The single-visit approach as a cervical cancer prevention strategy among women with HIV in Ethiopia: successes and lessons learned
Shiferaw N , Salvador-Davila G , Kassahun K , Brooks MI , Weldegebreal T , Tilahun Y , Zerihun H , Nigatu T , Lulu K , Ahmed I , Blumenthal PD , Asnake M . Glob Health Sci Pract 2016 4 (1) 87-98 INTRODUCTION: Cervical cancer is the second most common form of cancer for women in Ethiopia. Using a single-visit approach to prevent cervical cancer, the Addis Tesfa (New Hope) project in Ethiopia tested women with HIV through visual inspection of the cervix with acetic acid wash (VIA) and, if tests results were positive, offered immediate cryotherapy of the precancerous lesion or referral for loop electrosurgical excision procedure (LEEP). The objective of this article is to review screening and treatment outcomes over nearly 4 years of project implementation and to identify lessons learned to improve cervical cancer prevention programs in Ethiopia and other resource-constrained settings. METHODS: We analyzed aggregate client data from August 2010 to March 2014 to obtain the number of women with HIV who were counseled, screened, and treated, as well as the number of annual follow-up visits made, from the 14 tertiary- and secondary-level health facilities implementing the single-visit approach. A health facility assessment (HFA) was also implemented from August to December 2013 to examine the effects of the single-visit approach on client flow, staff workload, and facility infrastructure 3 years after initiating the approach. RESULTS: Almost all (99%) of the 16,632 women with HIV counseled about the single-visit approach were screened with VIA during the study period; 1,656 (10%) of them tested VIA positive (VIA+) for precancerous lesions. Among those who tested VIA+ and were thus eligible for cryotherapy, 1,481 (97%) received cryotherapy treatment, but only 80 (63%) women eligible for LEEP actually received the treatment. The HFA results showed frequent staff turnover, some shortage of essential supplies, and rooms that were judged by providers to be too small for delivery of cervical cancer prevention services. CONCLUSION: The high proportions of VIA screening and cryotherapy treatment in the Addis Tesfa project suggest high acceptance of such services by women with HIV and feasibility of implementation in secondary- and tertiary-level health facilities. However, success of cervical cancer prevention programming must address wider health system challenges to ensure sustainability and appropriate scale-up to the general population of Ethiopia and other resource-constrained settings. |
Updated projected prevalence of self-reported doctor-diagnosed arthritis and arthritis-attributable activity limitation among US adults, 2015-2040
Hootman JM , Helmick CG , Barbour KE , Theis KA , Boring MA . Arthritis Rheumatol 2016 68 (7) 1582-7 OBJECTIVE: To update projections of arthritis prevalence and arthritis-attributable activity limitations (AAAL) for adults using a newer baseline. METHODS: Baseline prevalence data were obtained from the 2010-2012 National Health Interview Survey. Arthritis was defined as a "yes" response to "Have you ever been told by a doctor or other health professional that you have some form of arthritis, rheumatoid arthritis, gout, lupus or fibromyalgia?" AAAL was defined as a "yes" response to "Are you limited in any way in any of your usual activities because of arthritis or joint symptoms." The baseline prevalence of arthritis and AAAL was stratified by age (18-34, 35-44, 45-54, 55-64, 65-74, 75-84, and 85+) and sex and statistically weighted to account for the complex survey design. Projected arthritis and AAAL prevalence was calculated by multiplying the US Census projected age and sex population estimates for 2015-2040 (in 5-year intervals) by the baseline estimates, and summed to provide the total prevalence estimates for each year. RESULTS: In 2010-2012 there were 52.5 million (22.7%) US adults with doctor-diagnosed arthritis, of whom 22.7 million (9.8% of all adults) had AAAL. By 2040 the prevalence of doctor-diagnosed arthritis is projected to increase 49% to 78.4 million (25.9% of adults). The number of adults with AAAL will also increase 52% to 34.6 million (11.4% of all adults). CONCLUSION: Updated projections suggest arthritis and AAAL will remain large and growing problems for clinical and public health systems, which must plan and create policies and resources to address these future needs. |
Low risk of solid tumors in persons with Down syndrome
