State socioeconomic indicators and self-reported hypertension among US adults, 2011 Behavioral Risk Factor Surveillance System
Fan AZ , Strasser SM , Zhang X , Fang J , Crawford CG . Prev Chronic Dis 2015 12 E27 INTRODUCTION: Hypertension is the leading cause of chronic disease and premature death in the United States. To date, most risk factors for hypertension have been identified at the individual (micro) level. The association of macro-level (area) socioeconomic factors and hypertension prevalence rates in the population has not been studied extensively. METHODS: We used the 2011 Behavioral Risk Factor Surveillance System to examine whether state socioeconomic status (SES) indicators predict the prevalence of self-reported hypertension. Quintiles of state median household income, unemployment rate among the population aged 16 to 64 years, and the proportion of the population under the national poverty line were used as the proxy for state SES. Hypertension status was determined by the question "Have you ever been told by a doctor, nurse, or other health professional that you have high blood pressure?" Logistic regression was used to assess the relationship between state SES and hypertension with adjustment for individual covariates (demographic and socioeconomic factors and lifestyle behaviors). RESULTS: States with a median household income of $43,225 or less (odds ratio [95% confidence interval] = 1.16 [1.08-1.25]) and states with 18.7% or more of residents living below the poverty line (odds ratio [95% confidence interval] = 1.14 [1.04-1.24]) had a higher prevalence of hypertension than states with the most residents in the most advantageous quintile of the indicators. CONCLUSION: The observed state SES-hypertension association indicates that area SES may contribute to the burden of hypertension in community-dwelling adults. |
The effect of lifestyle intervention and metformin on preventing or delaying diabetes among women with and without gestational diabetes: the Diabetes Prevention Program Outcomes Study 10-year follow-up
Aroda VR , Christophi CA , Edelstein SL , Zhang P , Herman WH , Barrett-Connor E , Delahanty LM , Montez MG , Ackermann RT , Zhuo X , Knowler WC , Ratner RE . J Clin Endocrinol Metab 2015 100 (4) jc20143761 CONTEXT: Gestational diabetes (GDM) confers a high risk of type 2 diabetes. In the Diabetes Prevention Program (DPP), intensive lifestyle (ILS) and metformin prevented or delayed diabetes in women with a history of GDM. OBJECTIVE: The objective of the study was to evaluate the impact of ILS and metformin intervention over 10 years in women with and without a history of GDM in the DPP/Diabetes Prevention Program Outcomes Study. DESIGN: This was a randomized controlled clinical trial with an observational follow-up. SETTING: The study was conducted at 27 clinical centers. PARTICIPANTS: Three hundred fifty women with a history of GDM and 1416 women with previous live births but no history of GDM participated in the study. The participants had an elevated body mass index and fasting glucose and impaired glucose tolerance at study entry. INTERVENTIONS: Interventions included placebo, ILS, or metformin. OUTCOMES MEASURE: Outcomes measure was diabetes mellitus. RESULTS: Over 10 years, women with a history of GDM assigned to placebo had a 48% higher risk of developing diabetes compared with women without a history of GDM. In women with a history of GDM, ILS and metformin reduced progression to diabetes compared with placebo by 35% and 40%, respectively. Among women without a history of GDM, ILS reduced the progression to diabetes by 30%, and metformin did not reduce the progression to diabetes. CONCLUSIONS: Women with a history of GDM are at an increased risk of developing diabetes. In women with a history of GDM in the DPP/Diabetes Prevention Program Outcomes Study, both lifestyle and metformin were highly effective in reducing progression to diabetes during a 10-year follow-up period. Among women without a history of GDM, lifestyle but not metformin reduced progression to diabetes. |
Health behaviors among people with epilepsy - results from the 2010 National Health Interview Survey
Cui W , Zack MM , Kobau R , Helmers SL . Epilepsy Behav 2015 44c 121-126 OBJECTIVES: This study aimed to estimate and compare the prevalence of selected health behavior-alcohol use, cigarette smoking, physical activity, and sufficient sleep-between people with and without a history of epilepsy in a large, nationally representative sample in the United States. METHODS: We used data from the 2010 cross-sectional National Health Interview Survey (NHIS) to compare the prevalence of each health behavior for people with and without epilepsy while adjusting for sex, age, race/ethnicity, and family income. We also further categorized those with epilepsy into active epilepsy and inactive epilepsy and calculated their corresponding prevalences. RESULTS: The percentages of adults with a history of epilepsy (50.1%, 95% CI=45.1%-55.2%) and with active epilepsy (44.4%, 95% CI=37.6%-51.5%) who were current alcohol drinkers were significantly lower than that of those without epilepsy (65.1%, 95% CI=64.2%-66.0%). About 21.8% (95% CI=18.1%-25.9%) of adults with epilepsy and 19.3% (95% CI=18.7%-19.9%) of adults without epilepsy were current smokers. Adults with active epilepsy were significantly less likely than adults without epilepsy to report following recommended physical activity guidelines for Americans (35.2%, 95% CI=28.8%-42.1% vs. 46.3%, 95% CI=45.4%-47.2%) and to report walking for at least ten minutes during the seven days prior to being surveyed (39.6%, 95% CI=32.3%-47.4% vs. 50.8%, 95% CI=49.9%-51.7%). The percentage of individuals with active epilepsy (49.8%, 95% CI=42.0%-57.7%) who reported sleeping an average of 7 or 8h a day was significantly lower than that of those without epilepsy (61.9%, 95% CI=61.2%-62.7%). CONCLUSIONS: Because adults with epilepsy are significantly less likely than adults without epilepsy to engage in recommended levels of physical activity and to get the encouraged amount of sleep for optimal health and well-being, promoting more safe physical activity and improved sleep quality is necessary among adults with epilepsy. Ending tobacco use and maintaining low levels of alcohol consumption would also better the health of adults with epilepsy. |
Identifying and addressing the needs of adolescents and young adults with cancer: summary of an Institute of Medicine workshop
Nass SJ , Beaupin LK , Demark-Wahnefried W , Fasciano K , Ganz PA , Hayes-Lattin B , Hudson MM , Nevidjon B , Oeffinger KC , Rechis R , Richardson LC , Seibel NL , Smith AW . Oncologist 2015 20 (2) 186-195 Cancer is the leading disease-related cause of death in adolescents and young adults (AYAs). This population faces many short- and long-term health and psychosocial consequences of cancer diagnosis and treatment, but many programs for cancer treatment, survivorship care, and psychosocial support do not focus on the specific needs of AYA cancer patients. Recognizing this health care disparity, the National Cancer Policy Forum of the Institute of Medicine convened a public workshop to examine the needs of AYA patients with cancer. Workshop participants identified many gaps and challenges in the care of AYA cancer patients and discussed potential strategies to address these needs. Suggestions included ways to improve access to care for AYAs, to deliver cancer care that better meets the medical and psychosocial needs of AYAs, to develop educational programs for providers who care for AYA cancer survivors, and to enhance the evidence base for AYAs with cancer by facilitating participation in research. |
Identifying promising practices for evaluation: the National Breast and Cervical Cancer Early Detection Program
DeGroff A , Cheung K , Dawkins-Lyn N , Hall MA , Melillo S , Glover-Kudon R . Cancer Causes Control 2015 26 (5) 767-74 PURPOSE: The Centers for Disease Control and Prevention conducted a systematic screening and assessment process to identify promising practices implemented by grantees of the National Breast and Cervical Cancer Early Detection Program and its partners that were appropriate for rigorous evaluation. METHODS: The systematic screening and assessment (SSA) process was conducted from September 2010 through March 2012 and included five steps: (1) nominations of promising practices; (2) a first rating by subject matter experts; (3) field-based evaluability assessments; (4) a second rating by experts; and (5) use of results. Nominations were sought in three program areas including health education and promotion, quality assurance and quality improvement, and case management/patient navigation. RESULTS: A total of 98 practices were nominated of which 54 % were eligible for the first review by the experts. Fifteen practices were selected for evaluability assessment with ten forwarded for the second review by the experts. Three practices were ultimately recommended for rigorous evaluation, and one evaluation was conducted. Most nominated practices were based on evidence-based strategies rather than representing new, innovative activities. Issues were identified through the process including inconsistent implementation and lack of implementation fidelity. CONCLUSION: While the SSA was successful in identifying several programs for evaluation, the process also revealed important shortcomings in program implementation. Training and technical assistance could help address these issues and support improved programming. |
Cancer screening among a population-based sample of insured women
Alford SH , Leadbetter S , Rodriguez JL , Hawkins NA , Scholl LE , Peipins LA . Prev Med Rep 2015 2 15-20 PURPOSE: Screening has been shown to lower the morbidity and mortality for breast, cervical, and colorectal cancers. Despite the availability of cancer screening, nearly 70,000 women die each year from these cancers. We conducted a study in 2008 within a privately-insured patient population of women who were members of an integrated health care system in Southeastern Michigan, for whom information on ovarian cancer risk as well as personal and family history of cancer was available. METHODS: We used a population-based, weighted stratified random sample of women from a single health care institution to assess the proportion with up-to-date breast, cervical, and colorectal screening. Multivariable analyses were conducted to identify predictors of screening behavior. RESULTS: In our study, women reported cervical and breast cancer screening above 90% and colorectal cancer screening above 75%. CONCLUSIONS: The results of our study hold promise that Healthy People 2020 cancer screening objectives might be obtainable as access to health insurance is expanded among US residents. |
Rapid intervention to reduce Ebola transmission in a remote village - Gbarpolu County, Liberia, 2014
Blackley DJ , Lindblade KA , Kateh F , Broyles LN , Westercamp M , Neatherlin JC , Pillai SK , Tucker A , Mott JA , Walke H , Nyenswah T . MMWR Morb Mortal Wkly Rep 2015 64 (7) 175-178 As late as September 14, 2014, Liberia's Gbarpolu County had reported zero cases of Ebola virus disease (Ebola). On October 25, the Bong County Health Team, a local health department in the Liberian Ministry of Health and Social Welfare (MOHSW), received confirmation of Ebola in a man who had recently left Geleyansiesu, a remote village of approximately 800 residents, after his wife and daughter had died of illnesses consistent with Ebola. MOHSW requested assistance from CDC, the World Health Organization, and other international partners to investigate and confirm the outbreak in Geleyansiesu and begin interventions to interrupt transmission. A total of 22 cases were identified, of which 18 (82%) were laboratory confirmed by real-time polymerase chain reaction. There were 16 deaths (case-fatality rate = 73%). Without road access to or direct telecommunications with the village, interventions had to be tailored to the local context. Public health interventions included 1) education of the community about Ebola, transmission of the virus, signs and symptoms, the importance of isolating ill patients from family members, and the potential benefits of early diagnosis and treatment; 2) establishment of mechanisms to alert health authorities of possibly infected persons leaving the village to facilitate safe transport to the closest Ebola treatment unit (ETU); 3) case investigation, contact tracing, and monitoring of contacts; 4) training in hygienic burial of dead bodies; 5) active case finding and diagnosis; and 6) isolation and limited no-touch treatment in the village of patients unwilling or unable to seek care at an ETU. The findings of this investigation could inform interventions aimed at controlling focal outbreaks in difficult-to-reach communities, which has been identified as an important component of the effort to eliminate Ebola from Liberia. |
Rapid response to Ebola outbreaks in remote areas - Liberia, July-November 2014
Kateh F , Nagbe T , Kieta A , Barskey A , Gasasira AN , Driscoll A , Tucker A , Christie A , Karmo B , Scott C , Barradas D , Blackley D , Dweh E , Warren F , Mahoney F , Kassay G , Calvert GM , Castro G , Logan G , Appiah G , Kirking H , Koon H , Papowitz H , Walke H , Cole IB , Montgomery J , Neatherlin J , Tappero JW , Forrester J , Woodring J , Mott J , Attfield K , DeCock K , Lindblade KA , Powell K , Yeoman K , Adams L , Broyles LN , Slutsker L , Belcher L , Cooper L , Santos M , Westercamp M , Weinberg MP , Massoudi M , Dea M , Patel M , Hennessey M , Fomba M , Lubogo M , Maxwell N , Moonan P , Arzoaquoi S , Gee S , Zayzay S , Pillai S , Williams S , Zarecki SM , Yett S , James S , Grube S , Gupta S , Nelson T , Malibiche T , Frank W , Smith W , Nyenswah T . MMWR Morb Mortal Wkly Rep 2015 64 (7) 188-192 West Africa is experiencing its first epidemic of Ebola virus disease (Ebola). As of February 9, Liberia has reported 8,864 Ebola cases, of which 3,147 were laboratory-confirmed. Beginning in August 2014, the Liberia Ministry of Health and Social Welfare (MOHSW), supported by CDC, the World Health Organization (WHO), and others, began systematically investigating and responding to Ebola outbreaks in remote areas. Because many of these areas lacked mobile telephone service, easy road access, and basic infrastructure, flexible and targeted interventions often were required. Development of a national strategy for the Rapid Isolation and Treatment of Ebola (RITE) began in early October. The strategy focuses on enhancing capacity of county health teams (CHT) to investigate outbreaks in remote areas and lead tailored responses through effective and efficient coordination of technical and operational assistance from the MOHSW central level and international partners. To measure improvements in response indicators and outcomes over time, data from investigations of 12 of 15 outbreaks in remote areas with illness onset dates of index cases during July 16-November 20, 2014, were analyzed. The times to initial outbreak alerts and durations of the outbreaks declined over that period while the proportions of patients who were isolated and treated increased. At the same time, the case-fatality rate in each outbreak declined. Implementation of strategies, such as RITE, to rapidly respond to rural outbreaks of Ebola through coordinated and tailored responses can successfullyreduce transmission and improve outcomes. |
Severe acute respiratory illness deaths in sub-Saharan Africa and the role of influenza: a case-series from 8 countries
