The reach and health impacts of the National Breast and Cervical Cancer Early Detection Program
Guy GP Jr , Tangka FK , Hall IJ , Miller JW , Royalty J . Cancer Causes Control 2015 26 (5) 649-50 Early Detection Program,” contains 16 articles that provide an in-depth examination of the National Breast and Cervical Cancer Early Detection Program (NBCCEDP). Since 1990, the NBCCEDP has provided access to breast and cervical cancer screening and diagnostic services to more than 4.3 million low-income, underinsured, and uninsured women in the USA [1]. It is the largest organized cancer screening program in the country and, by design, reaches women who are underserved and may not have access to these services otherwise. | The first article in this special issue provides an overview of the NBCCEDP—its design, history, service delivery components, program impact, and potential role moving forward [2]. The remaining articles use data from the NBCCEDP to describe its reach and impact. Together, these findings provide a vital resource for understanding the important role of the NBCCEDP in providing high-quality breast and cervical cancer screening and diagnostic services to underserved women in the USA. |
Multimorbidity in a prospective cohort: prevalence and associations with weight loss and health status in severely obese patients
Agborsangaya CB , Majumdar SR , Sharma AM , Gregg EW , Padwal RS . Obesity (Silver Spring) 2015 23 (3) 707-12 OBJECTIVE: To examine the prevalence of multimorbidity (≥2 chronic conditions) in severely obese patients and its associations with weight loss and health status over 2 years. METHODS: In a prospective cohort including 500 severely obese adults, self-reported prevalence of 20 chronic conditions was calculated at baseline and 2 years. Multivariable logistic regression models were fitted to test the covariate-adjusted associations between ≥5% weight reduction and reduction in multimorbidity and the association between health status (visual analogue scale [VAS]) and reduction in multimorbidity over 2 years. RESULTS: After 2 years, mean weight change was -12.9 +/-18.7 kg, 53% had ≥5% weight reduction, mean change in VAS was 11.5 +/- 21.2, and 53.5% had ≥10% increase in VAS. Multimorbidity was reported in 95.4% and 92.8% patients at baseline and 2 years, respectively. Weight loss (≥5%) over 2 years was associated with reduction in multimorbidity (adjusted OR = 1.7, 95% CI 1.1-2.7). Reduction in multimorbidity was associated with clinically important improvements (≥10% increase in VAS) in health status (adjusted OR = 2.5, 95% CI 1.6, 4.0). CONCLUSIONS: Multimorbidity is common in severely obese patients. Having ≥5% weight reduction over 2 years was associated with a reduction in multimorbidity, which was also associated with improvements in health status. |
Provider management of equivocal cervical cancer screening results among underserved women, 2009-2011: follow-up of atypical squamous cells of undetermined significance
Watson M , Benard V , Lin L , Rockwell T , Royalty J . Cancer Causes Control 2015 26 (5) 759-64 PURPOSE: Reflex human papillomavirus (HPV) testing is the preferred triage option for most women diagnosed with atypical squamous cells of undetermined significance (ASC-US). This study was conducted to describe follow-up results of women with ASC-US Pap test results in the National Breast and Cervical Cancer Early Detection Program (NBCCEDP), focusing on HPV test use. METHODS: We examined the follow-up of 45,049 women in the NBCCEDP with ASC-US Pap tests during 2009-2011. Data on demographic characteristics, diagnostic procedures, and clinical outcomes were analyzed. RESULTS: NBCCEDP providers diagnosed 45,049 women (4.5 % of all Pap tests) with an ASC-US result. Of those, 28,271 (62.8 %) were followed with an HPV test, 3,883 (8.6 %) with a repeat Pap test, 6,592 (14.6 %) with colposcopy, and 6,303 were lost to follow-up (14.0 %). Women aged 40 and older were followed more often with an HPV test. White, black, and Asian/Pacific Islander women were followed more often with an HPV test after an ASC-US Pap compared to Hispanic and American Indian/Alaska Native (AI/AN) women. Among women with a positive HPV test on follow-up, almost 90 % continued with colposcopy as recommended. AI/AN women had the highest rates of HPV positivity (55.2 %) and of no follow-up (25.0 %). CONCLUSION: This is the first analysis describing follow-up of ASC-US Pap test results in the NBCCEDP, providing a window into current management of ASC-US results. Findings raise concerns about persistent disparities among AI/AN women. During 2009-2011, nearly two-thirds of women with an ASC-US Pap test result were followed with an HPV reflex test. |
Employment and activity limitations among adults with chronic obstructive pulmonary disease - United States, 2013
Wheaton AG , Cunningham TJ , Ford ES , Croft JB . MMWR Morb Mortal Wkly Rep 2015 64 (11) 289-295 Chronic obstructive pulmonary disease (COPD) is a group of progressive respiratory conditions, including emphysema and chronic bronchitis, characterized by airflow obstruction and symptoms such as shortness of breath, chronic cough, and sputum production. COPD is an important contributor to mortality and disability in the United States. Healthy People 2020 has several COPD-related objectives,* including to reduce activity limitations among adults with COPD. To assess the state-level prevalence of COPD and the association of COPD with various activity limitations among U.S. adults, CDC analyzed data from the 2013 Behavioral Risk Factor Surveillance System (BRFSS). Among U.S. adults in all 50 states, the District of Columbia (DC), and two U.S. territories, 6.4% (an estimated 15.7 million adults) had been told by a physician or other health professional that they have COPD. Adults who reported having COPD were more likely to report being unable to work (24.3% versus 5.3%), having an activity limitation caused by health problems (49.6% versus 16.9%), having difficulty walking or climbing stairs (38.4% versus 11.3%), or using special equipment to manage health problems (22.1% versus 6.7%), compared with adults without COPD. Smokers who have been diagnosed with COPD are encouraged to quit smoking, which can slow the progression of the disease and reduce mobility impairment. In addition, COPD patients should consider participation in a pulmonary rehabilitation program that combines patient education and exercise training to address barriers to physical activity, such as respiratory symptoms and muscle wasting. |
Clinical outcomes of mammography in the National Breast and Cervical Cancer Early Detection Program, 2009-2012
White A , Miller J , Royalty J , Ryerson AB , Benard V , Helsel W , Kammerer W . Cancer Causes Control 2015 26 (5) 723-32 PURPOSE: The National Breast and Cervical Cancer Early Detection Program (NBCCEDP) enrolls asymptomatic women for cancer screening and symptomatic women for diagnostic services. This study describes the results of mammograms provided by the NBCCEDP, by examination indication (screening or diagnostic), and by age group. METHODS: For the first NBCCEDP-funded mammogram received during 2009-2012, we calculated age-specific percentages of abnormal findings, rates of follow-up testing, and invasive and in situ breast cancer diagnoses per 1,000 mammograms. Logistic regression was used to estimate the odds for each of these outcomes by examination indication. RESULTS: The NBCCEDP provided 941,649 screening, 175,310 diagnostic, and 30,434 unknown indication mammograms to 1,147,393 women. The percentage with abnormal mammograms was higher for diagnostic mammograms (40.1 %) than for screening mammograms (15.5 %). Compared with women aged 40-49 years, fewer women aged 50-64 years had abnormal results for screening (13.7 vs. 19.7 %) and diagnostic mammograms (37.7 vs. 42.7 %). Follow-up rates per 1,000 mammograms were lower among women aged 50-64 compared to those aged 40-49 (screening: 143.9 vs. 207.5; diagnostic: 645.3 vs. 760.9); biopsy rates exhibited a similar pattern (screening: 24.1 vs. 32.9; diagnostic: 167.7 vs. 169.7). For screening mammograms, older women had more cancers detected than younger women (invasive: 3.6 vs. 2.2; in situ: 2.3 vs. 2.0). Similarly, for diagnostic mammograms, cancer detection was higher for older women (invasive: 67.8 vs. 36.6; in situ: 17.4 vs. 11.1). CONCLUSIONS: Abnormal mammograms and diagnostic follow-up procedures were less frequent in women aged 50-64 years compared to women aged 40-49 years, while breast cancer detection was higher, regardless of indication for the mammogram. Some of these differences between age groups were greater for screening mammograms than for diagnostic mammograms. Cancer detection rates were higher for diagnostic mammograms compared with screening mammograms. These findings support the NBCCEDP's priority of serving women aged 50-64 years and providing both screening and diagnostic mammograms. |
Collaborative drug therapy management: case studies of three community-based models of care
Snyder ME , Earl TR , Gilchrist S , Greenberg M , Heisler H , Revels M , Matson-Koffman D . Prev Chronic Dis 2015 12 E39 Collaborative drug therapy management agreements are a strategy for expanding the role of pharmacists in team-based care with other providers. However, these agreements have not been widely implemented. This study describes the features of existing provider-pharmacist collaborative drug therapy management practices and identifies the facilitators and barriers to implementing such services in community settings. We conducted in-depth, qualitative interviews in 2012 in a federally qualified health center, an independent pharmacy, and a retail pharmacy chain. Facilitators included 1) ensuring pharmacists were adequately trained; 2) obtaining stakeholder (eg, physician) buy-in; and 3) leveraging academic partners. Barriers included 1) lack of pharmacist compensation; 2) hesitation among providers to trust pharmacists; 3) lack of time and resources; and 4) existing informal collaborations that resulted in reduced interest in formal agreements. The models described in this study could be used to strengthen clinical-community linkages through team-based care, particularly for chronic disease prevention and management. |
Towards tuberculosis elimination: an action framework for low-incidence countries
