Impact of minority nonnucleoside reverse transcriptase inhibitor resistance mutations on resistance genotype after virologic failure.
Li JZ , Paredes R , Ribaudo HJ , Kozal MJ , Svarovskaia ES , Johnson JA , Geretti AM , Metzner KJ , Jakobsen MR , Hullsiek KH , Ostergaard L , Miller MD , Kuritzkes DR . J Infect Dis 2013 207 (6) 893-7 Drug-resistant human immunodeficiency virus type 1 (HIV-1) minority variants increase the risk of virologic failure for first-line nonnucleoside reverse transcriptase inhibitor (NNRTI)-based regimens. We performed a pooled analysis to evaluate the relationship between NNRTI-resistant minority variants and the likelihood and types of resistance mutations detected at virologic failure. In multivariable logistic regression analysis, higher NNRTI minority variant copy numbers, non-white race, and nevirapine use were associated with a higher risk of NNRTI resistance at virologic failure. Among participants on efavirenz, K103N was the most frequently observed resistance mutation at virologic failure regardless of the baseline minority variant. However, the presence of baseline Y181C minority variant was associated with a higher probability of Y181C detection after virologic failure. NNRTI regimen choice and preexisting NNRTI-resistant minority variants were both associated with the probability and type of resistance mutations detected after virologic failure. |
Measles outbreak in South Africa: epidemiology of laboratory-confirmed measles cases and assessment of intervention, 2009-2011
Ntshoe GM , McAnerney JM , Archer BN , Smit SB , Harris BN , Tempia S , Mashele M , Singh B , Thomas J , Cengimbo A , Blumberg LH , Puren A , Moyes J , van den Heever J , Schoub BD , Cohen C . PLoS One 2013 8 (2) e55682 BACKGROUND: Since 1995, measles vaccination at nine and 18 months has been routine in South Africa; however, coverage seldom reached >95%. We describe the epidemiology of laboratory-confirmed measles case-patients and assess the impact of the nationwide mass vaccination campaign during the 2009 to 2011 measles outbreak in South Africa. METHODS: Serum specimens collected from patients with suspected-measles were tested for measles-specific IgM antibodies using an enzyme-linked immunosorbent assay and genotypes of a subset were determined. To estimate the impact of the nationwide mass vaccination campaign, we compared incidence in the seven months pre- (1 September 2009-11 April 2010) and seven months post-vaccination campaign (24 May 2010-31 December 2010) periods in seven provinces of South Africa. RESULTS: A total of 18,431 laboratory-confirmed measles case-patients were reported from all nine provinces of South Africa (cumulative incidence 37 per 100,000 population). The highest cumulative incidence per 100,000 population was in children aged <1 year (603), distributed as follows: <6 months (302/100,000), 6 to 8 months (1083/100,000) and 9 to 11 months (724/100,000). Forty eight percent of case-patients were ≥5 years (cumulative incidence 54/100,000). Cumulative incidence decreased with increasing age to 2/100,000 in persons ≥40 years. A single strain of measles virus (genotype B3) circulated throughout the outbreak. Prior to the vaccination campaign, cumulative incidence in the targeted vs. non-targeted age group was 5.9-fold higher, decreasing to 1.7 fold following the campaign (P<0.001) and an estimated 1,380 laboratory-confirmed measles case-patients were prevented. CONCLUSION: We observed a reduction in measles incidence following the nationwide mass vaccination campaign even though it was conducted approximately one year after the outbreak started. A booster dose at school entry may be of value given the high incidence in persons >5 years. |
Pathogenesis, transmissibility, and ocular tropism of a highly pathogenic avian influenza A (H7N3) virus associated with human conjunctivitis
Belser JA , Davis CT , Balish A , Edwards LE , Zeng H , Maines TR , Gustin KM , Martinez IL , Fasce R , Cox NJ , Katz JM , Tumpey TM . J Virol 2013 87 (10) 5746-54 H7 subtype influenza A viruses, responsible for numerous outbreaks in land-based poultry in Europe and the Americas, have caused over 100 cases of confirmed or presumed human infection over the last decade. The emergence of a highly pathogenic avian influenza H7N3 virus in poultry throughout the state of Jalisco, Mexico, resulting in two cases of human infection, prompted us to examine the virulence of this virus [A/Mexico/InDRE7218/2012 (MX/7218)] and related avian H7 subtype viruses in mouse and ferret models. Several high and low pathogenicity H7N3 and H7N9 viruses replicated efficiently in the respiratory tract of mice without prior adaptation following intranasal inoculation, but only MX/7218 virus caused lethal disease in this species. H7N3 and H7N9 viruses were also detected in the mouse eye following ocular inoculation. Virus from both H7N3 and H7N9 subtypes replicated efficiently in the upper and lower respiratory tract of ferrets, however, only MX/7218 virus infection caused clinical signs and symptoms and was capable of transmission to naive ferrets in a direct contact model. Similar to other highly pathogenic H7 viruses, MX/7218 replicated to high titers in human bronchial epithelial cells, yet downregulated numerous genes related to NF-kappaB-mediated signaling transduction. These findings indicate that the recently isolated North American lineage H7 subtype virus associated with human conjunctivitis is capable of causing severe disease in mice and spreading to naive contact ferrets, while concurrently retaining the ability to replicate within ocular tissue allowing the eye to serve as a portal of entry. |
Epidemiology of recurrent tuberculosis in the United States, 1993-2010
Kim L , Moonan PK , Yelk Woodruff RS , Kammerer JS , Haddad MB . Int J Tuberc Lung Dis 2013 17 (3) 357-60 Recurrent tuberculosis (TB) can result from reactivation of a previous TB episode or reinfection with a new Mycobacterium tuberculosis strain. A retrospective analysis of all recurrent TB cases reported in the United States during 1993-2010 was conducted. The proportion of recurrent cases remained stable during the study period (annual range 4.2-5.7%). Compared with persons without a previous diagnosis of TB, persons with recurrent TB experienced lower treatment completion within 12 months and higher mortality during the recurrent episode. Persons with recurrent TB have poorer outcomes, suggesting the need for targeted interventions to ensure treatment completion. |
An integrated city-driven perinatal HIV prevention program covering 1.8 million pregnant women in Shenzhen, China, 2000 to 2010
Song J , Feng T , Bulterys M , Zhang D , Korhonen C , Shi X , Wang X , Cheng J , Chen L , Ma H . Sex Transm Dis 2013 40 (4) 329-34 BACKGROUND: Despite the scale-up of prevention of mother-to-child transmission (PMTCT) programs worldwide, the translation from research studies into public health policy has been slow. This report details the experiences of a city-driven PMTCT program in China using existing health resources. METHODS: The PMTCT program was devised to hospital based and city-wide. It achieves full use of available resources: the local Centers for Disease Control and Prevention, the Infectious Disease Hospital, Maternal and Child Health Hospitals, and all qualified comprehensive hospitals. RESULTS: From 2000 to 2010, 1,843,122 pregnant women attended prenatal care or labor and delivery services. Overall, 97.4% received pretest HIV counseling, and 96.2% were tested for HIV. Among the 81.1% (1,495,122) of women who attended prenatal clinics, 97.2% (1,452,753) received pretest counseling and 95.7% (1,430,799) were tested for HIV. Among the 18.9% (348,000) of women with an undocumented HIV status at labor and delivery, 98.6% (343,038) received pretest counseling, and 98.1% (341,371) were tested for HIV. In total, 229 women were determined HIV positive for a prevalence of 1.3 per 10,000 pregnant women. Among the 107 HIV-infected women who carried to delivery, 87.9% received antiretroviral prophylaxis for themselves and their infants. Among the 58 women who were identified HIV positive at labor, 10.3% of mothers and 72.4% of infants received antiretroviral prophylaxis. The estimated mother-to-child transmission rate was 5.3% (95% confidence interval, 2.2%-10.7%). CONCLUSIONS: With appropriate integration, existing health care resources are adequate for a comprehensive city-driven PMTCT program in an area with a low HIV prevalence. |
Burden of human metapneumovirus infection in young children
