Candida auris Admission Screening Pilot in Select Units of New York City Healthcare Facilities, 2017-2019.
Rowlands J , Dufort E , Chaturvedi S , Zhu Y , Quinn M , Bucher C , Erazo R , Haley V , Kuang J , Ostrowsky B , Southwick K , Vallabhaneni S , Greenko J , Tserenpuntsag B , Blog D , Lutterloh E . Am J Infect Control 2023 51 (8) 866-870 BACKGROUND: This pilot project implemented admission screening for Candida auris (C. auris) using real-time polymerase chain reaction (rt-PCR) in select high-risk units within health care facilities in New York City. METHODS: An admission screening encounter consisted of collecting 2 swabs, to be tested by rt-PCR, and a data collection form for individuals admitted to ventilator units at 2 nursing homes (NHA and NHB), and the ventilator/pulmonary unit, intensive care unit, and cardiac care unit at a hospital (Hospital C) located in New York City from November 2017 to November 2019. RESULTS: C. auris colonization was identified in 6.9% (n = 188/2,726) of admissions to participating units. Rates were higher among admissions to NHA and NHB (20.7% and 22.0%, respectively) than Hospital C (3.6%). Within Hospital C, the ventilator/pulmonary unit had a higher rate (5.7%) than the intensive care unit (3.8%) or cardiac care unit (2.5%). DISCUSSION: Consistent with prior research, we found that individuals admitted to ventilator units were at higher risk of C. auris colonization. CONCLUSIONS: This project demonstrates the utility of admission screening using rt-PCR testing to rapidly identify C. auris colonization among admissions to health care facilities so that appropriate transmission-based precautions and control measures can be implemented rapidly to help decrease transmission. |
HIV virologic response, patterns of drug resistance mutations and correlates among adolescents and young adults: A cross-sectional study in Tanzania.
Rugemalila J , Kamori D , Kunambi P , Mizinduko M , Sabasaba A , Masoud S , Msafiri F , Mugusi S , Mutagonda R , Mlunde L , Amani D , Mboya E , Mahiti M , Ruhago G , Mushi J , Sambu V , Mgomella G , Jullu B , Maokola W , Njau P , Mutayoba B , Barabona G , Ueno T , Pembe A , Nagu T , Sunguya B , Aboud S . PLoS One 2023 18 (2) e0281528 BACKGROUND: The emergence of HIV drug resistance mutations (DRMs) is of significant threat to achieving viral suppression (VS) in the quest to achieve global elimination targets. We hereby report virologic outcomes and patterns of acquired DRMs and its associated factors among adolescents and young adults (AYA) from a broader HIV drug resistance surveillance conducted in Tanzania. METHODS: Data of AYA was extracted from a cross-sectional study conducted in 36 selected facilities using a two-stage cluster sampling design. Dried blood spot (DBS) samples were collected and samples with a viral load (VL) ≥1000 copies/mL underwent genotyping for the HIV-1 pol gene. Stanford HIV database algorithm predicted acquired DRMs, Fisher's exact test and multivariable logistic regression assessed factors associated with DRMs and VS, respectively. FINDINGS: We analyzed data of 578 AYA on antiretroviral therapy (ART) for 9-15 and ≥ 36 months; among them, 91.5% and 88.2% had VS (VL<1000copies/mL) at early and late time points, respectively. Genotyping of 64 participants (11.2%) who had VL ≥1000 copies/ml detected 71.9% of any DRM. Clinically relevant DRMs were K103N, M184V, M41L, T215Y/F, L210W/L, K70R, D67N, L89V/T, G118R, E138K, T66A, T97A and unexpectedly absent K65R. Participants on a protease inhibitor (PI) based regimen were twice as likely to not achieve VS compared to those on integrase strand transfer inhibitors (INSTI). The initial VL done 6 months after ART initiation of ≥1000copies/mL was the primary factor associated with detecting DRMs (p = .019). CONCLUSIONS: VS amongst AYA is lower than the third UNAIDs target. Additionally, a high prevalence of ADR and high levels of circulating clinically relevant DRMs may compromise the long-term VS in AYA. Furthermore, the first VL result of ≥1000copies/ml after ART initiation is a significant risk factor for developing DRMs. Thus, strict VL monitoring for early identification of treatment failure and genotypic testing during any ART switch is recommended to improve treatment outcomes for AYA. |
Comparison of outpatient antibiotic prescriptions among older adults in IQVIA Xponent and publicly available Medicare Part D data, 2018
Beshearse EM , Gouin KA , Fleming-Dutra KE , Tsay S , Hicks LA , Kabbani S . Antimicrob Steward Healthc Epidemiol 2023 3 (1) e32 The distributions of antibiotic prescriptions by geography, antibiotic class, and prescriber specialty are similar in the US Centers for Medicare and Medicaid Services (CMS) Part D Prescriber Public Use Files and IQVIA Xponent dataset. Public health organizations and healthcare systems can use these data to track antibiotic use and guide antibiotic stewardship interventions for older adults. |
Recommended and prevalent use of glucagon-like peptide-1 receptor agonists and sodium-glucose cotransporter-2 inhibitors in a national population-based sample
Tang S , Shao H , Ali MK , Zhang P . Ann Intern Med 2023 176 (4) 582-583 Background: The 2022 consensus report from the American Diabetes Association and European Association for the Study of Diabetes recommended using glucagon-like peptide-1 receptor agonists (GLP-1 RAs) among persons with type 2 diabetes (T2D) who have established or are at high risk for atherosclerotic cardiovascular disease (ASCVD), and using sodium–glucose cotransporter-2 inhibitors (SGLT2is) among those with T2D who have established ASCVD, chronic kidney disease, or heart failure or are at high risk for ASCVD (level A evidence) (1). | | Objective: To estimate, using nationally representative data, the number and percentage of persons with T2D who would meet the recommended criteria and were using these medications in the United States. |
The value of the Nutrition and Obesity Policy Research and Evaluation Network in advancing the evidence base for effective nutrition and obesity policy: assessment using the Consolidated Framework for Collaborative Research
Vasquez T , Levi R , Akers M , Lowry-Warnock A , Blanck HM , Seligman H . BMC Public Health 2023 23 (1) 375 INTRODUCTION: Addressing nutrition disparities and preventing obesity require multi-level interventions, including policies that address the nutrition environment and other social determinants of health. The Nutrition and Obesity Policy Research Evaluation Network (NOPREN) was established in 2009 to conduct transdisciplinary research and accelerate the translation and implementation of science-based policy interventions. This study examined NOPREN's collaborative practices and identified opportunities to improve network impact. METHODS: Using a mixed-methods approach, we combined quantitative survey data (n = 106) and in-depth, qualitative interviews (n = 18) to evaluate the experiences of NOPREN members and understand the extent to which NOPREN was achieving its goals. RESULTS: Using the Consolidated Framework for Collaborative Research (CFCR), quantitative and qualitative results were organized into 11 themes. We find that NOPREN's structure and standardized processes facilitate connections to individuals and resources, foster relationships, and support effective cross-sector collaborations. Areas of improvement include capacity building and a more intentional approach towards recruitment of a diverse membership. CONCLUSION: A collaborative research network can build synergy across sectors and accelerate knowledge transfer. These findings will be used to inform the network's strategic priorities to maximize impact. Findings may also inform similar collaborative efforts for addressing complex public health problems. |
Evaluation of the health information system for monitoring and evaluating the voluntary medical male circumcision program in Mozambique, 2013-2019
Elias HI , Langa JC , Braga JM , Nukeri Z , Rossetto EV , Baltazar CS . Pan Afr Med J 2022 42 (no pagination) 236 Introduction: the prevalence of human immunodeficiency virus (HIV) in Mozambique has increased from 11.5% in 2009 to 13.2% in 2015. The Mozambique Ministry of Health (MOH) developed a 5-year strategy (2013-2017) for male voluntary medical circumcision (VMMC) to increase in the provinces where there is the greatest number of HIV. We aimed to evaluate the health information system for monitoring and evaluating VMMC in Mozambique from 2013-2019. Method(s): we reviewed the records of the National Health Information System for Monitoring and Evaluation (SIS-MA) database for VMMC of the MOH. The evaluation was based on the updated guidelines for the evaluation of public health surveillance systems of the Centers for Disease Control and Prevention. Result(s): the coverage rate for VMMC in Mozambique in the period under study was (89%) (1,784,335/2,000,000). The system was expected to circumcise for the year 2019 (162,052) and 390,590 was reached, exceeding the target 241.0% (390,590/162,052). Of the total number of men circumcised, 0.7% (12,391/1,784,335) were HIV-positive (previously tested) and 0.4% (6,382/1,784,335) had a record of adverse events in the period under review (2013-2019). Zambezia Province had the highest VMMC coverage (in numbers) at 16.0% (396,876/2,476,395) while Maputo City had the least 19.7% (107,104/543,096). The system was able to operate both online and offline and continue functioning with introducing new changes (e.g. the new male circumcision complication reporting). Conclusion(s): the system was representative, flexible, simple, with good data quality and low acceptability. We recommended continuous and routine entry of quality data into the system, guide organizations for improved functioning. Copyright © 2022, African Field Epidemiology Network. All rights reserved. |
Accelerating HIV epidemic control in Benue state, Nigeria, 2019-2021: the APIN program experience
Jwanle P , Ibiloye O , Obaje M , Ngwoke K , Usha T , Amoo O , Ogunsola O , Okezie U , Olaitan R , Ofuche E , Onwuatuelo I , Samuels J , Fagbamigbe J , Nwagagbo F , Ogbanufe O , Okoye M , Okonkwo P . Ther Adv Infect Dis 2023 10 20499361231153549 INTRODUCTION: As at 2019, Nigeria was ranked the fourth highest HIV burden in the world. There is varied geographical HIV prevalence in Nigeria. The progress made is inequitable across geographical locations and sub-populations (18). Benue state has the second highest HIV prevalence in Nigeria. In 2018, about 35,623 people living with HIV (PLHIV) were yet to commence antiretroviral treatment (ART) in the state, accounting for an estimated ART coverage gap of 11% out of the combined gap of 320,921 in the country. To close this gap, the Benue ART surge (BAS) was implemented. The aim of this study was to describe the BAS strategic approaches and demonstrate progress in expanding ART access for PLHIV in Benue State, Nigeria. METHODS: BAS was implemented in 252 health facilities from May 2019 to September 2021. Data were collected and reported using an Excel-based dashboard and electronic medical records. The trend of HIV case identification, ART initiation, viral load suppression rate, and rate of interruption in treatment during the BAS period was then described and analyzed. RESULTS: Out of 893,462 clients reached, 6.7% (n = 60,297) were diagnosed with HIV and 99.8% (n = 60,236) were initiated on ART. HIV case identification per month increased by 467% from 650 at baseline to a peak of 3685 in August 2020, and then declined by 35% to 2380 in September 2021. All new HIV-infected patients (100%) were linked to ART. Viral load testing coverage and viral load suppression rate increased from 30% (43,185/126,004) and 84% (n = 36,165/43,185) at baseline to 95% (n = 193,890/204,095) and 96% (185,785/193,890), respectively. CONCLUSION: Implementation of the BAS improved access to comprehensive HIV services in Benue State. The increase in HIV case identification and ART initiation significantly reduced the HIV treatment gap in the state. To fast track the attainment of UNAIDS 95-95-95 goals, lessons learnt from the BAS should be adapted and scaled up in the national HIV program in Nigeria. |
Effect of predeparture testing on postarrival SARS-CoV-2-positive test results among international travelers - CDC traveler-based genomic surveillance program, four U.S. Airports, March-September 2022