Lonnroth K , Migliori GB , Abubakar I , D'Ambrosio L , de Vries G , Diel R , Douglas P , Falzon D , Gaudreau MA , Goletti D , Gonzalez Ochoa ER , LoBue P , Matteelli A , Njoo H , Solovic I , Story A , Tayeb T , van der Werf MJ , Weil D , Zellweger JP , Abdel Aziz M , Al Lawati MR , Aliberti S , Arrazola de Oñate W , Barreira D , Bhatia V , Blasi F , Bloom A , Bruchfeld J , Castelli F , Centis R , Chemtob D , Cirillo DM , Colorado A , Dadu A , Dahle UR , De Paoli L , Dias HM , Duarte R , Fattorini L , Gaga M , Getahun H , Glaziou P , Goguadze L , Del Granado M , Haas W , Järvinen A , Kwon GY , Mosca D , Nahid P , Nishikiori N , Noguer I , O'Donnell J , Pace-Asciak A , Pompa MG , Popescu GG , Robalo Cordeiro C , Rønning K , Ruhwald M , Sculier JP , Simunović A , Smith-Palmer A , Sotgiu G , Sulis G , Torres-Duque CA , Umeki K , Uplekar M , van Weezenbeek C , Vasankari T , Vitillo RJ , Voniatis C , Wanlin M , Raviglione MC . Eur Respir J 2015 45 (4) 928-52 This paper describes an action framework for countries with low tuberculosis (TB) incidence (<100 TB cases per million population) that are striving for TB elimination. The framework sets out priority interventions required for these countries to progress first towards "pre-elimination" (<10 cases per million) and eventually the elimination of TB as a public health problem (less than one case per million). TB epidemiology in most low-incidence countries is characterised by a low rate of transmission in the general population, occasional outbreaks, a majority of TB cases generated from progression of latent TB infection (LTBI) rather than local transmission, concentration to certain vulnerable and hard-to-reach risk groups, and challenges posed by cross-border migration. Common health system challenges are that political commitment, funding, clinical expertise and general awareness of TB diminishes as TB incidence falls. The framework presents a tailored response to these challenges, grouped into eight priority action areas: 1) ensure political commitment, funding and stewardship for planning and essential services; 2) address the most vulnerable and hard-to-reach groups; 3) address special needs of migrants and cross-border issues; 4) undertake screening for active TB and LTBI in TB contacts and selected high-risk groups, and provide appropriate treatment; 5) optimise the prevention and care of drug-resistant TB; 6) ensure continued surveillance, programme monitoring and evaluation and case-based data management; 7) invest in research and new tools; and 8) support global TB prevention, care and control. The overall approach needs to be multisectorial, focusing on equitable access to high-quality diagnosis and care, and on addressing the social determinants of TB. Because of increasing globalisation and population mobility, the response needs to have both national and global dimensions. |
Loss to follow-up and bias assessment among a cohort of Thai men who have sex with men in Bangkok, Thailand
Pattanasin S , Wimonsate W , Chonwattana W , Tongtoyai J , Chaikummao S , Sriporn A , Sukwicha W , Mock PA , Holtz TH . Int J STD AIDS 2015 27 (3) 196-206 Minimising loss to follow-up is essential to obtain unbiased results. This study aimed to assess factors associated with loss to follow-up and effects on biasing exposure-outcome associations in a cohort of men who have sex with men in Bangkok. We enrolled sexually active Thai men who have sex with men, at least 18 years old, in a study with 4-monthly follow-up visits. At each visit, men answered HIV risk behaviour questions using audio computer-assisted self-interview. Logistic regression was used to evaluate factors associated with loss to follow-up and bias between exposures and prevalent HIV infection were estimated using adjusted relative odds ratios. From 2006 to 2010, we enrolled 1744 men who have sex with men; as of April, 2014, 1256 (72%) had completed at least the month-36 visit; loss to follow-up was 9.6%. Factors independently associated with loss to follow-up were age (18-21 years), education (primary level or less, secondary or vocational education), living outside Bangkok and vicinity, sexual orientation (bisexual, heterosexual), previous HIV testing, HIV infection, and behaviour in the past 4 months (recreational drug use, reporting group sex). An effect of loss to follow-up on factors of prevalent HIV infection was found by sexual orientation (transgender) and unprotected anal intercourse (receptive/insertive). These findings highlight the need to strengthen post-HIV test counselling. Directed counselling for HIV care should be given to young men who have sex with men and recreational drug users. |
Modeling undetected live poliovirus circulation after apparent interruption of transmission: implications for surveillance and vaccination
Kalkowska DA , Duintjer Tebbens RJ , Pallansch MA , Cochi SL , Wassilak SGF , Thompson KM . BMC Infect Dis 2015 15 66 Most poliovirus infections occur with no symptoms and this leads to the possibility of silent circulation, which complicates the confirmation of global goals to permanently end poliovirus transmission. Previous simple models based on hypothetical populations assumed perfect detection of symptomatic cases and suggested the need to observe no paralytic cases from wild polioviruses (WPVs) for approximately 3-4 years to achieve 95% confidence about eradication, but the complexities in real populations and the imperfect nature of surveillance require consideration. Methods: We revisit the probability of undetected poliovirus circulation using a more comprehensive model that reflects the conditions in a number of places with different characteristics related to WPV transmission, and we model the actual environmental WPV detection that occurred in Israel in 2013. We consider the analogous potential for undetected transmission of circulating vaccine-derived polioviruses. The model explicitly accounts for the impact of different vaccination activities before and after the last detected case of paralytic polio, different levels of surveillance, variability in transmissibility and neurovirulence among serotypes, and the possibility of asymptomatic participation in transmission by previously-vaccinated or infected individuals. Results: We find that prolonged circulation in the absence of cases and thus undetectable by case-based surveillance may occur if vaccination keeps population immunity close to but not over the threshold required for the interruption of transmission, as may occur in northwestern Nigeria for serotype 2 circulating vaccine-derived poliovirus in the event of insufficient tOPV use. Participation of IPV-vaccinated individuals in asymptomatic fecal-oral transmission may also contribute to extended transmission undetectable by case-based surveillance, as occurred in Israel. We also find that gaps or quality issues in surveillance could significantly reduce confidence about actual disruption. Maintaining high population immunity and high-quality surveillance for several years after the last detected polio cases will remain critical elements of the polio end game. Conclusions: Countries will need to maintain vigilance in their surveillance for polioviruses and recognize that their risks of undetected circulation may differ as a function of their efforts to manage population immunity and to identify cases or circulating live polioviruses. |
Opportunities for strengthening provider-initiated testing and counselling for HIV in Namibia
Davyduke T , Pietersen I , Lowrance D , Amwaama S , Taegtmeyer M . AIDS Care 2015 27 (8) 1-5 This short report identifies enablers and barriers to the uptake of provider-initiated testing and counselling for HIV (PITC) in Namibia and identifies key opportunities for strengthening this vital aspect of the national HIV response. We explored this through facility mapping, register reviews and qualitative methods including focus group discussions and in-depth interviews. Four health facilities (clinics and hospitals) in two regions were included in the study. We identified that PITC in Namibia was largely delivered by lay counsellors operating in designated rapid testing rooms located in health facilities and found a large number of missed opportunities for HIV testing through this model. Nurses did not see it as an integral part of their role, were not aware of HIV testing and counselling policy, felt inadequately trained and supported, and experienced staffing shortages. Institutional issues also acted as barriers to nurses performing or initiating discussions about PITC. Wider dissemination and implementation of policy, increasing privacy of consultation spaces and community sensitisation are simple measures that represent opportunities for strengthening this response and ensuring that symptomatic individuals who are unaware of their HIV status do not fall through the net. |
Oral human papillomavirus is common in individuals with Fanconi anemia
Sauter SL , Wells SI , Zhang X , Hoskins EE , Davies SM , Myers KC , Mueller R , Panicker G , Unger ER , Sivaprasad U , Brown DR , Mehta PA , Butsch Kovacic M . Cancer Epidemiol Biomarkers Prev 2015 24 (5) 864-72 BACKGROUND: Fanconi Anemia (FA) is a rare genetic disorder resulting in a loss of function of the FA-related DNA repair pathway. Individuals with FA are predisposed to some cancers including oropharyngeal and gynecological cancers with known associations with human papillomavirus (HPV) in the general population. Since individuals with FA respond poorly to chemotherapy and radiation, prevention of cancer is critical. METHODS: To determine if individuals with FA are particularly susceptible to oral HPV infection, we analyzed survey-based risk factor data and tested DNA isolated from oral rinses from 126 individuals with FA and 162 unaffected first-degree family members for 37 HPV types. RESULTS: Fourteen individuals (11.1%) with FA tested positive, significantly more (p=0.003) than family members (2.5%). While HPV prevalence was even higher for sexually active individuals with FA (17.7% vs. 2.4% in family; p=0.003). HPV positivity also tended to be higher in the sexually inactive (8.7% in FA vs. 2.9% in siblings). Indeed, having FA increased HPV positivity 4.9 fold (95%CI: 1.6-15.4) considering age and sexual experience, but did not differ by other potential risk factors. CONCLUSION: Our studies suggest that oral HPV is more common in individuals with FA. It will be essential to continue to explore associations between risk factors and immune dysfunction on HPV incidence and persistence over time. Impact HPV vaccination should be emphasized in those with FA as a first step to prevent oropharyngeal cancers, although additional studies are needed to determine if the level of protection it offers in this population is adequate. |
Effect of a culture-based screening algorithm on tuberculosis incidence in immigrants and refugees bound for the United States: a population-based cross-sectional study
Liu Y , Posey DL , Cetron MS , Painter JA . Ann Intern Med 2015 162 (6) 420-8 BACKGROUND: Before 2007, immigrants and refugees bound for the United States were screened for tuberculosis (TB) by a smear-based algorithm that could not diagnose smear-negative/culture-positive TB. In 2007, the Centers for Disease Control and Prevention implemented a culture-based algorithm. OBJECTIVE: To evaluate the effect of the culture-based algorithm on preventing the importation of TB to the United States by immigrants and refugees from foreign countries. DESIGN: Population-based, cross-sectional study. SETTING: Panel physician sites for overseas medical examination. PATIENTS: Immigrants and refugees with TB. MEASUREMENTS: Comparison of the increase of smear-negative/culture-positive TB cases diagnosed overseas among immigrants and refugees by the culture-based algorithm with the decline of reported cases among foreign-born persons within 1 year after arrival in the United States from 2007 to 2012. RESULTS: Of the 3 212 421 arrivals of immigrants and refugees from 2007 to 2012, a total of 1 650 961 (51.4%) were screened by the smear-based algorithm and 1 561 460 (48.6%) were screened by the culture-based algorithm. Among the 4032 TB cases diagnosed by the culture-based algorithm, 2195 (54.4%) were smear-negative/culture-positive. Before implementation (2002 to 2006), the annual number of reported cases among foreign-born persons within 1 year after arrival was relatively constant (range, 1424 to 1626 cases; mean, 1504 cases) but decreased from 1511 to 940 cases during implementation (2007 to 2012). During the same period, the annual number of smear-negative/culture-positive TB cases diagnosed overseas among immigrants and refugees bound for the United States by the culture-based algorithm increased from 4 to 629. LIMITATION: This analysis did not control for the decline in new arrivals of nonimmigrant visitors to the United States and the decrease of incidence of TB in their countries of origin. CONCLUSION: Implementation of the culture-based algorithm may have substantially reduced the incidence of TB among newly arrived, foreign-born persons in the United States. PRIMARY FUNDING SOURCE: None. |