McMorrow ML , Wemakoy EO , Tshilobo JK , Emukule GO , Mott JA , Njuguna H , Waiboci L , Heraud JM , Rajatonirina S , Razanajatovo NH , Chilombe M , Everett D , Heyderman RS , Barakat A , Nyatanyi T , Rukelibuga J , Cohen AL , Cohen C , Tempia S , Thomas J , Venter M , Mwakapeje E , Mponela M , Lutwama J , Duque J , Lafond K , Nzussouo NT , Williams T , Widdowson MA . J Infect Dis 2015 212 (6) 853-60 BACKGROUND: Data on causes of respiratory deaths in Africa are limited. METHODS: From January to April 2013, 28 African countries were invited to participate in a review of severe acute respiratory illness (SARI) deaths identified from influenza surveillance during 2009 - 2012. RESULTS: Twenty-three (82%) countries responded, 11 (48%) collect mortality data, and 8 provided data. Data were collected from 37,714 SARI cases and 3091 (8.2%, range by country 5.1-25.9%) tested positive for influenza. There were 1073 (2.8%, range by country 0.1-5.3%) deaths reported among whom 57 (5.3%) were influenza-positive. Case fatality proportion (CFP) was higher among countries with systematic death reporting than those with sporadic reporting. The influenza-associated CFP was 1.8% (57/3091) compared to 2.9% (1016/34,623) for influenza-negative cases (p<0.001). Among 834 (77.7%) deaths tested for other respiratory pathogens, rhinovirus (n=107, 12.8%), adenovirus (n=64, 6.0%), respiratory syncytial virus (n=60, 5.6%), and S. pneumoniae (n=57, 5.3%) were most commonly identified. Among 1073 deaths, 402 (37.5%) were aged 0-4 years, 462 (43.1%) aged 5-49 years, and 209 (19.5%) aged 50 years and older. CONCLUSIONS: Few African countries systematically collect data on respiratory hospitalization outcomes. Stronger surveillance for respiratory deaths may identify risk groups for targeted vaccine use and other prevention strategies. |
A systematic review of HIV and STI behavior change interventions for female sex workers in the United States
Abad N , Baack BN , O'Leary A , Mizuno Y , Herbst JH , Lyles CM . AIDS Behav 2015 19 (9) 1701-19 The lives of female sex workers (FSW) in the US are typically marked by substance abuse, violence, trauma, and poverty. These factors place FSW at risk for acquiring and transmitting HIV and other sexually transmitted infections (STIs). The purpose of this systematic review is to examine HIV/STI interventions conducted in the US that aim to reduce sexual- or drug-related risk behavior among FSW. Eighteen studies describing 19 unique interventions met our selection criteria: five exclusively targeted FSW, two reported stratified data for FSW, and 12 included at least 50 % FSW. Results indicate that 15 interventions provided HIV/STI information, 13 provided substance abuse prevention information, and few included content tailored to specific needs of FSW. Our findings suggest that current HIV/STI prevention efforts in the US do not adequately address the needs of FSW. Interventions are needed to address issues facing FSW in order to reduce HIV/STI transmission in this high-risk group. |
Time from infection with the human immunodeficiency virus to diagnosis, United States
Hall HI , Song R , Szwarcwald CL , Green T . J Acquir Immune Defic Syndr 2015 69 (2) 248-51 HIV testing efforts increased in recent years to reduce the percentage of persons with HIV unaware of their infection and to detect HIV early. An analysis of CD4 data from national HIV surveillance indicates that diagnosis delays decreased during 2003-2011; on average, persons diagnosed in 2011 had been infected 5.6 years before their diagnosis compared with 7.0 years among those diagnosed in 2003. Diagnosis delays were longer among females, blacks, Hispanics/Latinos, and younger persons, but shorter among men who have sex with men, compared with their counterparts. Continued efforts to implement routine testing can help reduce diagnosis delays. |
Update: Ebola virus disease epidemic - West Africa, February 2015
CDC Incident Management System Ebola Epidemiology Team , Guinea Interministerial Committee for Response Against the Ebola Virus , World Health Organization , CDC Guinea Response Team , Liberia Ministry of Health and Social Welfare , CDC Liberia Response Team , Sierra Leone Ministry of Health and Sanitation , CDC Sierra Leone Response Team , CDC NCEZID Viral Special Pathogens Branch , Srivastava P . MMWR Morb Mortal Wkly Rep 2015 64 (7) 186-187 CDC is assisting ministries of health and working with other organizations to end the ongoing epidemic of Ebola virus disease (Ebola) in West Africa. The updated data in this report were compiled from situation reports from the Guinea Interministerial Committee for Response Against the Ebola Virus, the Liberia Ministry of Health and Social Welfare, the Sierra Leone Ministry of Health and Sanitation, and the World Health Organization. |
Middle East Respiratory Syndrome-Coronavirus (MERS-CoV): CDC update for clinicians
Rasmussen SA , Gerber SI , Swerdlow DL . Clin Infect Dis 2015 60 (11) 1686-9 Although much recent focus has been on the recognition of Ebola virus disease among travelers from West Africa, cases of Middle East Respiratory Syndrome-Coronavirus (MERS-CoV), including travel-associated cases, continue to be reported. US clinicians need to be familiar with recommendations regarding when to suspect MERS-CoV, how to make a diagnosis, and what infection control measures need to be instituted when a case is suspected. Infection control is especially critical, given that most cases have been health care-associated. Two cases of MERS-CoV were identified in the United States in May of 2014; because these cases were detected promptly and appropriate control measures were put in place quickly, no secondary cases occurred. This paper summarizes information that US clinicians need to know to prevent secondary cases of MERS-CoV from occurring in the US. |
The movement of multidrug-resistant tuberculosis across borders in East Africa needs a regional and global solution
Cain KP , Marano N , Kamene M , Sitienei J , Mukherjee S , Galev A , Burton J , Nasibov O , Kioko J , De Cock KM . PLoS Med 2015 12 (2) e1001791 Kevin Cain and colleagues reflect on the cross border movement of people from Somalia with MDR-TB and the implications for MDR-TB programs in East Africa. |
Epidemiology of severe acute respiratory illness (SARI) among adults and children aged ≥5 years in a high HIV-prevalence setting, 2009-2012
Cohen C , Walaza S , Moyes J , Groome M , Tempia S , Pretorius M , Hellferscee O , Dawood H , Haffejee S , Variava E , Kahn K , Tshangela A , von Gottberg A , Wolter N , Cohen AL , Kgokong B , Venter M , Madhi SA . PLoS One 2015 10 (2) e0117716 OBJECTIVE: There are few published studies describing severe acute respiratory illness (SARI) epidemiology amongst older children and adults from high HIV-prevalence settings. We aimed to describe SARI epidemiology amongst individuals aged ≥5 years in South Africa. METHODS: We conducted prospective surveillance for individuals with SARI from 2009-2012. Using polymerase chain reaction, respiratory samples were tested for ten viruses, and blood for pneumococcal DNA. Cumulative annual SARI incidence was estimated at one site with population denominators. FINDINGS: We enrolled 7193 individuals, 9% (621/7067) tested positive for influenza and 9% (600/6519) for pneumococcus. HIV-prevalence was 74% (4663/6334). Among HIV-infected individuals with available data, 41% of 2629 were receiving antiretroviral therapy (ART). The annual SARI hospitalisation incidence ranged from 325-617/100,000 population. HIV-infected individuals experienced a 13-19 times greater SARI incidence than HIV-uninfected individuals (p<0.001). On multivariable analysis, compared to HIV-uninfected individuals, HIV-infected individuals were more likely to be receiving tuberculosis treatment (odds ratio (OR):1.7; 95%CI:1.1-2.7), have pneumococcal infection (OR 2.4; 95%CI:1.7-3.3) be hospitalised for >7 days rather than <2 days (OR1.7; 95%CI:1.2-2.2) and had a higher case-fatality ratio (8% vs 5%;OR1.7; 95%CI:1.2-2.3), but were less likely to be infected with influenza (OR 0.6; 95%CI:0.5-0.8). On multivariable analysis, independent risk indicators associated with death included HIV infection (OR 1.8;95%CI:1.3-2.4), increasing age-group, receiving mechanical ventilation (OR 6.5; 95%CI:1.3-32.0) and supplemental-oxygen therapy (OR 2.6; 95%CI:2.1-3.2). CONCLUSION: The burden of hospitalized SARI amongst individuals aged ≥5 years is high in South Africa. HIV-infected individuals are the most important risk group for SARI hospitalization and mortality in this setting. |
Human immunodeficiency virus transmission at each step of the care continuum in the United States
Skarbinski J , Rosenberg E , Paz-Bailey G , Hall HI , Rose CE , Viall AH , Fagan JL , Lansky A , Mermin JH . JAMA Intern Med 2015 175 (4) 588-96 Importance: Human immunodeficiency virus (HIV) transmission risk is primarily dependent on behavior (sexual and injection drug use) and HIV viral load. National goals emphasize maximizing coverage along the HIV care continuum, but the effect on HIV prevention is unknown. Objectives: To estimate the rate and number of HIV transmissions attributable to persons at each of the following 5 HIV care continuum steps: HIV infected but undiagnosed, HIV diagnosed but not retained in medical care, retained in care but not prescribed antiretroviral therapy, prescribed antiretroviral therapy but not virally suppressed, and virally suppressed. Design, Setting, and Participants: A multistep, static, deterministic model that combined population denominator data from the National HIV Surveillance System with detailed clinical and behavioral data from the National HIV Behavioral Surveillance System and the Medical Monitoring Project to estimate the rate and number of transmissions along the care continuum. This analysis was conducted January 2013 to June 2014. The findings reflect the HIV-infected population in the United States in 2009. Main Outcomes and Measures: Estimated rate and number of HIV transmissions. Results: Of the estimated 1 148 200 persons living with HIV in 2009, there were 207 600 (18.1%) who were undiagnosed, 519 414 (45.2%) were aware of their infection but not retained in care, 47 453 (4.1%) were retained in care but not prescribed ART, 82 809 (7.2%) were prescribed ART but not virally suppressed, and 290 924 (25.3%) were virally suppressed. Persons who are HIV infected but undiagnosed (18.1% of the total HIV-infected population) and persons who are HIV diagnosed but not retained in medical care (45.2% of the population) were responsible for 91.5% (30.2% and 61.3%, respectively) of the estimated 45 000 HIV transmissions in 2009. Compared with persons who are HIV infected but undiagnosed (6.6 transmissions per 100 person-years), persons who were HIV diagnosed and not retained in medical care were 19.0% (5.3 transmissions per 100 person-years) less likely to transmit HIV, and persons who were virally suppressed were 94.0% (0.4 transmissions per 100 person-years) less likely to transmit HIV. Men, those who acquired HIV via male-to-male sexual contact, and persons 35 to 44 years old were responsible for the most HIV transmissions by sex, HIV acquisition risk category, and age group, respectively. Conclusions and Relevance: Sequential steps along the HIV care continuum were associated with reduced HIV transmission rates. Improvements in HIV diagnosis and retention in care, as well as reductions in sexual and drug use risk behavior, primarily for persons undiagnosed and not receiving antiretroviral therapy, would have a substantial effect on HIV transmission in the United States. |
Implementation of Ebola case-finding using a village chieftaincy taskforce in a remote outbreak - Liberia, 2014
Hagan JE , Smith W , Pillai SK , Yeoman K , Gupta S , Neatherlin J , Slutsker L , Lindblade KA , DeCock KM , Kateh F , Nyenswah T . MMWR Morb Mortal Wkly Rep 2015 64 (7) 183-185 On October 16, 2014, a woman aged 48 years traveled from Monrovia, Liberia, to the Kayah region of Rivercess County, a remote, resource-poor, and sparsely populated region of Liberia, and died on October 21 with symptoms compatible with Ebola virus disease (Ebola). She was buried in accordance with local tradition, which included grooming, touching, and kissing the body by family and other community members while it was being prepared for burial. During October 24-November 12, eight persons with probable and 13 with confirmed Ebola epidemiologically linked to the deceased woman had onset of symptoms. Nineteen of the 21 persons lived in five nearby villages in Kayah region; two, both with probable cases, lived in neighboring Grand Bassa County (Figure). Four of the confirmed cases in Kayah were linked by time and location, although the source case could not be determined because the patients had more than one exposure. |
2014 MERS-CoV outbreak in Jeddah - a link to health care facilities
Oboho IK , Tomczyk SM , Al-Asmari AM , Banjar AA , Al-Mugti H , Aloraini MS , Alkhaldi KZ , Almohammadi EL , Alraddadi BM , Gerber SI , Swerdlow DL , Watson JT , Madani TA . N Engl J Med 2015 372 (9) 846-54 BACKGROUND: A marked increase in the number of cases of Middle East respiratory syndrome coronavirus (MERS-CoV) infection occurred in Jeddah, Saudi Arabia, in early 2014. We evaluated patients with MERS-CoV infection in Jeddah to explore reasons for this increase and to assess the epidemiologic and clinical features of this disease. METHODS: We identified all cases of laboratory-confirmed MERS-CoV infection in Jeddah that were reported to the Saudi Arabian Ministry of Health from January 1 through May 16, 2014. We conducted telephone interviews with symptomatic patients who were not health care personnel, and we reviewed hospital records. We identified patients who were reported as being asymptomatic and interviewed them regarding a history of symptoms in the month before testing. Descriptive analyses were performed. RESULTS: Of 255 patients with laboratory-confirmed MERS-CoV infection, 93 died (case fatality rate, 36.5%). The median age of all patients was 45 years (interquartile range, 30 to 59), and 174 patients (68.2%) were male. A total of 64 patients (25.1%) were reported to be asymptomatic. Of the 191 symptomatic patients, 40 (20.9%) were health care personnel. Among the 151 symptomatic patients who were not health care personnel, 112 (74.2%) had data that could be assessed, and 109 (97.3%) of these patients had had contact with a health care facility, a person with a confirmed case of MERS-CoV infection, or someone with severe respiratory illness in the 14 days before the onset of illness. The remaining 3 patients (2.7%) reported no such contacts. Of the 64 patients who had been reported as asymptomatic, 33 (52%) were interviewed, and 26 of these 33 (79%) reported at least one symptom that was consistent with a viral respiratory illness. CONCLUSIONS: The majority of patients in the Jeddah MERS-CoV outbreak had contact with a health care facility, other patients, or both. This highlights the role of health care-associated transmission. (Supported by the Ministry of Health, Saudi Arabia, and by the U.S. Centers for Disease Control and Prevention.). |
Community quarantine to interrupt Ebola virus transmission - Mawah Village, Bong County, Liberia, August-October, 2014
Nyenswah T , Blackley DJ , Freeman T , Lindblade KA , Arzoaquoi SK , Mott JA , Williams JN , Halldin CN , Kollie F , Laney AS . MMWR Morb Mortal Wkly Rep 2015 64 (7) 179-182 On September 30, 2014, the Bong County health officer notified the county Ebola task force of a growing outbreak of Ebola virus disease (Ebola) in Mawah, a village of approximately 800 residents. During September 9-16, household quarantine had been used by the community in response to a new Ebola infection. Because the infection led to a local outbreak that grew during September 17-20, county authorities suggested community quarantine be considered, and beginning on approximately September 20, the Fuamah District Ebola Task Force (Task Force) engaged Mawah leaders to provide education about Ebola and to secure cooperation for the proposed measures. On September 30, Bong County requested technical assistance to develop strategies to limit transmission in the village and to prevent spread to other areas. The county health team, with support from the Task Force and CDC, traveled to Mawah on October 1 and identified approximately two dozen residents reporting symptoms consistent with Ebola. Because of an ambulance shortage, 2 days were required, beginning October 1, to transport the patients to an Ebola treatment unit in Monrovia. Community quarantine measures, consisting of restrictions on entering or leaving Mawah, regulated river crossings, and market closures, were implemented on October 1. Local leaders raised concerns about availability of medical care and food. The local clinic was reopened on October 11, and food was distributed on October 12. The Task Force reported a total of 22 cases of Ebola in Mawah during September 9-October 2, of which 19 were fatal. During October 3-November 21, no new cases were reported in the village. Involving community members during planning and implementation helped support a safe and effective community quarantine in Mawah. |