Bart SM , Smith TC , Guagliardo SAJ , Walker AT , Rome BH , Li SL , Aichele TWS , Stein R , Ernst ET , Morfino RC , Cetron MS , Friedman CR . MMWR Morb Mortal Wkly Rep 2023 72 (8) 206-209 Beginning December 6, 2021, all international air passengers boarding flights to the United States were required to show either a negative result from a SARS-CoV-2 viral test taken ≤1 day before departure or proof of recovery from COVID-19 within the preceding 90 days (1). As of June 12, 2022, predeparture testing was no longer mandatory but remained recommended by CDC (2,3). Various modeling studies have estimated that predeparture testing the day before or the day of air travel reduces transmission or importation of SARS-CoV-2 by 31%-76% (4-7). Postarrival SARS-CoV-2 pooled testing data from CDC's Traveler-based Genomic Surveillance program were used to compare SARS-CoV-2 test results among volunteer travelers arriving at four U.S. airports during two 12-week periods: March 20-June 11, 2022, when predeparture testing was required, and June 12-September 3, 2022, when predeparture testing was not required. In a multivariable logistic regression model, pooled nasal swab specimens collected during March 20-June 11 were 52% less likely to be positive for SARS-CoV-2 than were those collected during June 12-September 3, after adjusting for COVID-19 incidence in the flight's country of origin, sample pool size, and collection airport (adjusted odds ratio [aOR] = 0.48, 95% CI = 0.39-0.58) (p<0.001). These findings support predeparture testing as a tool for reducing travel-associated SARS-CoV-2 transmission and provide important real-world evidence that can guide decisions for future outbreaks and pandemics. |
Estimating the impact of HIV PrEP regimens containing long-acting injectable cabotegravir or daily oral tenofovir disoproxil fumarate/emtricitabine among men who have sex with men in the United States: a mathematical modelling study for HPTN 083
Mitchell KM , Boily MC , Hanscom B , Moore M , Todd J , Paz-Bailey G , Wejnert C , Liu A , Donnell DJ , Grinsztejn B , Landovitz RJ , Dimitrov DT . Lancet Reg Health Am 2023 18 100416 BACKGROUND: The HPTN 083 trial demonstrated superiority of HIV pre-exposure prophylaxis (PrEP) containing long-acting injectable cabotegravir (CAB) to daily oral tenofovir disoproxil fumarate/emtricitabine (TDF/FTC) among men who have sex with men (MSM). We compared the potential population-level impact of TDF/FTC and CAB among MSM in Atlanta, Georgia. METHODS: An MSM HIV transmission model was calibrated to Atlanta-specific data on HIV prevalence and PrEP usage (percentage of uninfected MSM on PrEP), assuming only PrEP-indicated MSM used PrEP. CAB effectiveness (efficacy × adherence) of 91% was estimated using data from HPTN 083 and previous TDF/FTC trials. We estimated HIV infections averted over 5/10 years if TDF/FTC use were maintained, or if all TDF/FTC users switched to CAB in January 2022 (vs. no PrEP or continued TDF/FTC use). CAB scenarios with 10%/20% more users were also considered. Progress towards Ending the HIV Epidemic (EHE) goals (75%/90% fewer HIV infections in 2025/2030 vs. 2017) was estimated. FINDINGS: We predicted TDF/FTC at current usage (∼28%) would avert 36.3% of new HIV infections (95% credible interval 25.6-48.7%) among all Atlanta MSM over 2022-2026 vs. no PrEP. Switching to CAB with similar usage may prevent 44.6% (33.2-56.6%) infections vs. no PrEP and 11.9% (5.2-20.2%) infections vs. continued TDF/FTC. Increasing CAB usage 20% could increase the incremental impact over TDF/FTC to 30.0% over 2022-2026, getting ∼60% towards reaching EHE goals (47%/54% fewer infections in 2025/2030). Reaching the 2030 EHE goal would require 93% CAB usage. INTERPRETATION: If CAB effectiveness were like HPTN 083, CAB could prevent more infections than TDF/FTC at similar usage. Increased CAB usage could contribute substantially towards reaching EHE goals, but the usage required to meet EHE goals is unrealistic. FUNDING: NIH, MRC. |
Hantavirus pulmonary syndrome: 1993-2018
Thorp L , Fullerton L , Whitesell A , Dehority W . Pediatrics 2023 151 (4) OBJECTIVES: From 1993 to 2018, hantavirus infections were reported in 39 states, with hantavirus pulmonary syndrome (HPS) as the most common and fatal manifestation. To identify differences in the presentation of HPS between children and adults, we hypothesized that children with HPS would be diagnosed later in their illness course given the nonspecific clinical features of HPS. METHODS: This was an evaluation of the clinical and demographic characteristics of national HPS cases from 1993 to 2018. Data were from the Centers for Disease Control and Prevention database and 1 state department of health, comprising 97% of US cases. We compared children (0 to 12 years), adolescents (13 to 18 years), and adults using nonparametric and parametric analyses, with additional exploratory analyses to identify clinical variables associated with mortality. RESULTS: Among 719 HPS patients, 22 (3.0%) were aged ≤12 years, 47 (6.5%) were 13 to 18 years old, and the remaining 650 (90.4%) were adults. Overall mortality was 35.4% and did not differ between age groups (P = .8). The time between symptom onset and death differed by age group, with children living a median of 2 days (interquartile range [IQR] 2 to 3), adolescents 4 days (IQR 3 to 5), and adults 5 days (IQR 4 to 8; P = .001). The mean highest hematocrit and median highest creatinine level were significantly associated with mortality in those 0 to 18 years old but not adults. CONCLUSIONS: In our dataset representing the largest study of HPS in the United States, we found that children with HPS died more quickly than adults and that highest hematocrit and creatinine levels were associated with death only among those <19 years old. |
Preschool-aged household contacts as a risk factor for viral respiratory infections in healthcare personnel
Most ZM , Nyquist AC , Radonovich LJ , Rodriguez-Barradas MC , Price CS , Simberkoff MS , Bessesen MT , Cummings DAT , Rattigan SM , Warren-Gash C , Gaydos CA , Gibert CL , Gorse GJ , Perl TM . Open Forum Infect Dis 2023 10 (2) ofad057 BACKGROUND: Viral respiratory infections (VRIs) are common and are occupational risks for healthcare personnel (HCP). VRIs can also be acquired at home and other settings among HCPs. We sought to determine if preschool-aged household contacts are a risk factor for VRIs among HCPs working in outpatient settings. METHODS: We conducted a secondary analysis of data from a cluster randomized trial at 7 medical centers in the United States over 4 influenza seasons from 2011-2012 to 2014-2015. Adult HCPs who routinely came within 6 feet of patients with respiratory infections were included. Participants were tested for respiratory viruses whenever symptomatic and at 2 random times each season when asymptomatic. The exposure of interest was the number of household contacts 0-5 years old (preschool-aged) at the beginning of each HCP-season. The primary outcome was the rate of polymerase chain reaction-detected VRIs, regardless of symptoms. The VRI incidence rate ratio (IRR) was calculated using a mixed-effects Poisson regression model that accounted for clustering at the clinic level. RESULTS: Among the 4476 HCP-seasons, most HCPs were female (85.4%) and between 30 and 49 years of age (54.6%). The overall VRI rate was 2.04 per 100 person-weeks. In the adjusted analysis, HCPs having 1 (IRR, 1.22 [95% confidence interval {CI}, 1.05-1.43]) and ≥2 (IRR, 1.35 [95% CI, 1.09-1.67]) preschool-aged household contacts had higher VRI rates than those with zero preschool-aged household contacts. CONCLUSIONS: Preschool-aged household contacts are a risk factor for developing VRIs among HCPs working in outpatient settings. |
Symptoms and systemic drug reactions in persons receiving weekly rifapentine plus isoniazid (3HP) treatment for latent tuberculosis infection
Sadowski C , Belknap R , Holland DP , Moro RN , Chen MP , Wright A , Millet JP , Cayla JA , Scott NA , Borisov A , Gandhi NR . Clin Infect Dis 2023 76 (12) 2090-2097 BACKGROUND: Three months of weekly rifapentine plus isoniazid (3HP) therapy for latent tuberculosis infections (LTBI) is recommended worldwide. The development of symptoms and systemic drug reactions (SDR) on 3HP have not been fully characterized. We aimed to determine the patterns of symptom development and identify SDR and associated factors in patients on 3HP. METHODS: We analyzed symptoms data in participants undergoing 3HP in Tuberculosis Trials Consortium's (TBTC) iAdhere study (Study 33). We examined the patterns of symptom reporting across participants from baseline and four monthly visits. Bivariate analyses and multivariable regression models were used to identify factors associated with SDR. Risk ratios and 95% confidence intervals (CI) were calculated. RESULTS: Among 1,002 participants receiving 3HP, 768 (77%) reported at least one symptom; 97% of these symptoms were grade 1 (79%) or grade 2 (18%). Most symptoms developed in the first month and resolved. 111 (11%) participants had symptoms that met criteria for SDR; however, 53 (48%) of these participants completed therapy. Factors associated with SDR and discontinuation included female sex (RR 2.05, CI: 1.19-3.54), age ≥45 years (RR 1.99, CI: 1.19-3.31), and use of concomitant medications (RR 2.26, CI: 1.15-4.42). CONCLUSIONS: Although most patients receiving 3HP reported symptoms, most were mild, occurred early, and resolved without stopping treatment. Among patients experiencing SDR, nearly half were able to complete therapy. Patient and provider education should focus on differentiating severe reactions where 3HP should be stopped from minor symptoms that will resolve. |
Qualitative conceptual content analysis of COVID-19 vaccine administration error inquiries
Hall E , Odafe S , Madden J , Schillie S . Vaccines (Basel) 2023 11 (2) The launch of the COVID-19 vaccination program was the largest vaccination campaign in U.S. history, with an unprecedented demand for vaccine and new vaccination providers, warranting significant education and communication efforts. NIP-INFO (nipinfo@cdc.gov) is the Centers for Disease Control and Prevention's (CDC's) immunization inquiry response service, and it receives inquiries for COVID-19 and routine non-COVID vaccines. A qualitative analysis of NIP-INFO's content was performed to better characterize and understand some of the knowledge gaps and reasons that COVID-19 vaccine administration errors occur. A total of 734 COVID-19 vaccine administration error inquiries were received between January 2021 and April 2022. The most frequent inquiries related to storage (n = 191; 26.0%), incorrect dosage or product (n = 190; 25.9%), unauthorized age group (n = 108; 14.7%), and schedule (n = 105; 14.3%). Training and communication strategies are imperative to ensure proper vaccine administration and build and maintain vaccine confidence. |
What happens in Vegas, stays in your lungs: an assessment of fine particulate matter in casinos that prohibit and allow smoking in Las Vegas, Nevada, USA
Tynan MA , Cohen MA , Harris JR . Tob Control 2023 INTRODUCTION: Despite progress in adoption of smoke-free policies, smoking in casinos is allowed in some US states, including Nevada. In 2020, for the first time, a resort-style casino in Las Vegas prohibited smoking voluntarily. This study is the first to assess air quality in this casino and compare results with similar casinos that allow smoking. METHODS: A real-time personal aerosol monitor evaluated particulate matter with a diameter <2.5 µm (PM2.5), a surrogate for secondhand smoke (SHS). PM2.5 was measured at eight Las Vegas casinos, including the smoke-free casino. Each casino was visited twice, and PM2.5 was assessed in smoking-permitted gaming areas and areas where smoking is otherwise prohibited. RESULTS: Average PM2.5 levels were significantly higher in casinos that allow smoking, for both casino gaming areas and areas where smoking is otherwise prohibited (p<0.05). Mean PM2.5 in gaming areas was 164.9 µg/m(3) in casinos that allow smoking and 30.5 µg/m(3) in the smoke-free casino. Mean PM2.5 in areas where smoking is otherwise prohibited was 83.2 µg/m(3) in casinos which allowed smoking in gaming areas, and 48.1 µg/m(3) in the smoke-free casino. CONCLUSION: Despite robust evidence about the harms of SHS, tens of thousands of casino employees and tens of millions of tourists are exposed to high levels of SHS in Las Vegas casinos annually, with PM2.5 levels 5.4 times higher in gaming areas when compared with a smoke-free casino. The only way to protect people from SHS exposure is to prohibit smoking in all indoor areas. |
Notes from the Field: Aircraft Wastewater Surveillance for Early Detection of SARS-CoV-2 Variants - John F. Kennedy International Airport, New York City, August-September 2022.