Evolution of Ebola virus disease from exotic infection to global health priority, Liberia, mid-2014
Arwady MA , Bawo L , Hunter JC , Massaquoi M , Matanock A , Dahn B , Ayscue P , Nyenswah T , Forrester JD , Hensley LE , Monroe B , Schoepp RJ , Chen TH , Schaecher KE , George T , Rouse E , Schafer IJ , Pillai SK , De Cock KM . Emerg Infect Dis 2015 21 (4) 578-584 Over the span of a few weeks during July and August 2014, events in West Africa changed perceptions of Ebola virus disease (EVD) from an exotic tropical disease to a priority for global health security. We describe observations during that time of a field team from the Centers for Disease Control and Prevention and personnel of the Liberian Ministry of Health and Social Welfare. We outline the early epidemiology of EVD within Liberia, including the practical limitations on surveillance and the effect on the country's health care system, such as infections among health care workers. During this time, priorities included strengthening EVD surveillance; establishing safe settings for EVD patient care (and considering alternative isolation and care models when Ebola Treatment Units were overwhelmed); improving infection control practices; establishing an incident management system; and working with Liberian airport authorities to implement EVD screening of departing passengers. |
Increased risk for group B Streptococcus sepsis in young infants exposed to HIV, Soweto, South Africa, 2004-2008
Cutland CL , Schrag SJ , Thigpen MC , Velaphi SC , Wadula J , Adrian PV , Kuwanda L , Groome MJ , Buchmann E , Madhi SA . Emerg Infect Dis 2015 21 (4) 638-645 Although group B Streptococcus (GBS) is a leading cause of severe invasive disease in young infants worldwide, epidemiologic data and knowledge about risk factors for the disease are lacking from low- to middle-income countries. To determine the epidemiology of invasive GBS disease among young infants in a setting with high maternal HIV infection, we conducted hospital-based surveillance during 2004-2008 in Soweto, South Africa. Overall GBS incidence was 2.72 cases/1,000 live births (1.50 and 1.22, respectively, among infants with early-onset disease [EOD] and late-onset [LOD] disease). Risk for EOD and LOD was higher for HIV-exposed than HIV-unexposed infants. GBS serotypes Ia and III accounted for 84.0% of cases, and 16.9% of infected infants died. We estimate that use of trivalent GBS vaccine (serotypes Ia, Ib, and III) could prevent 2,105 invasive GBS cases and 278 deaths annually among infants in South Africa; therefore, vaccination of all pregnant women in this country should be explored. |
Antiviral treatment among older adults hospitalized with influenza, 2006-2012
Lindegren ML , Griffin MR , Williams JV , Edwards KM , Zhu Y , Mitchel E , Fry AM , Schaffner W , Talbot HK . PLoS One 2015 10 (3) e0121952 OBJECTIVE: To describe antiviral use among older, hospitalized adults during six influenza seasons (2006-2012) in Davidson County, Tennessee, USA. METHODS: Among adults ≥50 years old hospitalized with symptoms of respiratory illness or non-localizing fever, we collected information on provider-initiated influenza testing and nasal/throat swabs for influenza by RT-PCR in a research laboratory, and calculated the proportion treated with antivirals. RESULTS: We enrolled 1753 adults hospitalized with acute respiratory illness. Only 26% (457/1753) of enrolled patients had provider-initiated influenza testing. Thirty-eight patients had a positive clinical laboratory test, representing 2.2% of total patients and 8.3% of tested patients. Among the 38 subjects with clinical laboratory-confirmed influenza, 26.3% received antivirals compared to only 4.5% of those with negative clinical influenza tests and 0.7% of those not tested (p<0.001). There were 125 (7.1%) patients who tested positive for influenza in the research laboratory. Of those with research laboratory-confirmed influenza, 0.9%, 2.7%, and 2.8% received antivirals (p=.046) during pre-pandemic, pandemic, and post-pandemic influenza seasons, respectively. Both research laboratory-confirmed influenza (adjusted odds ratio [AOR] 3.04 95%CI 1.26-7.35) and clinical laboratory-confirmed influenza (AOR 3.05, 95%CI 1.07-8.71) were independently associated with antiviral treatment. Severity of disease, presence of a high-risk condition, and symptom duration were not associated with antiviral use. CONCLUSIONS: In urban Tennessee, antiviral use was low in patients recognized to have influenza by the provider as well as those unrecognized to have influenza. The use of antivirals remained low despite recommendations to treat all hospitalized patients with confirmed or suspected influenza. |
Deaths associated with respiratory syncytial and influenza viruses among persons ≥5 years of age in HIV-prevalent area, South Africa, 1998-2009
Tempia S , Walaza S , Viboud C , Cohen AL , Madhi SA , Venter M , von Mollendorf C , Moyes J , McAnerney JM , Cohen C . Emerg Infect Dis 2015 21 (4) 600-608 We estimated deaths attributable to influenza and respiratory syncytial virus (RSV) among persons >5 years of age in South Africa during 1998-2009 by applying regression models to monthly deaths and laboratory surveillance data. Rates were expressed per 100,000 person-years. The mean annual number of seasonal influenza-associated deaths was 9,093 (rate 21.6). Persons >65 years of age and HIV-positive persons accounted for 50% (n = 4,552) and 28% (n = 2,564) of overall seasonal influenza-associated deaths, respectively. In 2009, we estimated 4,113 (rate 9.2) influenza A(H1N1)pdm09-associated deaths. The mean of annual RSV-associated deaths during the study period was 511 (rate 1.2); no RSV-associated deaths were estimated in persons >45 years of age. Our findings support the recommendation for influenza vaccination of older persons and HIV-positive persons. Surveillance for RSV should be strengthened to clarify the public health implications and severity of illness associated with RSV infection in South Africa. |
Isolation of Cryptococcus gattii from Oregon soil and tree bark, 2010-2011
DeBess E , Lockhart SR , Iqbal N , Cieslak PR . BMC Microbiol 2014 14 (1) 323 BACKGROUND: In Oregon, human and animal infections by C. gattii were first identified in 2004. Cryptococcus gattii is considered to be an emerging non-zoonotic infection affecting animals and humans in Oregon. We report a longitudinal environmental isolation of C. gattii after an Oregon dog was diagnosed with the disease in 2009. RESULTS: Cryptococcus gattii was isolated twice from the same location with a span of one year between isolation dates. Cryptococcus gattii molecular types VGIIa and VGI were isolated in 2010 from soil and tree bark near the home of a 9-month-old dog which three months previously had an infection caused by C. gattii genotype VGIIa. The environment featured heavy growth of Douglas Fir trees. In 2011, a second set of soil and tree bark samples was collected in the same area and C. gattii VGIIa was again identified from the environment, along with genotypes VGIIb and VGIIc. CONCLUSIONS: The use of animal surveillance data to identify environmental niches of C. gattii should be considered to expand the understanding of this emerging pathogen. Understanding the ecology and how the environment and other factors might modify the existing niches is important for assessing risk and for designing measures to protect human and animal health. |
Increasing sample size in prospective birth cohorts: back-extrapolating prenatal levels of persistent organic pollutants in newly enrolled children
Verner MA , Gaspar FW , Chevrier J , Gunier RB , Sjodin A , Bradman A , Eskenazi B . Environ Sci Technol 2015 49 (6) 3940-8 Study sample size in prospective birth cohorts of prenatal exposure to persistent organic pollutants (POPs) is limited by costs and logistics of follow-up. Increasing sample size at the time of health assessment would be beneficial if predictive tools could reliably back-extrapolate prenatal levels in newly enrolled children. We evaluated the performance of three approaches to back-extrapolate prenatal levels of p,p'-dichlorodiphenyltrichloroethane (DDT), p,p'-dichlorodiphenyldichloroethylene (DDE) and four polybrominated diphenyl ether (PBDE) congeners from maternal and/or child levels 9 years after delivery: a pharmacokinetic model and predictive models using deletion/substitution/addition or Super Learner algorithms. Model performance was assessed using the root mean squared error (RMSE), R(2), and slope and intercept of the back-extrapolated versus measured levels. Super Learner outperformed the other approaches with RMSEs of 0.10 to 0.31, R(2)s of 0.58 to 0.97, slopes of 0.42 to 0.93 and intercepts of 0.08 to 0.60. Typically, models performed better for p,p'-DDT/E than PBDE congeners. The pharmacokinetic model performed well when back-extrapolating prenatal levels from maternal levels for compounds with longer half-lives like p,p'-DDE and BDE-153. Results demonstrate the ability to reliably back-extrapolate prenatal POP levels from levels 9 years after delivery, with Super Learner performing best based on our fit criteria. |
A statistical approach for rare-variant association testing in affected sibships.
Epstein MP , Duncan R , Ware EB , Jhun MA , Bielak LF , Zhao W , Smith JA , Peyser PA , Kardia SL , Satten GA . Am J Hum Genet 2015 96 (4) 543-54 Sequencing and exome-chip technologies have motivated development of novel statistical tests to identify rare genetic variation that influences complex diseases. Although many rare-variant association tests exist for case-control or cross-sectional studies, far fewer methods exist for testing association in families. This is unfortunate, because cosegregation of rare variation and disease status in families can amplify association signals for rare variants. Many researchers have begun sequencing (or genotyping via exome chips) familial samples that were either recently collected or previously collected for linkage studies. Because many linkage studies of complex diseases sampled affected sibships, we propose a strategy for association testing of rare variants for use in this study design. The logic behind our approach is that rare susceptibility variants should be found more often on regions shared identical by descent by affected sibling pairs than on regions not shared identical by descent. We propose both burden and variance-component tests of rare variation that are applicable to affected sibships of arbitrary size and that do not require genotype information from unaffected siblings or independent controls. Our approaches are robust to population stratification and produce analytic p values, thereby enabling our approach to scale easily to genome-wide studies of rare variation. We illustrate our methods by using simulated data and exome chip data from sibships ascertained for hypertension collected as part of the Genetic Epidemiology Network of Arteriopathy (GENOA) study. |
Characterization of large structural genetic mosaicism in human autosomes.