Hasle H , Friedman JM , Olsen JH , Rasmussen SA . Genet Med 2016 18 (11) 1151-1157 PURPOSE: The aim of this study was to investigate cancer incidence in a large cohort of persons with Down syndrome. METHODS: Down syndrome was identified from the Danish Cytogenetic Register. Cancer occurrence was identified by linkage to the Danish Cancer Registry. Standardized incidence ratios (SIRs) and 95% confidence intervals (CIs) were calculated based on observed and expected numbers from rates for all Danish residents. The cohort consisted of 3,530 persons with Down syndrome contributing 89,570 person-years at risk. RESULTS: Acute leukemia risk was highest from 1-4 years of age and remained elevated until age 30. The overall risk of solid tumors was decreased (SIR 0.45; 95% CI 0.34-0.59), especially in persons 50 years or older (SIR 0.27; 95% CI 0.16-0.43). We found a significantly lower risk of lung cancer (SIR 0.10; 95% CI 0.00-0.56), breast cancer (SIR 0.16; 95% CI 0.03-0.47), and cervical cancer (SIR 0.0; 95% CI 0.00-0.77). Testicular cancer was the only solid tumor with an increased SIR (2.9; 95% CI 1.6-4.8). CONCLUSIONS: The risk of all major groups of solid tumors was decreased, except testicular cancer. Altered screening strategies should be considered for persons with Down syndrome. This unusual pattern of cancer occurrence may help understanding carcinogenesis in the general population. |
Obesity, prediabetes, and perceived stress in municipal workers
O'Keefe LC , Brown KC , Frith KH , Heaton KL , Maples EH , Phillips JA , Vance DE . Workplace Health Saf 2016 64 (10) 453-461 The primary cause of death for men and women in the United States is heart disease. Obesity and diabetes are major contributors to heart disease, and the risk is worsened in the presence of stress. It is clinically useful to identify predictors of obesity and prediabetes in a working population. The purpose of this current cross-sectional, correlational study was to examine relationships among obesity, prediabetes, and perceived stress in municipal workers using a subset of worksite wellness program data from employees screened in 2010 and 2011. Multiple regression models indicated that age, gender, race, HA1c, shift schedule, physical activity, and occupation were significant predictors of obesity in municipal workers (p< .01). Prediabetes in municipal workers was predicted by age, Black race, and body mass index (BMI;p< .01). Perceived stress was not a significant predictor of obesity or prediabetes in municipal workers. Overall, the findings of this study provide guidance to occupational health nurses when evaluating individuals in an occupational health setting. Further research is needed to examine relationships among the variables and validate the models. |
Impact of intensive lifestyle intervention on preference-based quality of life in type 2 diabetes: results from the Look AHEAD trial
Zhang P , Hire D , Espeland MA , Knowler WC , Thomas S , Tsai AG , Glick HA . Obesity (Silver Spring) 2016 24 (4) 856-64 OBJECTIVE: To assess the effect of an intensive lifestyle intervention (ILI) compared with standard diabetes support and education (DSE) on preference-based health-related quality of life (HRQOL) in persons with overweight or obesity and type 2 diabetes. METHODS: Look AHEAD was a multisite, randomized trial of 5,145 participants assigned to ILI or DSE. Four instruments were administered during the trial: Feeling Thermometer (FT), Health Utilities Index Mark 2 (HUI2), Health Utilities Index Mark 3 (HUI3), and Short Form 6D (SF-6D). Linear mixed effect models were used to estimate the mean difference in preference scores by treatment group for 9 years. RESULTS: The ILI had higher mean FT (0.019, 95% CI, 0.015-0.024, P < 0.001) and SF-6D (0.011, 95% CI, 0.006-0.014, P < 0.001) scores than the DSE. No significant group differences were observed for the HUI2 (0.004, 95% CI, -0.003 to 0.010, P = 0.23) and HUI3 (0.004, -0.004 to 0.012, P = 0.36). In year 1, the ILI had higher mean preference scores for all instruments. Thereafter, the increases remained significant only for FT and SF-6D, and the effects also become smaller. CONCLUSIONS: ILI aimed at reducing body weight among persons with overweight or obesity and type 2 diabetes improves preference-based HRQOL in the short term, but its long-term effect is unclear. |
Characteristics, rates, and trends of melanoma incidence among Hispanics in the USA
Garnett E , Townsend J , Steele B , Watson M . Cancer Causes Control 2016 27 (5) 647-59 PURPOSE: The purpose of this study is to describe the epidemiology of melanoma among Hispanics using data that cover nearly 100 % of the US population. METHODS: The study used population-based cancer incidence data from the National Program of Cancer Registries and the Surveillance, Epidemiology and End Results Program to examine melanoma incidence rates and trends among Hispanics by sex, age, race, histology, anatomic location, stage, and tumor thickness. RESULTS: From 2008 to 2012, 6,623 cases of melanoma were diagnosed among Hispanics. Rates were higher among males (4.6) than among females (4.0), but females younger than age 55 had higher rates than males. The most common histologic subtype was superficial spreading melanoma (23 %). Melanomas with poorer outcomes, such