Morfino RC , Bart SM , Franklin A , Rome BH , Rothstein AP , Aichele TWS , Li SL , Bivins A , Ernst ET , Friedman CR . MMWR Morb Mortal Wkly Rep 2023 72 (8) 210-211 As SARS-CoV-2 testing declines worldwide, surveillance of international travelers for SARS-CoV-2 enables detection of emerging variants and fills gaps in global genomic surveillance (1). Because SARS-CoV-2 can be detected in feces and urine of some infected persons (2), wastewater surveillance in airports and on aircraft has been proposed by the global public health community† as a low-cost mechanism to monitor SARS-CoV-2 variants entering the United States. Sampling wastewater directly from aircraft can be used to link SARS-CoV-2 lineage data with flight origin countries without active engagement of travelers (3). | | During August 1–September 9, 2022, the biotech company Ginkgo Bioworks, in collaboration with CDC, evaluated the feasibility of SARS-CoV-2 variant detection in aircraft wastewater from incoming international flights. Aircraft wastewater samples were collected from selected flights from the United Kingdom, Netherlands, and France arriving at John F. Kennedy International Airport in New York City. Wastewater (approximately 0.25 gal [1 L]) was collected from each plane during normal maintenance using a device that attaches to the lavatory service panel port and the lavatory service truck hose. |
Optimizing hierarchical tree dissection parameters using historic epidemiologic data as 'ground truth'.
Jacobson D , Barratt J . PLoS One 2023 18 (2) e0282154 Hierarchical clustering of pathogen genotypes is widely used to complement epidemiologic investigations of outbreaks. Investigators must dissect trees to obtain genetic partitions that provide epidemiologists with meaningful information. Statistical approaches to tree dissection often require a user-defined parameter to predict the optimal partition number and augmenting this parameter can drastically impact resultant partition memberships. Here, we demonstrate how to optimize a given tree dissection parameter to maximize accuracy irrespective of the tree dissection method used. We hierarchically clustered 1,873 genotypes of the foodborne pathogen Cyclospora spp., including 587 possessing links to historic outbreaks. We dissected the resulting tree using a statistical method requiring users to select the value of a 'stringency parameter' (s), with a recommended value of 95% to 99.5%. We dissected this hierarchical tree across s-values from 94% to 99.5% (at increments of 0.25%), to identify a value that maximized partitioning accuracy, defined as the degree to which genetic partitions conform to known epidemiologic groupings. We show that s-values of 96.5% and 96.75% yield the highest accuracy (> 99.9%) when clustering Cyclospora sp. isolates with known epidemiologic linkages. In practice, the optimized s-value will generate robust genetic partitions comprising isolates likely derived from a common food source, even when the epidemiologic grouping is not known prior to genetic clustering. While the s-value is specific to the tree dissection method used here, the optimization approach described could be applied to any parameter/method used to dissect hierarchical trees. |
Genetic characterization of Strongyloides fuelleborni infecting free-roaming African vervets (Chlorocebus aethiops sabaeus) on the Caribbean island of St. Kitts.
Richins T , Sapp SGH , Ketzis JK , Willingham AL , Mukaratirwa S , Qvarnstrom Y , Barratt JLN . Int J Parasitol Parasites Wildl 2023 20 153-161 Human strongyloidiasis is an important neglected tropical disease primarily caused by the nematode Strongyloides stercoralis, and to a lesser extent Strongyloides fuelleborni which mainly infects non-human primates. Zoonotic sources of infection have important implications for control and prevention of morbidity and mortality caused by strongyloidiasis. Recent molecular evidence suggests that for S. fuelleborni, primate host specificity is variable among genotypes across the Old World, and consequently that these types likely vary in their capacity for human spillover infections. Populations of free-roaming vervet monkeys (Chlorocebus aethiops sabaeus), introduced to the Caribbean Island of Staint Kitts from Africa, live in close contact with humans, and concern has arisen regarding their potential to serve as reservoirs of zoonotic infections. In this study, we sought to determine the genotypes of S. fuelleborni infecting St. Kitts vervets to explore whether they are potential reservoirs for human-infecting S. fuelleborni types. Fecal specimens were collected from St. Kitts vervets and S. fuelleborni infections were confirmed microscopically and by PCR. Strongyloides fuelleborni genotypes were determined from positive fecal specimens using an Illumina amplicon sequencing-based genotyping approach targeting the mitochondrial cox1 locus and 18S rDNA hypervariable regions I and IV of Strongyloides species. Phylogenetic analysis of resultant genotypes supported that S. fuelleborni from St. Kitts vervets is of an exclusively African variety, falling within the same monophyletic group as an isolate which has been detected previously in a naturally infected human from Guinea-Bissau. This observation highlights that St. Kitts vervets may serve as potential reservoirs for zoonotic S. fuelleborni infection, which warrants further exploration. |
Implementation of a methodological protocol for the national survey on tuberculosis catastrophic costs in Brazil
Maciel ELN , Negri Ldsa , Guidoni LM , Fregona GC , Loureiro RB , Daré IB , Prado TND , Sanchez MN , Diaz-Quijano FA , Tonini M , Zandonade E , Baena IG , Ershova J . Rev Soc Bras Med Trop 2023 56 e0493 The World Health Organization (WHO) has set goals to end the tuberculosis (TB) pandemic by 2035, that is, to reduce the incidence to less than 10 cases per 100,000 inhabitants and the mortality rate by 95%. Although TB is a disease affecting people of all socioeconomic classes, it is mainly found in marginalized and vulnerable populations 1 . In 2019, before the onset of the coronavirus disease 2019 pandemic (COVID-19), 10 million people were diagnosed with TB worldwide, 7.1 million were reported to public health services, and 1.4 million died of the disease, including 20,800 people with human immunodeficiency virus (HIV) 2 , 3 . |
A census tract-level examination of HIV care outcomes and social vulnerability among Black/African American, Hispanic/Latino, and White Adults in the Southern United States, 2018
Elenwa F , Gant Z , Hu X , Johnson AS . J Community Health 2023 1-18 We examined the association between social vulnerability and HIV diagnoses, linkage to HIV medical care, and viral suppression among adults in the Southern U.S. Data from CDC's National HIV Surveillance System (NHSS) were used to determine census tract-level HIV diagnosis rates and percentages of persons linked to care within one month and with viral suppression within six months of diagnosis among Black/African American, Hispanic/Latino, and White adults aged ≥ 18 years residing in the Southern U.S. in 2018. Census tract-level social vulnerability data were obtained from the 2018 CDC Social Vulnerability Index (SVI). Rate and proportion ratios were used to determine the difference between the lowest quartile of SVI scores (Q1) and the highest quartile (Q4) by age group, transmission category, and region of residence and stratified by sex assigned at birth. Areas with the highest social vulnerability (Q4) had the highest rates of HIV diagnoses (Black: 56.5, Hispanic/Latino: 27.2, and White: 10.3). Those in Q4 also had the lowest percentages of adults linked to care (Black: 76.1%, Hispanic/Latino: 81.2%, and White: 77.8%), and the lowest percentages of adults with viral suppression (Black: 59.8%, Hispanic/Latino: 68.4%, and White: 65.7%). This ecological study found an association between social vulnerability, HIV diagnoses, and poorer care outcomes among Black/African American, Hispanic/Latino, and White adults. Tailoring interventions and improving access for persons residing in areas with the highest social vulnerability is necessary to reduce HIV transmission and improve health outcomes in the Southern U.S. |
Mediation of an association between neighborhood socioeconomic environment and type 2 diabetes through the leisure-time physical activity environment in an analysis of three independent samples
Moon KA , Nordberg CM , Orstad SL , Zhu A , Uddin J , Lopez P , Schwartz MD , Ryan V , Hirsch AG , Schwartz BS , Carson AP , Long DL , Meeker M , Brown J , Lovasi GS , Adhikari S , Kanchi R , Avramovic S , Imperatore G , Poulsen MN . BMJ Open Diabetes Res Care 2023 11 (2) INTRODUCTION: Inequitable access to leisure-time physical activity (LTPA) resources may explain geographic disparities in type 2 diabetes (T2D). We evaluated whether the neighborhood socioeconomic environment (NSEE) affects T2D through the LTPA environment. RESEARCH DESIGN AND METHODS: We conducted analyses in three study samples: the national Veterans Administration Diabetes Risk (VADR) cohort comprising electronic health records (EHR) of 4.1 million T2D-free veterans, the national prospective cohort REasons for Geographic and Racial Differences in Stroke (REGARDS) (11 208 T2D free), and a case-control study of Geisinger EHR in Pennsylvania (15 888 T2D cases). New-onset T2D was defined using diagnoses, laboratory and medication data. We harmonized neighborhood-level variables, including exposure, confounders, and effect modifiers. We measured NSEE with a summary index of six census tract indicators. The LTPA environment was measured by physical activity (PA) facility (gyms and other commercial facilities) density within street network buffers and population-weighted distance to parks. We estimated natural direct and indirect effects for each mediator stratified by community type. RESULTS: The magnitudes of the indirect effects were generally small, and the direction of the indirect effects differed by community type and study sample. The most consistent findings were for mediation via PA facility density in rural communities, where we observed positive indirect effects (differences in T2D incidence rates (95% CI) comparing the highest versus lowest quartiles of NSEE, multiplied by 100) of 1.53 (0.25, 3.05) in REGARDS and 0.0066 (0.0038, 0.0099) in VADR. No mediation was evident in Geisinger. CONCLUSIONS: PA facility density and distance to parks did not substantially mediate the relation between NSEE and T2D. Our heterogeneous results suggest that approaches to reduce T2D through changes to the LTPA environment require local tailoring. |