Machiela MJ , Zhou W , Sampson JN , Dean MC , Jacobs KB , Black A , Brinton LA , Chang IS , Chen C , Chen C , Chen K , Cook LS , Crous Bou M , De Vivo I , Doherty J , Friedenreich CM , Gaudet MM , Haiman CA , Hankinson SE , Hartge P , Henderson BE , Hong YC , Hosgood HD 3rd , Hsiung CA , Hu W , Hunter DJ , Jessop L , Kim HN , Kim YH , Kim YT , Klein R , Kraft P , Lan Q , Lin D , Liu J , Le Marchand L , Liang X , Lissowska J , Lu L , Magliocco AM , Matsuo K , Olson SH , Orlow I , Park JY , Pooler L , Prescott J , Rastogi R , Risch HA , Schumacher F , Seow A , Setiawan VW , Shen H , Sheng X , Shin MH , Shu XO , VanDen Berg D , Wang JC , Wentzensen N , Wong MP , Wu C , Wu T , Wu YL , Xia L , Yang HP , Yang PC , Zheng W , Zhou B , Abnet CC , Albanes D , Aldrich MC , Amos C , Amundadottir LT , Berndt SI , Blot WJ , Bock CH , Bracci PM , Burdett L , Buring JE , Butler MA , Carreon T , Chatterjee N , Chung CC , Cook MB , Cullen M , Davis FG , Ding T , Duell EJ , Epstein CG , Fan JH , Figueroa JD , Fraumeni JF Jr , Freedman ND , Fuchs CS , Gao YT , Gapstur SM , Patino-Garcia A , Garcia-Closas M , Gaziano JM , Giles GG , Gillanders EM , Giovannucci EL , Goldin L , Goldstein AM , Greene MH , Hallmans G , Harris CC , Henriksson R , Holly EA , Hoover RN , Hu N , Hutchinson A , Jenab M , Johansen C , Khaw KT , Koh WP , Kolonel LN , Kooperberg C , Krogh V , Kurtz RC , LaCroix A , Landgren A , Landi MT , Li D , Liao LM , Malats N , McGlynn KA , McNeill LH , McWilliams RR , Melin BS , Mirabello L , Peplonska B , Peters U , Petersen GM , Prokunina-Olsson L , Purdue M , Qiao YL , Rabe KG , Rajaraman P , Real FX , Riboli E , Rodriguez-Santiago B , Rothman N , Ruder AM , Savage SA , Schwartz AG , Schwartz KL , Sesso HD , Severi G , Silverman DT , Spitz MR , Stevens VL , Stolzenberg-Solomon R , Stram D , Tang ZZ , Taylor PR , Teras LR , Tobias GS , Viswanathan K , Wacholder S , Wang Z , Weinstein SJ , Wheeler W , White E , Wiencke JK , Wolpin BM , Wu X , Wunder JS , Yu K , Zanetti KA , Zeleniuch-Jacquotte A , Ziegler RG , de Andrade M , Barnes KC , Beaty TH , Bierut LJ , Desch KC , Doheny KF , Feenstra B , Ginsburg D , Heit JA , Kang JH , Laurie CA , Li JZ , Lowe WL , Marazita ML , Melbye M , Mirel DB , Murray JC , Nelson SC , Pasquale LR , Rice K , Wiggs JL , Wise A , Tucker M , Perez-Jurado LA , Laurie CC , Caporaso NE , Yeager M , Chanock SJ . Am J Hum Genet 2015 96 (3) 487-97 Analyses of genome-wide association study (GWAS) data have revealed that detectable genetic mosaicism involving large (>2 Mb) structural autosomal alterations occurs in a fraction of individuals. We present results for a set of 24,849 genotyped individuals (total GWAS set II [TGSII]) in whom 341 large autosomal abnormalities were observed in 168 (0.68%) individuals. Merging data from the new TGSII set with data from two prior reports (the Gene-Environment Association Studies and the total GWAS set I) generated a large dataset of 127,179 individuals; we then conducted a meta-analysis to investigate the patterns of detectable autosomal mosaicism (n = 1,315 events in 925 [0.73%] individuals). Restricting to events >2 Mb in size, we observed an increase in event frequency as event size decreased. The combined results underscore that the rate of detectable mosaicism increases with age (p value = 5.5 x 10(-31)) and is higher in men (p value = 0.002) but lower in participants of African ancestry (p value = 0.003). In a subset of 47 individuals from whom serial samples were collected up to 6 years apart, complex changes were noted over time and showed an overall increase in the proportion of mosaic cells as age increased. Our large combined sample allowed for a unique ability to characterize detectable genetic mosaicism involving large structural events and strengthens the emerging evidence of non-random erosion of the genome in the aging population. |
Complete Genome Sequence of Corynebacterium minutissimum, an Opportunistic Pathogen and the Causative Agent of Erythrasma.
Penton PK , Tyagi E , Humrighouse BW , McQuiston JR . Genome Announc 2015 3 (2) Corynebacterium minutissimum was first isolated in 1961 from infection sites of patients presenting with erythrasma, a common cutaneous infection characterized by a rash. Since its discovery, C. minutissimum has been identified as an opportunistic pathogen in immunosuppressed cancer and HIV patients. Here, we report the whole-genome sequence of C. minutissimum. |
Norovirus genotype profiles associated with foodborne transmission, 1999-2012.
Verhoef L , Hewitt J , Barclay L , Ahmed SM , Lake R , Hall AJ , Lopman B , Kroneman A , Vennema H , Vinje J , Koopmans M . Emerg Infect Dis 2015 21 (4) 592-599 Worldwide, noroviruses are a leading cause of gastroenteritis. They can be transmitted from person to person directly or indirectly through contaminated food, water, or environments. To estimate the proportion of foodborne infections caused by noroviruses on a global scale, we used norovirus transmission and genotyping information from multiple international outbreak surveillance systems (Noronet, CaliciNet, EpiSurv) and from a systematic review of peer-reviewed literature. The proportion of outbreaks caused by food was determined by genotype and/or genogroup. Analysis resulted in the following final global profiles: foodborne transmission is attributed to 10% (range 9%%-11%) of all genotype GII.4 outbreaks, 27% (25%-30%) of outbreaks caused by all other single genotypes, and 37% (24%%-52%) of outbreaks caused by mixtures of GII.4 and other noroviruses. When these profiles are applied to global outbreak surveillance data, results indicate that approximately 14% of all norovirus outbreaks are attributed to food. |
Mycoplasma pneumoniae outbreak in a long-term care facility - Nebraska, 2014
Hastings DL , Harrington KJ , Kutty PK , Rayman RJ , Spindola D , Diaz MH , Thurman KA , Winchell JM , Safranek TJ . MMWR Morb Mortal Wkly Rep 2015 64 (11) 296-299 On June 20, 2014, a Nebraska long-term care facility notified the East Central District Health Department (ECDHD) and Nebraska Department of Health and Human Services (NDHHS) of an outbreak of respiratory illness characterized by cough and fever in 22 residents and resulting in four deaths during the preceding 2 weeks. To determine the etiologic agent, identify additional cases, and implement control measures, Nebraska and CDC investigators evaluated the facility's infection prevention measures and collected nasopharyngeal (NP) and oropharyngeal (OP) swabs or autopsy specimens from patients for real-time polymerase chain reaction (PCR) testing at CDC. The facility was closed to new admissions until 1 month after the last case, droplet precautions were implemented, ill residents were isolated, and group activities were canceled. During the outbreak, a total of 55 persons experienced illnesses that met the case definition; 12 were hospitalized, and seven died. PCR detected Mycoplasma pneumoniae DNA in 40% of specimens. M. pneumoniae should be considered a possible cause of respiratory illness outbreaks in long-term care facilities. Morbidity and mortality from respiratory disease outbreaks at long-term care facilities might be minimized if facilities monitor for respiratory disease clusters, report outbreaks promptly, prioritize diagnostic testing in outbreak situations, and implement timely and strict infection control measures to halt transmission. |
Nosocomial hepatitis C virus transmission from tampering with injectable anesthetic opioids
Hatia RI , Dimitrova Z , Skums P , Teo EY , Teo CG . Hepatology 2015 62 (1) 101-10 The extent of provider-to-patient hepatitis C virus (HCV) transmission from diversion, self-injection and substitution ("tampering") of anesthetic opioids is unknown. To quantify the contribution of opioid tampering to nosocomial hepatitis C outbreaks, data from healthcare-related hepatitis C outbreaks occurring in developed countries from 1990-2012 were collated, grouped and compared. Tampering was associated with 17% (8/46) of outbreaks but 53% (438/833) of cases. Of the tampering outbreaks, 6 (75%) involved fentanyl, 5 (63%) occurred in the United States, and one each in Australia, Israel and Spain. Case counts ranged from 5-275 in the tampering outbreaks (mean, 54.8; median, 25), and 1-99 in the non-tampering outbreaks (mean, 10.4; median, 5); between them, the difference in mean ranks of counts was significant (p<0.01). To estimate HCV transmission risks from tampering, risk-assessment models were constructed, and these risks compared with those from surgery. The HCV transmission risk from exposure to an opioid preparation tampered by a provider of unknown HCV-infection status who is a person who injects drugs (PWID) (0.62%; standard error [e]=0.38%) exceeds 16,757 times the risk from surgery by a surgeon of unknown HCV-infection status (0.000037%; e=0.000029%), and 135 times by an HCV-infected surgeon (0.0046%; e=0.0033%). To pose a 50% patient transmission risk, an infected surgeon may take 30 years, compared to <1 year for a PWID-tamperer, and weeks or days for a PWID-tamperer who intensifies access to opioids. CONCLUSION: Disproportionately many cases of HCV infection from nosocomial outbreaks were attributable to provider tampering of anesthetic opioids. The transmission risk from tampering is substantially higher than from surgery. |
Safety and immunogenicity of a live attenuated tetravalent dengue vaccine candidate in Flavivirus-naive adults: a randomized, double-blind Phase I clinical trial
George SL , Wong MA , Dube TJ , Boroughs KL , Stovall JL , Luy BE , Haller AA , Osorio JE , Eggemeyer LM , Irby-Moore S , Frey SE , Huang CY , Stinchcomb DT . J Infect Dis 2015 212 (7) 1032-41 BACKGROUND: Dengue viruses (DENV) infect over 300 million people annually causing 96 million cases of dengue disease and 22,000 deaths. A safe vaccine which protects against DENV disease is a global health priority. METHODS: We enrolled 72 flavivirus-naive healthy adults in a Phase I double-blind randomized placebo-controlled dose escalation trial (low and high dose) of a live attenuated recombinant tetravalent dengue vaccine candidate (TDV) given in two doses 90 days apart. Volunteers were followed for safety, vaccine component viremia, and development of neutralizing antibodies to the four DENV. RESULTS: The majority of adverse events were mild, with no vaccine-related serious adverse events (SAE). Vaccinees reported injection site pain (52% vs. 17%) or erythema (73% vs. 25%) more frequently than placebo recipients. Low levels of TDV-2, -3, and -4 viremia were observed after the first but not second administration. Overall seroconversion rates and geometric mean neutralization titers after two doses were: DENV-1 (84.2%, 54.1), DENV-2 (92.1%, 292.8), DENV-3 (86.8%, 32.3), and DENV-4 (71.1%, 15.0) and>90.0% of high dose recipients had trivalent or broader responses. CONCLUSIONS: TDV was generally well-tolerated, induced trivalent or broader neutralizing antibodies to DENV in most flavivirus-naive vaccinees, and is undergoing further development. |
Updated recommendations for the use of typhoid vaccine - Advisory Committee on Immunization Practices, United States, 2015
Jackson BR , Iqbal S , Mahon B . MMWR Morb Mortal Wkly Rep 2015 64 (11) 305-308 These revised recommendations of the Advisory Committee on Immunization Practices update recommendations published in MMWR in 1994 and include updated information on the two currently available vaccines and on vaccine safety. They also include an update on the epidemiology of enteric fever in the United States, focusing on increasing drug resistance in Salmonella enterica serotype Typhi, the cause of typhoid fever, as well as the emergence of Salmonella serotype Paratyphi A, a cause of paratyphoid fever, against which typhoid vaccines offer little or no protection. |