as nodular (NM) and acral lentiginous melanoma (ALM), were more common among males. Hispanic females had the highest proportion of melanoma on the lower limb and hip (33.7 %), while Hispanic males had the highest proportion on the trunk (29.9 %). Incidence rates for later-stage diagnosis and thicker tumors were significantly higher among Hispanic men than among women. Incidence rates decreased significantly during 2003-2012 (AAPC = -1.4). CONCLUSIONS: Clinicians and public health practitioners will need to reach the growing Hispanic population in the USA with strategies for primary prevention and early diagnosis of melanoma. Results suggest Hispanics and providers need education to increase awareness about the characteristics of melanoma among Hispanics, including types that occur on non-sun-exposed areas (ALM and NM). Skin cancer prevention and awareness interventions targeting Hispanics should be culturally relevant. |
Declining trends in invasive orthopedic interventions for people with hemophilia enrolled in the Universal Data Collection program (2000-2010)
Tobase P , Lane H , Siddiqi AE , Ingram-Rich R , Ward RS . Haemophilia 2016 22 (4) 604-14 INTRODUCTION: Recurrent joint hemarthroses due to hemophilia (Factor VIII and Factor IX deficiency) often lead to invasive orthopedic interventions to decrease frequency of bleeding and/or to alleviate pain associated with end-stage hemophilic arthropathy. AIM: Identify trends in invasive orthopedic interventions among people with hemophilia who were enrolled in the Universal Data Collection (UDC) program during the period 2000-2010. METHODS: Data were collected from 130 hemophilia treatment centers in the United States annually during the period 2000-2010, in collaboration with the Centers for Disease Control and Prevention (CDC). The number of visits in which an invasive orthopedic intervention was reported was expressed as a proportion of the total visits in each year of the program. Invasive orthopedic interventions consisted of arthroplasty, arthrodesis, and synovectomy. Joints included in this study were the shoulder, elbow, hip, knee, and ankle. RESULTS: A 5.6% decrease in all invasive orthopedic interventions in all joints of people with hemophilia enrolled in the UDC program over the 11-year study period was observed. CONCLUSIONS: These data reflect a declining trend in invasive orthopedic interventions in people with hemophilia. Further research is needed to understand the characteristics that may influence invasive orthopedic interventions. |
Prevalent mutator genotype identified in fungal pathogen Candida glabrata promotes multi-drug resistance.
Healey KR , Zhao Y , Perez WB , Lockhart SR , Sobel JD , Farmakiotis D , Kontoyiannis DP , Sanglard D , Taj-Aldeen SJ , Alexander BD , Jimenez-Ortigosa C , Shor E , Perlin DS . Nat Commun 2016 7 11128 The fungal pathogen Candida glabrata has emerged as a major health threat since it readily acquires resistance to multiple drug classes, including triazoles and/or echinocandins. Thus far, cellular mechanisms promoting the emergence of resistance to multiple drug classes have not been described in this organism. Here we demonstrate that a mutator phenotype caused by a mismatch repair defect is prevalent in C. glabrata clinical isolates. Strains carrying alterations in mismatch repair gene MSH2 exhibit a higher propensity to breakthrough antifungal treatment in vitro and in mouse models of colonization, and are recovered at a high rate (55% of all C. glabrata recovered) from patients. This genetic mechanism promotes the acquisition of resistance to multiple antifungals, at least partially explaining the elevated rates of triazole and multi-drug resistance associated with C. glabrata. We anticipate that identifying MSH2 defects in infecting strains may influence the management of patients on antifungal drug therapy. |
Results of interferon-based treatments in Alaska Native and American Indian population with chronic hepatitis C
Livingston SE , Townshend-Bulson LJ , Bruden DJ , Homan CE , Gove JE , Plotnik JN , Simons BC , Spradling PR , McMahon BJ . Int J Circumpolar Health 2016 75 30696 BACKGROUND: There have been few reports of hepatitis C virus (HCV) treatment results with interferon-based regimens in indigenous populations. OBJECTIVE: To determine interferon-based treatment outcome among Alaska Native and American Indian (AN/AI) population. DESIGN: In an outcomes study of 1,379 AN/AI persons with chronic HCV infection from 1995 through 2013, we examined treatment results of 189 persons treated with standard interferon, interferon plus ribavirin, pegylated interferon plus ribavirin and triple therapy with a protease inhibitor. For individuals treated with pegylated interferon and ribavirin, the effect of patient characteristics on response was also examined. RESULTS: Sustained virologic response (SVR) with standard interferon was 16.7% (3/18) and with standard