Racial differences in social determinants of health and outcomes among Hispanic/Latino persons with HIV-United States, 2015-2020
Padilla M , Luna-Gierke RE , Carree T , Gutierrez M , Yuan X , Dasgupta S . J Racial Ethn Health Disparities 2023 BACKGROUND: Hispanic/Latino people with HIV (PWH) experience disparities in health outcomes compared with other racial and ethnic groups. Disaggregated data based on race for Hispanic/Latino PWH in the United States are rarely reported, potentially masking inequities. METHODS: The Medical Monitoring Project (MMP) is a complex sample survey of adults with diagnosed HIV. We used weighted interview and medical record data collected from June 2015-May 2021 to examine differences in social determinants of health (SDH) and health outcomes by self-reported race among Hispanic/Latino adults with diagnosed HIV. RESULTS: Compared with White Hispanic/Latino PWH, Black Hispanic/Latino PWH were more likely to be unemployed (PR, 1.4; CI, 1.2-1.8), have a disability (PR, 1.3; CI, 1.2-1.5), have experienced homelessness (PR, 1.8; CI, 1.2-2.6), and have been incarcerated (PR, 2.6; CI, 1.5-4.5). American Indian/Alaska Native (AI/AN) (PR, 1.8; CI, 1.1-2.7) and multiracial (PR, 2.0; CI, 1.4-2.9) Hispanic/Latino PWH were more likely to have experienced homelessness than White Hispanic/Latino PWH. Black (PR, 1.3; CI, 1.2-1.5) and multiracial (PR, 1.2; CI, 1.1-1.5) Hispanic/Latino PWH were more likely to be virally unsuppressed than White Hispanic/Latino PWH. CONCLUSION: Black, multiracial, and AI/AN Hispanic/Latino PWH experience disparities in SDH and HIV outcomes. Lumping Hispanic/Latino people into one racial and ethnic category obscures health disparities, which might limit our progress towards reaching national HIV goals. Future studies should consider disaggregating by other factors such as Hispanic origin, place of birth, immigration status, and primary language. Doing so recognizes the diversity of the Hispanic/Latino population. |
The use of adaptive sampling to reach disadvantaged populations for immunization programs and assessments: A systematic review
Koyuncu A , Ishizumi A , Daniels D , Jalloh MF , Wallace AS , Prybylski D . Vaccines (Basel) 2023 11 (2) Vaccines prevent 4-5 million deaths every year, but inequities in vaccine coverage persist among key disadvantaged subpopulations. Under-immunized subpopulations (e.g., migrants, slum residents) may be consistently missed with conventional methods for estimating immunization coverage and assessing vaccination barriers. Adaptive sampling, such as respondent-driven sampling, may offer useful strategies for identifying and collecting data from these subpopulations that are often "hidden" or hard-to-reach. However, use of these adaptive sampling approaches in the field of global immunization has not been systematically documented. We searched PubMed, Scopus, and Embase databases to identify eligible studies published through November 2020 that used an adaptive sampling method to collect immunization-related data. From the eligible studies, we extracted relevant data on their objectives, setting and target population, and sampling methods. We categorized sampling methods and assessed their frequencies. Twenty-three studies met the inclusion criteria out of the 3069 articles screened for eligibility. Peer-driven sampling was the most frequently used adaptive sampling method (57%), followed by geospatial sampling (30%), venue-based sampling (17%), ethnographic mapping (9%), and compact segment sampling (9%). Sixty-one percent of studies were conducted in upper-middle-income or high-income countries. Data on immunization uptake were collected in 65% of studies, and data on knowledge and attitudes about immunizations were collected in 57% of studies. We found limited use of adaptive sampling methods in measuring immunization coverage and understanding determinants of vaccination uptake. The current under-utilization of adaptive sampling approaches leaves much room for improvement in how immunization programs calibrate their strategies to reach "hidden" subpopulations. |
COVID-19 vaccination recommendations and practices for women of reproductive age, U.S. Physicians, Fall 2021
Meghani M , Zapata LB , Polen K , Galang RR , Razzaghi H , Meaney-Delman D , Ellington S . Prev Med Rep 2023 32 102141 Pregnant people with COVID-19 are at increased risk for severe illness and adverse pregnancy outcomes. COVID-19 vaccinations are safe and effective, including for pregnant and recently pregnant people. The objective of this analysis was to describe the extent to which primary care physicians across the United States report confidence in talking with female patients of reproductive age about COVID-19 vaccination, recommending COVID-19 vaccinations to pregnant patients, and offering COVID-19 vaccinations at their practices in fall 2021. We analyzed cross-sectional data from the Fall 2021 DocStyles survey, a web-based panel survey of U.S. primary healthcare providers (64% response rate). Family practitioners/internists, obstetrician-gynecologists, and pediatricians were asked about confidence in talking with female patients of reproductive age about COVID-19 vaccination, vaccination practices regarding pregnant patients, and offering COVID-19 vaccinations. We describe results overall and by select physician characteristics. Among 1501 respondents, most were family practitioners/internists (67%), 17% were obstetrician-gynecologists, and 17% were pediatricians. Overall, 63% were very confident talking with female patients of reproductive age about COVID-19 vaccination, 80% recommended pregnant patients get vaccinated as soon as possible, and 50% offered COVID-19 vaccinations at their current practice. Obstetrician-gynecologists were most confident in talking with female patients, but only one-third offered the vaccine at their practices. This analysis found that most physicians felt confident talking about COVID-19 vaccinations and recommended pregnant patients get vaccinated as soon as possible. Provider recommendation for vaccination remains a key strategy for achieving high vaccination coverage, and consistent recommendations may improve vaccine acceptance among pregnant and postpartum people. |
COVID-19 vaccine reactogenicity and vaccine attitudes among children and parents/guardians after multisystem inflammatory syndrome in children or COVID-19 hospitalization: September 2021-May 2022
Yousaf AR , Kunkel A , Abrams JY , Shah AB , Hammett TA , Arnold KE , Beltran YL , Laham FR , Kao CM , Hunstad DA , Hussaini L , Baida N , Salazar L , Perez MA , Rostad CA , Godfred-Cato S , Campbell AP , Belay ED . Pediatr Infect Dis J 2023 42 (3) 252-259 BACKGROUND: Multisystem inflammatory syndrome in children (MIS-C) is a multiorgan hyperinflammatory condition following SARS-CoV-2 infection. Data on COVID-19 vaccine adverse events and vaccine attitudes in children with prior MIS-C are limited. We described characteristics associated with COVID-19 vaccination, vaccine adverse events and vaccine attitudes in children with a history of MIS-C or COVID-19 and their parents/guardians. METHODS: We enrolled children previously hospitalized for MIS-C or COVID-19 from 3 academic institutions. We abstracted charts and interviewed children and parents/guardians regarding vaccine adverse events and acceptability. RESULTS: Of 163 vaccine-eligible children enrolled with a history of MIS-C and 70 with history of COVID-19, 51 (31%) and 34 (49%), respectively, received mRNA COVID-19 vaccine a median of 10 (Interquartile Range 6-13) months after hospital discharge. Among 20 children with MIS-C and parents/guardians who provided interviews, local injection site reaction of brief duration (mean 1.8 days) was most commonly reported; no children required medical care within 2 weeks postvaccination. Vaccine survey results of interviewed, vaccinated children and their parents/guardians: of 20 children with MIS-C and 15 children with COVID-19, 17 (85%) and 13 (87%), respectively, listed doctors in the top 3 most trusted sources for vaccine information; 13 (65%) and 9 (60%) discussed vaccination with their doctor. CONCLUSIONS: COVID-19 vaccination was well tolerated in children with prior MIS-C or COVID-19 participating in our investigation. Parents/guardians regarded their children's doctors as a trusted source of information for COVID-19 vaccines, and most vaccinated children's parents/guardians had discussed COVID-19 vaccination for their child with their doctor. |
Editorial: Ubiquitin and ubiquitin-like modifications in viral infection and innate immunity
Sparrer KMJ , Bergeron É , Gupta S . Front Immunol 2023 14 1148296 The Research Topic ‘ubiquitin and ubiquitin-like modifications in viral infection and innate immunity’ aimed to advance our knowledge and understanding of the regulation of innate immune signaling by ubiquitin and ubiquitin-like modifiers during infection, its interplay with viral proteins and the application of modern techniques to decode these interactions. Six original research papers, three mini-reviews, one review article, and one perspective article that covered various aspects of the Research Topic were eventually part of the collection. |
Effectiveness of maternal influenza vaccination in Peru PRIME Cohort
Owusu D , Dawood FS , Azziz-Baumgartner E , Tinoco Y , Soto G , Gonzalez O , Cabrera S , Florian R , Llajaruna E , Hunt DR , Wesley MG , Yau T , Arriola CS . Open Forum Infect Dis 2023 10 (2) ofad033 BACKGROUND: Few studies have examined influenza vaccine effectiveness (VE) among women during pregnancy in middle-income countries. We used data from a prospective cohort of women who were pregnant in Peru to estimate effectiveness of the 2018 Southern Hemisphere influenza vaccine. METHODS: Women at <28 weeks gestation were enrolled from 4 tertiary level hospitals in Lima, Peru at the start of the 2018 influenza season and followed until the end of their pregnancies. Participants had mid-turbinate nasal swabs collected and tested for influenza by reverse-transcription polymerase chain reaction (RT-PCR) with onset of ≥1 of myalgia, cough, runny nose or nasal congestion, sore throat, or difficulty breathing. Time-varying Cox proportional hazard regression models were used to estimate the risk of RT-PCR-confirmed influenza infection after adjusting for inverse probability treatment weight. RESULTS: We followed 1896 women for a median of 127 days (interquartile range [IQR], 86-174). Participants had a median age of 29 years (IQR, 24-34). Among the 1896 women, 49% were vaccinated with the 2018 influenza vaccine and 1039 (55%) developed influenza-like illness, 76 (7%) of whom had RT-PCR-confirmed influenza. Incidence rates of RT-PCR-confirmed influenza were 36.6 and 15.3 per 100 000 person-days among women who were unvaccinated and vaccinated, respectively. Adjusted influenza VE was 22% (95% confidence interval, -64.1% to 62.9%). CONCLUSIONS: Participants vaccinated against influenza had more than 50% lower incidence of RT-PCR-confirmed influenza illness. Although the VE estimated through propensity weight-adjusted time-varying Cox regression did not reach statistical significance, our findings provide additional evidence about the value of maternal influenza vaccination in middle-income countries. |