Community-acquired pneumonia requiring hospitalization among U.S. children
Jain S , Williams DJ , Arnold SR , Ampofo K , Bramley AM , Reed C , Stockmann C , Anderson EJ , Grijalva CG , Self WH , Zhu Y , Patel A , Hymas W , Chappell JD , Kaufman RA , Kan JH , Dansie D , Lenny N , Hillyard DR , Haynes LM , Levine M , Lindstrom S , Winchell JM , Katz JM , Erdman D , Schneider E , Hicks LA , Wunderink RG , Edwards KM , Pavia AT , McCullers JA , Finelli L . N Engl J Med 2015 372 (9) 835-45 BACKGROUND: Incidence estimates of hospitalizations for community-acquired pneumonia among children in the United States that are based on prospective data collection are limited. Updated estimates of pneumonia that has been confirmed radiographically and with the use of current laboratory diagnostic tests are needed. METHODS: We conducted active population-based surveillance for community-acquired pneumonia requiring hospitalization among children younger than 18 years of age in three hospitals in Memphis, Nashville, and Salt Lake City. We excluded children with recent hospitalization or severe immunosuppression. Blood and respiratory specimens were systematically collected for pathogen detection with the use of multiple methods. Chest radiographs were reviewed independently by study radiologists. RESULTS: From January 2010 through June 2012, we enrolled 2638 of 3803 eligible children (69%), 2358 of whom (89%) had radiographic evidence of pneumonia. The median age of the children was 2 years (interquartile range, 1 to 6); 497 of 2358 children (21%) required intensive care, and 3 (<1%) died. Among 2222 children with radiographic evidence of pneumonia and with specimens available for bacterial and viral testing, a viral or bacterial pathogen was detected in 1802 (81%), one or more viruses in 1472 (66%), bacteria in 175 (8%), and both bacterial and viral pathogens in 155 (7%). The annual incidence of pneumonia was 15.7 cases per 10,000 children (95% confidence interval [CI], 14.9 to 16.5), with the highest rate among children younger than 2 years of age (62.2 cases per 10,000 children; 95% CI, 57.6 to 67.1). Respiratory syncytial virus was more common among children younger than 5 years of age than among older children (37% vs. 8%), as were adenovirus (15% vs. 3%) and human metapneumovirus (15% vs. 8%). Mycoplasma pneumoniae was more common among children 5 years of age or older than among younger children (19% vs. 3%). CONCLUSIONS: The burden of hospitalization for children with community-acquired pneumonia was highest among the very young, with respiratory viruses the most commonly detected causes of pneumonia. (Funded by the Influenza Division of the National Center for Immunization and Respiratory Diseases.). |
A comparison of referred sexual partners to their community recruited counterparts in The BROTHERS Project (HPTN 061)
Hall G , Li K , Wilton L , Wheeler D , Fogel J , Wang L , Koblin B . AIDS Behav 2015 19 (12) 2214-23 The BROTHERS Project (HPTN 061) was established to determine the feasibility and acceptability of a multi-component intervention among African American MSM to reduce HIV incidence. The goal of this analysis was to determine if the sexual partner referral approach used in HPTN 061 broadened the reach of recruitment with regards to characteristics associated with higher infection rates and barriers to quality health care. Overall, referred sexual partners had notable structural barrier differences in comparison to community-recruited participants: lower income, less education, higher unemployment, HIV positive diagnosis, incarceration history, and no health insurance. The study’s findings pose implications for utilizing the sexual partner referral approach in reaching African American MSM who may not be accessed by traditional recruitment methods or who are well-integrated in health care systems. |
Critique and lessons learned from using multiple methods to estimate population size of men who have sex with men in Ghana
Quaye S , Fisher Raymond H , Atuahene K , Amenyah R , Aberle-Grasse J , McFarland W , El-Adas A . AIDS Behav 2015 19 Suppl 1 S16-23 Population size estimation of key populations at risk of HIV is essential to every national response. We implemented population size estimation of men who have sex with men (MSM) in Ghana using a three-stage approach within the 2011 Ghana Men's Study: during the study's formative assessment, the larger integrated bio-behavioral surveillance (IBBS) survey; and during the stakeholder meeting. We used six methods in combination within the three-stage approach (literature review, mapping with census, unique object multiplier, service multiplier, wisdom of the crowd, and modified Delphi) to generate size estimates from 16 locations (4 IBBS survey sites and 12 other locations) and used the estimates from the 16 sites to extrapolate the total MSM population size of Ghana. We estimated the number of MSM in Ghana to be 30,579 with a plausible range of 21,645-34,470. The overall estimate suggests that the prevalence of MSM in Ghana is 0.48 % of the adult male population. Lessons learned are shared to inform and improve applications of the methods in future studies. |
Depressive symptoms by HIV serostatus are differentially associated with unprotected receptive and insertive anal sex among substance-using men who have sex with men in the United States
Hanson KE , Mansergh G , Koblin BA , Flores SA , Hudson SM , Myers L , Colfax GN . J Acquir Immune Defic Syndr 2015 68 (1) e13-6 Men who have sex with men (MSM) are still disproportionately affected by HIV/AIDS in the United States. While gay, bisexual, and other MSM represent an estimated 2% of the US population,1 as of 2010, this population accounted for approximately 56% of those living with HIV and 63% of new HIV infections.2 Studies of a syndemic association of multiple physical and mental health factors (eg, depression, substance use or abuse, childhood sexual abuse, experienced gay, or bisexual stigma) among MSM have found those factors to be associated with each other and with risk for HIV transmission.3,4 There are mixed research findings regarding the specific association of depression and unprotected anal sex (ie, without a condom), with supporting evidence found in some studies5 but not others.6,7 Recent studies that tend to support an association of depression and sexual risk among MSM5,8 have applied broad definitions of behavior and not stratified analyses by HIV serostatus or specific sexual risk behaviors. For example, Reisner et al8 assessed a combined variable of all unprotected sex (anal and/or vaginal) for both men and women, whereas Fendrich et al5 reported unprotected receptive and insertive anal sex separately but not stratified by HIV serostatus before calculating odds ratios. Stratified analysis for specific behaviors is critical in understanding nuanced associations for the highest risk behaviors for HIV acquisition/transmission by HIV serostatus (ie, unprotected receptive anal sex for HIV-negative MSM; unprotected insertive anal sex for HIV-positive MSM). This study examines the association of depressive symptoms and unprotected insertive and receptive anal sex, separately and by HIV serostatus, among substance-using MSM who reported recent unprotected sexual behavior. | A convenience sample of HIV-negative and HIV-positive MSM (n = 1203) who reported unprotected anal sex and substance use during anal sex in the previous 6 months was enrolled in the Project MIX trial in Chicago, Los Angeles, NY City, and San Francisco. The purpose of the trial was to test a behavioral intervention to reduce sexual risk behavior of substance-using MSM; study methods and results are discussed in detail elsewhere.9 CDC and local Institutional Review Boards in each city approved the study protocol. Participants completed a baseline assessment in 2005–2006 that measured self-reported demographic variables, HIV status (including only men first diagnosed as HIV positive >6 months before study enrollment), recent unprotected anal sex (UA, ie, without a condom in the past 3 months) with a nonprimary male partner [including unprotected receptive (URA) and insertive (UIA)], drug use during the sexual encounter, depressive symptoms, and other psychosocial variables. Depressive symptoms in the past week were measured using 7 items from Santor and Coyne's 9-item short version of the Center for Epidemiological Studies—Depression (CES-D) scale, Cronbach alpha = 0.87.10 Two items were dropped due to low interitem correlations, as done earlier.11 A mean overall score for each participant was dichotomized to indicate depressive symptoms occurred “never” or “sometimes” (1–2) or “more than sometimes” (>2 to 4) in the past week. |
Drug use, sexual risk, and syndemic production among men who have sex with men who engage in group sexual encounters
Hirshfield S , Schrimshaw EW , Stall RD , Margolis AD , Downing MJ Jr , Chiasson MA . Am J Public Health 2015 105 (9) e1-e10 OBJECTIVES: We surveyed men who have sex with men (MSM) to determine whether sexual risk behaviors, recent drug use, and other psychosocial problems differed between men who engaged in one-on-one and group sexual encounters. METHODS: We conducted an Internet-based cross-sectional survey of 7158 MSM aged 18 years or older in the United States recruited from a gay-oriented sexual networking Web site in 2008. Among MSM who engaged in group sexual encounters, we compared their past-60-day sexual behaviors in one-on-one encounters and group sexual encounters. We also compared risk profiles and syndemic production between men who did and did not participate in group sex. RESULTS: Men reporting a group-sex encounter had significantly higher polydrug use and sexual risk than did the men not reporting group sex in the past 60 days. The odds of engaging in group sex with 4 or more sexual partners significantly increased with the number of psychosocial problems, supporting evidence of syndemic production. CONCLUSIONS: We identified a particularly high-risk subgroup in the MSM population with considerable psychosocial problems that may be reached online. Research is needed on how to engage these high-risk men in combination prevention interventions. |
Perceptions of HIV risk and explanations of sexual risk behavior offered by heterosexual black male barbershop patrons in Brooklyn, NY
Taylor TN , Joseph M , Henny KD , Pinto AR , Agbetor F , Camilien B , Williams KM , Browne RC , White M , Gousse Y , Brown H , Taylor RD , Wilson TE . J Health Dispar Res Pract 2014 7 (6) 1-25 To describe HIV risk factors among adult heterosexual Black men recruited from four barbershops located in high HIV seroprevalent neighborhoods of Brooklyn, NY. Data on HIV-risk related behaviors and other characteristics were collected from barbershop clients. All participants (n=60) completed brief risk assessments; and a subset (n=22) also completed focus groups and/or individual interviews. Of the subset of 22 men, 68% were US born, 59% had been in jail/prison, 32% were unemployed; and during the 3 months before the interviews, 68% reported at least two partners and 45% reported unprotected vaginal or anal sex with two or more women. Emergent themes included: 1) the psychological function of multiple partnerships; 2) calculated risk taking regarding condom use; 3) the role of emotional attachment and partner trust in condom use; 4) low perceived HIV risk and community awareness; and 5) lack of relationship between HIV testing and safer sex practices. Interventions among heterosexual Black men should focus not only on increasing HIV awareness and reducing sexual risk, but also on contextual and interpersonal factors that influence sexual risk. |
Quality assurance of drugs used in clinical trials: proposal for adapting guidelines
Newton PN , Schellenberg D , Ashley EA , Ravinetto R , Green MD , Kuile FO , Tabernero P , White NJ , Guerin PJ . BMJ 2015 350 h602 Paul Newton and colleagues propose that clinical trial guidelines should include a requirement to assess and state the quality of the drugs and other medical products used |
Bacterial composition in a metropolitan drinking water distribution system utilizing different source waters
Gomez-Alvarez V , Humrighouse BW , Revetta RP , Santo Domingo JW . J Water Health 2015 13 (1) 140-151 We investigated the bacterial composition of water samples from two service areas within a drinking water distribution system (DWDS), each associated with a different primary source of water (groundwater, GW; surface water, SW) and different treatment process. Community analysis based on 16S rRNA gene clone libraries indicated that Actinobacteria (Mycobacterium spp.) and alpha-Proteobacteria represented nearly 43 and 38% of the total sequences, respectively. Sequences closely related to Legionella, Pseudomonas, and Vibrio spp. were also identified. In spite of the high number of sequences (71%) shared in both areas, multivariable analysis revealed significant differences between the GW and SW areas. While the dominant phylotypes where not significantly contributing in the ordination of samples, the populations associated with the core of phylotypes (1-10% in each sample) significantly contributed to the differences between both service areas. Diversity indices indicate that the microbial community inhabiting the SW area is more diverse and contains more distantly related species coexisting with local assemblages as compared with the GW area. The bacterial community structure of SW and GW service areas were dissimilar, suggesting that their respective source water and/or water quality parameters shaped by the treatment processes may contribute to the differences in community structure observed. |
Serology for trachoma surveillance after cessation of mass drug administration
Martin DL , Bid R , Sandi F , Goodhew EB , Massae PA , Lasway A , Philippin H , Makupa W , Molina S , Holland MJ , Mabey DC , Drakeley C , Lammie PJ , Solomon AW . PLoS Negl Trop Dis 2015 9 (2) e0003555 BACKGROUND: Trachoma, caused by Chlamydia trachomatis (Ct), is the leading infectious cause of blindness worldwide. Yearly azithromycin mass drug administration (MDA) plays a central role in efforts to eliminate blinding trachoma as a public health problem. Programmatic decision-making is currently based on the prevalence of the clinical sign "trachomatous inflammation-follicular" (TF) in children. We sought to test alternative tools for trachoma surveillance based on serology in the 12-year cohort of Kahe Mpya, Rombo District, Tanzania, where ocular chlamydial infection was eliminated with azithromycin MDA by 2005. METHODOLOGY AND PRINCIPAL FINDINGS: The present study was a community-based cross-sectional survey in Kahe Mpya. Of 989 residents, 571 people aged 6 months to 87 years were enrolled: 58% of the total population and 73% of 1-9 year olds, the key WHO indicator age group. Participants were examined for TF, had conjunctival swabs collected for nucleic acid amplification test (NAAT)-based detection of Ct, and blood collected for analysis of antibodies to the Ct antigens pgp3 and CT694 by multiplex bead-based immunoassay. Seroconversion rate was used to estimate changes in the force of infection in a reversible catalytic model. No conjunctival swabs tested positive for Ct infection by NAAT. Among 1-9 year olds, TF prevalence was 6.5%, whereas only 3.5% were seropositive. Force of infection modelling indicated a 10-fold decrease in seroconversion rate at a time corresponding to MDA commencement. Without baseline serological data, the inferences we can make about antibody status before MDA and the longevity of the antibody response are limited, though our use of catalytic modelling overcomes some of these limitations. CONCLUSIONS/SIGNIFICANCE: Serologic tests support NAAT findings of very low to zero prevalence of ocular Ct in this community and have potential to provide objective measures of transmission and useful surveillance tools for trachoma elimination programs. |
How is national recipient hemovigilance conducted in the United States?