Use of 9-valent human papillomavirus (HPV) vaccine: updated HPV vaccination recommendations of the Advisory Committee on Immunization Practices
Petrosky E , Bocchini JA Jr , Hariri S , Chesson H , Curtis CR , Saraiya M , Unger ER , Markowitz LE . MMWR Morb Mortal Wkly Rep 2015 64 (11) 300-304 During its February 2015 meeting, the Advisory Committee on Immunization Practices (ACIP) recommended 9-valent human papillomavirus (HPV) vaccine (9vHPV) (Gardasil 9, Merck and Co., Inc.) as one of three HPV vaccines that can be used for routine vaccination. HPV vaccine is recommended for routine vaccination at age 11 or 12 years. ACIP also recommends vaccination for females aged 13 through 26 years and males aged 13 through 21 years not vaccinated previously. Vaccination is also recommended through age 26 years for men who have sex with men and for immunocompromised persons (including those with HIV infection) if not vaccinated previously. 9vHPV is a noninfectious, virus-like particle (VLP) vaccine. Similar to quadrivalent HPV vaccine (4vHPV), 9vHPV contains HPV 6, 11, 16, and 18 VLPs. In addition, 9vHPV contains HPV 31, 33, 45, 52, and 58 VLPs. 9vHPV was approved by the Food and Drug Administration (FDA) on December 10, 2014, for use in females aged 9 through 26 years and males aged 9 through 15 years. For these recommendations, ACIP reviewed additional data on 9vHPV in males aged 16 through 26 years. 9vHPV and 4vHPV are licensed for use in females and males. Bivalent HPV vaccine (2vHPV), which contains HPV 16, 18 VLPs, is licensed for use in females. This report summarizes evidence considered by ACIP in recommending 9vHPV as one of three HPV vaccines that can be used for vaccination and provides recommendations for vaccine use. |
Herpes zoster vaccine effectiveness and manifestations of herpes zoster and associated pain by vaccination status
Marin M , Yawn BP , Hales CM , Wollan PC , Bialek SR , Zhang J , Kurland MJ , Harpaz R . Hum Vaccin Immunother 2015 11 (5) 1157-64 Options for managing herpes zoster (HZ)-related pain and complications have limited effectiveness, making HZ prevention through vaccination an important strategy. Limited data are available on HZ vaccine effectiveness against confirmed HZ and manifestations of HZ among vaccinated persons. We conducted a matched case-control study to assess HZ vaccine effectiveness for prevention of HZ and other HZ-related outcomes and a cohort study of persons with HZ to compare HZ-related outcomes by vaccination status. Cases were identified through active surveillance among persons age ≥60 years with HZ onset and health-care encounters during 2010-2011 in Southeastern Minnesota. Controls were age- and sex-matched to cases. Data were collected by medical record review and from participants via interviews and daily pain diaries. 266 HZ case-patients and 362 matched controls were enrolled in the vaccine effectiveness studies and 303 case-patients in the cohort study of HZ characteristics by vaccination status. Vaccination was associated with 54% (95% CI:32%-69%) reduction in HZ incidence, 58% (95% CI:31%-75%) reduction in HZ prodromal symptoms, and 70% (95% CI:33%-87%) reduction in medically-attended prodrome. HZ vaccine was statistically significant effective at preventing postherpetic neuralgia (PHN) measured at 30 days after rash onset, 61% (95% CI: 22%-80%). Among persons who developed HZ, no differences were found by vaccination status in severity or duration of HZ pain after rash onset. In this population-based study, HZ vaccination was associated with >50% reduction in HZ, HZ prodrome, and medically-attended prodrome. |
Human papillomavirus vaccination of females in a large health claims database in the United States, 2006-2012
Dunne EF , Stokley S , Chen W , Zhou F . J Adolesc Health 2015 56 (4) 408-13 PURPOSE: Information on vaccine utilization from a variety of sources is useful to give a status of the vaccine program and define opportunities to improve uptake. We evaluated MarketScan Commercial Claims and Encounters database on human papillomavirus (HPV) vaccine initiation and completion of all three doses among girls/women from 2006 to 2012. METHODS: Data were obtained from the 2006-2012 MarketScan Commercial Claims and Encounters database. The study population included female enrollees aged 11-26 years who were continuously enrolled in the same private insurance plan from 2006 to 2012 (n = 407,371). We evaluated overall and yearly vaccine initiation and completion, demographic characteristics associated with vaccine initiation, clinical visits in which vaccine was given, and missed opportunities for vaccination. RESULTS: By the end of 2012, 36.9% of females aged 11-26 years had received at least one HPV vaccine dose. Vaccination coverage was highest among females aged 17-18 years (49.3%) and aged 15-16 years (43.1%) and lowest among females aged 11-12 years (16.8%). Between 2007 and 2012, 96.1% of the 246,192 unvaccinated females had at least one missed opportunity (a heath care visit without HPV vaccine administered). CONCLUSIONS: Over a 6 year period, HPV vaccine initiation was lowest in the girls aged 11-12 years. Importantly, most (96.1%) unvaccinated females had at least one missed vaccination opportunity, and providers and health systems should focus efforts on using existing visits for vaccination. |
Persistent low carriage of serogroup A Neisseria meningitidis two years after mass vaccination with the meningococcal conjugate vaccine, MenAfriVac
Kristiansen PA , Ba A , Ouedraogo AS , Sanou I , Ouedraogo R , Sangare L , Diomande F , Kandolo D , Saga I , Misegades L , Clark TA , Preziosi MP , Caugant DA . BMC Infect Dis 2014 14 (1) 663 BACKGROUND: The conjugate vaccine against serogroup A Neisseria meningitidis (NmA), MenAfriVac, is currently being introduced throughout the African meningitis belt. In repeated multicentre cross-sectional studies in Burkina Faso we demonstrated a significant effect of vaccination on NmA carriage for one year following mass vaccination in 2010. A new multicentre carriage study was performed in October-November 2012, two years after MenAfriVac mass vaccination. METHODS: Oropharyngeal samples were collected and analysed for presence of N. meningitidis (Nm) from a representative selection of 1-29-year-olds in three districts in Burkina Faso using the same procedures as in previous years. Characterization of Nm isolates included serogrouping, multilocus sequence typing, and porA and fetA sequencing. A small sample of invasive isolates collected during the epidemic season of 2012 through the national surveillance system were also analysed. RESULTS: From a total of 4964 oropharyngeal samples, overall meningococcal carriage prevalence was 7.86%. NmA prevalence was 0.02% (1 carrier), significantly lower (OR, 0.05, 95% CI, P inverted question mark= inverted question mark0.005, 0.006-0.403) than pre-vaccination prevalence (0.39%). The single NmA isolate was sequence type (ST)-7, P1.20,9;F3-1, a clone last identified in Burkina Faso in 2003. Nm serogroup W (NmW) dominated with a carriage prevalence of 6.85%, representing 87.2% of the isolates. Of 161 NmW isolates characterized by molecular techniques, 94% belonged to the ST-11 clonal complex and 6% to the ST-175 complex. Nm serogroup X (NmX) was carried by 0.60% of the participants and ST-181 accounted for 97% of the NmX isolates. Carriage prevalence of serogroup Y and non-groupable Nm was 0.20% and 0.18%, respectively. Among the 20 isolates recovered from meningitis cases, NmW dominated (70%), followed by NmX (25%). ST-2859, the only ST with a serogroup A capsule found in Burkina Faso since 2004, was not found with another capsule, neither among carriage nor invasive isolates. CONCLUSIONS: The significant reduction of NmA carriage still persisted two years following MenAfriVac vaccination, and no cases of NmA meningitis were recorded. High carriage prevalence of NmW ST-11 was consistent with the many cases of NmW meningitis in the epidemic season of 2012 and the high proportion of NmW ST-11 among the characterized invasive isolates. |
Immunization information systems
Pabst LJ , Williams W . J Public Health Manag Pract 2015 21 (3) 225-6 The use of electronic health information to support clinical and public health services has increased in recent years. One of the leaders in advancing this field is immunization information systems (IISs). Immunization information systems are confidential, population-based, computerized databases that record all immunization doses administered by participating providers to persons residing within a given geopolitical area. They began to be established in the 1970s mostly as local or regional systems that were intended primarily to consolidate childhood vaccination histories to support immunization delivery at the point of pediatric clinical care. In recent years, IISs have evolved to utilize emerging interfacing technology and industry standards to facilitate the exchange of information among a more diverse set of clinical and public health immunization partners within and outside their respective jurisdictions. They have developed a multitude of functions and features that have made them essential components of immunization service delivery and management to clinicians, public health, and other stakeholders such as schools and health plans for individuals of all ages. With the growing exchange of electronic health information and the increased demand on IIS data and services, IISs face new opportunities and challenges to ensure the complete, accurate, and timely capture and availability of immunization information. |
Evaluation of a u.s. Public health laboratory service for the molecular detection of drug resistant tuberculosis.
Yakrus MA , Metchock B , Starks AM . Tuberc Res Treat 2015 2015 701786 Crucial to interrupting the spread of tuberculosis (TB) is prompt implementation of effective treatment regimens. We evaluated satisfaction, comfort with interpretation, and use of molecular results from a public health service provided by the Centers for Disease Control and Prevention (CDC) for the molecular detection of drug resistant Mycobacterium tuberculosis complex (MTBC). An electronic survey instrument was used to collect information anonymously from U.S. Public Health Laboratories (PHL) that submitted at least one isolate of MTBC to CDC from September 2009 through February 2011. Over 97% of those responding expressed satisfaction with the turnaround time for receiving results. Twenty-six PHL (74%) reported molecular results to healthcare providers in less than two business days. When comparing the molecular results from CDC with their own phenotypic drug susceptibility testing, 50% of PHL observed discordance. No respondents found the molecular results difficult to interpret and 82% were comfortably discussing them with TB program officials and healthcare providers. Survey results indicate PHL were satisfied with CDC's ability to rapidly provide interpretable molecular results for isolates of MTBC submitted for determination of drug resistance. To develop educational materials and strategies for service improvement, reasons for discordant results and areas of confusion need to be identified. |
An evaluation of the level of agreement in Bordetella species identification in three United States laboratories during a period of increased pertussis.