Interim estimates of 2022-23 seasonal influenza vaccine effectiveness - Wisconsin, October 2022-February 2023
McLean HQ , Petrie JG , Hanson KE , Meece JK , Rolfes MA , Sylvester GC , Neumann G , Kawaoka Y , Belongia EA . MMWR Morb Mortal Wkly Rep 2023 72 (8) 201-205 In the United States, 2022-23 influenza activity began earlier than usual, increasing in October 2022, and has been associated with high rates of hospitalizations among children* (1). Influenza A(H3N2) represented most influenza viruses detected and subtyped during this period, but A(H1N1)pdm09 viruses cocirculated as well. Most viruses characterized were in the same genetic subclade as and antigenically similar to the viruses included in the 2022-23 Northern Hemisphere influenza vaccine (1,2). Effectiveness of influenza vaccine varies by season, influenza virus subtype, and antigenic match with circulating viruses. This interim report used data from two concurrent studies conducted at Marshfield Clinic Health System (MCHS) in Wisconsin during October 23, 2022-February 10, 2023, to estimate influenza vaccine effectiveness (VE). Overall, VE was 54% against medically attended outpatient acute respiratory illness (ARI) associated with laboratory-confirmed influenza A among patients aged 6 months-64 years. In a community cohort of children and adolescents aged <18 years, VE was 71% against symptomatic laboratory-confirmed influenza A virus infection. These interim analyses indicate that influenza vaccination substantially reduced the risk for medically attended influenza among persons aged <65 years and for symptomatic influenza in children and adolescents. Annual influenza vaccination is the best strategy for preventing influenza and its complications. CDC recommends that health care providers continue to administer annual influenza vaccine to persons aged ≥6 months as long as influenza viruses are circulating (2). |
Potently neutralizing human monoclonal antibodies against the zoonotic pararubulavirus Sosuga virus
Parrington HM , Kose N , Armstrong E , Handal LS , Diaz S , Reidy J , Dong J , Stewart-Jones GB , Shrivastava-Ranjan P , Jain S , Albariño CG , Carnahan RH , Crowe JE . JCI Insight 2023 8 (8) Sosuga virus (SOSV) is a recently discovered paramyxovirus with a single known human case of disease. There has been little laboratory research on SOSV pathogenesis or immunity, and no approved therapeutics or vaccines are available. Here, we report the discovery of human monoclonal antibodies (mAbs) from the circulating memory B cells of the only known human case and survivor of SOSV infection. We isolated six mAbs recognizing the functional attachment protein hemagglutinin-neuraminidase (HN) and 18 mAbs against the fusion (F) protein. The anti-HN mAbs all target the globular head of the HN protein and can be organized into 4 competition-binding groups that exhibit epitope diversity. The anti-F mAbs can be divided into pre- or postfusion conformation-specific categories and further into 8 competition-binding groups. The only antibody in the panel that did not display neutralization activity was the single, postfusion-specific anti-F mAb. Most of the anti-HN mAbs were more potently neutralizing than the anti-F mAbs, with mAbs in one of the HN competition-binding groups possessing ultra-potent (<1 ng/mL) half maximal inhibitory (IC50) virus neutralization values. These findings provide insight into the molecular basis for human antibody recognition of paramyxovirus surface proteins and the mechanisms of SOSV neutralization. |
Surveillance for multisystem inflammatory syndrome in U.S. children aged 5-11 years who received Pfizer-BioNTech COVID-19 vaccine, November 2021-March 2022
Cortese MM , Taylor AW , Akinbami LJ , Thames-Allen A , Yousaf AR , Campbell AP , Maloney SA , Harrington T , Anyalechi EG , Munshi D , Kamidani S , Curtis CR , McCormick DW , Staat MA , Edwards KM , Creech CB , Museru O , Marquez P , Thompson D , Su JR , Schlaudecker EP , Broder KR . J Infect Dis 2023 228 (2) 143-148 Multisystem inflammatory syndrome in children (MIS-C) is a complication of SARS-CoV-2 infection; in the U.S., reporting of MIS-C after COVID-19 vaccination is required for vaccine safety monitoring. Pfizer-BioNTech COVID-19 vaccine was authorized for children aged 5-11 years on October 29, 2021. Covering a period when ∼7 million children received vaccine, surveillance for MIS-C ≤90 days post-vaccination using passive systems identified 58 children with MIS-C and laboratory evidence of past/recent SARS-CoV-2 infection, and 4 without evidence. During a period with extensive SARS-CoV-2 circulation, MIS-C illness in children after COVID-19 vaccination who lacked evidence of SARS-CoV-2 infection was rare (<1 per million vaccinated children). |
Using real-time data to guide decision-making during an influenza pandemic: A modelling analysis
Haw DJ , Biggerstaff M , Prasad P , Walker J , Grenfell B , Arinaminpathy N . PLoS Comput Biol 2023 19 (2) e1010893 Influenza pandemics typically occur in multiple waves of infection, often associated with initial emergence of a novel virus, followed (in temperate regions) by a resurgence accompanying the onset of the annual influenza season. Here, we examined whether data collected from an initial pandemic wave could be informative, for the need to implement non-pharmaceutical measures in any resurgent wave. Drawing from the 2009 H1N1 pandemic in 10 states in the USA, we calibrated simple mathematical models of influenza transmission dynamics to data for laboratory confirmed hospitalisations during the initial 'spring' wave. We then projected pandemic outcomes (cumulative hospitalisations) during the fall wave, and compared these projections with data. Model results showed reasonable agreement for all states that reported a substantial number of cases in the spring wave. Using this model we propose a probabilistic decision framework that can be used to determine the need for preemptive measures such as postponing school openings, in advance of a fall wave. This work illustrates how model-based evidence synthesis, in real-time during an early pandemic wave, could be used to inform timely decisions for pandemic response. |
Neuroimaging for mild traumatic brain injury in children: cross-sectional study using national claims data
Waltzman D , Miller GF , Patel N , Sarmiento K , Breiding M , Lumba-Brown A . Pediatr Radiol 2023 53 (6) 1163-1170 BACKGROUND: Current guidelines recommend healthcare professionals avoid routine use of neuroimaging for diagnosing mild traumatic brain injury (mTBI). OBJECTIVE: This study aimed to examine current use of CT and MRI among children and young adult patients with mTBI and factors that increase likelihood of neuroimaging in this population. MATERIALS AND METHODS: Data were analyzed using the 2019 MarketScan commercial claims and encounters database for the commercially insured population for both inpatient and outpatient claims. Descriptive statistics and logistic regression models for patients ≤24 years of age who received an ICD-10-CM code indicative of a possible mTBI were analyzed. RESULTS: Neuroimaging was performed in 16.9% (CT; 95% CI=16.7-17.1) and 0.9% (MRI; 95% CI=0.8-0.9) of mTBI outpatient visits (including emergency department visits) among children (≤18 years old). Neuroimaging was performed in a higher percentage of outpatient visits for patients 19-24 years old (CT=47.1% [95% CI=46.5-47.6] and MRI=1.7% [95% CI=1.5-1.8]), and children aged 15-18 years old (CT=20.9% [95% CI=20.5-21.2] and MRI=1.4% [95% CI=1.3-1.5]). Outpatient visits for males were 1.22 (95% CI=1.10-1.25) times more likely to include CT compared to females, while there were no differences by sex for MRI or among inpatient stays. Urban residents, as compared to rural, were less likely to get CT in outpatient settings (adjusted odds ratio [aOR]=0.55, 95% CI=0.53-0.57). Rural residents demonstrated a larger proportion of inpatient admissions that had a CT. CONCLUSIONS: Despite recommendations to avoid routine use of neuroimaging for mTBI, neuroimaging remained common practice in 2019. |
Multiplex Real-time PCR Assay for the Detection of all Chlamydia Species and Simultaneous Differentiation of C. psittaci and C. pneumoniae in Human Clinical Specimens.
Wolff BJ , Gaines A , Conley AB , Norris E , Rishishwar L , Chande AT , Yang E , Diaz MH , Winchell JM . Ann Lab Med 2023 43 (4) 375-380 We developed and assessed the performance of a new multiplex real-time PCR assay for the detection of all Chlamydia species and simultaneous differentiation of Chlamydia psittaci and Chlamydia pneumoniae-two important human respiratory pathogens-in human clinical specimens. Next-generation sequencing was used to identify unique targets to design real-time PCR assays targeting all Chlamydia species, C. psittaci, and C. pneumoniae. To validate the assay, we used a panel of 49 culture isolates comprising seven C. psittaci genotypes, eight C. pneumoniae isolates, seven other Chlamydia species, and 22 near-neighbor bacterial and viral isolates, along with 22 specimens from external quality assessment (EQA) panels and 34 nasopharyngeal and oropharyngeal swabs and cerebrospinal fluid, stool, and sputum specimens previously identified as positive or negative for C. psittaci or C. pneumoniae. The assays were 100% specific, with limits of detection of 7.64- 9.02 fg/μL. The assay results matched with historical assay results for all specimens, except for one owing to the increased sensitivity of the new C. psittaci assay; the results of the EQA specimens were 100% accurate. This assay may improve the timely and accurate clinical diagnosis of Chlamydia infections and provide a greater understanding of the burden of disease caused by these agents. |
Mucosal and systemic neutralizing antibodies to norovirus induced in infant mice orally inoculated with recombinant rotaviruses.