Chung KW , Harvey A , Basavaraju SV , Kuehnert MJ . Transfusion 2015 55 (4) 703-7 A national recipient hemovigilance system was introduced in the United States in 2010, when voluntary enrollment began as part of the National Healthcare Safety Network (NHSN) Hemovigilance Module. NHSN is a secure, Web-based surveillance system operated by the Centers for Disease Control and Prevention and used by US health care facilities to report a variety of patient safety information. The Hemovigilance Module is used for comprehensive monitoring of transfusion-related adverse events. Participating facilities can utilize analytic tools available within the module to identify opportunities for enhancing transfusion safety, evaluate the effectiveness of interventions, and compare facility specific transfusion-related data to aggregate national estimates. Data may be voluntarily shared by facilities with external partners for patient safety improvement initiatives and to fulfill reporting mandates. We describe the key characteristics of the Hemovigilance Module, highlight the benefits for participating facilities, and discuss the use of reported data for establishing national estimates of transfusion-associated adverse events to identify gaps in transfusion safety and opportunities for interventions. National hemovigilance systems are essential to recognize gaps in transfusion safety and identify opportunities for interventions to improve patient safety and outcomes. |
Disability status, mortality, and leading causes of death in the United States community population
Forman-Hoffman VL , Ault KL , Anderson WL , Weiner JM , Stevens A , Campbell VA , Armour BS . Med Care 2015 53 (4) 346-54 OBJECTIVE: We examined the effect of functional disability on all-cause mortality and cause-specific deaths among community-dwelling US adults. METHODS: We used data from 142,636 adults who participated in the 1994-1995 National Health Interview Survey-Disability Supplement eligible for linkage to National Death Index records from 1994 to 2006 to estimate the effects of disability on mortality and leading causes of death. RESULTS: Adults with any disability were more likely to die than adults without disability (19.92% vs. 10.94%; hazard ratio=1.51, 95% confidence interval, 1.45-1.57). This association was statistically significant for most causes of death and for most types of disability studied. The leading cause of death for adults with and without disability differed (heart disease and malignant neoplasms, respectively). CONCLUSIONS: Our results suggest that all-cause mortality rates are higher among adults with disabilities than among adults without disabilities and that significant associations exist between several types of disability and cause-specific mortality. Interventions are needed that effectively address the poorer health status of people with disabilities and reduce the risk of death. |
Notes from the field: cryptosporidiosis associated with consumption of unpasteurized goat milk - Idaho, 2014
Rosenthal M , Pedersen R , Leibsle S , Hill V , Carter K , Roellig DM . MMWR Morb Mortal Wkly Rep 2015 64 (7) 194-195 On August 27, 2014, the Idaho Department of Health and Welfare's Division of Public Health (DPH) was notified of two cases of cryptosporidiosis in siblings aged <3 years. Idaho's Southwest District Health (SWDH) investigated and found that both children had consumed raw (unpasteurized) goat milk produced at a dairy licensed by the Idaho State Department of Agriculture (ISDA) and purchased at a retail store. Milk produced before August 18, the date of illness onset, was unavailable for testing from retail stores, the household, or the dairy. Samples of raw goat milk produced on August 18, 21, 25, and 28, taken from one opened container from the siblings' household, one unopened container from the retailer, and two unopened containers from the dairy, all tested positive for Cryptosporidium by real-time polymerase chain reaction (PCR) at a commercial laboratory. On August 30, ISDA placed a hold order on all raw milk sales from the producer. ISDA and SWDH issued press releases advising persons not to consume the raw milk; SWDH issued a medical alert, and Idaho's Central District Health Department issued an advisory to health care providers about the outbreak. |
'One Health' investigation: outbreak of human Salmonella Braenderup infections traced to a mail-order hatchery - United States, 2012-2013
Nakao JH , Pringle J , Jones RW , Nix BE , Borders J , Heseltine G , Gomez TM , Mc Cluskey B , Roney CS , Brinson D , Erdman M , McDaniel A , Behravesh CB . Epidemiol Infect 2015 143 (10) 1-9 Human salmonellosis linked to contact with live poultry is an increasing public health concern. In 2012, eight unrelated outbreaks of human salmonellosis linked to live poultry contact resulted in 517 illnesses. In July 2012, PulseNet, a national molecular surveillance network, reported a multistate cluster of a rare strain of Salmonella Braenderup infections which we investigated. We defined a case as infection with the outbreak strain, determined by pulsed-field gel electrophoresis, with illness onset from 25 July 2012-27 February 2013. Ill persons and mail-order hatchery (MOH) owners were interviewed using standardized questionnaires. Traceback and environmental investigations were conducted. We identified 48 cases in 24 states. Twenty-six (81%) of 32 ill persons reported live poultry contact in the week before illness; case-patients named 12 different MOHs from eight states. The investigation identified hatchery D as the ultimate poultry source. Sampling at hatchery D yielded the outbreak strain. Hatchery D improved sanitation procedures and pest control; subsequent sampling failed to yield Salmonella. This outbreak highlights the interconnectedness of humans, animals, and the environment and the importance of industry knowledge and involvement in solving complex outbreaks. Preventing these infections requires a 'One Health' approach that leverages expertise in human, animal, and environmental health. |
Outbreaks attributed to fresh leafy vegetables, United States, 1973-2012
Herman KM , Hall AJ , Gould LH . Epidemiol Infect 2015 143 (14) 1-11 Leafy vegetables are an essential component of a healthy diet; however, they have been associated with high-profile outbreaks causing severe illnesses. We reviewed leafy vegetable-associated outbreaks reported to the Centers for Disease Control and Prevention between 1973 and 2012. During the study period, 606 leafy vegetable-associated outbreaks, with 20 003 associated illnesses, 1030 hospitalizations, and 19 deaths were reported. On average, leafy vegetable-associated outbreaks were larger than those attributed to other food types. The pathogens that most often caused leafy vegetable-associated outbreaks were norovirus (55% of outbreaks with confirmed aetiology), Shiga toxin-producing Escherichia coli (STEC) (18%), and Salmonella (11%). Most outbreaks were attributed to food prepared in a restaurant or catering facility (85%). An ill food worker was implicated as the source of contamination in 31% of outbreaks. Efforts by local, state, and federal agencies to control leafy vegetable contamination and outbreaks should span from the point of harvest to the point of preparation. |
Consumer education needed on norovirus prevention and control: findings from a nationally representative survey of U.S. adults
Cates SC , Kosa KM , Brophy JE , Hall AJ , Fraser A . J Food Prot 2015 78 (3) 484-490 Noroviruses (NoVs) are the leading cause of foodborne disease in the United States; however, little is known about consumers' knowledge of NoV infection and their understanding of how to prevent and control associated illness. A nationally representative Web-enabled panel survey of U.S. adults (n = 1,051) was conducted to collect information on consumers' awareness and knowledge of NoVs. Respondents who had heard of NoVs were asked 22 true-and-false questions on the transmission, prevention, and control of NoVs. Forty-seven percent of respondents reported awareness of NoVs, and 85% of respondents had heard of the terms "cruise ship virus," "the stomach bug," or "the stomach flu," which are commonly used to describe NoVs. Of those respondents who had previously heard of NoV or other terms used by consumers to describe NoV (n = 948), 36% correctly answered 11 or more of the 22 true-and-false questions, suggesting that consumers have limited knowledge on how to prevent and control NoV infection. Most consumers do not understand that the primary mode of transmission for NoV infection is fecal to oral, and many have the misperception that meat and poultry are sources of NoV infection. There is the need to educate consumers about how to prevent and control NoV infection. Although there is a proliferation of food safety education materials available, most focus on foodborne bacteria rather than viruses. The survey results will be used to revise existing consumer food safety educational materials to include information on NoV prevention and control. |
Identification and morphologic and molecular characterization of Cyclospora macacae n. sp. from rhesus monkeys in China.
Li N , Ye J , Arrowood MJ , Ma J , Wang L , Xu H , Feng Y , Xiao L . Parasitol Res 2015 114 (5) 1811-6 Cyclospora spp. in nonhuman primates are most closely related to Cyclospora cayetanensis, an emerging human pathogen causing outbreaks of cyclosporiasis in North America. Studies thus far indicate the possible existence of host specificity in Cyclospora spp. In this study, 411 fecal specimens from free-range rhesus monkeys (Macaca mulatta) were collected and examined for Cyclospora by sequence analysis of the small subunit rRNA gene. A novel Cyclospora species was identified in 28 (6.8 %) specimens and named Cyclospora macacae based on morphologic and molecular characterizations. The oocyst of C. macacae is spherical and measures 8.49 +/- 0.55 x 8.49 +/- 0.49 mum in diameter. Phylogenetic analysis grouped this species together with the other four Cyclospora species infecting primates, including C. cayetanensis in humans, forming a monophyletic group closely related to avian Eimeria species. In addition, C. cayetanensis was detected in one specimen, although whether rhesus monkeys can serve as a natural reservoir host of C. cayetanensis needs further investigation. |
Whole genome detection of rotavirus mixed infections in human, porcine and bovine samples co-infected with various rotavirus strains collected from sub-Saharan Africa.
