needed to identify dengue cases, including symptoms (56%), early indicators of shock (54%), or timing of thrombocytopenia (48%). Fewer than 20% correctly identified all prevention messages, severe dengue warning signs, or circumstances in which a dengue patient should return for care. Knowledge of clinical management was limited; few participants correctly identified scenarios when plasma leakage occurred (10%) or a crystalloid solution was indicated (7%); however, 45% correctly identified when a blood transfusion was indicated. Because of the ongoing threat of dengue, we recommend clinicians in south Texas receive dengue clinical management training. |
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CDC Science Clips is an online, continuously updated, searchable database of scientific literature published by CDC authors. Each article features an Altmetric Attention Score to track social and mainstream media mentions. If you are aware of a CDC-authored publication that does not appear in this database, please let us know.
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