Edwards KM , Zhu Y , Griffin MR , Weinberg GA , Hall CB , Szilagyi PG , Staat MA , Iwane M , Prill MM , Williams JV . N Engl J Med 2013 368 (7) 633-43 BACKGROUND: The inpatient and outpatient burden of human metapneumovirus (HMPV) infection among young children has not been well established. METHODS: We conducted prospective, population-based surveillance for acute respiratory illness or fever among inpatient and outpatient children less than 5 years of age in three U.S. counties from 2003 through 2009. Clinical and demographic data were obtained from parents and medical records, HMPV was detected by means of a reverse-transcriptase polymerase-chain-reaction assay, and population-based rates of hospitalization and estimated rates of outpatient visits associated with HMPV infection were determined. RESULTS: HMPV was detected in 200 of 3490 hospitalized children (6%), 222 of 3257 children in outpatient clinics (7%), 224 of 3001 children in the emergency department (7%), and 10 of 770 asymptomatic controls (1%). Overall annual rates of hospitalization associated with HMPV infection were 1 per 1000 children less than 5 years of age, 3 per 1000 infants less than 6 months of age, and 2 per 1000 children 6 to 11 months of age. Children hospitalized with HMPV infection, as compared with those hospitalized without HMPV infection, were older and more likely to receive a diagnosis of pneumonia or asthma, to require supplemental oxygen, and to have a longer stay in the intensive care unit. The estimated annual burden of outpatient visits associated with HMPV infection was 55 clinic visits and 13 emergency department visits per 1000 children. The majority of HMPV-positive inpatient and outpatient children had no underlying medical conditions, although premature birth and asthma were more frequent among hospitalized children with HMPV infection than among those without HMPV infection. CONCLUSIONS: HMPV infection is associated with a substantial burden of hospitalizations and outpatient visits among children throughout the first 5 years of life, especially during the first year. Most children with HMPV infection were previously healthy. (Funded by the Centers for Disease Control and Prevention and the National Institutes of Health.). |
Ecology of potential West Nile virus vectors in southeastern Louisiana: enzootic transmission in the relative absence of Culex quinquefasciatus
Godsey MS Jr , King RJ , Burkhalter K , Delorey M , Colton L , Charnetzky D , Sutherland G , Ezenwa VO , Wilson LA , Coffey M , Milheim LE , Taylor VG , Palmisano C , Wesson DM , Guptill SC . Am J Trop Med Hyg 2013 88 (5) 986-96 A study of West Nile virus (WNV) ecology was conducted in St. Tammany Parish, Louisiana, from 2002 to 2004. Mosquitoes were collected weekly throughout the year using Centers for Disease Control and Prevention (CDC) light traps placed at 1.5 and 6 m above the ground and gravid traps. A total of 379,466 mosquitoes was collected. WNV was identified in 33 pools of mosquitoes comprising five species; 23 positive pools were from Culex nigripalpus collected during 2003. Significantly more positive pools were obtained from Cx. nigripalpus collected in traps placed at 6 m than 1.5 m that year, but abundance did not differ by trap height. In contrast, Cx. nigripalpus abundance was significantly greater in traps placed at 6 m in 2002 and 2004. Annual temporal variation in Cx. nigripalpus peak seasonal abundance has significant implications for WNV transmission in Louisiana. Two WNV-positive pools, one each from Anopheles crucians s.l. and Cx. erraticus, were collected during the winter of 2004, showing year-round transmission. The potential roles of additional mosquito species in WNV transmission in southeastern Louisiana are discussed. |
Seasonal concentrations and determinants of indoor particulate matter in a low-income community in Dhaka, Bangladesh
Gurley ES , Salje H , Homaira N , Ram PK , Haque R , Petri WA Jr , Bresee J , Moss WJ , Luby SP , Breysse P , Azziz-Baumgartner E . Environ Res 2013 121 11-6 Indoor exposure to particulate matter (PM) increases the risk of acute lower respiratory tract infections, which are the leading cause of death in young children in Bangladesh. Few studies, however, have measured children's exposures to indoor PM over time. The World Health Organization recommends that daily indoor concentrations of PM less than 2.5mcm in diameter (PM(2.5)) not exceed 25mcg/m(3). This study aimed to describe the seasonal variation and determinants of concentrations of indoor PM(2.5) in a low-income community in urban Dhaka, Bangladesh. PM(2.5) was measured in homes monthly during May 2009 to April 2010. We calculated the time-weighted average, 90th percentile PM(2.5) concentrations and the daily hours PM(2.5) exceeded 100mcg/m(3). Linear regression models were used to estimate the associations between fuel use, ventilation, indoor smoking, and season to each metric describing indoor PM(2.5) concentrations. Time-weighted average PM(2.5) concentrations were 190mcg/m(3) (95% CI 170-210). Sixteen percent of 258 households primarily used biomass fuels for cooking and PM(2.5) concentrations in these homes had average concentrations 75mcg/m(3) (95% CI 56-124) greater than other homes. PM(2.5) concentrations were also associated with burning both biomass and kerosene, indoor smoking, and ventilation, and were more than twice as high during winter than during other seasons. Young children in this community are exposed to indoor PM(2.5) concentrations 7 times greater than those recommended by World Health Organization guidelines. Interventions to reduce biomass burning could result in a daily reduction of 75mcg/m(3) (40%) in time-weighted average PM(2.5) concentrations. |
Menopause and lead body burden among US women aged 45-55, NHANES 1999-2010
Mendola P , Brett K , Dibari JN , Pollack AZ , Tandon R , Shenassa ED . Environ Res 2013 121 110-3 BACKGROUND: Environmental factors in menopause have received limited attention. Lead is a known reproductive toxicant associated with delayed puberty in girls that may also affect menopause. METHODS: The odds of menopause among US women aged 45-55 were estimated in the National Health and Nutrition Examination Survey, 1999-2010, in relation to quartiles of blood lead. Women still menstruating (n=2158) were compared to women with natural menopause (n=1063). Logistic regression models included age, race/ethnicity, current hormone use, poverty, smoking and where available, bone density or bone alkaline phosphatase. RESULTS: Lead levels (ug/dL) were higher in menopausal women, geometric mean (standard error)=1.71 (0.04) vs. 1.23 (0.02). Adjusted odds of menopause and 95% confidence intervals for lead quartiles (lowest quartile referent) were 1.7 (1.0-2.8), 2.1 (1.2-3.6), and 4.2 (2.5-7.0) respectively. Results adjusting for bone markers were generally similar but had less precision. CONCLUSIONS: Blood lead was associated with natural menopause in US women even after adjustment for bone turnover. This raises concern that lead exposure, even at low levels, may shorten women's reproductive lifespan. |
Effects of gestational and lactational exposure to heptachlor epoxide on age at puberty and reproductive function in men and women
Luderer U , Kesner JS , Fuller JM , Krieg EF Jr , Meadows JW , Tramma SL , Yang H , Baker D . Environ Res 2013 121 84-94 BACKGROUND: For 15 months in 1981-1982, the commercial milk supply on the Hawaiian island of Oahu was contaminated with heptachlor epoxide, a metabolite of the insecticide heptachlor, resulting in gestational and/or lactational exposure to offspring of women who drank cow milk during that period. OBJECTIVE: To determine whether gestational and lactational exposure to heptachlor epoxide alters reproductive function and age at puberty in men or women. METHODS: 457 participants were recruited from a prior high school enrollment sampling frame of 20,000 adults born during 1981-1982 who lived on Oahu since at least first grade. Number of glasses of cow milk consumed weekly by the mother during the participant's gestation was used as a surrogate measure of heptachlor epoxide exposure. Reproductive function measures included semen analyses; reproductive hormones or their metabolites in daily urine specimens for one menstrual cycle; serum reproductive hormone levels in both sexes; and reported ages of onset for pubertal milestones. RESULTS: We observed no strong associations of heptachlor epoxide exposure during gestation and lactation with reproductive endpoints. In females, heptachlor epoxide exposure was associated with longer luteal phase length and slower drop in the ratio of estradiol to progesterone metabolites after ovulation. In males, heptachlor epoxide exposure was weakly associated with higher serum follicle stimulating hormone and luteinizing hormone concentrations, but no dose-response relationship was apparent. CONCLUSIONS: The results provide limited evidence that gestational and lactational exposure to heptachlor epoxide, due to milk contamination on Oahu in 1981-1982, resulted in clinically significant disturbances of reproductive function in men or women. |
Genetic variation and exchange in Trypanosoma cruzi isolates from the United States.