Nyaga MM , Jere KC , Esona MD , Seheri ML , Stucker KM , Halpin RA , Akopov A , Stockwell TB , Peenze I , Diop A , Ndiaye K , Boula A , Maphalala G , Berejena C , Mwenda JM , Steele AD , Wentworth DE , Mphahlele MJ . Infect Genet Evol 2015 31 321-34 Group A rotaviruses (RVA) are among the main global causes of severe diarrhea in children under the age of 5years. Strain diversity, mixed infections and untypeable RVA strains are frequently reported in Africa. We analysed rotavirus-positive human stool samples (n=13) obtained from hospitalised children under the age of 5 years who presented with acute gastroenteritis at sentinel hospital sites in six African countries, as well as bovine and porcine stool samples (n=1 each), to gain insights into rotavirus diversity and evolution. Polyacrylamide gel electrophoresis (PAGE) analysis and genotyping with G-(VP7) and P-specific (VP4) typing primers suggested that 13 of the 15 samples contained more than 11 segments and/or mixed G/P genotypes. Full-length amplicons for each segment were generated using RVA-specific primers and sequenced using the Ion Torrent and/or Illumina MiSeq next-generation sequencing platforms. Sequencing detected at least one segment in each sample for which duplicate sequences, often having distinct genotypes, existed. This supported and extended the PAGE and RT-PCR genotyping findings that suggested these samples were collected from individuals that had mixed rotavirus infections. The study reports the first porcine (MRC-DPRU1567) and bovine (MRC-DPRU3010) mixed infections. We also report a unique genome segment 9 (VP7), whose G9 genotype belongs to lineage VI and clusters with porcine reference strains. Previously, African G9 strains have all been in lineage III. Furthermore, additional RVA segments isolated from humans have a clear evolutionary relationship with porcine, bovine and ovine rotavirus sequences, indicating relatively recent interspecies transmission and reassortment. Thus, multiple RVA strains from sub-Saharan Africa are infecting mammalian hosts with unpredictable variations in their gene segment combinations. Whole-genome sequence analyses of mixed RVA strains underscore the considerable diversity of rotavirus sequences and genome segment combinations that result from a complex evolutionary history involving multiple host species. |
Transmission of hepatitis C virus associated with surgical procedures - New Jersey 2010 and Wisconsin 2011
Apostolou A , Bartholomew ML , Greeley R , Guilfoyle SM , Gordon M , Genese C , Davis JP , Montana B , Borlaug G . MMWR Morb Mortal Wkly Rep 2015 64 (7) 165-170 Incidents of health care-associated hepatitis C virus (HCV) transmission that resulted from breaches in injection safety and infection prevention practices have been previously documented. During 2010 and 2011, separate, unrelated, occurrences of HCV infections in New Jersey and Wisconsin associated with surgical procedures were investigated to determine sources of HCV and mechanisms of HCV transmission. Molecular analyses of HCV strains and epidemiologic investigations indicated that transmission likely resulted from breaches of infection prevention practices. Health care and public health professionals should consider health care-associated transmission when evaluating acute HCV infections. |
Uncovering the role of antibiotics in the transmission of multidrug-resistant organisms
McDonald LC . JAMA Intern Med 2015 175 (4) 633-4 Conventional wisdom has suggested two distinct categories of epidemiologic risk factors in the development of Clostridium difficile infection (CDI): factors that increase the risk of transmission of C. difficile and factors that disrupt the patient’s lower intestinal microbiota, a major host defense against infection. This host defense function may be best understood in terms of the expression of these microorganisms collective and representative genome, known as the microbiome. Although antibiotics appear to be the major disruptive force of the microbiome in hospitalized patients, there is evidence that other medications such as proton pump inhibitors and antidepressants, as well as chronic conditions such as obesity1, may also be associated with microbiome disruption and/or CDI. In addition to increasing the risk for infection, the microbiome disruption from antibiotics may also increase C. difficile transmission via increased likelihood of asymptomatic colonization and, once colonized, increasing clonal expansion and domination of the microbiota by C. difficile. Meanwhile, there is increasing evidence pointing to the importance of asymptomatic carriers in the transmission of C. difficile in hospitals. However, few studies have examined the epidemiology of antibiotics effecting transmission of C. difficile between patients, something Brown et al have addressed in this issue of JAMA Int Med.2 | This study examined an individual acute care hospital cohort over 4 years, capturing both individual level risk factors such as age, gender, previous admission, and inpatient medication exposures including but not limited to antibiotic exposures. In addition, average characteristics of the ward or unit population over the 46-month study period were recorded including mean age and antibiotic, chemotherapeutic, and antacid medications in days of therapy (DOT)/100 patient-days, as well as mean feeding tube use. Other ward and unit-level risk factors included patient density and hand hygiene compliance. Multivariable models and, most importantly, a multilevel model, were constructed in which patient factors and ward factors were examined together in regard to their increasing risk of CDI. |
Donor-derived Strongyloides stercoralis infection in solid organ transplant recipients in the United States, 2009-2013
Abanyie FA , Gray EB , Delli Carpini KW , Yanofsky A , McAuliffe I , Rana M , Chin-Hong PV , Barone CN , Davis JL , Montgomery SP , Huprikar S . Am J Transplant 2015 15 (5) 1369-75 Infection with Strongyloides stercoralis is typically asymptomatic in immunocompetent hosts, despite chronic infection. In contrast, immunocompromised hosts such as solid organ transplant recipients are at risk for hyperinfection syndrome and/or disseminated disease, frequently resulting in fatal outcomes. Infection in these recipients may result from reactivation of latent infection or infection through transmission from an infected donor. We describe the Centers for Disease Control and Prevention's experience with seven clusters of donor-derived infection from 2009 to 2013. Six of the seven (86%) donors were born in Latin America; donor screening was not performed prior to organ transplantation in any of these investigations. Eleven of the 20 (55%) organ recipients were symptomatic, two of whom died from complications of strongyloidiasis. We also describe the New York Organ Donor Network (NYODN) experience with targeted donor screening from 2010 to 2013. Of the 233 consented potential donors tested, 10 tested positive for Strongyloides antibody; and 18 organs were transplanted. The majority (86%) of the donors were born in Central or South America. Fourteen recipients received prophylaxis after transplantation; no recipients developed strongyloidiasis. The NYODN experience provides evidence that when targeted donor screening is performed prior to transplantation, donor-derived infection can be averted in recipients. |
Safety of measles-containing vaccines in 1-year-old children
Klein NP , Lewis E , Fireman B , Hambidge SJ , Naleway A , Nelson JC , Belongia EA , Yih WK , Nordin JD , Hechter RC , Weintraub E , Baxter R . Pediatrics 2015 135 (2) e321-9 BACKGROUND AND OBJECTIVES: All measles-containing vaccines are associated with several types of adverse events, including seizure, fever, and immune thrombocytopenia purpura (ITP). Because the measles-mumps-rubella-varicella (MMRV) vaccine compared with the separate measles-mumps-rubella (MMR) and varicella (MMR + V) vaccine increases a toddler's risk for febrile seizures, we investigated whether MMRV is riskier than MMR + V and whether either vaccine elevates the risk for additional safety outcomes. METHODS: Study children were aged 12 to 23 months in the Vaccine Safety Datalink from 2000 to 2012. Nine study outcomes were investigated: 7 main outcomes (anaphylaxis, ITP, ataxia, arthritis, meningitis/encephalitis, acute disseminated encephalomyelitis, and Kawasaki disease), seizure, and fever. Comparing MMRV with MMR + V, relative risk was estimated by using stratified exact binomial tests. Secondary analyses examined post-MMRV or MMR + V risk versus comparison intervals; risk and comparison intervals were then contrasted for MMRV versus MMR+V. RESULTS: We evaluated 123 200 MMRV and 584 987 MMR + V doses. Comparing MMRV with MMR + V, risks for the 7 main outcomes were not significantly different. Several outcomes had few or zero postvaccination events. Comparing risk versus comparison intervals, ITP risk was higher after MMRV (odds ratio [OR]: 11.3 [95% confidence interval (CI): 1.9 to 68.2]) and MMR + V (OR: 10 [95% CI: 4.5 to 22.5]) and ataxia risk was lower after both vaccines (MMRV OR: 0.8 [95% CI: 0.5 to 1]; MMR + V OR: 0.8 [95% CI: 0.7 to 0.9]). Compared with MMR + V, MMRV increased risk of seizure and fever 7 to 10 days after vaccination. CONCLUSIONS: This study did not identify any new safety concerns comparing MMRV with MMR + V or after either the MMRV or the MMR + V vaccine. This study provides reassurance that these outcomes are unlikely after either vaccine. |
Trends in varicella mortality in the United States: data from vital statistics and the national surveillance system
Leung J , Bialek SR , Marin M . Hum Vaccin Immunother 2015 11 (3) 662-8 This manuscript describes trends in US varicella mortality using national vital statistics system data for 2008-2011, the first years of the routine 2-dose varicella vaccination program, and characteristics of varicella deaths reported to CDC during 1996-2013. We obtained data on deaths with varicella as underlying or contributing cause from the 2008-2011 Mortality Multiple Cause-of Death records and calculated rates to compare with the prevaccine and mature 1-dose varicella vaccination program eras. We also reviewed available records of varicella deaths reported to CDC through the national varicella death surveillance. The annual average age-adjusted mortality rate for varicella as the underlying cause was 0.05 per million population during 2008-2011, an 87% reduction from the prevaccine years. Varicella deaths among persons aged <20 years declined by 99% in 2008-2011 compared with prevaccine years. There was a 70% decline in varicella mortality rates among those <20 years in 2008-2011 compared to 2005-2007. Among the 83 deaths reported to CDC during 1996-2013 classified as likely due to varicella, 24 (29%) were among immunocompromised individuals. Five were among persons previously vaccinated with 1 dose of varicella vaccine. In conclusion, although the US varicella vaccination program has significantly reduced varicella disease burden, there are still opportunities to prevent varicella and its associated morbidity and mortality through routine varicella vaccination, catch-up vaccination, and ensuring that household contact of immunocompromised persons have evidence of immunity. |
Development and characterization of a panel of cross-reactive monoclonal antibodies generated using H1N1 influenza virus
Guo CY , Tang YG , Qi ZL , Liu Y , Zhao XR , Huo XP , Li Y , Feng Q , Zhao PH , Wang X , Li Y , Wang HF , Hu J , Zhang XJ . Immunobiology 2015 220 (8) 941-6 To characterize the antigenic epitopes of the hemagglutinin (HA) protein of H1N1 influenza virus, a panel consisting of 84 clones of murine monoclonal antibodies (mAbs) were generated using the HA proteins from the 2009 pandemic H1N1 vaccine lysate and the seasonal influenza H1N1(A1) vaccines. Thirty-three (39%) of the 84 mAbs were found to be strain-specific, and 6 (7%) of the 84 mAbs were subtype-specific. Twenty (24%) of the 84 mAbs recognized the common HA epitopes shared by 2009 pandemic H1N1, seasonal A1 (H1N1), and A3 (H3N2) influenza viruses. Twenty-five of the 84 clones recognized the common HA epitopes shared by the 2009 pandemic H1N1, seasonal A1 (H1N1) and A3 (H3N2) human influenza viruses, and H5N1 and H9N2 avian influenza viruses. We found that of the 16 (19%) clones of the 84 mAbs panel that were cross-reactive with human respiratory pathogens, 15 were made using the HA of the seasonal A1 (H1N1) virus and 1 was made using the HA of the 2009 pandemic H1N1 influenza virus. Immunohistochemical analysis of the tissue microarray (TMA) showed that 4 of the 84 mAb clones cross-reacted with human tissue (brain and pancreas). Our results indicated that the influenza virus HA antigenic epitopes not only induce type-, subtype-, and strain-specific monoclonal antibodies against influenza A virus but also cross-reactive monoclonal antibodies against human tissues. Further investigations of these cross-reactive (heterophilic) epitopes may significantly improve our understanding of viral antigenic variation, epidemics, pathophysiologic mechanisms, and adverse effects of influenza vaccines. |
Emotion dysregulation mediates the relationship between traumatic exposure and aggression in healthy young women
Miles SR , Tharp AT , Stanford M , Sharp C , Menefee D , Kent TA . Pers Individ Dif 2015 76 222-227 Research has linked trauma-sequelae, such as posttraumatic stress disorder, to aggression. However, not all who experience a trauma become violent, suggesting non-trauma factors, such as emotion dysregulation, influence aggression expression and if confirmed, may influence treatment approaches. Aggression can be considered a multifaceted construct with Impulsive Aggression (IA) as emotional, reactive, and uncontrolled and Premeditated Aggression (PA) as deliberate, planned, and instrumental. We hypothesized that parceling apart IA and PA may further refine predictors of aggression in the context of trauma exposure. We tested this hypothesis in undergraduate women (N = 208) who completed trauma, emotion, and aggression measures. Path analysis indicated that Borderline Features, including emotion dysregulation, mediated the relationship between trauma exposure and IA and PA. The finding extends clinical literature by providing evidence that emotion dysregulation influences both IA and PA in a non-clinical sample, while clinical sample research shows emotion dysregulation more specifically mediated the relationship between trauma and IA. Factors responsible for these differences are discussed. |
Epidemiology of traumatic brain injury