Burgos-Rivera B , Lee AD , Bowden KE , Faulkner AE , Seaton BL , Lembke BD , Cartwright CP , Martin SW , Tondella ML . J Clin Microbiol 2015 53 (6) 1842-7 While PCR is the most common method used for detecting Bordetella pertussis in the US, most laboratories use insertion sequence 481 (IS481), which is not specific for B. pertussis; therefore, the relative contribution of other Bordetella species is not understood. The objectives of this study were to evaluate the proportion of other Bordetella spp. misidentified as B. pertussis during a period of increased pertussis incidence, determine the level of agreement in Bordetella species detection between US commercial laboratories and CDC, and assess the relative diagnostic sensitivity of CDC's PCR assay when using a different PCR master mix. Specimens collected between May 2012-2013 were tested at two US commercial laboratories for B. pertussis and B. parapertussis detection. Every fifth specimen positive for IS481 and/or IS1001 with Ct values ≤35 was sent to CDC for PCR testing that identifies Bordetella species. Specimens with CDC PCR indeterminate or negative results were tested using an alternate PCR master mix. Of 755 specimens, there was agreement in species identification for 83.4% (n=630). Of those with different identifications (n=125), 79.2% (n=99) were identified as indeterminate B. pertussis at CDC. Overall, 0.66% (n=5) of the specimens were identified as B. holmesii or B. bronchiseptica at CDC. Of 115 specimens with indeterminate or negative results, 46.1% (n=53) were B. pertussis positive when tested by an alternate master mix, suggesting possible increase in assay sensitivity. This study demonstrates good agreement between the two US commercial laboratories and CDC and little misidentification of Bordetella species during the 2012 US epidemic. |
A virus-like particle system identifies the endonuclease domain of Crimean-Congo hemorrhagic fever virus.
Devignot S , Bergeron E , Nichol S , Mirazimi A , Weber F . J Virol 2015 89 (11) 5957-67 Crimean-Congo Hemorrhagic Fever virus (CCHFV; genus Nairovirus) is an extremely pathogenic member of the Bunyaviridae family. Since handling of the virus requires a BSL-4 facility, little is known about pathomechanisms and host interactions. Here, we describe the establishment of a transcriptionally competent (tc)-VLP system for CCHFV. Recombinant polymerase (L), nucleocapsid protein (N) and a reporter minigenome expressed in human HuH-7 cells resulted in formation of transcriptionally active nucleocapsids that could be packaged by co-expressed CCHFV glycoproteins into tc-VLPs. The tc-VLPs resembled authentic virus particles in their protein composition and neutralization sensitivity to anti-CCHFV antibodies, and could recapitulate all steps of the viral replication cycle. Particle attachment, entry and primary transcription were modelled by infection of naive cells. The subsequent steps of genome replication, secondary transcription, and particle assembly and release can be obtained upon passaging the tc-VLPs on cells expressing CCHFV structural proteins. The utility of the VLP system was demonstrated by showing that the endonuclease domain of L is located around amino acid D693, as it was predicted in silico by Morin et al. (PLoS Pathogens 6: e1001038). The tc-VLP system will greatly facilitate studies and diagnostics of CCHFV under non-BSL-4 conditions. IMPORTANCE: Crimean-Congo Hemorrhagic Fever virus (CCHFV) is an extremely virulent pathogen of humans. Since the virus can only be handled at the highest biosafety level, research is restricted to a few specialized laboratories. We developed a plasmid-based system to produce virus-like particles with the ability to infect cells and transcribe a reporter genome. Due to the absence of viral genes, the virus-like particles are unable to spread or cause disease, thus allowing to study aspects of CCHFV biology under relaxed biosafety conditions. |
Quantification of tetrabromo benzoic acid and tetrabromo phthalic acid in rats exposed to the flame retardant Uniplex FPR-45
Silva MJ , Hilton D , Furr J , Gray LE , Preau JL , Calafat AM , Ye X . Arch Toxicol 2015 90 (3) 551-7 The first withdrawal of certain polybrominated diphenyl ethers flame retardants from the US market occurred in 2004. Since then, use of brominated non-PBDE compounds such as bis(2-ethylhexyl)-2,3,4,5-tetrabromophthalate (BEH-TEBP) and 2-ethylhexyl-2,3,4,5-tetrabromobenzoate (EH-TBB) in commercial formulations has increased. Assessing human exposure to these chemicals requires identifying metabolites that can potentially serve as their biomarkers of exposure. We administered by gavage a dose of 500 mg/Kg bw of Uniplex FRP-45 (>95 % BEH-TEBP) to nine adult female Sprague-Dawley rats. Using authentic standards and mass spectrometry, we positively identified and quantified 2,3,4,5-tetrabromo benzoic acid (TBBA) and 2,3,4,5-tetrabromo phthalic acid (TBPA) in 24-h urine samples collected 1 day after dosing the rats and in serum at necropsy, 2 days post-exposure. Interestingly, TBBA and TBPA concentrations correlated well (R 2 = 0.92). The levels of TBBA, a known metabolite of EH-TBB, were much higher than the levels of TBPA both in urine and serum. Because Uniplex FRP-45 was technical grade and EH-TBB was present in the formulation, TBBA likely resulted from the metabolism of EH-TBB. Taken together, our data suggest that TBBA and TBPA may serve as biomarkers of exposure to non-PBDE brominated flame retardant mixtures. Additional research can provide useful information to better understand the composition and in vivo toxicokinetics of these commercial mixtures. |
Effects of nitrogen-doped multi-walled carbon nanotubes compared to pristine multi-walled carbon nanotubes on human small airway epithelial cells
Mihalchik AL , Ding W , Porter DW , McLoughlin C , Schwegler-Berry D , Sisler JD , Stefaniak AB , Snyder-Talkington BN , Cruz-Silva R , Terrones M , Tsuruoka S , Endo M , Castranova V , Qian Y . Toxicology 2015 333 25-36 Nitrogen-doped multi-walled carbon nanotubes (ND-MWCNTs) are modified multi-walled carbon nanotubes (MWCNTs) with enhanced electrical properties that are used in a variety of applications, including fuel cells and sensors; however, the mode of toxic action of ND-MWCNT has yet to be fully elucidated. In the present study, we compared the interaction of ND-MWCNT or pristine MWCNT-7 with human small airway epithelial cells (SAEC) and evaluated their subsequent bioactive effects. Transmission electron microscopy, X-ray photoelectron spectroscopy, Raman spectroscopy, and X-ray diffraction suggested the presence of N-containing defects in the lattice of the nanotube. The ND-MWCNTs were determined to be 93.3% carbon, 3.8% oxygen, and 2.9% nitrogen. A dose-response cell proliferation assay showed that low doses of ND-MWCNT (1.2mug/ml) or MWCNT-7 (0.12mug/ml) increased cellular proliferation, while the highest dose of 120mug/ml of either material decreased proliferation. ND-MWCNT and MWCNT-7 appeared to interact with SAEC at 6h and were internalized by 24h. ROS were elevated at 6 and 24h in ND-MWCNT exposed cells, but only at 6h in MWCNT-7 exposed cells. Significant alterations to the cell cycle were observed in SAEC exposed to either 1.2mug/ml of ND-MWCNT or MWCNT-7 in a time and material-dependent manner, possibly suggesting potential damage or alterations to cell cycle machinery. Our results indicate that ND-MWCNT induce effects in SAEC over a time and dose-related manner which differ from MWCNT-7. Therefore, the physicochemical characteristics of the materials appear to alter their biological effects. |
Effects of ultraviolet germicidal irradiation (UVGI) on N95 respirator filtration performance and structural integrity
Lindsley WG , Martin SB Jr , Thewlis RE , Sarkisian K , Nwoko JO , Mead KR , Noti JD . J Occup Environ Hyg 2015 12 (8) 509-17 The ability to disinfect and reuse disposable N95 filtering facepiece respirators (FFRs) may be needed during a pandemic of an infectious respiratory disease such as influenza. Ultraviolet germicidal irradiation (UVGI) is one possible method for respirator disinfection. However, UV radiation degrades polymers, which presents the possibility that UVGI exposure could degrade the ability of a disposable respirator to protect the worker. To study this, we exposed both sides of material coupons and respirator straps from four models of N95 FFRs to UVGI doses from 120 to 950 J/cm2. We then tested the particle penetration, flow resistance and the bursting strengths of the individual respirator coupon layers, and the breaking strength of the respirator straps. We found that UVGI exposure led to a small increase in particle penetration (up to 1.25%) and had little effect on the flow resistance. UVGI exposure had a more pronounced effect on the strengths of the respirator materials. At the higher UVGI doses, the strength of the layers of respirator material was substantially reduced (in some cases, by >90%). The changes in the strengths of the respirator materials varied considerably among the different models of respirators. UVGI had less of an effect on the respirator straps; a dose of 2360 J/cm2 reduced the breaking strength of the straps by 20% to 51%. Our results suggest that UVGI could be used to effectively disinfect disposable respirators for reuse, but the maximum number of disinfection cycles will be limited by the respirator model and the UVGI dose required to inactivate the pathogen. |
Evaluation of fibrogenic potential of industrial multi-walled carbon nanotubes in acute aspiration experiment
Khaliullin TO , Shvedova AA , Kisin ER , Zalyalov RR , Fatkhutdinova LM . Bull Exp Biol Med 2015 158 (5) 684-7 Local inflammatory response in the lungs and fibrogenic potential of multi-walled carbon nanotubes were studied in an acute aspiration experiment in mice. The doses were chosen based on the concentration of nanotubes in the air at a workplace of the company-producer. ELISA, flow cytometry, enhanced darkfield microscopy, and histological examination showed that multi-walled carbon nanotubes induced local inflammation, oxidative stress, and connective tissue growth (fibrosis). Serum levels of TGF-beta1 and osteopontin proteins can serve as potential exposure biomarkers. |
Field evaluation of personal sampling methods for multiple bioaerosols
Wang CH , Chen BT , Han BC , Liu AC , Hung PC , Chen CY , Chao HJ . PLoS One 2015 10 (3) e0120308 Ambient bioaerosols are ubiquitous in the daily environment and can affect health in various ways. However, few studies have been conducted to comprehensively evaluate personal bioaerosol exposure in occupational and indoor environments because of the complex composition of bioaerosols and the lack of standardized sampling/analysis methods. We conducted a study to determine the most efficient collection/analysis method for the personal exposure assessment of multiple bioaerosols. The sampling efficiencies of three filters and four samplers were compared. According to our results, polycarbonate (PC) filters had the highest relative efficiency, particularly for bacteria. Side-by-side sampling was conducted to evaluate the three filter samplers (with PC filters) and the NIOSH Personal Bioaerosol Cyclone Sampler. According to the results, the Button Aerosol Sampler and the IOM Inhalable Dust Sampler had the highest relative efficiencies for fungi and bacteria, followed by the NIOSH sampler. Personal sampling was performed in a pig farm to assess occupational bioaerosol exposure and to evaluate the sampling/analysis methods. The Button and IOM samplers yielded a similar performance for personal bioaerosol sampling at the pig farm. However, the Button sampler is more likely to be clogged at high airborne dust concentrations because of its higher flow rate (4 L/min). Therefore, the IOM sampler is a more appropriate choice for performing personal sampling in environments with high dust levels. In summary, the Button and IOM samplers with PC filters are efficient sampling/analysis methods for the personal exposure assessment of multiple bioaerosols. |
The influence of diet on the use of near-infrared spectroscopy to determine the age of female Aedes aegypti mosquitoes