Roellig DM , Savage MY , Fujita AW , Barnabe C , Tibayrenc M , Steurer FJ , Yabsley MJ . PLoS One 2013 8 (2) e56198 Trypanosoma cruzi, the causative agent of Chagas disease, is a multiclonal parasite with high levels of genetic diversity and broad host and geographic ranges. Molecular characterization of South American isolates of T. cruzi has demonstrated homologous recombination and nuclear hybridization, as well as the presence of 6 main genetic clusters or "discrete typing units" (DTUs). Few studies have extensively investigated such exchange events and genetic diversity in North American isolates. In the current study, we genetically characterized over 50 US isolates from wildlife reservoirs (e.g., raccoons, opossums, armadillos, skunks), domestic dogs, humans, nonhuman primates, and reduviid vectors from nine states (TX, CA, OK, SC, FL, GA, MD, LA, TN) using a multilocus sequencing method. Single nucleotide polymorphisms were identified in sequences of the mismatch-repair class 2 (MSH2) and Tc52 genes. Typing based on the two genes often paralleled genotyping by classic methodologies using mini-exon and 18S and 24Salpha rRNA genes. Evidence for genetic exchange was obtained by comparing sequence phylogenies of nuclear and mitochondrial gene targets, dihydrofolate reductase-thymidylate synthase (DHFR-TS) and the cytochrome oxidase subunit II- NADH dehydrogenase subunit I region (COll-ND1), respectively. We observed genetic exchange in several US isolates as demonstrated by incongruent mitochondrial and nuclear genes phylogenies, which confirms a previous finding of a single genetic exchange event in a Florida isolate. The presence of SNPs and evidence of genetic exchange illustrates that strains from the US are genetically diverse, even though only two phylogenetic lineages have been identified in this region. |
Hepatitis E virus isolated from rabbits is genetically heterogeneous but with very similar antigenicity to human HEV.
Wang S , Dong C , Dai X , Cheng X , Liang J , Dong M , Purdy MA , Meng J . J Med Virol 2013 85 (4) 627-35 Rabbit hepatitis E virus (HEV) in China may represent a novel HEV genotype, although no consensus has been reached. It is unclear whether the ORF2 capsid protein containing the immunodominant epitopes from rabbit HEV differs from those of human HEV. In this study, 661 bile samples collected from domestic rabbits in Jiangsu province, eastern China were amplified by RT-nPCR using a set of HEV universal ORF2 primers. All 42 (6.4%) positive PCR products were sequenced. Phylogenetic analysis using the ORF2 sequences of 557 bp in length showed the Jiangsu isolates were separate from HEV genotypes 1, 2, 3, 4, avian HEV and rat HEV, and clustered together with rabbit HEV sequences. These 42 isolates were divided into five branches including two newly identified in the present study. Comparison with rabbit HEV sequences from China available in GenBank, using a 298 bp ORF2 segment, showed these sequences clustered together into a unique rabbit HEV clade, and were divided into eight sub-branches with high genetic heterogeneity. In addition, 267 serum samples collected from domestic rabbits, serial serum samples from two rhesus monkeys experimentally infected with HEV genotype 1 or 4, and serial serum samples from two New-Zealand rabbits infected experimentally with rabbit HEV were tested simultaneously by EIA using recombinant truncated ORF2 capsid proteins derived from rabbit and human HEV. The virtually identical results obtained suggest that rabbit and human HEV ORF2 antigens contain very similar immunodominant epitopes. All these data are helpful to identify the biological characteristics of the newly identified rabbit HEV. (J. Med. Virol. 85:627-635, 2013. (c) 2013 Wiley Periodicals, Inc.) |
Sexual risk behavior among HIV-uninfected men who have sex with men (MSM) participating in a tenofovir pre-exposure prophylaxis (PrEP) randomized trial in the United States
Liu AY , Vittinghoff E , Chillag K , Mayer K , Thompson M , Grohskopf L , Colfax G , Pathak S , Gvetadze R , O'Hara B , Collins B , Ackers M , Paxton L , Buchbinder SP . J Acquir Immune Defic Syndr 2013 64 (1) 87-94 OBJECTIVE: To evaluate for changes in sexual behaviors associated with daily pill-use among MSM participating in a PrEP trial. DESIGN: Randomized, double-blind, placebo-controlled trial. Participants were randomized 1:1:1:1 to receive tenofovir disoproxil fumarate or placebo at enrollment or after a 9-month delay and followed for 24 months. METHODS: 400 HIV-negative MSM reporting anal sex with a man in the past 12 months and meeting other eligibility criteria enrolled in San Francisco, Atlanta, and Boston. Sexual risk was assessed at baseline and quarterly visits using Audio Computer-Assisted Self-Interview. The association of pill-taking with sexual behavior was evaluated using logistic and negative-binomial regression for repeated measures. RESULTS: Overall indices of behavioral risk declined or remained stable during follow-up. Mean numbers of partners and proportion reporting unprotected anal sex (UAS) declined during follow-up (p<0.05), and mean UAS episodes remained stable. During the initial 9 months, changes in risk practices were similar in the group that began pills immediately vs. those in the delayed arm. These indices of risk did not differ significantly after initiation of pill-use in the delayed arm or continuation of study medication in the immediate arm. Use of poppers, amphetamines, and sexual performance-enhancing drugs were independently associated with one or more indices of sexual risk. CONCLUSIONS: There was no evidence of risk compensation among HIV-uninfected MSM in this clinical trial. Monitoring for risk compensation should continue now that PrEP has been shown to be efficacious in MSM and other populations and will be provided in open-label trials and other contexts. |
Knowledge, attitudes, and practices regarding syphilis screening among men who have sex with men in San Francisco
Katz KA , Raymond HF , Bernstein KT , Klausner JD . Sex Transm Dis 2013 40 (4) 318-22 BACKGROUND: Syphilis screening for men who have sex with men (MSM) in San Francisco (SF) is recommended every 3 to 6 months. We surveyed MSM in SF to determine the prevalence and factors associated with complying with that recommendation, identify screening barriers, and investigate whether identifying low perceived syphilis risk as a reason for not testing correlated with syphilis risk factors. METHODS: We conducted a cross-sectional survey as part of the National HIV Behavioral Surveillance System. We used logistic regression to analyze factors associated with complying with the SF-specific screening recommendation and with identifying low perceived risk as a reason for not testing. We analyzed data on screening barriers descriptively. RESULTS: Among 441 MSM, 37.5% (95% confidence interval [CI], 31.5%-43.6%) complied with the recommendation. Compliance was associated with human immunodeficiency virus infection (odds ratio [OR], 3.6; 95% CI, 1.7-7.8), more than 10 male sex partners (OR, 4.3; 95% CI, 1.6-12.0), having unprotected anal sex with a casual partner (OR, 4.2; 95% CI, 2.0-8.9), and knowing the recommendation (OR, 4.1; 95% CI, 2.1-8.2). Low perceived risk, time constraints, and not knowing that one should get screened were identified as reasons for not testing by 61.7%, 18.9%, and 18.8%, respectively. Identifying low perceived risk as a reason for not testing was associated with having more than 10 sex partners (OR, 0.2; 95% CI, 0.1-0.5). CONCLUSIONS: Attempts to improve compliance with the syphilis screening recommendation should include education regarding recommended screening frequency and syphilis risk factors and interventions to increase screening convenience. |