Faul M , Coronado V . Handb Clin Neurol 2015 127 3-13 Traumatic brain injury (TBI) is a leading cause of death, and in a recent analysis it was found that nearly one-third of all injury-related deaths in the US have at least one diagnosis of TBI (CDC-Quickstats, 2010). This chapter presents the burden of TBI as regards age group, gender, costs, race, emergency department (ED) visits, hospitalizations, and deaths. Injury trends over a 15 year period are examined. Rehabilitation estimates and disability estimates are also available. Through good epidemiology we can better understand the causes of TBI and design more effective intervention programs to reduce injury. Important sources of evidence for this chapter include mostly studies from the US because of their leading work in the epidemiology of this important injury. |
Assessment and management of fall risk in primary care settings
Phelan EA , Mahoney JE , Voit JC , Stevens JA . Med Clin North Am 2015 99 (2) 281-293 Falls among older adults are neither purely accidental nor inevitable; research has shown that many falls are preventable. Primary care providers play a key role in preventing falls. However, fall risk assessment and management is performed infrequently in primary care settings. This article provides an overview of a clinically relevant, evidence-based approach to fall risk screening and management. It describes resources, including the STEADI (Stopping Elderly Accidents, Deaths, and Injuries) tool kit that can help providers integrate fall prevention into their practice. |
Bullying and suicidal ideation and behaviors: a meta-analysis
Holt MK , Vivolo-Kantor AM , Polanin JR , Holland KM , DeGue S , Matjasko JL , Wolfe M , Reid G . Pediatrics 2015 135 (2) e496-e509 BACKGROUND AND OBJECTIVES: Over the last decade there has been increased attention to the association between bullying involvement (as a victim, perpetrator, or bully-victim) and suicidal ideation/behaviors. We conducted a meta-analysis to estimate the association between bullying involvement and suicidal ideation and behaviors. METHODS: We searched multiple online databases and reviewed reference sections of articles derived from searches to identify cross-sectional studies published through July 2013. Using search terms associated with bullying, suicide, and youth, 47 studies (38.3% from the United States, 61.7% in non-US samples) met inclusion criteria. Seven observers independently coded studies and met in pairs to reach consensus. RESULTS: Six different meta-analyses were conducted by using 3 predictors (bullying victimization, bullying perpetration, and bully/victim status) and 2 outcomes (suicidal ideation and suicidal behaviors). A total of 280 effect sizes were extracted and multilevel, random effects meta-analyses were performed. Results indicated that each of the predictors were associated with risk for suicidal ideation and behavior (range, 2.12 [95% confidence interval (CI), 1.67-2.69] to 4.02 [95% CI, 2.39-6.76]). Significant heterogeneity remained across each analysis. The bullying perpetration and suicidal behavior effect sizes were moderated by the study's country of origin; the bully/victim status and suicidal ideation results were moderated by bullying assessment method. CONCLUSIONS: Findings demonstrated that involvement in bullying in any capacity is associated with suicidal ideation and behavior. Future research should address mental health implications of bullying involvement to prevent suicidal ideation/behavior. |
CDC Grand Rounds: preventing youth violence
David-Ferdon C , Simon TR , Spivak H , Gorman-Smith D , Savannah SB , Listenbee RL , Iskander J . MMWR Morb Mortal Wkly Rep 2015 64 (7) 171-174 Youth violence occurs when persons aged 10-24 years, as victims, offenders, or witnesses, are involved in the intentional use of physical force or power to threaten or harm others. Youth violence typically involves young persons hurting other young persons and can take different forms. Examples include fights, bullying, threats with weapons, and gang-related violence. Different forms of youth violence can also vary in the harm that results and can include physical harm, such as injuries or death, as well as psychological harm. Youth violence is a significant public health problem with serious and lasting effects on the physical, mental, and social health of youth. In 2013, 4,481 youths aged 10-24 years (6.9 per 100,000) were homicide victims. Homicide is the third leading cause of death among persons aged 10-24 years (after unintentional injuries and suicide) and is responsible for more deaths in this age group than the next seven leading causes of death combined. Males and racial/ethnic minorities experience the greatest burden of youth violence. Rates of homicide deaths are approximately six times higher among males aged 10-24 years (11.7 per 100,000) than among females (2.0). Rates among non-Hispanic black youths (27.6 per 100,000) and Hispanic youths (6.3) are 13 and three times higher, respectively, than among non-Hispanic white youths (2.1). The number of young persons who are physically harmed by violence is more than 100 times higher than the number killed. In 2013, an estimated 547,260 youths aged 10-24 years (847 per 100,000) were treated in U.S. emergency departments for nonfatal physical assault-related injuries. |
Recalibration of the limiting antigen avidity EIA to determine mean duration of recent infection in divergent HIV-1 subtypes
Duong YT , Kassanjee R , Welte A , Morgan M , De A , Dobbs T , Rottinghaus E , Nkengasong J , Curlin ME , Kittinunvorakoon C , Raengsakulrach B , Martin M , Choopanya K , Vanichseni S , Jiang Y , Qiu M , Yu H , Hao Y , Shah N , Le LV , Kim AA , Nguyen TA , Ampofo W , Parekh BS . PLoS One 2015 10 (2) e0114947 BACKGROUND: Mean duration of recent infection (MDRI) and misclassification of long-term HIV-1 infections, as proportion false recent (PFR), are critical parameters for laboratory-based assays for estimating HIV-1 incidence. Recent review of the data by us and others indicated that MDRI of LAg-Avidity EIA estimated previously required recalibration. We present here results of recalibration efforts using >250 seroconversion panels and multiple statistical methods to ensure accuracy and consensus. METHODS: A total of 2737 longitudinal specimens collected from 259 seroconverting individuals infected with diverse HIV-1 subtypes were tested with the LAg-Avidity EIA as previously described. Data were analyzed for determination of MDRI at ODn cutoffs of 1.0 to 2.0 using 7 statistical approaches and sub-analyzed by HIV-1 subtypes. In addition, 3740 specimens from individuals with infection >1 year, including 488 from patients with AIDS, were tested for PFR at varying cutoffs. RESULTS: Using different statistical methods, MDRI values ranged from 88-94 days at cutoff ODn = 1.0 to 177-183 days at ODn = 2.0. The MDRI values were similar by different methods suggesting coherence of different approaches. Testing for misclassification among long-term infections indicated that overall PFRs were 0.6% to 2.5% at increasing cutoffs of 1.0 to 2.0, respectively. Balancing the need for a longer MDRI and smaller PFR (<2.0%) suggests that a cutoff ODn = 1.5, corresponding to an MDRI of 130 days should be used for cross-sectional application. The MDRI varied among subtypes from 109 days (subtype A&D) to 152 days (subtype C). CONCLUSIONS: Based on the new data and revised analysis, we recommend an ODn cutoff = 1.5 to classify recent and long-term infections, corresponding to an MDRI of 130 days (118-142). Determination of revised parameters for estimation of HIV-1 incidence should facilitate application of the LAg-Avidity EIA for worldwide use. |
Results of a pilot study using self-collected mid-turbinate nasal swabs for detection of influenza virus infection among pregnant women
Thompson MG , Ferber JR , Odouli R , David D , Shifflett P , Meece JK , Naleway AL , Bozeman S , Spencer SM , Fry AM , Li K . Influenza Other Respir Viruses 2015 9 (3) 155-60 BACKGROUND: We evaluated the feasibility of asking pregnant women to self-collect and ship respiratory specimens. METHODS: In a preliminary laboratory study, we compared the RT-PCR cycle threshold (CT) values of influenza A and B viruses incubated at 4 storage temperatures (from 4-35 degrees C) for 6 time periods (8, 24, 48, 72, and 168 hours and 30-days), resulting in 24 conditions that were compared to an aliquot tested after standard freezing (-20 degrees C) (baseline condition). In a subsequent pilot study, during January-February, 2014, we delivered respiratory specimen collection kits to 53 pregnant women with a medically attended acute respiratory illness using three delivery methods. RESULTS: CT values were stable after storage at temperatures <27 degrees C for up to 72 hours for influenza A viruses and 48 hours for influenza B viruses. Of 53 women who received kits during the pilot, 89% collected and shipped nasal swabs as requested. However, 30% (14/47) of the women took over 2 days to collect and ship their specimen. The human control gene, ribonuclease P (RNase P), was detected in 100% of nasal swab specimens. However, the mean CT values for RNase P (26.5, 95% confidence interval [CI] = 26.0-27.1) and for the 8 influenza A virus positives in our pilot (32.2, 95% CI = 28.9-35.5) were significantly higher than the CTs observed in our 2010-12 study using staff-collected nasal pharyngeal swabs (p-values < .01). DISCUSSION: Self-collection of respiratory specimens is a promising research method, but further research is needed to quantify the sensitivity and specificity of the approach. |
Francisella tularensis LVS surface and membrane proteins as targets of effective post-exposure immunization for tularemia
Chandler JC , Sutherland MD , Harton MR , Molins CR , Anderson RV , Heaslip DG , Bosio CM , Belisle JT . J Proteome Res 2015 14 (2) 664-75 Francisella tularensis causes disease (tularemia) in a large number of mammals, including man. We previously demonstrated enhanced efficacy of conventional antibiotic therapy for tularemia by postexposure passive transfer of immune sera developed against a F. tularensis LVS membrane protein fraction (MPF). However, the protein composition of this immunogenic fraction was not defined. Proteomic approaches were applied to define the protein composition and identify the immunogens of MPF. MPF consisted of at least 299 proteins and 2-D Western blot analyses using sera from MPF-immunized and F. tularensis LVS-vaccinated mice coupled to liquid chromatography-tandem mass spectrometry identified 24 immunoreactive protein spots containing 45 proteins. A reverse vaccinology approach that applied labeling of F. tularensis LVS surface proteins and bioinformatics was used to reduce the complexity of potential target immunogens. Bioinformatics analyses of the immunoreactive proteins reduced the number of immunogen targets to 32. Direct surface labeling of F. tularensis LVS resulted in the identification of 31 surface proteins. However, only 13 of these were reactive with MPF and/or F. tularensis LVS immune sera. Collectively, this use of orthogonal proteomic approaches reduced the complexity of potential immunogens in MPF by 96% and allowed for prioritization of target immunogens for antibody-based immunotherapies against tularemia. |
Antibody effector functions mediated by Fcγ-receptors are compromised during persistent viral infection
Wieland A , Shashidharamurthy R , Kamphorst AO , Han JH , Aubert RD , Choudhury BP , Stowell SR , Lee J , Punkosdy GA , Shlomchik MJ , Selvaraj P , Ahmed R . Immunity 2015 42 (2) 367-78 T cell dysfunction is well documented during chronic viral infections but little is known about functional abnormalities in humoral immunity. Here we report that mice persistently infected with lymphocytic choriomeningitis virus (LCMV) exhibit a severe defect in Fcgamma-receptor (FcgammaR)-mediated antibody effector functions. Using transgenic mice expressing human CD20, we found that chronic LCMV infection impaired the depletion of B cells with rituximab, an anti-CD20 antibody widely used for the treatment of B cell lymphomas. In addition, FcgammaR-dependent activation of dendritic cells by agonistic anti-CD40 antibody was compromised in chronically infected mice. These defects were due to viral antigen-antibody complexes and not the chronic infection per se, because FcgammaR-mediated effector functions were normal in persistently infected mice that lacked LCMV-specific antibodies. Our findings have implications for the therapeutic use of antibodies and suggest that high levels of pre-existing immune complexes could limit the effectiveness of antibody therapy in humans. |
Comparative evaluation of the protective efficacy of two formulations of a recombinant Chlamydia abortus subunit candidate vaccine in a mouse model
Pan Q , Pais R , Ohandjo A , He C , He Q , Omosun Y , Igietseme JU , Eko FO . Vaccine 2015 33 (15) 1865-72 Chlamydia abortus (C. abortus) is the causative agent of ovine enzootic abortion (OEA) and poses a zoonotic risk to pregnant women. Current live attenuated 1B vaccines are efficacious but cause disease in vaccinated animals and inactivated vaccines are only marginally protective. We tested the ability of a new C. abortus subunit vaccine candidate based on the conserved and immunogenic polymorphic membrane protein D (Pmp18D) formulated in CpG1826+FL (Fms-like tyrosine kinase 3 Ligand; Flt3L) or Vibrio cholerae ghosts (VCG) to induce innate and cross protective immunity against genital C. abortus infection. We found that delivery of rPmp18D with VCG was more effective than with CpG+FL in up-regulating the expression of molecules critically involved in T cell activation and differentiation, including MHC II, CD40, CD80, and CD86, activation of TLRs and NLRP3 inflammasome engagement, and secretion of IL-1beta and TNF-alpha but not IL-10 and IL-4. rVCG-Pmp18D-immunized mice elicited more robust antigen-specific IFN-gamma, IgA and IgG2c antibody responses compared to CpG+FL-delivered rPmp18D. Based on the number of mice with positive vaginal cultures, length of vaginal shedding, and number of inclusion forming units recovered following challenge with the heterologous C. abortus strain B577, vaccine delivery with VCG induced superior protective immunity than delivery with a combination of CpG1826 and FL, a nasal DC-targeting adjuvant. These results demonstrate that the ability of VCG to enhance protective immunity against genital C. abortus infection is superior to that of CpG+FL adjuvants. |
Comparison of real-time PCR methods for the detection of Naegleria fowleri in surface water and sediment
Streby A , Mull BJ , Levy K , Hill VR . Parasitol Res 2015 114 (5) 1739-46 Naegleria fowleri is a thermophilic free-living ameba found in freshwater environments worldwide. It is the cause of a rare but potentially fatal disease in humans known as primary amebic meningoencephalitis. Established N. fowleri detection methods rely on conventional culture techniques and morphological examination followed by molecular testing. Multiple alternative real-time PCR assays have been published for rapid detection of Naegleria spp. and N. fowleri. Foursuch assays were evaluated for the detection of N. fowleri from surface water and sediment. The assays were compared for thermodynamic stability, analytical sensitivity and specificity, detection limits, humic acid inhibition effects, and performance with seeded environmental matrices. Twenty-one ameba isolates were included in the DNA panel used for analytical sensitivity and specificity analyses. N. fowleri genotypes I and III were used for method performance testing. Two of the real-time PCR assays were determined to yield similar performance data for specificity and sensitivity for detecting N. fowleri in environmental matrices. |