Kawagishi T , Sánchez-Tacuba L , Feng N , Costantini VP , Tan M , Jiang X , Green KY , Vinjé J , Ding S , Greenberg HB . Proc Natl Acad Sci U S A 2023 120 (9) e2214421120 Rotaviruses (RVs) preferentially replicate in the small intestine and frequently cause severe diarrheal disease, and the following enteric infection generally induces variable levels of protective systemic and mucosal immune responses in humans and other animals. Rhesus rotavirus (RRV) is a simian RV that was previously used as a human RV vaccine and has been extensively studied in mice. Although RRV replicates poorly in the suckling mouse intestine, infection induces a robust and protective antibody response. The recent availability of plasmid only-based RV reverse genetics systems has enabled the generation of recombinant RVs expressing foreign proteins. However, recombinant RVs have not yet been experimentally tested as potential vaccine vectors to immunize against other gastrointestinal pathogens in vivo. This is a newly available opportunity because several live-attenuated RV vaccines are already widely administered to infants and young children worldwide. To explore the feasibility of using RV as a dual vaccine vector, we rescued replication-competent recombinant RRVs harboring bicistronic gene segment 7 that encodes the native RV nonstructural protein 3 (NSP3) protein and a human norovirus (HuNoV) VP1 protein or P domain from the predominant genotype GII.4. The rescued viruses expressed HuNoV VP1 or P protein in infected cells in vitro and elicited systemic and local antibody responses to HuNoV and RRV following oral infection of suckling mice. Serum IgG and fecal IgA from infected suckling mice bound to and neutralized both RRV and HuNoV. These findings have encouraging practical implications for the design of RV-based next-generation multivalent enteric vaccines to target HuNoV and other human enteric pathogens. |
Porcine fungal mock community analyses: Implications for mycobiome investigations
Arfken AM , Frey JF , Carrillo NI , Dike NI , Onyeachonamm O , Rivera DN , Davies CP , Summers KL . Front Cell Infect Microbiol 2023 13 928353 INTRODUCTION: The gut microbiome is an integral partner in host health and plays a role in immune development, altered nutrition, and pathogen prevention. The mycobiome (fungal microbiome) is considered part of the rare biosphere but is still a critical component in health. Next generation sequencing has improved our understanding of fungi in the gut, but methodological challenges remain. Biases are introduced during DNA isolation, primer design and choice, polymerase selection, sequencing platform selection, and data analyses, as fungal reference databases are often incomplete or contain erroneous sequences. METHODS: Here, we compared the accuracy of taxonomic identifications and abundances from mycobiome analyses which vary among three commonly selected target gene regions (18S, ITS1, or ITS2) and the reference database (UNITE - ITS1, ITS2 and SILVA - 18S). We analyze multiple communities including individual fungal isolates, a mixed mock community created from five common fungal isolates found in weanling piglet feces, a purchased commercial fungal mock community, and piglet fecal samples. In addition, we calculated gene copy numbers for the 18S, ITS1, and ITS2 regions of each of the five isolates from the piglet fecal mock community to determine whether copy number affects abundance estimates. Finally, we determined the abundance of taxa from several iterations of our in-house fecal community to assess the effects of community composition on taxon abundance. RESULTS: Overall, no marker-database combination consistently outperformed the others. Internal transcribed space markers were slightly superior to 18S in the identification of species in tested communities, but Lichtheimia corymbifera, a common member of piglet gut communities, was not amplified by ITS1 and ITS2 primers. Thus, ITS based abundance estimates of taxa in piglet mock communities were skewed while 18S marker profiles were more accurate. Kazachstania slooffiae displayed the most stable copy numbers (83-85) while L. corymbifera displayed significant variability (90-144) across gene regions. DISCUSSION: This study underscores the importance of preliminary studies to assess primer combinations and database choice for the mycobiome sample of interest and raises questions regarding the validity of fungal abundance estimates. |
Adolescents with autism spectrum disorder: Diagnostic patterns, co-occurring conditions, and transition planning
Hughes MM , Shaw KA , Patrick ME , DiRienzo M , Bakian AV , Bilder DA , Durkin MS , Hudson A , Spivey MH , DaWalt LS , Salinas A , Schwenk YD , Lopez M , Baroud TM , Maenner MJ . J Adolesc Health 2023 73 (2) 271-278 PURPOSE: The objectives of this study were to describe child characteristics associated with later autism spectrum disorder (ASD) identification and the health status and educational transition plans of adolescents with ASD. METHODS: Longitudinal population-based surveillance cohort from the Autism Developmental Disabilities Monitoring Network during 2002-2018 in five catchment areas in the United States. Participants included 3,148 children born in 2002 whose records were first reviewed for ASD surveillance in 2010. RESULTS: Of the 1,846 children identified in the community as an ASD case, 11.6% were first identified after age 8 years. Children who were more likely to have ASD identified at older ages were Hispanic; were born with low birth weight; were verbal; had high intelligence quotient or adaptive scores; or had certain co-occurring neuropsychological conditions by age 8 years. By age 16 years, neuropsychological conditions were common with more than half of the adolescents with ASD having a diagnosis of attention-deficit/hyperactivity disorder or anxiety. Intellectual disability (ID) status was unchanged for the majority (>80%) of children from ages 8-16 years. A transition plan was completed for over 94% of adolescents, but disparities were observed in planning by ID status. DISCUSSION: A high percentage of adolescents with ASD have co-occurring neuropsychological conditions, markedly higher than at age 8. While most adolescents had transition planning, this occurred less often for those with ID. Ensuring access to services for all people with ASD during adolescence and transition to adulthood may help to promote overall health and quality of life. |
The effect of interventions distributing home fortification products on infant and young child feeding (IYCF) practices: A systematic narrative review
Locks LM , Newell KB , Imohe A , Moloney GM , Shaker L , Paudyal N , Jefferds MED . Matern Child Nutr 2023 19 (3) e13488 Interventions distributing micronutrient powders (MNPs) and small-quantity lipid-based nutrient supplements (SQ-LNS), or home fortification products (HFPs), have the potential to improve infant and young child feeding (IYCF) practices and children's nutrition. We systematically searched for studies on the effect of interventions distributing HFP on IYCF practices. We identified 12 (8 MNP, 4 SQ-LNS) studies: seven programmes with IYCF behaviour change communications (BCC) and MNP (IYCF-MNP) and one provided MNP without IYCF BCC (MNP only). Three SQ-LNS studies came from randomised trials without an IYCF component (SQ-LNS only) and one from a programme with both IYCF BCC and SfQ-LNS (IYCF-SQ-LNS). Five IYCF-MNP programmes reported positive associations with some IYCF practices-four with minimum dietary diversity, two with minimum meal frequency, four with minimum acceptable diet, and three with the initiation of complementary foods at 6 months. Two reported no association between MNP and IYCF indicators, and one reported a decline in IYCF practices during the intervention, although it also reported significant changes to the IYCF programme during the evaluation period. Two studies from interventions that distributed SQ-LNS (one from a related set of randomised controlled trials and the sole IYCF-SQ-LNS programme) reported a positive association with IYCF practices; one trial reported no change in breast milk intake with the provision of SQ-LNS and one found no association with IYCF practices. SQ-LNS and MNP can address nutrient gaps for young children in low-resource settings; our findings indicate that programmes that combine HFP with IYCF interventions may also contribute to improved IYCF practices in some settings. |
Tackling post-discharge mortality in children living in LMICs to reduce child deaths
Akech S , Kwambai T , Wiens MO , Chandna A , Berkley JA , Snow RW . Lancet Child Adolesc Health 2023 7 (3) 149-151 The Sustainable Development Goal (SDG) target 3.2 is | to end preventable deaths of newborns and children | younger than 5 years by 2030. However, in 2020, more | than 5 million children younger than 5 years died, | mostly from preventable causes, and mainly in subSaharan Africa (54%) and southern Asia (26%).1 | As | increasing numbers of children with life-threatening | illnesses seek care from hospitals, the role of highquality facility-based care becomes increasingly crucial | for achieving this SDG target.2 | A growing body of | evidence points to a previously under-recognised | contributor to child mortality: deaths after hospital | discharge. Recent studies show that approximately | half of all deaths among children admitted to hospitals | in low-income and middle-income countries (LMICs) | occur within 6 months of discharge.3,4 That half of these | post-discharge deaths occur at home is of additional | concern. These findings indicate that children who are | discharged from hospital remain highly vulnerable in | the immediate post-discharge period. The reasons for | this vulnerability are undeniably complex and could | be related to multiple interacting factors such as | premature discharge, residual underlying conditions, | risky home environments, poor health-seeking | behaviours, and weak health systems.4–6 What is clear | is that achieving SDG target 3.2 on neonatal and child | mortality will be impossible without concerted efforts | to address post-discharge mortality and that hospitals | are additional points in the health system to identify | the most vulnerable |
Dietary contributions of food outlets by urbanization level in the US population 2 years and older, NHANES 2013-2018
Ansai N , Wambogo EA , Herrick KA , Zimmer M , Reedy J , Hales CM , Ogden CL . Am J Clin Nutr 2023 117 (5) 946-954 BACKGROUND: Differences in food access, availability, affordability, and dietary intake are influenced by the food environment, which includes outlets where foods are obtained. These differences between food outlets within rural and urban food environments in the US are not well understood. OBJECTIVE: The aim of this analysis was to describe the contribution of foods and beverages from six outlets - grocery stores, convenience stores, full-service restaurants, quick-service restaurants, schools, and other outlets - to total energy intake and Healthy Eating Index (HEI)-2015 scores in the US population, by urbanization level (non-metropolitan statistical areas (MSA), small to medium MSA, and large MSA). DESIGN: Data were from the National Health and Nutrition Examination Survey 2013-2018. Dietary intake from one 24-hour dietary recall was analyzed by the outlet where a food or beverage was obtained and by urbanization. Linear regression, adjusted for sex, age, race and Hispanic origin, and family income, was used to predict the contribution of each food outlet to total energy intake and HEI-2015 total and component scores by urbanization level. RESULTS: During 2013-2018, foods and beverages from grocery stores, quick-service, and full-service restaurants provided 62.1%, 15.1% and 8.5% of energy intake, respectively. The percent of energy intake from full- and quick-service restaurants increased with increasing urbanization level. HEI-2015 total scores increased with increasing urbanization level overall (48.1 non-MSAs, 49.2 small to medium MSAs, and 51.3 large MSAs), for grocery stores (46.7 non-MSAs, 48.0 small to medium MSAs, and 50.6 large MSAs), and for quick-service restaurants (35.8 non-MSAs, 36.3 small to medium MSAs, and 37.5 large MSAs). CONCLUSION: Grocery stores and restaurants were the largest contributors of energy intake in urban and rural areas. Diet quality improved with increasing urbanization overall and for grocery stores and quick-service restaurants. |