Differences between HIV-positive and HIV-negative African American men who have sex with men in two major U.S. metropolitan areas
Robinson BB , Galbraith JS , Swinburne Romine RE , Zhang Q , Herbst JH . Arch Sex Behav 2013 42 (2) 267-78 Alarmingly high HIV prevalence rates among African American men who have sex with men (AAMSM) require the development of effective prevention interventions. In this study of AAMSM conducted in two cities, we explored similarities and differences between HIV-positive and HIV-negative AAMSM on sociodemographic variables, HIV-related risk behaviors, and attitudinal constructs. Differences emerged in several major life areas: (1) poverty, employment, and use of mental health services, (2) sexual risk behaviors, and (3) self-identification with gay identity and culture. With regard to sociodemographic indicators, HIV-positive AAMSM were doing worse than HIV-negative AAMSM in that they were more likely to be disabled, to be living below the poverty level, and accessing mental health services. With regard to risk behaviors and partner characteristics, HIV-positive AAMSM were acting more responsibly than their HIV-negative counterparts, as they were more likely to have used a condom the last time they had sex. In addition, when compared to their HIV-negative counterparts, HIV-positive AAMSM were more likely to have either no casual partners at all or main or casual partners who were HIV-positive, thus preventing new HIV transmission by partnering with other HIV-positive men. Attitudinally, HIV-positive men were more accepting of their sexual attractions to men and were more likely to identify as gay than their HIV-negative peers. Although causality cannot be determined, the findings of this study can be used to strengthen HIV prevention efforts by improving the selection of targeted behaviors and prevention messages for HIV-positive and HIV-negative AAMSM. |
Does discussing sexually transmissible infections or HIV with a parent increase condom use among young women using other contraceptive methods?
Bradley H , Leichliter JS , Gift TL . Sex Health 2013 10 (1) 82-90 BACKGROUND: Young people may be more likely to use condoms if they discuss sexual risks with their parents. However, no previous study has examined whether discussing sexual risks with a parent is differently associated with condom use among women using and not using other contraceptive methods. METHODS: Using weighted data from the 2006-2008 National Survey of Family Growth, we examined condom use at last sex among 1206 sexually active unmarried women aged 15-24 years. Using logistic regression, we examined the association between condom use and discussing sexually transmissible infections (STIs) with parents before the age of 18 years, adjusted for women's characteristics (age, ethnicity, income and condom use at first sex). We estimated the predicted probability of condom use by whether women discussed STIs with parents, stratified by use of other contraceptive methods. RESULTS: Overall, 53% of women used condoms at last sex. Among 564 women using other contraceptives, 42% used condoms, versus 64% of 642 women not using other contraceptive methods (P<0.01). After adjustment for covariates, the predicted probability of condom use among women using other contraceptives was 47% among women who discussed STIs with their parents (v. 31% of those not discussing STIs; P<0.01). Among women not using other contraceptives, the predicted probability of condom use remained 64% regardless of whether they discussed STIs with their parents. CONCLUSIONS: Young women who use other contraceptive methods are less likely to use condoms, but discussing STIs with parents is associated with increased condom use among these women. |
Molecular analyses of Fusarium isolates recovered from a cluster of invasive mold infections in a Brazilian hospital.
Scheel CM , Hurst SF , Barreiros G , Akiti T , Nucci M , Balajee SA . BMC Infect Dis 2013 13 49 BACKGROUND: Invasive fusariosis (IF) is a rare but often fatal fungal infection in immunosuppressed patients. In 2007, cases of IF above the expected epidemiologic baseline were detected in the hematology ward of a hospital in Rio de Janeiro, Brazil. Possible sources of infection were investigated by performing environmental sampling and patient isolate collection, followed by molecular typing. Isolates from dermatology patients with superficial fusariosis were included in the study for comparison to molecular types found in the community. METHODS: Environmental sampling focused on water-related sources in and around the hematology ward. Initially, we characterized 166 clinical and environmental isolates using the Fusarium translation elongation factor 1alpha (EF-1alpha) genetic locus. Isolates included 68 collected from water-related sources in the hospital environment, 55 from 18 hematology patients, and 43 from the skin/nails of 40 outpatients seen at the hospital dermatology clinic. Multi-locus sequence typing was performed on Fusarium solani species complex (FSSC) species 1 and 2 isolates to investigate their relatedness further. RESULTS: Most of the hematology samples were FSSC species 2, with species type FSSC 2-d the most commonly isolated from these patients. Most of the outpatient dermatology samples were also FSSC 2, with type 2-d again predominating. In contrast, environmental isolates from water sources were mostly Fusarium oxysporum species complex (FOSC) and those from air samples mostly Fusarium incarnatum-equiseti species complex (FIESC). A third of the environmental samples were FSSC, with species types FSSC 1-a and FSSC 1-b predominating. CONCLUSIONS: Fusarium isolate species types from hematology patient infections were highly similar to those recovered from dermatology patients in the community. Four species types (FSSC 1-a, 1-b, 2-d and 2-f) were shared between hematology patients and the environment. Limitations in environmental sampling do not allow for nosocomial sources of infection to be ruled out. Future studies will focus on environmental factors that may have influenced the prevalence of FSSC fusariosis in this hematology ward. |
Mycobacterium chelonae facial infections following injection of dermal filler