Age at autism spectrum disorder (ASD) diagnosis by race, ethnicity, and primary household language among children with special health care needs, United States, 2009-2010
Jo H , Schieve LA , Rice CE , Yeargin-Allsopp M , Tian LH , Blumberg SJ , Kogan MD , Boyle CA . Matern Child Health J 2015 19 (8) 1687-97 We examined prevalence of diagnosed autism spectrum disorder (ASD) and age at diagnosis according to child's race/ethnicity and primary household language. From the 2009-2010 National Survey of Children with Special Health Care Needs, we identified 2729 3-17-year-old US children whose parent reported a current ASD diagnosis. We compared ASD prevalence, mean diagnosis age, and percentage with later diagnoses (≥5 years) across racial/ethnic/primary household language groups: non-Hispanic-white, any language (NHW); non-Hispanic-black, any language (NHB); Hispanic-any-race, English (Hispanic-English); and Hispanic-any-race, other language (Hispanic-Other). We assessed findings by parent-reported ASD severity level and adjusted for family sociodemographics. ASD prevalence estimates were 15.3 (NHW), 10.4 (NHB), 14.1 (Hispanic-English), and 5.2 (Hispanic-Other) per 1000 children. Mean diagnosis age was comparable across racial/ethnic/language groups for 3-4-year-olds. For 5-17-year-olds, diagnosis age varied by race/ethnicity/language and also by ASD severity. In this group, NHW children with mild/moderate ASD had a significantly higher proportion (50.8 %) of later diagnoses than NHB (33.5 %) or Hispanic-Other children (18.0 %). However, NHW children with severe ASD had a comparable or lower (albeit non-significant) proportion (16.4 %) of later diagnoses than NHB (37.8 %), Hispanic-English (30.8 %), and Hispanic-Other children (12.0 %). While NHW children have comparable ASD prevalence and diagnosis age distributions as Hispanic-English children, they have both higher prevalence and proportion of later diagnoses than NHB and Hispanic-Other children. The diagnosis age findings were limited to mild/moderate cases only. Thus, the prevalence disparity might be primarily driven by under-representation (potentially under-identification) of older children with mild/moderate ASD in the two minority groups. |
Stochastic reservoir simulation for the modeling of uncertainty in coal seam degasification
Karacan CO , Olea RA . Fuel (Lond) 2015 148 87-97 Coal seam degasification improves coal mine safety by reducing the gas content of coal seams and also by generating added value as an energy source. Coal seam reservoir simulation is one of the most effective ways to help with these two main objectives. As in all modeling and simulation studies, how the reservoir is defined and whether observed productions can be predicted are important considerations. Using geostatistical realizations as spatial maps of different coal reservoir properties is a more realistic approach than assuming uniform properties across the field. In fact, this approach can help with simultaneous history matching of multiple wellbores to enhance the confidence in spatial models of different coal properties that are pertinent to degasification. The problem that still remains is the uncertainty in geostatistical simulations originating from the partial sampling of the seam that does not properly reflect the stochastic nature of coal property realizations. Stochastic simulations and using individual realizations, rather than E-type, make evaluation of uncertainty possible. This work is an advancement over Karacan et al. (2014) in the sense of assessing uncertainty that stems from geostatistical maps. In this work, we batched 100 individual realizations of 10 coal properties that were randomly generated to create 100 bundles and used them in 100 separate coal seam reservoir simulations for simultaneous history matching. We then evaluated the history matching errors for each bundle and defined the single set of realizations that would minimize the error for all wells. We further compared the errors with those of E-type and the average realization of the best matches. Unlike in Karacan et al. (2014), which used E-type maps and average of quantile maps, using these 100 bundles created 100 different history match results from separate simulations, and distributions of results for in-place gas quantity, for example, from which uncertainty in coal property realizations could be evaluated. The study helped to determine the realization bundle that consisted of the spatial maps of coal properties, which resulted in minimum error. In addition, it was shown that both E-type and the average of realizations that gave the best match for invidual approximated the same properties resonably. Moreover, the determined realization bundle showed that the study field initially had 151.5 million m3 (cubic meter) of gas and 1.04 million m3 water in the coal, corresponding to Q90 of the entire range of probability for gas and close to Q75 for water. In 2013, in-place fluid amounts decreased to 138.9 million m3 and 0.997 million m3 for gas and water, respectively. |
Usual intake of added sugars and lipid profiles among the U.S. adolescents: National Health and Nutrition Examination Survey, 2005-2010
Zhang Z , Gillespie C , Welsh JA , Hu FB , Yang Q . J Adolesc Health 2015 56 (3) 352-9 PURPOSE: Although studies suggest that higher consumption of added sugars is associated with cardiovascular risk factors in adolescents, none have adjusted for measurement errors or examined its association with the risk of dyslipidemia. METHODS: We analyzed data of 4,047 adolescents aged 12-19 years from the 2005-2010 National Health and Nutrition Examination Survey, a nationally representative, cross-sectional survey. We estimated the usual percentage of calories (%kcal) from added sugars using up to two 24-hour dietary recalls and the National Cancer Institute method to account for measurement error. RESULTS: The average usual %kcal from added sugars was 16.0%. Most adolescents (88.0%) had usual intake of ≥10% of total energy, and 5.5% had usual intake of ≥25% of total energy. After adjustment for potential confounders, usual %kcal from added sugars was inversely associated with high-density lipoprotein (HDL) and positively associated with triglycerides (TGs), TG-to-HDL ratio, and total cholesterol (TC) to HDL ratio. Comparing the lowest and highest quintiles of intake, HDLs were 49.5 (95% confidence interval [CI], 47.4-51.6) and 46.4 mg/dL (95% CI, 45.2-47.6; p = .009), TGs were 85.6 (95% CI, 75.5-95.6) and 101.2 mg/dL (95% CI, 88.7-113.8; p = .037), TG to HDL ratios were 2.28 (95% CI, 1.84-2.70) and 2.73 (95% CI, 2.11-3.32; p = .017), and TC to HDL ratios were 3.41 (95% CI, 3.03-3.79) and 3.70 (95% CI, 3.24-4.15; p = .028), respectively. Comparing the highest and lowest quintiles of intake, adjusted odds ratio of dyslipidemia was 1.41 (95% CI, 1.01-1.95). The patterns were consistent across sex, race/ethnicity, and body mass index subgroups. No association was found for TC, low-density lipoprotein, and non-HDL cholesterol. CONCLUSIONS: Most U.S. adolescents consumed more added sugars than recommended for heart health. Usual intake of added sugars was significantly associated with several measures of lipid profiles. |
Fruits and vegetables as a healthier snack throughout the day among families with older children: findings from a survey of parent-child dyads
Smith TM , Pinard CA , Byker Shanks C , Wethington H , Blanck HM , Yaroch AL . Eat Behav 2015 17c 136-139 Most U.S. youth fail to eat the recommended amount of fruits and vegetables (FV) however many consume too many calories as added sugars and solid fats, often as snacks. The aim of this study was to assess factors associated with serving FV as snacks and with meals using parent-child dyads. A cross-sectional sample of U.S. children aged 9 to 18, and their caregiver/parent (n=1522) were part of a Consumer Panel of households for the 2008 YouthStyles mail survey. Chi-square test of independence and multivariable logistic regression were used to assess associations between serving patterns of FV as snacks with variations in serving patterns, and covariates including dietary habits. Most parents (72%) reported serving FV at meals and as snacks. Fruit was most frequently served as a snack during the day (52%) and vegetables were most frequently served as a snack during the day (22%) but rarely in the morning. Significant differences in child FV intake existed among FV as a snack serving patterns by parents. Compared to children whose parents served FV only at meals, children whose parents reported serving FV as snacks in addition to meals were significantly more likely to have consumed FV the day before (using a previous day screener), P<0.05. Contributing to the growing collection of literature describing parent-child dyad dietary behaviors, these findings suggest promoting FV access and intake throughout the day, not only at meals, by including serving as snacks, may increase FV intake among older children and adolescents. |
Where occupation and environment overlap: US Forest Service worker exposure to Libby Amphibole fibers
Harper M , Butler C , Berry D , Wroble J . J Occup Environ Hyg 2015 12 (5) 0 The National Institute for Occupational Safety and Health (NIOSH) conducted an evaluation of exposures to asbestiform amphibole, known as Libby Amphibole (LA) to personnel from the US Department of Agriculture-Forest Service (USFS) working in the Kootenai National Forest near a former vermiculite mine near Libby, Montana. LA is associated with vermiculite that was obtained from this mine; mining and processing over many years have resulted in the spread of LA into the surrounding Kootenai forest where it has been found in tree bark, soil and forest floor litter. As a result of this and other contamination, Libby and surrounding areas have been designated a "Superfund" site by the US Environmental Protection Agency (EPA). This paper describes the application of EPA methods for assessing cancer risks to NIOSH sampling results. Phase-contrast microscopy for airborne asbestos fiber evaluation was found to be less useful than transmission electron microscopy in the presence of interfering organic (plant) fibers. NIOSH method 7402 was extended by examination of larger areas of the filter, but fiber counts remained low. There are differences between counting rules in NIOSH 7402 and the ISO method used by EPA, but these are minor in the context of the uncertainty in concentration estimates from the low counts. Estimates for cancer risk are generally compatible with those previously estimated by the EPA. However, there are limitations to extrapolating these findings of low risk throughout the entire area and to tasks that were not evaluated. |
Asthma history, job type and job changes among US nurses
Dumas O , Varraso R , Zock JP , Henneberger PK , Speizer FE , Wiley AS , Le Moual N , Camargo CA Jr . Occup Environ Med 2015 72 (7) 482-8 OBJECTIVES: Nurses are at increased risk of occupational asthma, an observation that may be related to disinfectants exposure. Whether asthma history influences job type or job changes among nurses is unknown. We investigated this issue in a large cohort of nurses. METHODS: The Nurses' Health Study II is a prospective study of US female nurses enrolled in 1989 (ages 24-44 years). Job status and asthma were assessed in biennial (1989-2011) and asthma-specific questionnaires (1998, 2003). Associations between asthma history at baseline (diagnosis before 1989, n=5311) and job type at baseline were evaluated by multinomial logistic regression. The relations of asthma history and severity during follow-up to subsequent job changes were evaluated by Cox models. RESULTS: The analytic cohort included 98 048 nurses. Compared with nurses in education/administration (likely low disinfectant exposure jobs), women with asthma history at baseline were less often employed in jobs with likely high disinfectant exposure, such as operating rooms (odds ratio 0.73 (95% CI 0.63 to 0.86)) and emergency room/inpatient units (0.89 (0.82 to 0.97)). During a 22-year follow-up, nurses with a baseline history of asthma were more likely to move to jobs with lower exposure to disinfectants (HR 1.13 (1.07 to 1.18)), especially among those with more severe asthma (HR for mild persistent: 1.13; moderate persistent 1.26; severe persistent: 1.50, compared with intermittent asthma, p trend: 0.004). CONCLUSIONS: Asthma history was associated with baseline job type and subsequent job changes among nurses. This may partly reflect avoidance of tasks involving disinfectant use, and may introduce bias in cross-sectional studies on disinfectant exposure and asthma in nurses. |
Guest editorial: fire safety in mines
Litton CD . Fire Technol 2015 51 (2) 225-6 Fires in underground mines pose unique problems typically not encountered in other industries. The underground tunnels and entries may be lined with coal or heavily laden with wood for support providing an almost endless supply of fuel while the forced ventilation airflow provides a constant supply of oxygen to fuel the fires that occur while, at the same time, transporting smoke and toxic gases to distances far-removed from the affected fire area. Other fuels exist such as conveyor belts or liquid diesel fuel that may also contribute to the overall fire hazard if consumed as part of a spreading fire. Fires in mines may often be of spontaneous origin when coal is oxidized resulting in self-heating and a smoldering fire that is difficult to prevent and to control. To address these types of fires, Pandey et al. [1] describe the development of chemical retardants that can inhibit, if not prevent, the oxidation and subsequent self-heating of coal. Regardless of the type of fire or combustibles involved, escape-ways and means of egress are often limited placing a high burden on early detection and warning systems in order to rapidly start the evacuation and control measures when fire prevention techniques have not been successful. Understanding the characteristics of the smoke and toxic gases produced can aid in the development of better detection and monitoring systems as well as provide a better understanding of the hazards of toxicity and obscuration that mine fires produce. To aid in this understanding, Perera and Litton [2] discuss the results of experiments to define and quantify the physical and optical properties of aerosols produced from both smoldering and flaming fires from a variety of combustible mine materials. |
Epidemiology and molecular characterization of Cryptosporidium spp. in humans, wild primates, and domesticated animals in the Greater Gombe Ecosystem, Tanzania.