Occasions, locations, and reasons for consuming sugar-sweetened beverages among U.S. Adults
Lee SH , Park S , Lehman TC , Ledsky R , Blanck HM . Nutrients 2023 15 (4) Frequent intake of sugar-sweetened beverages (SSBs) is associated with adverse health outcomes such as obesity, type 2 diabetes, and cardiovascular disease. Little is known about when, where, and why U.S. adults consume SSBs. This study, using data from an online survey distributed in 2021, examined the occasions, locations, and reasons for consuming SSBs and the characteristics of the adults who consume them. Nearly 7 of 10 adults reported consuming a SSB (1-6 times) in the past 7 days, and more than a third (38%) reported doing so once or more per day (on average). For comparative purposes, the sample was limited to adults who reported consuming SSBs within the last 7 days. Mealtimes were reported as the most frequent occasion for the intake of SSBs (43%) and SSBs were most often consumed at home (70%). Over half of respondents (56%) reported they consume SSBs because they enjoy the taste. Younger adults (18-34 years old) were more likely to consume SSBs in social settings than older adults (≥50 years old). Hispanic adults were less likely to consume SSBs at the beginning of the day compared to non-Hispanic White adults. Younger (18-34 years old) and middle-aged (35-49 years old) adults were more likely to consume SSBs in restaurants, at work, and in cars than older adults (≥50 years old). Women were less likely to consume SSBs at work than men. Hispanic adults were less likely to consume SSBs in cars than non-Hispanic White adults, while those earning USD 50,000-<USD 100,000 were more likely to consume SSBs in cars than those earning ≥USD 100,000. Younger and middle-aged adults were more likely to consume SSBs due to cravings and enjoyment of the carbonation compared to older adults. These findings provide insights on specific populations for whom to tailor messaging and adapt interventions to help reduce SSB intake. |
COVID-19 workplace mitigation strategies and employee leave policies implemented during the height of the pandemic, United States, Fall 2020 and 2021
Guerin RJ , Barile JP , Groenewold MR , Free HL , Okun AH . Int J Environ Res Public Health 2023 20 (4) COVID-19 workplace mitigation strategies implemented within US businesses have been effective at preventing disease and protecting workers, but the extent of their use is not well understood. We examined reported COVID-19 workplace mitigation strategies by business size, geographic region, and industry using internet panel survey data from US adult respondents working full- or part-time outside the home (fall 2020, N = 1168) andfull- or part-time, inside or outside the home (fall 2021, N = 1778). We used chi-square tests to assess the differences in the strategies used (e.g., masking and COVID-19 screening) and ANOVA tests to examine the group differences on a mitigation strategies summative score. Fewer COVID-19 mitigation strategies were reported by respondents in fall 2021 (compared to fall 2020) across businesses of different sizes and regions. The participants in microbusinesses (1-10 employees) reported significantly (p < 0.05) lower mitigation scores than all other business sizes, and the respondents in these businesses were significantly less likely (p < 0.05) to have paid leave than those in enterprises with >10 employees. The healthcare and education sectors had the highest reported mean score of COVID-19 workplace mitigation strategies. Small and essential businesses are critical to the US economy. Insight is needed on their use of mitigation strategies to protect workers during the current and future pandemics. |
Healthcare workers' infection risk perceptions of aerosol-generating procedures and affective response
Benishek LE , Radonovich LJ , Blackley BH , Weissman DN . Antimicrob Steward Healthc Epidemiol 2023 3 (1) e29 OBJECTIVE: To understand healthcare worker (HCW) perceptions of infection risk associated with aerosol-generating procedures (AGPs) and their affective response to performing AGPs. DESIGN: Systematic review. METHODS: Systematic searches of PubMed, CINHAL Plus, and Scopus were conducted using combinations of selected keywords and synonyms. To reduce bias, titles and abstracts were screened for eligibility by 2 independent reviewers. Also, 2 independent reviewers extracted data from each eligible record. Discrepancies were discussed until consensus was reached. RESULTS: In total, 16 reports from across the globe were included in this review. Findings suggest that AGPs are generally perceived to place HCWs at high risk of becoming infected with respiratory pathogens and that this perception stimulates a negative affective response and hesitancy to participate in the procedures. CONCLUSIONS: AGP risk perception are complex and context dependent but have important influences on HCW infection control practices, decision to participate in AGPs, emotional welfare, and workplace satisfaction. New and unfamiliar hazards paired with uncertainty lead to fear and anxiety about personal and others' safety. These fears may create a psychological burden conducive to burnout. Empirical research is needed to thoroughly understand the interplay between HCW risk perceptions of distinct AGPs, their affective responses to conducting these procedures under various conditions, and their resulting decision to participate in these procedures. Results from such studies are essential for advancing clinical practice; they point to methods for mitigating provider distress and better recommendations for when and how to conduct AGPs. |
Robot-related fatalities at work in the United States, 1992-2017
Layne LA . Am J Ind Med 2023 66 (6) 454-461 BACKGROUND: Industrial robots became more commonplace in the US workplace during the mid- to latter part of the twentieth century. Recent scientific advances have led to the development of new types of robots, resulting in rapidly changing work environments. Information on occupational robot-related fatalities is currently limited for this developing field. METHODS: Robot fatalities were identified by a keyword search in restricted-access research files from the Census of Fatal Occupational Injuries (CFOI) surveillance system of the Bureau of Labor Statistics from the years 1992-2017. RESULTS: There were 41 robot-related fatalities identified by the keyword search during the 26-year period of this study, 85% of which were males, with the most cases (29%) occurring within the age group 35-44 years. Fatalities occurred primarily with large employers that were geographically clustered, with the Midwest accounting for 46% of the total. Most of the cases involved stationary robots (83%) and robots striking the decedents while operating under their own power (78%). Many of these striking incidents occurred while maintenance was being performed on a robot. CONCLUSIONS: The changing nature of robotics in the workplace suggests that emerging technologies may introduce new hazards in the workplace. Emerging technologies have led to an increase in the number of robots in the workplace and to increased human exposure to robotic machinery. These patterns demonstrate that public health professionals will likely face significant challenges to keep pace with developments in robotics to ensure the safety and health of workers across the country. |
Implications of shale gas well integrity failure near a longwall mine under shallow cover
Ajayi KM , Khademian Z , Schatzel SJ , Rubinstein EN . Min Metall Explor 2023 This study simulates the impact of a shale gas well casing breach near a longwall mine. Field studies are conducted to measure mining-induced permeability changes over the abutment pillar of a longwall mine, and a geomechanical model is developed in 3DEC, a three-dimensional numerical modeling code, to predict the aperture of fractures in the overburden at the study site. The predicted aperture values are used to determine mining-induced permeabilities and the results are compared with the field measurements. These aperture values are provided as inputs into fracture flow code (FFC), which generates a stochastic discrete fracture network (DFN) model for the study site and predicts the potential shale gas flow to the mine. Results from 100 DFN realizations are statistically analyzed using the bootstrapping method to compensate for notable variation in fracture geometry. The results show a significant difference between the gas inflow for nearby panels due to increase in the induced permeability during mining of the second panel. The average gas flow to the mine was calculated as 4.72×10−2 m3/s (49 cfm) for a hypothetical breach at the Sewickley horizon during the first panel mining, 8.97×10−3 m3/s (19 cfm) for a hypothetical breach at the Uniontown horizon during the first panel mining, 2.16×10−1 m3/s (458 cfm) for a hypothetical breach at the Sewickley horizon during the second panel mining, and 8.07×10−2 m3/s (171 cfm) for a hypothetical breach at the Uniontown horizon during the second panel mining. Depending on the mine ventilation system, this could result in methane concentrations exceeding regulatory limits. Hence, these findings provide insights into the potential risk of an unconventional gas well casing breach near a longwall mine under shallow cover. © 2023, This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply. |
Association of infection with Toxoplasma gondii and Toxocara on cognitive function among US adults aged 60 and over, NHANES 2011-2014
Kruszon-Moran D , Brody D , Pearce B . J Epidemiol Community Health 2023 77 (5) 315-321 BACKGROUND: Toxoplasma gondii and Toxocara are common parasites that infect humans globally. Our aim was to examine the relationship between T. gondii and Toxocara infection and cognition. METHODS: Multivariate logistic regression was used to test the association of T. gondii and Toxocara seropositivity on indices of cognitive function (a word list learning trial with delayed recall from the Consortium to Establish a Registry for Alzheimer's Disease, an animal fluency test (AFT) and a digit symbol substitution test (DSST)) among 2643 adults aged 60 years and older in the 2011-2014 National Health and Nutrition Examination Survey. RESULTS: Seropositivity to T. gondii or Toxocara were both associated with lower scores in all three cognitive function measures examined in univariate analyses. Except for the DSST, these associations were not significant after adjustment for age, gender, race and Hispanic origin, poverty level, education, US birth status, depression and hypertension. On stratification to account for significant interactions, Toxocara seropositivity was associated with worse scores on the AFT among those born outside the USA, worse scores on the DSST among those aged 60-69 years, female, Hispanic and with a high school diploma or less. Lower DSST scores with Toxocara infection was greater for adults living below compared with at or above the poverty level. CONCLUSIONS: Seropositivity to these parasites, particularly to Toxocara, may be associated with diminished cognitive performance in certain subgroups of older adults. |
Women attending antenatal care as a sentinel surveillance population for malaria in Geita region, Tanzania: feasibility and acceptability to women and providers