Rodriguez JM , Xie YL , Winthrop KL , Schafer S , Sehdev P , Solomon J , Jensen B , Toney NC , Lewis PF . Aesthet Surg J 2013 33 (2) 265-9 A cluster of 3 facial Mycobacterium chelonae infections occurred after cosmetic dermal filler injections at a plastic surgery clinic. Pulsed-field gel electrophoresis showed that M chelonae isolated from the clinic tap water were identical to the patient wound isolates. Review of injection procedures identified application of nonsterile ice to the skin prior to injection as a possible source of M chelonae. Surveys of regional laboratories and a national plastic surgery listserv identified no other cases related to the injection of this brand of dermal filler. This is the first report of cutaneous M chelonae infections following the injection of dermal fillers. It adds to a growing body of literature on postinjection M chelonae infections and reinforces the importance of optimal skin disinfection steps prior to percutaneous procedures. LEVEL OF EVIDENCE: 5. |
Waning immunity to pertussis following 5 doses of DTaP
Tartof SY , Lewis M , Kenyon C , White K , Osborn A , Liko J , Zell E , Martin S , Messonnier NE , Clark TA , Skoff TH . Pediatrics 2013 131 (4) e1047-52 OBJECTIVE: To assess the risk of pertussis by time since vaccination in children in Minnesota and Oregon who received 5 doses of acellular pertussis vaccines (DTaP). METHODS: These cohort analyses included Minnesota and Oregon children born between 1998 and 2003 who had 5 DTaP doses recorded in state Immunization Information Systems. Immunization records and statewide pertussis surveillance data were combined. Incidence rates and risk ratios for pertussis were calculated for the 6 years after receipt of the fifth DTaP dose. RESULTS: The cohorts included 224 378 Minnesota children and 179 011 from Oregon; 458 and 89 pertussis cases were identified in Minnesota and Oregon, respectively. Pertussis incidence rates rose each year of follow-up: 15.6/100 000 (95% confidence interval [CI]: 11.1-21.4) at year 1 to 138.4/100 000 (CI: 113.3-166.9) at year 6 (Minnesota); 6.2/100 000 (CI: 3.3-10.6) in year 1 to 24.4/100 000 (CI: 15.0-37.8) in year 6 (Oregon). Risk ratios increased from 1.9 (CI: 1.3-2.9) in year 2 to 8.9 (CI: 6.0-13.0) in year 6 (Minnesota) and from 1.3 (CI: 0.6-2.8) in year 2 to 4.0 (CI: 1.9-8.4) in year 6 (Oregon). CONCLUSIONS: This evaluation reports steady increase in risk of pertussis in the years after completion of the 5-dose DTaP series. This rise is likely attributable in part to waning immunity from DTaP vaccines. Continuing to monitor disease burden and vaccine effectiveness in fully vaccinated children in coming years will be important to assess ongoing risk as additional cohorts vaccinated solely with acellular pertussis vaccines are introduced. |
Effectiveness of pentavalent and monovalent rotavirus vaccines in concurrent use among US children <5 years old, 2009-2011
Payne DC , Boom JA , Staat MA , Edwards KM , Szilagyi PG , Klein EJ , Selvarangan R , Azimi PH , Harrison C , Moffatt M , Johnston SH , Sahni LC , Baker CJ , Rench MA , Donauer S , McNeal M , Chappell J , Weinberg GA , Tasslimi A , Tate JE , Wikswo M , Curns AT , Sulemana I , Mijatovic-Rustempasic S , Esona MD , Bowen MD , Gentsch JR , Parashar UD . Clin Infect Dis 2013 57 (1) 13-20 BACKGROUND: We assessed vaccine effectiveness (VE) for RotaTeq(R) (RV5; 3 doses) and Rotarix(R) (RV1; 2 doses) at reducing rotavirus acute gastroenteritis (AGE) inpatient and emergency department (ED) visits in geographically and demographically diverse US children. METHODS: We enrolled children <5 years old hospitalized or visiting the ED with AGE symptoms from November 2009 through June 2010 and from November 2010 through June 2011 at 7 medical institutions. Fecal specimens were tested for rotavirus by enzyme immunoassay and genotyped. Vaccine receipt among laboratory-confirmed rotavirus cases was compared with AGE children negative for rotavirus (rotavirus-negative AGE controls). Regression models calculated VE estimates for each vaccine, age, ethnicity, predominant genotype, and clinical setting. RESULTS: RV5-specific analyses included 359 rotavirus cases and 1,811 rotavirus-negative AGE controls. RV1-specific analyses included 60 rotavirus cases and 155 rotavirus-negative AGE controls. RV5 and RV1 were 84% (CI=78%-88%) and 70% (CI=39%-86%) effective, respectively, against rotavirus-associated ED visits and hospitalizations combined. By clinical setting, RV5 VE against ED and inpatient rotavirus-associated visits was 81% (CI=70%-84%) and 86% (CI=74-91%), respectively. RV1 was 78% (CI= 46%-91%) effective against ED rotavirus disease; study power was insufficient to evaluate inpatient RV1 VE. No waning of immunity was evident during the first four years of life for RV5, nor during the first two years of life for RV1. RV5 provided statistically significant genotype-specific protection against each of the four major circulating rotavirus strains (G1P[8], G2P[4], G3P[8], G12P[8]), while RV1 also had a statistically significant VE for the most common genotype, G3P[8]. CONCLUSION: Both RV5 and RV1 significantly protected against medically-attended rotavirus gastroenteritis in this real-world assessment. |
Duration of protection against hepatitis A for the current two-dose vaccine compared to a three-dose vaccine schedule in children
Raczniak GA , Thomas T , Bulkow L , Negus S , Zanis C , Bruce MG , Spradling PR , Teshale EH , McMahon BJ . Vaccine 2013 31 (17) 2152-5 BACKGROUND: Hepatitis A is mostly a self-limiting disease but causes substantial economic burden. Consequently, United States Advisory Committee for Immunization Practices recommends inactivated hepatitis A vaccination for all children beginning at age 1 year and for high risk adults. The hepatitis A vaccine is highly effective but the duration of protection is unknown. METHODS: We examined the proportion of children with protective hepatitis A antibody levels (anti-HAV ≥20mIU/mL) as well as the geometric mean concentration (GMC) of anti-HAV in a cross sectional convenience sample of individuals aged 12-24 years, who had been vaccinated with a two-dose schedule in childhood, with the initial dose at least 5 years ago. We compared a subset of data from persons vaccinated with two-doses (720 EL.U.) at age 3-6 years with a demographically similar prospective cohort that received a three-dose (360 EL.U.) schedule and have been followed for 17 years. RESULTS: No significant differences were observed when comparing GMC between the two cohorts at 10 (P=0.467), 12 (P=0.496), and 14 (P=0.175) years post-immunization. For the three-dose cohort, protective antibody levels remain for 17 years and have stabilized leveled-off over the past 7 years. CONCLUSION: The two- and three-dose schedules provide similar protection >14 years after vaccination, indicating a booster dose is not needed at this time. Plateauing anti-HAV GMC levels suggest protective antibody levels may persist long-term. |
Detection of the A2058G and A2059G 23S rRNA gene point mutations associated with azithromycin resistance in Treponema pallidum by use of a TaqMan real-time multiplex PCR assay.