Parsons MB , Travis D , Lonsdorf EV , Lipende I , Roellig DM , Kamenya S , Zhang H , Xiao L , Gillespie TR . PLoS Negl Trop Dis 2015 9 (2) e0003529 Cryptosporidium is an important zoonotic parasite globally. Few studies have examined the ecology and epidemiology of this pathogen in rural tropical systems characterized by high rates of overlap among humans, domesticated animals, and wildlife. We investigated risk factors for Cryptosporidium infection and assessed cross-species transmission potential among people, non-human primates, and domestic animals in the Gombe Ecosystem, Kigoma District, Tanzania. A cross-sectional survey was designed to determine the occurrence and risk factors for Cryptosporidium infection in humans, domestic animals and wildlife living in and around Gombe National Park. Diagnostic PCR revealed Cryptosporidium infection rates of 4.3% in humans, 16.0% in non-human primates, and 9.6% in livestock. Local streams sampled were negative. DNA sequencing uncovered a complex epidemiology for Cryptosporidium in this system, with humans, baboons and a subset of chimpanzees infected with C. hominis subtype IfA12G2; another subset of chimpanzees infected with C. suis; and all positive goats and sheep infected with C. xiaoi. For humans, residence location was associated with increased risk of infection in Mwamgongo village compared to one camp (Kasekela), and there was an increased odds for infection when living in a household with another positive person. Fecal consistency and other gastrointestinal signs did not predict Cryptosporidium infection. Despite a high degree of habitat overlap between village people and livestock, our results suggest that there are distinct Cryptosporidium transmission dynamics for humans and livestock in this system. The dominance of C. hominis subtype IfA12G2 among humans and non-human primates suggest cross-species transmission. Interestingly, a subset of chimpanzees was infected with C. suis. We hypothesize that there is cross-species transmission from bush pigs (Potaochoerus larvatus) to chimpanzees in Gombe forest, since domesticated pigs are regionally absent. Our findings demonstrate a complex nature of Cryptosporidium in sympatric primates, including humans, and stress the need for further studies. |
Performance of an HRP-2 rapid diagnostic test in Nigerian children less than 5 years of age
Ajumobi O , Sabitu K , Nguku P , Kwaga J , Ntadom G , Gitta S , Elizeus R , Oyibo W , Nsubuga P , Maire M , Poggensee G . Am J Trop Med Hyg 2015 92 (4) 828-33 The diagnostic performance of histidine-rich protein 2 (HRP-2)-based malaria rapid diagnostic test (RDT) was evaluated in a mesoendemic area for malaria, Kaduna, Nigeria. We compared RDT results with expert microscopy results of blood samples from 295 febrile children under 5 years. Overall, 11.9% (35/295) tested positive with RDT compared with 10.5% (31/295) by microscopy: sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were 100%, 98.5%, 88.6%, and 100%, respectively. The RDT sensitivity was not affected by transmission season, parasite density, and age. Specificity and positive PV decreased slightly during the high-transmission season (97.5% and 83.3%). The RDT test positivity rates in the low- and high-transmission seasons were 9.4% and 13.5%, respectively. The overall satisfactory test performance of this RDT correlated with low false-positive rate, absence of invalid and false-negative tests in the study. |
Human infections with Sarcocystis species
Fayer R , Esposito DH , Dubey JP . Clin Microbiol Rev 2015 28 (2) 295-311 Recurrent outbreaks of muscular sarcocystosis among tourists visiting islands in Malaysia have focused international attention on sarcocystosis, a disease once considered rare in humans. Sarcocystis species require two hosts, definitive and intermediate, to complete their life cycle. Humans can serve as definitive hosts, with intestinal sarcocystosis for two species acquired from eating undercooked meat: Sarcocystis hominis, from beef, and Sarcocystis suihominis, from pork. Symptoms such as nausea, stomachache, and diarrhea vary widely depending on the number of cysts ingested but appear more severe with pork than with beef. Humans serve as intermediate hosts for Sarcocystis nesbitti, a species with a reptilian definitive host, and possibly other unidentified species, acquired by ingesting sporocysts from feces-contaminated food or water and the environment; infections have an early phase of development in vascular endothelium, with illness that is difficult to diagnose; clinical signs include fever, headache, and myalgia. Subsequent development of intramuscular cysts is characterized by myositis. Presumptive diagnosis based on travel history to tropical regions, elevated serum enzyme levels, and eosinophilia is confirmed by finding sarcocysts in muscle biopsy specimens. There is no vaccine or confirmed effective antiparasitic drug for muscular sarcocystosis, but anti-inflammatory drugs may reduce symptoms. Prevention strategies are also discussed. |
A cohort study of the effectiveness of insecticide-treated bed nets to prevent malaria in an area of moderate pyrethroid resistance, Malawi
Lindblade KA , Mwandama D , Mzilahowa T , Steinhardt L , Gimnig J , Shah M , Bauleni A , Wong J , Wiegand R , Howell P , Zoya J , Chiphwanya J , Mathanga DP . Malar J 2015 14 (1) 31 BACKGROUND: Insecticide-treated bed nets (ITNs) are the cornerstone of malaria control in sub-Saharan Africa but their effectiveness may be compromised by the spread of pyrethroid resistance among malaria vectors. The objective of this investigation was to assess the effectiveness of ITNs to prevent malaria in an area of Malawi with moderate pyrethroid resistance. METHODS: One deltamethrin ITN was distributed in the study area for every two individuals in each household plus one extra ITN for households with an odd number of residents. A fixed cohort of 1,199 children aged six to 59 months was seen monthly for one year and at sick visits to measure malaria infection and use of ITNs. Insecticide resistance among malaria vectors was measured. The effect of ITN use on malaria incidence was assessed, adjusting for potential confounders using generalized estimating equations accounting for repeated measures. RESULTS: There were 1,909 infections with Plasmodium falciparum over 905 person-years at risk (PYAR), resulting in an observed incidence of 2.1 infections per person-year (iPPY). ITNs were used during 97% of the PYAR. The main vector was Anopheles funestus: mortality in WHO tube assays after exposure to 0.05% deltamethrin was 38% (95% confidence interval (CI) 29 inverted question mark47), and resistance was due to elevated oxidase enzymes. After adjusting for potential confounders, the incidence of malaria infection among ITN users was 1.7 iPPY (95% CI 1.5-2.1) and among non-bed net users was 2.6 iPPY (95% CI 2.0-3.3). Use of ITNs reduced the incidence of malaria infection by 30% (rate ratio 0.7; 95% CI, 0.5-0.8) compared to no bed nets. CONCLUSION: ITNs significantly reduced the incidence of malaria infection in children in an area with moderate levels of pyrethroid resistance and considerable malaria transmission. This is the first study to show that ITNs provide protection in areas where pyrethroid-resistant An. funestus is the major malaria vector. Malaria control programmes should continue to distribute and promote ITNs in areas with low to moderate pyrethroid resistance; however, insecticide resistance may intensify further and it is not known whether ITNs will remain effective at higher levels of resistance. There is an urgent need to identify or develop new insecticides and technologies to limit the vulnerability of ITNs to insecticide resistance. |
Cost-effectiveness of two versus three or more doses of intermittent preventive treatment for malaria during pregnancy in sub-Saharan Africa: a modelling study of meta-analysis and cost data
Fernandes S , Sicuri E , Kayentao K , van Eijk AM , Hill J , Webster J , Were V , Akazili J , Madanitsa M , Ter Kuile FO , Hanson K . Lancet Glob Health 2015 3 (3) e143-53 BACKGROUND: In 2012, WHO changed its recommendation for intermittent preventive treatment of malaria during pregnancy (IPTp) from two doses to monthly doses of sulfadoxine-pyrimethamine during the second and third trimesters, but noted the importance of a cost-effectiveness analysis to lend support to the decision of policy makers. We therefore estimated the incremental cost-effectiveness of IPTp with three or more (IPTp-SP3+) versus two doses of sulfadoxine-pyrimethamine (IPTp-SP2). METHODS: For this analysis, we used data from a 2013 meta-analysis of seven studies in sub-Saharan Africa. We developed a decision tree model with a lifetime horizon. We analysed the base case from a societal perspective. We did deterministic and probabilistic sensitivity analyses with appropriate parameter ranges and distributions for settings with low, moderate, and high background risk of low birthweight, and did a separate analysis for HIV-negative women. Parameters in the model were obtained for all countries included in the original meta-analysis. We did simulations in hypothetical cohorts of 1000 pregnant women receiving either IPTp-SP3+ or IPTp-SP2. We calculated disability-adjusted life-years (DALYs) for low birthweight, severe to moderate anaemia, and clinical malaria. We calculated cost estimates from data obtained in observational studies, exit surveys, and from public procurement databases. We give financial and economic costs in constant 2012 US$. The main outcome measure was the incremental cost per DALY averted. FINDINGS: The delivery of IPTp-SP3+ to 1000 pregnant women averted 113.4 DALYs at an incremental cost of $825.67 producing an incremental cost-effectiveness ratio (ICER) of $7.28 per DALY averted. The results remained robust in the deterministic sensitivity analysis. In the probabilistic sensitivity analyses, the ICER was $7.7 per DALY averted for moderate risk of low birthweight, $19.4 per DALY averted for low risk, and $4.0 per DALY averted for high risk. The ICER for HIV-negative women was $6.2 per DALY averted. INTERPRETATION: Our findings lend strong support to the WHO guidelines that recommend a monthly dose of IPTp-SP from the second trimester onwards. FUNDING: Malaria in Pregnancy Consortium and the Bill & Melinda Gates Foundation. |
Assisted reproductive technology and the risk of preterm birth among primiparas
Dunietz GL , Holzman C , McKane P , Li C , Boulet SL , Todem D , Kissin DM , Copeland G , Bernson D , Sappenfield WM , Diamond MP . Fertil Steril 2015 103 (4) 974-979 e1 OBJECTIVE: To investigate the risk of preterm birth among liveborn singletons to primiparas who conceived with assisted reproductive technology (ART) using four mutually exclusive categories of infertility (female infertility only, male infertility only, female and male infertility, and unexplained infertility) and to examine preterm birth risk along the gestational age continuum. DESIGN: Retrospective cohort study. SETTING: Michigan (2000-2009), Massachusetts and Florida (2000-2010). PATIENT(S): Singletons born to primiparas who conceived with or without ART. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Preterm (<37 weeks' gestation) and preterm/early term birth <39 weeks' gestation). RESULT(S): For the male infertility only, female infertility only, combined male and female infertility, and unexplained infertility groups, ART-conceived singletons were significantly more likely than non-ART singletons to be born preterm: adjusted odds ratio (aOR) 1.24 (95% CI, 1.13, 1.37), aOR 1.60 (95% CI, 1.50, 1.70), aOR 1.49 (95% CI, 1.35, 1.64), and aOR 1.26 (1.12, 1.43) respectively. Among infants whose mothers were diagnosed with infertility, the odds of preterm birth were highest between 28-30 weeks [female infertility only, aOR 1.95 (95% CI, 1.59, 2.39); male and female infertility: 2.21 (95% CI, 1.62, 3.00)] compared with infants in the general population. Within the ART population, singletons of couples with female infertility only were more likely to be born preterm than singletons born to couples with other infertility diagnoses. CONCLUSION(S): Among singleton births to primiparas, those conceived with ART had an increased risk for preterm birth, even when only the male partner had been diagnosed with infertility. The risk of preterm birth for ART-conceived infants whose mothers were diagnosed with infertility included the earliest deliveries. |
Student-perceived school climate is associated with ADHD medication treatment among adolescents in Medicaid
Visser SN , Kramer D , Snyder AB , Sebian J , McGiboney G , Handler A . J Atten Disord 2015 23 (3) 234-245 OBJECTIVE: The objective of this study was to evaluate the relationship between school climate and ADHD medication treatment among adolescents in Medicaid in Georgia. METHOD: School climate and Medicaid claims data were aggregated for 159 GA counties. County-level school climate percentile and medicated ADHD prevalence were calculated. The t tests and regression models evaluated the relationship between school climate, medicated ADHD, and demographics, weighted by county population. Poorer 2008 school climate (<25th percentile) was regressed on 2011 medicated ADHD prevalence, controlling for potential confounders. RESULTS: The prevalence of medicated ADHD was 7.8% among Medicaid-enrolled GA adolescents. The average county-level prevalence of medicated ADHD was 10.0% (SD = 2.9%). Poorer school climate was associated with lower rates of medicated ADHD (p < .0001); along with demographics, these factors accounted for 50% of the county variation in medicated ADHD. CONCLUSION: School climate is associated with medicated ADHD among adolescents in Medicaid. Additional research may reveal whether high medicated ADHD may reflect a lack of access to non-pharmacological therapies in some communities. |
Ties that bind: community attachment and the experience of discrimination among black men who have sex with men
Van Sluytman L , Spikes P , Nandi V , Van Tieu H , Frye V , Patterson J , Koblin B . Cult Health Sex 2015 17 (7) 1-14 In the USA, the impact of psychological distress may be greater for Black men who have sex with men given that they may experience both racial discrimination in society at large and discrimination due to sexual orientation within Black communities. Attachments to community members may play a role in addressing psychological distress for members of this vulnerable population. This analysis is based on 312 Black men who have sex with men recruited for a behavioural intervention trial in New York City. Analyses were conducted using bivariate and multivariable logistic regression to examine the relationship of discrimination and community attachment to psychological distress. Most participants (63%) reported exposure to both discrimination due to race and sexual orientation. However, a majority of participants (89%) also reported racial and/or sexual orientation community attachment. Psychological distress was significant and negatively associated with older age (40 years and above), being a high school graduate and having racial and/or sexual orientation community attachments. Psychological distress was significantly and positively associated with being HIV-positive and experiencing both racial and sexual orientation discrimination. Similar results were found in the multivariable model. Susceptibility to disparate psychological distress outcomes must be understood in relation to social membership, including its particular norms, structures and ecological milieu. |
Assessing exposure to tobacco-specific carcinogen NNK using its urinary metabolite NNAL measured in US population: 2011-2012
Wei B , Blount BC , Xia B , Wang L . J Expo Sci Environ Epidemiol 2015 26 (3) 249-56 Carcinogenic tobacco-specific nitrosamines (TSNAs) such as 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone (NNK) are found only in tobacco and derived products. Food and Drug Administration of the United States (US FDA) lists NNK as one of the 93 harmful and potentially harmful constituents (HPHCs) found in tobacco products and tobacco smoke. The aim of this study was to use the urinary concentration of 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL), a major metabolite of NNK, to quantitatively estimate exposure to NNK in the US general population. In 2011-2012, the Centers for Disease Control and Prevention's National Health and Nutrition Examination Survey (NHANES) collected urine and serum samples from a representative sample of US residents. We used a serum cotinine cutoff of 10 ng/ml with combination of questionnaire data to select non-users from cigarette users and used self-reported data to determine different tobacco product user groups. We estimated the absorbed total daily dose of NNK using a probabilistic method based on a two-compartment model. The geometric mean (GM) for the daily dose of NNK among smokers aged 12-16 years was significantly higher than that for non-users at the same age stage exposed to second-hand smoke (SHS) (P<0.001). Among those exposed to SHS, the GM for daily dose of NNK in young children (6-11 years) was nearly three times of those for adults in the age range 21-59 years. Among cigarette users, non-Hispanic Whites had the highest NNK daily dose and Mexican Americans had the lowest levels. Exclusive snuff or chewing product users had significantly higher daily dose of NNK than did cigarette smokers. Our study found that the maximum daily dose of NNK for children aged from 6 to 11 years and that for a significant percentage of cigarette users, chewing product and snuff users were higher than an estimated provisional "reference" risk level. |
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