Emerson C , Ulimboka S , Lemwayi R , Kinyina A , Nhiga SL , Aaron S , Simeo J , Kitojo C , Reaves EJ , Drake M , Hussein Y , Bungire L , Gutman JR , Winch PJ . Malar J 2023 22 (1) 66 BACKGROUND: Measurement of malaria prevalence is conventionally estimated through infrequent cross-sectional household surveys that do not provide continuous information regarding malaria parasitaemia. Recent studies have suggested that malaria parasitaemia prevalence among women attending antenatal care (ANC) correlates with prevalence among children under 5 years old and that pregnant women could be a sentinel population for tracking malaria prevalence. In mainland Tanzania, 97% of women are tested for malaria parasitaemia during first ANC visits. However, acceptability among pregnant women and healthcare providers of collecting malaria risk factor data during ANC visits is limited. METHODS: A tablet-based questionnaire including 15 questions on insecticide-treated net ownership and use and care-seeking for febrile children was introduced at 40 healthcare facilities in Geita Region, Tanzania. Facilities were randomly selected from among those with 15-120 first ANC visits per month. To assess perspectives regarding introduction of the questionnaire, 21 semi-structured interviews were held with providers and facility in-charges at 12 facilities. Thirty pregnant and recently delivered women participated in focus group discussions at seven facilities to assess the acceptability of spending additional time answering questions about malaria risk. RESULTS: All pregnant women reported that introduction of ANC surveillance and spending 10 more minutes with providers answering questions about their health would be neutral or beneficial. They perceived being asked about their health as standard of care. Providers and in-charges reported that introduction of ANC surveillance was within their scope of practice. Nine of 21 indicated it could potentially benefit women's health. Six providers expressed concern about staffing shortages and need for reimbursement for extra time and noted that data management occurs after hours. CONCLUSIONS: Pregnant women and providers generally perceived ANC surveillance for malaria as acceptable and positive. Pregnant and recently delivered women saw this as a reasonable and even helpful intervention. To be seen as a part of standard practice, efforts are needed to ensure providers perceive a benefit for ANC clients and that staffing concerns are addressed. In addition, staff should receive feedback related to data submissions regarding malaria prevalence and risk factors among women at their facility, with actions to take. |
Association between adolescent self-reported physical activity behaviors and feeling close to people at school during the COVID-19 pandemic
Michael SL , Li J , Sliwa S , Cornett K , Hertz M . Am J Lifestyle Med 2023 The disruption of school operations and routines caused by the COVID-19 pandemic affected students’ physical and emotional well-being. Providing physical activity opportunities in schools can encourage students to positively engage with each other. Using a nationally representative sample of U.S. high school students from the Adolescent Behaviors and Experiences Survey (January to June 2021), we examined the association between physical activity behaviors and feeling close to people at school using sex-stratified and race/ethnicity-stratified multiple linear regressions models. Participating in team sports, being more physically active, and attending physical education (PE) during an average week were all associated with higher levels of feeling close to people at school, with variation by sex and race/ethnicity. These associations were also significant when the physical activity behavior variables were categorized to reflect national recommendations. Daily physical activity (i.e., ≥60 minutes all 7 days), daily PE (i.e., attended all 5 days), and the number of Comprehensive School Physical Activity Program (CSPAP) components implemented were associated with higher levels of feeling close to people at school. These findings suggest that opportunities for physical activity before, during, and after school are associated with increased levels of feeling close to people at school during crises like COVID-19. © Copyright 2023 The Author(s). |
In vitro testing of Trichomonas vaginalis drug susceptibility: evaluation of minimal lethal concentrations for metronidazole and tinidazole that correspond with treatment failure
Augostini P , Bradley ELP , Raphael BH , Secor WE . Sex Transm Dis 2023 50 (6) 370-373 BACKGROUND: The only drugs approved by the U.S. Food and Drug Administration for oral treatment of trichomoniasis belong to the 5-nitroimidazole group. Most individuals infected with Trichomonas vaginalis can be cured with a standard treatment of metronidazole or tinidazole, but it is estimated that more than 159,000 people fail treatment each year. Although a minimal lethal concentration (MLC) corresponding to treatment failure has been reported for metronidazole, the MLC for tinidazole associated with treatment failure has not been determined. We conducted a study using T. vaginalis isolates from women with reported treatment success or failure to determine these values. METHODS: We measured MLCs of 47 isolates obtained from women who had failed metronidazole treatment, 33 isolates from women who had failed tinidazole treatment, and 48 isolates from women successfully cured with metronidazole. The cutoff was calculated as the 95th percentile of MLCs of susceptible isolates for each drug. RESULTS: Our data confirmed the MLC previously associated with metronidazole treatment failure is ≥50 μg/ml and identified the MLC associated with tinidazole treatment failure as ≥6.3 μg/ml. For metronidazole, the agreement between laboratory result and treatment outcome was 93.7%, for tinidazole this agreement was 88.9%. CONCLUSIONS: The T. vaginalis susceptibility assay is useful for determining whether 5-nitroimidazole treatment failure in persons with trichomoniasis can be attributed to drug resistance. These results are useful for establishing interpretive guidance of test results and MLC levels can help guide appropriate patient treatment. |
Analysis of variable major protein antigenic variation in the relapsing fever spirochete, Borrelia miyamotoi, in response to polyclonal antibody selection pressure.
Gilmore RD , Armstrong BA , Brandt KS , Van Gundy TJ , Hojgaard A , Lopez JE , Kneubehl AR . PLoS One 2023 18 (2) e0281942 Borrelia miyamotoi is a tick-transmitted spirochete that is genetically grouped with relapsing fever Borrelia and possesses multiple archived pseudogenes that encode variable major proteins (Vmps). Vmps are divided into two groups based on molecular size; variable large proteins (Vlps) and variable small proteins (Vsps). Relapsing fever Borrelia undergo Vmp gene conversion at a single expression locus to generate new serotypes by antigenic switching which is the basis for immune evasion that causes relapsing fever in patients. This study focused on B. miyamotoi vmp expression when spirochetes were subjected to antibody killing selection pressure. We incubated a low passage parent strain with mouse anti-B. miyamotoi polyclonal antiserum which killed the majority population, however, antibody-resistant reisolates were recovered. PCR analysis of the gene expression locus in the reisolates showed vsp1 was replaced by Vlp-encoded genes. Gel electrophoresis protein profiles and immunoblots of the reisolates revealed additional Vlps indicating that new serotype populations were selected by antibody pressure. Sequencing of amplicons from the expression locus of the reisolates confirmed the presence of a predominant majority serotype population with minority variants. These findings confirm previous work demonstrating gene conversion in B. miyamotoi and that multiple serotype populations expressing different vmps arise when subjected to antibody selection. The findings also provide evidence for spontaneous serotype variation emerging from culture growth in the absence of antibody pressure. Validation and determination of the type, number, and frequency of serotype variants that arise during animal infections await further investigations. |
Swine-to-Ferret Transmission of Antigenically Drifted Contemporary Swine H3N2 Influenza A Virus Is an Indicator of Zoonotic Risk to Humans.
Souza CK , Kimble JB , Anderson TK , Arendsee ZW , Hufnagel DE , Young KM , Gauger PC , Lewis NS , Davis CT , Thor S , Vincent Baker AL . Viruses 2023 15 (2) Human-to-swine transmission of influenza A (H3N2) virus occurs repeatedly and plays a critical role in swine influenza A virus (IAV) evolution and diversity. Human seasonal H3 IAVs were introduced from human-to-swine in the 1990s in the United States and classified as 1990.1 and 1990.4 lineages; the 1990.4 lineage diversified into 1990.4.A-F clades. Additional introductions occurred in the 2010s, establishing the 2010.1 and 2010.2 lineages. Human zoonotic cases with swine IAV, known as variant viruses, have occurred from the 1990.4 and 2010.1 lineages, highlighting a public health concern. If a variant virus is antigenically drifted from current human seasonal vaccine (HuVac) strains, it may be chosen as a candidate virus vaccine (CVV) for pandemic preparedness purposes. We assessed the zoonotic risk of US swine H3N2 strains by performing phylogenetic analyses of recent swine H3 strains to identify the major contemporary circulating genetic clades. Representatives were tested in hemagglutination inhibition assays with ferret post-infection antisera raised against existing CVVs or HuVac viruses. The 1990.1, 1990.4.A, and 1990.4.B.2 clade viruses displayed significant loss in cross-reactivity to CVV and HuVac antisera, and interspecies transmission potential was subsequently investigated in a pig-to-ferret transmission study. Strains from the three lineages were transmitted from pigs to ferrets via respiratory droplets, but there were differential shedding profiles. These data suggest that existing CVVs may offer limited protection against swine H3N2 infection, and that contemporary 1990.4.A viruses represent a specific concern given their widespread circulation among swine in the United States and association with multiple zoonotic cases. |
Impacts over time of neighborhood-scale interventions to control ticks and tick-borne disease incidence
Ostfeld RS , Mowry S , Bremer W , Duerr S , Evans AS Jr , Fischhoff IR , Hinckley AF , Hook SA , Keating F , Pendleton J , Pfister A , Teator M , Keesing F . Vector Borne Zoonotic Dis 2023 23 (3) 89-105 Background: Controlling populations of ticks with biological or chemical acaricides is often advocated as a means of reducing human exposure to tick-borne diseases. Reducing tick abundance is expected to decrease immediate risk of tick encounters and disrupt pathogen transmission cycles, potentially reducing future exposure risk. Materials and Methods: We designed a placebo-controlled, randomized multiyear study to assess whether two methods of controlling ticks-tick control system (TCS) bait boxes and Met52 spray-reduced tick abundance, tick encounters with people and outdoor pets, and reported cases of tick-borne diseases. The study was conducted in 24 residential neighborhoods in a Lyme disease endemic zone in New York State. We tested the hypotheses that TCS bait boxes and Met52, alone or together, would be associated with increasing reductions in tick abundance, tick encounters, and cases of tick-borne disease over the 4-5 years of the study. Results: In neighborhoods with active TCS bait boxes, populations of blacklegged ticks (Ixodes scapularis) were not reduced over time in any of the three habitat types tested (forest, lawn, shrub/garden). There was no significant effect of Met52 on tick abundance overall, and there was no evidence for a compounding effect over time. Similarly, we observed no significant effect of either of the two tick control methods, used singly or together, on tick encounters or on reported cases of tick-borne diseases in humans overall, and there was no compounding effect over time. Thus, our hypothesis that effects of interventions would accumulate through time was not supported. Conclusions: The apparent inability of the selected tick control methods to reduce risk and incidence of tick-borne diseases after years of use requires further consideration. |
Content Index (Achived Edition)
- Antimicrobial Resistance and Antibiotic Stewardship
- Chronic Diseases and Conditions
- Communicable Diseases
- Disaster Preparedness and Emergency Services
- Environmental Health
- Epidemiology and Surveillance
- Genetics and Genomics
- Health Economics
- Health Equity and Health Disparities
- Immunity and Immunization
- Informatics
- Injury and Violence
- Laboratory Sciences
- Maternal and Child Health
- Nutritional Sciences
- Occupational Safety and Health
- Occupational Safety and Health - Mining
- Parasitic Diseases
- Physical Activity
- Reproductive Health
- Zoonotic and Vectorborne Diseases
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