Chen CY , Chi KH , Pillay A , Nachamkin E , Su JR , Ballard RC . J Clin Microbiol 2013 51 (3) 908-13 Macrolide treatment failure in syphilis patients is associated with a single point mutation (either A2058G or A2059G) in both copies of the 23S rRNA gene in Treponema pallidum strains. The conventional method for the detection of both point mutations uses nested PCR combined with restriction enzyme digestions, which is laborious and time-consuming. We initially developed a TaqMan-based real-time duplex PCR assay for detection of the A2058G mutation, and upon discovery of the A2059G mutation, we modified the assay into a triplex format to simultaneously detect both mutations. The point mutations detected by the real-time triplex PCR were confirmed by pyrosequencing. A total of 129 specimens PCR positive for T. pallidum that were obtained from an azithromycin resistance surveillance study conducted in the United States were analyzed. Sixty-six (51.2%) of the 129 samples with the A2058G mutation were identified by both real-time PCR assays. Of the remaining 63 samples that were identified as having a macrolide-susceptible genotype by the duplex PCR assay, 17 (27%) were found to contain the A2059G mutation by the triplex PCR. The proportions of macrolide-susceptible versus -resistant genotypes harboring either the A2058G or the A2059G mutation among the T. pallidum strains were 35.6, 51.2, and 13.2%, respectively. None of the T. pallidum strains examined had both point mutations. The TaqMan-based real-time triplex PCR assay offers an alternative to conventional nested PCR and restriction fragment length polymorphism analyses for the rapid detection of both point mutations associated with macrolide resistance in T. pallidum. |
A model of the recruitment-derecruitment and volume of lung units in an excised lung as it is inflated-deflated between minimum and maximum lung volume
Frazer DG , Lindsley WG , McKinney W , Reynolds JS , Franz GN , Jackson M , Goldsmith WT . J Biomech Eng 2013 135 (3) 34503 The role of the recruitment-derecruitment of small structures in the lung (lung units) as the lung increases and decreases in volume has been debated. The objective of this study was to develop a model to estimate the change in the number and volume of open lung units as an excised lung is inflated-deflated between minimum and maximum lung volume. The model was formulated based on the observation that the compliance of the slowly changing quasi-static pressure-volume (P-V) curve of an excised rat lung can differ from the compliance of a faster changing small sinusoidal pressure volume perturbations superimposed on the curve. In those regions of the curve where differences in compliance occur, the lung tissue properties exhibit nonlinear characteristics, which cannot be linearized using "incremental" or "small signal" analysis. The model attributes the differences between the perturbation and quasi-static compliance to an additional nonlinear compliance term that results from the sequential opening and closing of lung units. Using this approach, it was possible to calculate the normalized average volume and the normalized number of open units as the lung is slowly inflated-deflated. Results indicate that the normalized average volume and the normalized number of open units are not linearly related to normalized lung volume, and at equal lung volumes the normalized number of open units is greater and the normalized average lung unit volume is smaller during lung deflation when compared to lung inflation. In summary, a model was developed to describe the recruitment-derecruitment process in excised lungs based on the differences between small signal perturbation compliance and quasi-static compliance. Values of normalized lung unit volume and the normalized number of open lung units were shown to be nonlinear functions of both transpulmonary pressure and normalized lung volume. (2013 American Society of Mechanical Engineers.) |
Plasma and urine dimercaptopropanesulfonate concentrations after dermal application of transdermal DMPS (TD-DMPS)
Cohen JP , Ruha AM , Curry SC , Biswas K , Westenberger B , Ye W , Caldwell KL , Lovecchio F , Burkhart K , Samia N . J Med Toxicol 2013 9 (1) 9-15 2,3-Dimercaptopropane-1-sulfonate (DMPS) is a metal chelator approved in Europe for oral or intravenous use for heavy metal poisoning. Transdermally applied DMPS (TD-DMPS) is used by some alternative practitioners to treat autism, despite the absence of evidence for its efficacy. We found no literature evaluating the pharmacokinetics of the transdermal route of delivery or the ability of TD-DMPS to enhance urinary mercury elimination. We hypothesized that TD-DMPS is not absorbed. Eight adult volunteers underwent application of 1.5-3 drops/kg of TD-DMPS. Subjects provided 12-h urine collections the day before and day of application. Subjects underwent blood draws at 0, 30, 60,90, 120, and 240 min after TD-DMPS application. Plasma and urine were assayed for the presence of DMPS. Urine was assayed for any change in urinary mercury excretion after DMPS. One control subject ingested 250 mg of oral DMPS and underwent the same urine and blood collections and analyses. No subject had detectable urine DMPS or increased urine mercury excretion after TD-DMPS. One subject had detectable levels of DMPS in the 30-min plasma sample, suspected to be contamination. All other samples for that subject and the other seven subjects showed no detectable plasma DMPS. The control subject had detectable urine and plasma DMPS levels and increased urine mercury excretion. These results indicate that TD-DMPS is not absorbed. There was no increase in urine mercury excretion after TD-DMPS. Our results argue that TD-DMPS is an ineffective metal chelator. |
Analysis of a ricin biomarker, ricinine, in 989 individual human urine samples
Pittman CT , Guido JM , Hamelin EI , Blake TA , Johnson RC . J Anal Toxicol 2013 37 (4) 237-40 Ricinine (3-cyano-4-methoxy-N-methyl-2-pyridone) is a urinary biomarker that can be measured to confirm human exposure to castor bean products such as ricin. Because many consumer products contain castor oil, another castor bean product, ricinine may be detectable in the general population. The following study characterized urinary ricinine concentrations from 989 individuals who were presumed to be unexposed to ricin. An automated diagnostic method was utilized to simplify the analysis of this large sample set. Sample preparation included a 96-well polystyrene divinylbenzene high throughput extraction and preconcentration step. Purified samples were analyzed by an efficient dual column, reversed-phase liquid chromatography separation and 13C-isotope dilution tandem mass spectrometry. In this convenience sample set, only 1.2% of the urine specimens had detectable amounts of ricinine, randomly distributed between 0.186 and 4.15 ng/mL. |
Antigenicity and immunogenicity of Plasmodium vivax merozoite surface protein-3
Bitencourt AR , Vicentin EC , Jimenez MC , Ricci R , Leite JA , Costa FT , Ferreira LC , Russell B , Nosten F , Renia L , Galinski MR , Barnwell JW , Rodrigues MM , Soares IS . PLoS One 2013 8 (2) e56061 A recent clinical trial in African children demonstrated the potential utility of merozoite surface protein (MSP)-3 as a vaccine against Plasmodium falciparum malaria. The present study evaluated the use of Plasmodium vivax MSP-3 (PvMSP-3) as a target antigen in vaccine formulations against malaria caused by P. vivax . Recombinant proteins representing MSP-3alpha (PvMSP-3) and MSP-3beta of P. vivax were expressed as soluble histidine-tagged bacterial fusions. Antigenicity during natural infection was evaluated by detecting specific antibodies using sera from individuals living in endemic areas of Brazil. A large proportion of infected individuals presented IgG antibodies to PvMSP-3alpha (68.2%) and at least 1 recombinant protein representing PvMSP-3beta (79.1%). In spite of the large responder frequency, reactivity to both antigens was significantly lower than was observed for the immunodominant epitope present on the 19-kDa C-terminal region of PvMSP-1. Immunogenicity of the recombinant proteins was studied in mice in the absence or presence of different adjuvant formulations. PvMSP-3beta, but not PvMSP-3alpha, induced a TLR4-independent humoral immune response in the absence of any adjuvant formulation. The immunogenicity of the recombinant antigens were also tested in formulations containing different adjuvants (Alum, flagellin, CpG, Quil A,TiterMax(R) and incomplete Freunds adjuvant) and combinations of two adjuvants (Alum plus flagellin, and CpG plus flagellin). Recombinant PvMSP-3alpha and PvMSP-3beta elicited higher antibody titers capable of recognizing infected erythrocytes harvested from malaria patients. Our results confirm that P. vivax MSP-3 antigens are immunogenic during natural infection, and the corresponding recombinant proteins may be useful in elucidating their vaccine potential. |
Case report: severe disseminated adenovirus infection in a neonate following water birth delivery
Soileau SL , Schneider E , Erdman DD , Lu X , Ryan WD , McAdams RM . J Med Virol 2013 85 (4) 667-9 Adenovirus infections are a common cause of respiratory and enteric illnesses of late infancy and childhood. In neonates, adenovirus infections are rare, carrying a high morbidity and mortality rate. We present a case of infant who developed severe pneumonia and disseminated adenoviral infection following water birth delivery to a mother with gastroenteritis. The infant's infection was due to an adenovirus strain that has not been previously reported in neonates. (J. Med. Virol. 85:667-669, 2013. (c) 2013 Wiley Periodicals, Inc.) |
Do women with persistently negative nontreponemal test results transmit syphilis during pregnancy?