Liebman K , Swamidoss I , Vizcaino L , Lenhart A , Dowell F , Wirtz R . Am J Trop Med Hyg 2015 92 (5) 1070-5 Interventions targeting adult mosquitoes are used to combat transmission of vector-borne diseases, including dengue. Without available vaccines, targeting the primary vector, Aedes aegypti, is essential to prevent transmission. Older mosquitoes (≥ 7 days) are of greatest epidemiological significance due to the 7-day extrinsic incubation period of the virus. Age-grading of female mosquitoes is necessary to identify post-intervention changes in mosquito population age structure. We developed models using near-infrared spectroscopy (NIRS) to age-grade adult female Ae. aegypti. To determine if diet affects the ability of NIRS models to predict age, two identical larval groups were fed either fish food or infant cereal. Adult females were separated and fed sugar water +/- blood, resulting in four experimental groups. Females were killed 1, 4, 7, 10, 13, or 16 days postemergence. The head/thorax of each mosquito was scanned using a near-infrared spectrometer. Scans from each group were analyzed, and multiple models were developed using partial least squares regression. The best model included all experimental groups, and positively predicted the age group (< or ≥ 7 days) of 90.2% mosquitoes. These results suggest both larval and adult diets can affect the ability of NIRS models to accurately assign age categories to female Ae. aegypti. |
Chlorine isotopic composition of perchlorate in human urine as a means of distinguishing among exposure sources
Poghosyan A , Morel-Espinosa M , Valentin-Blasini L , Blount BC , Ferreccio C , Steinmaus CM , Sturchio NC . J Expo Sci Environ Epidemiol 2015 26 (3) 324-8 Perchlorate (ClO4-) is a ubiquitous environmental contaminant with high human exposure potential. Natural perchlorate forms in the atmosphere from where it deposits onto the surface of Earth, whereas synthetic perchlorate is manufactured as an oxidant for industrial, aerospace, and military applications. Perchlorate exposure can potentially cause adverse health effects in humans by interfering with the production of thyroid hormones through competitively blocking iodide uptake. To control and reduce perchlorate exposure, the contributions of different sources of perchlorate exposure need to be quantified. Thus, we demonstrate a novel approach for determining the contribution of different perchlorate exposure sources by quantifying stable and radioactive chlorine isotopes of perchlorate extracted from composite urine samples from two distinct populations: one in Atlanta, USA and one in Taltal, Chile (Atacama region). Urinary perchlorate from the Atlanta region resembles indigenous natural perchlorate from the western USA (delta37Cl=+4.1+/-1.0 per thousand; 36Cl/Cl=1 811 (+/-136) x 10-15), and urinary perchlorate from the Taltal, Chile region is similar to natural perchlorate in nitrate salt deposits from the Atacama Desert of northern Chile (delta37Cl=-11.0+/-1.0 per thousand; 36Cl/Cl=254 (+/-40) x 10-15). Neither urinary perchlorate resembled the isotopic pattern found in synthetic perchlorate. These results indicate that natural perchlorate of regional provenance is the dominant exposure source for the two sample populations, and that chlorine isotope ratios provide a robust tool for elucidating perchlorate exposure pathways. |
TV viewing, perceived similarity, coviewing, and mental well-being among African American, Latino, and White children
McDade-Montez E , Wallander J , Elliott M , Grunbaum JA , Tortolero S , Cuccaro P , Schuster MA . J Early Adolesc 2015 35 (3) 329-352 Research among adults has demonstrated concurrent and prospective negative associations between TV viewing and mental health, yet little research has examined these associations among African American and Latino youth or examined the role of children's involvement with TV and parental mediation of TV viewing via coviewing. The purpose of the present study is to examine associations between TV viewing, perceived similarity, and coviewing and mental well-being in African American, Latino, and White children. Results from Healthy Passages a study of 4,824 African American (30%), Latino (47%), and White (23%) fifth graders, indicated that TV viewing and perceived similarity were negatively associated with mental well-being among most groups of children, and coviewing was positively associated with mental well-being among Latinos. This study extends findings from adult research on media exposure and mental well-being into a diverse sample of fifth graders and illuminates the role of perceived similarity and coviewing. |
Factors associated with pressure ulcers in individuals with spina bifida
Kim S , Ward E , Dicianno BE , Clayton GH , Sawin KJ , Beierwaltes P , Thibadeau J . Arch Phys Med Rehabil 2015 96 (8) 1435-1441 e1 OBJECTIVE: To describe factors associated with pressure ulcers in individuals with spina bifida (SB) enrolled in the National Spina Bifida Patient Registry (NSBPR). DESIGN: unbalanced longitudinal, multicenter cohort study. SETTING: Nineteen SB clinics throughout the U.S. INTERVENTIONS: Not applicable PARTICIPANTS: Individuals with SB (N=3153) enrolled in 19 clinic sites that participate in the NSBPR. MAIN OUTCOME MEASURE: Pressure ulcer status (yes/no) at annual visit between 2009 and 2012. RESULTS: Of 3153 total participants, 19% reported ulcers at their most recent annual clinic visit. Seven factors, i.e., level of lesion, wheelchair use, urinary incontinence, shunt presence, above the knee orthopedic surgery, recent surgery, and male gender were significantly associated with the presence of pressure ulcers. Of these factors, the final logistic regression model included level of lesion, urinary incontinence, recent surgery, and male gender. The three adjusting variables SB type, SB clinic, and age group were significant in all analyses (all p<.001). CONCLUSION: Adjusting for SB type, SB clinic, and age group, we found seven factors, level of lesion, wheelchair use, urinary incontinence, shunt presence, above the knee orthopedic surgery, recent surgery, and male gender were associated with pressure ulcers. Identifying key factors associated with onset of pressure ulcers can be incorporated into clinical practice in ways to prevent and enhance treatment for pressure ulcers in the SB population. |
Gestational urinary bisphenol A and maternal and newborn thyroid hormone concentrations: the HOME Study
Romano ME , Webster GM , Vuong AM , Thomas Zoeller R , Chen A , Hoofnagle AN , Calafat AM , Karagas MR , Yolton K , Lanphear BP , Braun JM . Environ Res 2015 138 453-460 Bisphenol A (BPA), an endocrine disruptor used in consumer products, may perturb thyroid function. Prenatal BPA exposure may have sex-specific effects on thyroid hormones (THs). Our objectives were to investigate whether maternal urinary BPA concentrations during pregnancy were associated with THs in maternal or cord serum, and whether these associations differed by newborn sex or maternal iodine status. We measured urinary BPA concentrations at 16 and 26 weeks gestation among pregnant women in the HOME Study (2003-2006, Cincinnati, Ohio). Thyroid stimulating hormone (TSH) and free and total thyroxine (T4) and triiodothyronine (T3) were measured in maternal serum at 16 weeks (n=181) and cord serum at delivery (n=249). Associations between BPA concentrations and maternal or cord serum TH levels were estimated by multivariable linear regression. Mean maternal urinary BPA was not associated with cord THs in all newborns, but a 10-fold increase in mean BPA was associated with lower cord TSH in girls (percent change=-36.0%; 95% confidence interval (CI): -58.4, -1.7%), but not boys (7.8%; 95% CI: -28.5, 62.7%; p-for-effect modification=0.09). We observed no significant associations between 16-week BPA and THs in maternal or cord serum, but 26-week maternal BPA was inversely associated with TSH in girls (-42.9%; 95% CI: -59.9, -18.5%), but not boys (7.6%; 95% CI: -17.3, 40.2%; p-for-effect modification=0.005) at birth. The inverse BPA-TSH relation among girls was stronger, but less precise, among iodine deficient versus sufficient mothers. Prenatal BPA exposure may reduce TSH among newborn girls, particularly when exposure occurs later in gestation. |
Breastfeeding supportive hospital practices in the US differ by county urbanization level
Allen JA , Perrine CG , Scanlon KS . J Hum Lact 2015 31 (3) 440-3 BACKGROUND: Breastfeeding rates are lower among infants living in rural areas of the United States, yet there are limited data on whether hospital breastfeeding support differs between rural and urban areas. OBJECTIVE: This study aimed to describe whether maternity care practices supportive of breastfeeding vary by level of urbanization. METHODS: We linked data from the 2007, 2009, and 2011 Maternity Practices in Infant Nutrition and Care (mPINC) surveys with Rural-Urban Continuum Codes to categorize hospital counties as metropolitan urbanized, nonmetropolitan urbanized, less urbanized, and thinly populated. RESULTS: From 2007 to 2011, the average hospital mPINC score, a composite quality score ranging from 0 to 100, increased from 64 to 71 in metropolitan urbanized counties and from 54 to 65 in thinly populated areas. Scores were lowest in thinly populated counties in 2007 and 2009 and in less urbanized counties in 2011. Examination of 2011 mPINC scores by 7 domains of care revealed that hospitals in less urbanized counties had lower scores than those in metropolitan urbanized counties for feeding of breastfed infants, breastfeeding assistance, staff training, and structural and organizational aspects of care delivery; for 3 of these practices, scores were 10 or more points lower-breastfeeding assistance, structural and organizational aspects of care, and staff training. In contrast, hospitals in thinly populated areas had higher scores than in metropolitan areas for mother-infant contact and facility discharge care; differences were less than 10 points. CONCLUSION: Interventions that specifically target rural hospitals may reduce the gap in access to hospital maternity care practices supportive of breastfeeding by population density. |
Cause-specific mortality among children and young adults with epilepsy: results from the U.S. National Child Death Review Case Reporting System
Tian N , Shaw EC , Zack M , Kobau R , Dykstra H , Covington TM . Epilepsy Behav 2015 45 31-34 We investigated causes of death in children and young adults with epilepsy by using data from the U.S. National Child Death Review Case Reporting System (NCDR-CRS), a passive surveillance system composed of comprehensive information related to deaths reviewed by local child death review teams. Information on a total of 48,697 deaths in children and young adults 28 days to 24 years of age, including 551 deaths with epilepsy and 48,146 deaths without epilepsy, was collected from 2004 through 2012 in 32 states. In a proportionate mortality analysis by official manner of death, decedents with epilepsy had a significantly higher percentage of natural deaths but significantly lower percentages of deaths due to accidents, homicide, and undetermined causes compared with persons without epilepsy. With respect to underlying causes of death, decedents with epilepsy had significantly higher percentages of deaths due to drowning and most medical conditions including pneumonia and congenital anomalies but lower percentages of deaths due to asphyxia, weapon use, and unknown causes compared with decedents without epilepsy. The increased percentages of deaths due to pneumonia and drowning in children and young adults with epilepsy suggest preventive interventions including immunization and better instruction and monitoring before or during swimming. State-specific and national population-based mortality studies of children and young adults with epilepsy are recommended. |
Associations between workplace factors and carpal tunnel syndrome: A multi-site cross sectional study