Peterman TA , Newman DR , Davis D , Su JR . Sex Transm Dis 2013 40 (4) 311-5 BACKGROUND: Syphilis screening algorithms have been reversed to take advantage of new automated treponemal tests. Screening that begins with a treponemal test identifies persons with positive treponemal and negative nontreponemal test results who were missed when screening began with a nontreponemal test. The significance of these results is uncertain. We wondered if mothers with persistently negative nontreponemal test results could transmit syphilis to their newborns. METHODS: We reviewed congenital syphilis cases reported to the Centers for Disease Control and Prevention to identify all instances where (1) the mother had persistently negative nontreponemal test results (best evidence would be multiple negative nontreponemal test results with at least one >30 days after birth) and (2) the child had evidence of infection (best evidence a confirmed case, older child, stillbirth, or "probable" by the criteria of Kaufman et al.). RESULTS: A total of 23,863 patients with congenital syphilis had birthdates between 1991 and 2009. Of 106 mothers initially classified as having only negative nontreponemal test results reported, 20 were misclassified; the remaining 86 mothers had no infants with confirmed syphilis and no syphilitic stillbirths. The 23,757 other mothers had 284 (1.2%) infants with confirmed syphilis and 1271 (5.4%) syphilitic stillbirths. Twelve of the 86 mothers had negative nontreponemal test results more than 30 days after delivery; none of their children had convincing evidence of infection. One mother had a negative nontreponemal test result 27 days after delivery of a child with "positive x-rays" and elevated cerebrospinal fluid cell count or protein, but details were unavailable. Fifty-nine children were diagnosed at age 1 year or older; nontreponemal test results were available for 13 of the mothers, and all were positive. CONCLUSIONS: We found no convincing evidence of syphilis transmission from mothers with persistently negative nontreponemal test results. Only 1 case suggested that transmission may have occurred, and records were incomplete. |
Modelling blast induced damage from a fully coupled explosive charge
Onederra IA , Furtney JK , Sellers E , Iverson S . Int J Rock Mech Min Sci 2013 58 73-84 This paper presents one of the latest developments in the blasting engineering modelling field the Hybrid Stress Blasting Model (HSBM). HSBM includes a rock breakage engine to model detonation, wave propagation, rock fragmentation, and muck pile formation. Results from two controlled blasting experiments were used to evaluate the code's ability to predict the extent of damage. Results indicate that the code is capable of adequately predicting both the extent and shape of the damage zone associated with the influence of point-of-initiation and free-face boundary conditions. Radial fractures extending towards a free face are apparent in the modelling output and matched those mapped after the experiment. In the stage 2 validation experiment, the maximum extent of visible damage was of the order of 1.45 m for the fully coupled 38-mm emulsion charge. Peak radial velocities were predicted within a relative difference of only 1.59% at the nearest history point at 0.3 m from the explosive charge. Discrepancies were larger further away from the charge, with relative differences of -22.4% and -42.9% at distances of 0.46 m and 0.61 m, respectively, meaning that the model overestimated particle velocities at these distances. This attenuation deficiency in the modelling produced an overestimation of the damage zone at the corner of the block due to excessive stress reflections. The extent of visible damage in the immediate vicinity of the blasthole adequately matched the measurements. (C) 2012 Elsevier Ltd. All rights reserved. |
Self-contained breathing apparatus remaining service-life indicator performance requirements. Final rule
Centers for Disease Control and Prevention , Szalajda J . Fed Regist 2013 78 (9) 2618-22 On June 25, 2012, the Department of Health and Human Services (HHS) published a notice of proposed rulemaking proposing to update respirator approval standards in response to a petition to amend our regulations, current requirements for self-contained breathing apparatus (SCBA) remaining service-life indicators or warning devices. These indicators are built into a respirator to alert the user that the breathing air provided by the respirator is close to depletion. In this final rule, HHS responds to public comment on the proposed rule and revises the current standard, employed by the National Institute for Occupational Safety and Health (NIOSH) located within the Centers for Disease Control and Prevention (CDC), to allow greater flexibility in the setting of the indicator alarm to ensure that the alarm more effectively meets the different worker protection needs of different work operations. This final rule sets a minimum alarm point at 25 percent of the rated service time and allows the manufacturer to offer remaining service life set point at a higher value or values appropriate to the purchaser's use scenario. |
Physical activity interventions in Latin America: expanding and classifying the evidence
Hoehner CM , Ribeiro IC , Parra DC , Reis RS , Azevedo MR , Hino AA , Soares J , Hallal PC , Simoes EJ , Brownson RC . Am J Prev Med 2013 44 (3) e31-40 CONTEXT: Systematic reviews of public health interventions are useful for identifying effective strategies for informing policy and practice. The goals of this review were to (1) update a previous systematic review of physical activity interventions in Latin America which found that only school-based physical education had sufficient evidence to recommend widespread adoption; (2) assess the reporting of external validity elements; and (3) develop and apply an evidence typology for classifying interventions. EVIDENCE ACQUISITION: In 2010-2011, community-level, physical activity intervention studies from Latin America were identified, categorized, and screened based on the peer-reviewed literature or Brazilian theses published between 2006 and 2010. Articles meeting inclusion criteria were evaluated using U.S. Community Guide methods. External validity reporting was assessed among a subset of articles reviewed to date. An evidence rating typology was developed and applied to classify interventions along a continuum based on evidence about their effectiveness in the U.S. context, reach, adoption, implementation, institutionalization, and benefits and costs. EVIDENCE SYNTHESIS: Thirteen articles published between 2006 and 2010 met inclusion criteria and were abstracted systematically, yet when combined with evidence from articles from the previous systematic review, no additional interventions could be recommended for practice. Moreover, the reporting of external validity elements was low among a subset of 19 studies published to date (median=21% of elements reported). By applying the expanded evidence rating typology, one intervention was classified as evidence-based, seven as promising, and one as emerging. CONCLUSIONS: Several physical activity interventions have been identified as promising for future research and implementation in Latin America. Enhanced reporting of external validity elements will inform the translation of research into practice. |
Responding to the outbreak of invasive fungal infections: the value of public health to Americans
Bell BP , Khabbaz RF . JAMA 2013 309 (9) 883-4 The outbreak of invasive fungal infections among patients who received injections of contaminated methylprednisolone acetate prepared by the New England Compounding Center (in Framingham, Massachusetts) is a disturbing tragedy, already the largest health care–associated fungal outbreak reported in the United States, with 693 cases and 45 deaths reported as of January 28, 2013.1 Effectively responding to this catastrophic event required rapid actions by clinical and public health practitioners who worked to ensure discontinued use of the suspect medication, notify at-risk patients and their physicians, and decipher the many unknowns about the outbreak to provide the best guidance for minimizing harm. | In the United States, public health is a distributed system, with critical responsibilities at local, state, and federal levels. The fungal infections outbreak underscores the pivotal detection and response roles of state health departments, working with local clinical and public health colleagues. In this outbreak, the Tennessee Department of Health (TDOH) sounded the alarm based on a telephone call from an alert clinician treating a patient with an unusual form of meningitis.2 The clinician had not only asked about a broad range of possible patient exposures, but also recognized the potential public health implications and knew to contact the health department. This well-established linkage reflects long-term efforts of the TDOH to establish partnerships and work collaboratively with clinicians, hospitals, and other health care facilities to implement measures to reduce health care–associated infections. |
Chlamydia trachomatis infection among women 26 to 39 years of age in the United States, 1999 to 2010
Torrone EA , Geisler WM , Gift TL , Weinstock HS . Sex Transm Dis 2013 40 (4) 335-7 Using data from a nationally representative survey, we identified predictors of chlamydial infection in women aged 26 to 39 years. Chlamydia prevalence was low overall but varied by sociodemographics and sexual behaviors. Findings support current recommendations that women older than 25 years should not be routinely screened for chlamydial infection. |
Virus nomenclature below the species level: a standardized nomenclature for laboratory animal-adapted strains and variants of viruses assigned to the family Filoviridae
Kuhn JH , Bao Y , Bavari S , Becker S , Bradfute S , Brister JR , Bukreyev AA , Cai Y , Chandran K , Davey RA , Dolnik O , Dye JM , Enterlein S , Gonzalez JP , Formenty P , Freiberg AN , Hensley LE , Honko AN , Ignatyev GM , Jahrling PB , Johnson KM , Klenk HD , Kobinger G , Lackemeyer MG , Leroy EM , Lever MS , Lofts LL , Muhlberger E , Netesov SV , Olinger GG , Palacios G , Patterson JL , Paweska JT , Pitt L , Radoshitzky SR , Ryabchikova EI , Saphire EO , Shestopalov AM , Smither SJ , Sullivan NJ , Swanepoel R , Takada A , Towner JS , van der Groen G , Volchkov VE , Wahl-Jensen V , Warren TK , Warfield KL , Weidmann M , Nichol ST . Arch Virol 2013 158 (6) 1425-32 The International Committee on Taxonomy of Viruses (ICTV) organizes the classification of viruses into taxa, but is not responsible for the nomenclature for taxa members. International experts groups, such as the ICTV Study Groups, recommend the classification and naming of viruses and their strains, variants, and isolates. The ICTV Filoviridae Study Group has recently introduced an updated classification and nomenclature for filoviruses. Subsequently, and together with numerous other filovirus experts, a consistent nomenclature for their natural genetic variants and isolates was developed that aims at simplifying the retrieval of sequence data from electronic databases. This is a first important step toward a viral genome annotation standard as sought by the US National Center for Biotechnology Information (NCBI). Here, this work is extended to include filoviruses obtained in the laboratory by artificial selection through passage in laboratory hosts. The previously developed template for natural filovirus genetic variant naming (<virus name> <isolation host-suffix>/<country of sampling>/<year of sampling>/<genetic variant designation>-<isolate designation>) is retained, but it is proposed to adapt the type of information added to each field for laboratory animal-adapted variants. For instance, the full-length designation of an Ebola virus Mayinga variant adapted at the State Research Center for Virology and Biotechnology "Vector" to cause disease in guinea pigs after seven passages would be akin to "Ebola virus VECTOR/C.porcellus-lab/COD/1976/Mayinga-GPA-P7". As was proposed for the names of natural filovirus variants, we suggest using the full-length designation in databases, as well as in the method section of publications. Shortened designations (such as "EBOV VECTOR/C.por/COD/76/May-GPA-P7") and abbreviations (such as "EBOV/May-GPA-P7") could be used in the remainder of the text depending on how critical it is to convey information contained in the full-length name. "EBOV" would suffice if only one EBOV strain/variant/isolate is addressed. |
Virus nomenclature below the species level: a standardized nomenclature for natural variants of viruses assigned to the family Filoviridae
Kuhn JH , Bao Y , Bavari S , Becker S , Bradfute S , Brister JR , Bukreyev AA , Chandran K , Davey RA , Dolnik O , Dye JM , Enterlein S , Hensley LE , Honko AN , Jahrling PB , Johnson KM , Kobinger G , Leroy EM , Lever MS , Muhlberger E , Netesov SV , Olinger GG , Palacios G , Patterson JL , Paweska JT , Pitt L , Radoshitzky SR , Saphire EO , Smither SJ , Swanepoel R , Towner JS , van der Groen G , Volchkov VE , Wahl-Jensen V , Warren TK , Weidmann M , Nichol ST . Arch Virol 2013 158 (1) 301-11 The task of international expert groups is to recommend the classification and naming of viruses. The International Committee on Taxonomy of Viruses Filoviridae Study Group and other experts have recently established an almost consistent classification and nomenclature for filoviruses. Here, further guidelines are suggested to include their natural genetic variants. First, this term is defined. Second, a template for full-length virus names (such as "Ebola virus H.sapiens-tc/COD/1995/Kikwit-9510621") is proposed. These names contain information on the identity of the virus (e.g., Ebola virus), isolation host (e.g., members of the species Homo sapiens), sampling location (e.g., Democratic Republic of the Congo (COD)), sampling year, genetic variant (e.g., Kikwit), and isolate (e.g., 9510621). Suffixes are proposed for individual names that clarify whether a given genetic variant has been characterized based on passage zero material (-wt), has been passaged in tissue/cell culture (-tc), is known from consensus sequence fragments only (-frag), or does (most likely) not exist anymore (-hist). We suggest that these comprehensive names are to be used specifically in the methods section of publications. Suitable abbreviations, also proposed here, could then be used throughout the text, while the full names could be used again in phylograms, tables, or figures if the contained information aids the interpretation of presented data. The proposed system is very similar to the well-known influenzavirus nomenclature and the nomenclature recently proposed for rotaviruses. If applied consistently, it would considerably simplify retrieval of sequence data from electronic databases and be a first important step toward a viral genome annotation standard as sought by the National Center for Biotechnology Information (NCBI). Furthermore, adoption of this nomenclature would increase the general understanding of filovirus-related publications and presentations and improve figures such as phylograms, alignments, and diagrams. Most importantly, it would counter the increasing confusion in genetic variant naming due to the identification of ever more sequences through technological breakthroughs in high-throughput sequencing and environmental sampling. |
Barriers in the diagnosis and treatment of depression in women in the USA: where are we now?
Ko JY , Farr SL , Dietz PM . Neuropsychiatry (London) 2013 3 (1) 1-3 An estimated 14.8 million Americans aged 18 years and older, or approximately 6.7% of the adult US population, meet the criteria for major depressive disorder in any given year [1]. Women are almost twice as likely as men to report lifetime history of a major depressive episode, with their first episode occurring in adolescence through to mid-life [2]. An estimated 8–16% of US women aged 18–44 years are affected by depression [2,3]. Existing research has found depression to be associated with many adverse conditions throughout life, including concurrent psychiatric and substance use disorders, chronic conditions such as diabetes, decreased fertility, poor pregnancy outcomes such as preterm delivery or low birth-weight infants, and impaired maternal functioning and bonding. | Compared with men, women are more likely to visit their physician [101] and frequently interact with the healthcare system, especially during reproductive years [102]. However, only half of women with depression receive a clinical diagnosis [3], which is often the first step to treatment. Studies have shown that women who are younger, non-Hispanic white and uninsured are less likely to receive clinical diagnoses [3,4]. These groups are also less likely to seek treatment [5] and to receive appropriate treatment when care is sought [6]. Barriers to care have been well documented in the literature and include financial constraints such as healthcare coverage, fragmented care and stigma [3,7]. Given these constraints, addressing barriers in diagnosis and treatment of women with depression must be a multifaceted approach. |
Evaluation of the effects of a killed whole-cell vaccine against Mycobacterium avium subsp paratuberculosis in 3 herds of dairy cattle with natural exposure to the organism
Knust B , Patton E , Ribeiro-Lima J , Bohn JJ , Wells SJ . J Am Vet Med Assoc 2013 242 (5) 663-9 OBKECTIVE:To evaluate effects of vaccination with a killed whole-cell vaccine against Mycobacterium avium subsp paratuberculosis (MAP) on fecal shedding of the organism, development of clinical paratuberculosis (Johne's disease [JD]), milk production, measures of reproduction, and within-herd longevity of dairy cattle naturally exposed to MAP. DESIGN: Controlled clinical trial. ANIMALS: 200 vaccinated and 195 unvaccinated (control) dairy cows from 3 herds in Wisconsin. PROCEDURES: Every other heifer calf born in each herd received the MAP vaccine; 162 vaccinates and 145 controls that had ≥ 1 lactation were included in analyses. Bacteriologic culture of fecal samples for MAP was performed annually for 7 years; results were confirmed via histologic methods and PCR assay. Production records and culture results were evaluated to determine effects of vaccination on variables of interest in study cows. Annual whole-herd prevalence of MAP shedding in feces was also determined. RESULTS: Vaccinates had a significantly lower hazard of testing positive for MAP via culture of fecal samples than did controls over time (hazard ratio, 0.57; 95% confidence interval, 0.34 to 0.97). Fewer vaccinates developed clinical JD than did controls (n = 6 and 12, respectively), but these differences were nonsignificant. Overall within-herd longevity, total milk production, and calving-to-conception intervals were similar between vaccinates and controls. In all herds, prevalence of MAP shedding in feces decreased over time. CONCLUSIONS AND CLINICAL RELEVANCE: Vaccination with a killed whole-cell MAP vaccine appeared to be an effective tool as part of a program to control the spread of JD in dairy cattle. |
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