Fan ZJ , Harris-Adamson C , Gerr F , Eisen EA , Hegmann KT , Silverstein B , Evanoff B , Dale AM , Thiese MS , Garg A , Kapellusch J , Burt S , Merlino L , Rempel D . Am J Ind Med 2015 58 (5) 509-18 BACKGROUND: Few large epidemiologic studies have used rigorous case criteria, individual-level exposure measurements, and appropriate control for confounders to examine associations between workplace psychosocial and biomechanical factors and carpal tunnel syndrome (CTS). METHODS: Pooling data from five independent research studies, we assessed associations between prevalent CTS and personal, work psychosocial, and biomechanical factors while adjusting for confounders using multivariable logistic regression. RESULTS: Prevalent CTS was associated with personal factors of older age, obesity, female sex, medical conditions, previous distal upper extremity disorders, workplace measures of peak forceful hand activity, a composite measure of force and repetition (ACGIH Threshold Limit Value for Hand Activity Level), and hand vibration. CONCLUSIONS: In this cross-sectional analysis of production and service workers, CTS prevalence was associated with workplace and biomechanical factors. The findings were similar to those from a prospective analysis of the same cohort with differences that may be due to recall bias and other factors. |
Workplace exercise for control of occupational neck/shoulder disorders: a review of prospective studies
Lowe BD , Dick RB . Environ Health Insights 2014 8 75-95 A review was conducted of prospective studies (1997-2014) examining the efficacy of exercise as a workplace intervention to control neck/shoulder pain, symptoms, and disability. The review identified 38 relevant studies - 20 were classified with positive effects, 13 with null effects, and 5 as inconclusive. Of the positive studies, 12 were consistent with Level I evidence, 3 with Level II evidence, and 5 with Level IV evidence. Specific resistance training (SRT) exercise appeared to be associated with more positive studies (eight Level I studies) than other exercise modalities such as general resistance training, general physical exercise, stretching, and movement awareness exercises. Studies of longer trial duration tended toward more null findings and lower program compliance. Evidence for a primary preventive effect of workplace exercise is minimal. The findings of this review suggest that workplace exercise can be effective as tertiary prevention and therapeutic relief of neck/shoulder symptoms, at least over the shorter term. |
Access and use of interventions to prevent and treat malaria among pregnant women in Kenya and Mali: a qualitative study
Hill J , Kayentao K , Achieng F , Diarra S , Dellicour S , Diawara SI , Hamel MJ , Ouma P , Desai M , Doumbo OK , Ter Kuile FO , Webster J . PLoS One 2015 10 (3) e0119848 BACKGROUND: Coverage of malaria in pregnancy interventions in sub-Saharan Africa is suboptimal. We undertook a systematic examination of the operational, socio-economic and cultural constraints to pregnant women's access to intermittent preventive treatment (IPTp), long-lasting insecticide-treated nets (LLINs) and case management in Kenya and Mali to provide empirical evidence for strategies to improve coverage. METHODS: Focus group discussions (FGDs) were held as part of a programme of research to explore the delivery, access and use of interventions to control malaria in pregnancy. FGDs were held with four sub-groups: non-pregnant women of child bearing age (aged 15-49 years), pregnant women or mothers of children aged <1 year, adolescent women, and men. Content analysis was used to develop themes and sub-themes from the data. RESULTS: Women and men's perceptions of the benefits of antenatal care were generally positive; motivation among women consisted of maintaining a healthy pregnancy, disease prevention in mother and foetus, checking the position of the baby in preparation for delivery, and ensuring admission to a facility in case of complications. Barriers to accessing care related to the quality of the health provider-client interaction, perceived health provider skills and malpractice, drug availability, and cost of services. Pregnant women perceived themselves and their babies at particular risk from malaria, and valued diagnosis and treatment from a health professional, but cost of treatment at health facilities drove women to use herbal remedies or drugs bought from shops. Women lacked information on the safety, efficacy and side effects of antimalarial use in pregnancy. CONCLUSION: Women in these settings appreciated the benefits of antenatal care and yet health services in both countries are losing women to follow-up due to factors that can be improved with greater political will. Antenatal services need to be patient-centred, free-of-charge or highly affordable and accountable to the women they serve. |
Nicotine and the developing human: a neglected element in the electronic cigarette debate
England LJ , Bunnell RE , Pechacek TF , Tong VT , McAfee TA . Am J Prev Med 2015 49 (2) 286-93 The elimination of cigarettes and other combusted tobacco products in the U.S. would prevent tens of millions of tobacco-related deaths. It has been suggested that the introduction of less harmful nicotine delivery devices, such as electronic cigarettes or other electronic nicotine delivery systems, will accelerate progress toward ending combustible cigarette use. However, careful consideration of the potential adverse health effects from nicotine itself is often absent from public health debates. Human and animal data support that nicotine exposure during periods of developmental vulnerability (fetal through adolescent stages) has multiple adverse health consequences, including impaired fetal brain and lung development, and altered development of cerebral cortex and hippocampus in adolescents. Measures to protect the health of pregnant women and children are needed and could include (1) strong prohibitions on marketing that increase youth uptake; (2) youth access laws similar to those in effect for other tobacco products; (3) appropriate health warnings for vulnerable populations; (4) packaging to prevent accidental poisonings; (5) protection of non-users from exposure to secondhand electronic cigarette aerosol; (6) pricing that helps minimize youth initiation and use; (7) regulations to reduce product addiction potential and appeal for youth; and (8) the age of legal sale. |
AUDIT, AUDIT-C, and AUDIT-3: drinking patterns and screening for harmful, hazardous and dependent drinking in Katutura, Namibia
Seth P , Glenshaw M , Sabatier JH , Adams R , Du Preez V , DeLuca N , Bock N . PLoS One 2015 10 (3) e0120850 OBJECTIVES: To describe alcohol drinking patterns among participants in Katutura, Namibia, and to evaluate brief versions of the AUDIT against the full AUDIT to determine their effectiveness in detecting harmful drinking. METHODS: A cross-sectional survey was conducted in four constituencies and 639 participants, 18 years or older, completed a sociodemographic survey and the AUDIT. The effectiveness of the AUDIT-C (first three questions) and the AUDIT-3 (third question) was compared to the full AUDIT. RESULTS: Approximately 40% were identified as harmful, hazardous or likely dependent drinkers, with men having a higher likelihood than women (57.2% vs. 31.0%, p<.0001). Approximately 32% reported making and/or selling alcohol from home. The AUDIT-C performed best at a cutoff ≥ 3, better in men (sensitivity: 99.3%, specificity: 77.8%) than women (sensitivity: 91.7%, specificity: 77.4%). The AUDIT-3 performed poorly (maximum sensitivity: < 90%, maximum specificity: <51%). According to AUROC, the AUDIT-C performed better than the AUDIT-3. CONCLUSIONS: A large proportion of participants met criteria for alcohol misuse, indicating a need for screening and referral for further evaluation and intervention. The AUDIT-C was almost as effective as the full AUDIT and may be easier to implement in clinical settings as a routine screening tool in resource-limited settings because of its brevity. |
Molecular identification of Cryptosporidium spp. and Giardia duodenalis in grazing horses from Xinjiang, China.
Qi M , Zhou H , Wang H , Wang R , Xiao L , Arrowood MJ , Li J , Zhang L . Vet Parasitol 2015 209 169-72 A total of 262 fecal specimens collected from grazing horses at five locations in Xinjiang, China were examined by PCR for Cryptosporidium spp. and Giardia duodenalis. The Cryptosporidium and G. duodenalis infection rates were 2.7% and 1.5%, respectively. Seven Cryptosporidium-positive specimens were found in foals (16.3%), and four G. duodenalis-positive specimens were found in mares (2.5%). Sequence analyses of 18S rRNA and gp60 genes revealed that seven animals were positive for the subtype VIaA15G4 of Cryptosporidium horse genotype. G. duodenalis assemblages A and B were identified by molecular characterization of the 16S rRNA and tpi genes. This is the first report of Cryptosporidium horse genotype and G. duodenalis in grazing horses from China. |
Linking human health and livestock health: a "one-health" platform for integrated analysis of human health, livestock health, and economic welfare in livestock dependent communities
Thumbi SM , Njenga MK , Marsh TL , Noh S , Otiang E , Munyua P , Ochieng L , Ogola E , Yoder J , Audi A , Montgomery JM , Bigogo G , Breiman RF , Palmer GH , McElwain TF . PLoS One 2015 10 (3) e0120761 BACKGROUND: For most rural households in sub-Saharan Africa, healthy livestock play a key role in averting the burden associated with zoonotic diseases, and in meeting household nutritional and socio-economic needs. However, there is limited understanding of the complex nutritional, socio-economic, and zoonotic pathways that link livestock health to human health and welfare. Here we describe a platform for integrated human health, animal health and economic welfare analysis designed to address this challenge. We provide baseline epidemiological data on disease syndromes in humans and the animals they keep, and provide examples of relationships between human health, animal health and household socio-economic status. METHOD: We designed a study to obtain syndromic disease data in animals along with economic and behavioral information for 1500 rural households in Western Kenya already participating in a human syndromic disease surveillance study. Data collection started in February 2013, and each household is visited bi-weekly and data on four human syndromes (fever, jaundice, diarrhea and respiratory illness) and nine animal syndromes (death, respiratory, reproductive, musculoskeletal, nervous, urogenital, digestive, udder disorders, and skin disorders in cattle, sheep, goats and chickens) are collected. Additionally, data from a comprehensive socio-economic survey is collected every 3 months in each of the study households. FINDINGS: Data from the first year of study showed 93% of the households owned at least one form of livestock (55%, 19%, 41% and 88% own cattle, sheep, goats and chickens respectively). Digestive disorders, mainly diarrhea episodes, were the most common syndromes observed in cattle, goats and sheep, accounting for 56% of all livestock syndromes, followed by respiratory illnesses (18%). In humans, respiratory illnesses accounted for 54% of all illnesses reported, followed by acute febrile illnesses (40%) and diarrhea illnesses (5%). While controlling for household size, the incidence of human illness increased 1.31-fold for every 10 cases of animal illness or death observed (95% CI 1.16-1.49). Access and utilization of animal source foods such as milk and eggs were positively associated with the number of cattle and chickens owned by the household. Additionally, health care seeking was correlated with household incomes and wealth, which were in turn correlated with livestock herd size. CONCLUSION: This study platform provides a unique longitudinal dataset that allows for the determination and quantification of linkages between human and animal health, including the impact of healthy animals on human disease averted, malnutrition, household educational attainment, and income levels. |
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