interferon and ribavirin was 29.7% (11/37). Of 119 persons treated with pegylated interferon and ribavirin, 61 achieved SVR (51.3%), including 10 of 46 with genotype 1 (21.7%), 38 of 51 with genotype 2 (74.5%) and 13 of 22 with genotype 3 (59.1%). By multivariate analysis, SVR in the pegylated interferon group was associated with female sex (p=0.002), estimated duration of infection (p=0.034) and HCV genotype (p<0.0001). There was a high discontinuation rate due to side effects in those treated with pegylated interferon and ribavirin for genotype 1 (52.2%). Seven of 15 genotype 1 patients treated with pegylated interferon, ribavirin and telaprevir or boceprevir achieved SVR (46.7%). CONCLUSIONS: We had success with pegylated interferon-based treatment of AN/AI people with genotypes 2 and 3. However, there were low SVR and high discontinuation rates for those with genotype 1. |
Role of public-private partnerships in meeting healthcare challenges in Africa: A perspective from the public sector
Hader SL . J Infect Dis 2016 213 Suppl 2 S34 Public-private partnerships (PPPs) align public and private needs around mutual goals to move vital projects forward. When PPPs work to strengthen the critical link in the healthcare system, such as laboratory networks, as demonstrated in this supplement by authors from the International Laboratory Branch at the Centers for Disease Control and Prevention (CDC), in-country officials from the respective CDC and Ministries of Health, implementing partners, and Becton, Dickinson, and Company (BD), they significantly change the landscape of healthcare and patient outcomes. | The laboratory networks in African countries supported by a PPP between BD and US President's Emergency Plan for AIDS Relief are achieving a positive transformation. Over the years, the PPP has demonstrated significant contributions in developing a more competent laboratory workforce, reinforced laboratory systems, and improved treatment efficiencies by significantly reducing turnaround time to provide accurate laboratory results to patients afflicted by deadly diseases, such as multidrug resistant tuberculosis and human immunodeficiency virus (HIV). This PPP has not just improved efficiencies in the countries where they exist, it has also provided a successful model for other low-income countries to consider. | The effort needed to meet the UNAIDS 90-90-90 treatment goals to help end the AIDS epidemic by 2020 is tremendous, and neither governments nor the private sector can do it alone. These goals, which state that, by 2020, all people living with HIV will know their HIV status, 90% of all people with diagnosed HIV infection will receive sustained antiretroviral therapy, and 90% of all people receiving antiretroviral therapy will have viral suppression, are being significantly advanced as a result of this collaboration. We encourage more entities—public, private, health ministries, and nongovernmental organizations—to consider PPPs as an opportunity to efficiently and synergistically meet the needs of people living with HIV/AIDS and of their caregivers. |
Low risk of proximal tubular dysfunction associated with emtricitabine-tenofovir disoproxil fumarate pre-exposure prophylaxis in men and women
Mugwanya K , Baeten J , Celum C , Donnell D , Nickolas T , Mugo N , Branch A , Tappero J , Kiarie J , Ronald A , Yin M , Wyatt C . J Infect Dis 2016 214 (7) 1050-7 OBJECTIVE: Tenofovir disoproxil fumarate (TDF) is associated with proximal tubular dysfunction (tubulopathy) when used in HIV treatment. We evaluated whether TDF causes tubulopathy when used as HIV pre-exposure prophylaxis (PrEP) and whether tubulopathy predicts clinically relevant decline (≥25%) in estimated glomerular filtration rate (eGFR). METHODS: A subgroup analysis of the Partners PrEP Study, a randomized, placebo-controlled trial of daily oral TDF and emtricitabine (FTC)-TDF among HIV-uninfected African men and women (Clinicaltrials.gov numberNCT00557245). Tubulopathy was assessed in concurrently obtained urine and serum at the 24-month or last on-treatment visit, pre-defined as ≥2 of: tubular proteinuria, euglycemic glycosuria, increased urinary phosphate or uric acid excretion. RESULTS: Of 1549 persons studied (776 on FTC-TDF, 773 on placebo), 64% were male and median age was 37-years. Over median 24-months of study-drug exposure, the frequency of tubulopathy was 1.7% in FTC-TDF versus 1.3% for placebo [odds ratio (OR), 95%CI: 1.30 (0.52, 3.33); p=0.68]. Tubulopathy occurred in 2 of 52 (3.8%) persons with ≥25% eGFR decline versus 3 of 208 (1.4%) without ≥25% eGFR decline [adjusted OR 95%CL: 1.39 (0.10, 14.0); p >0.99]. CONCLUSIONS: Daily oral FTC-TDF PrEP was not significantly associated with tubulopathy over 24 months nor did tubulopathy predict clinically relevant eGFR decline. |
Notes from the field: Baseline assessment of the use of Ebola rapid diagnostic tests - Forecariah, Guinea, October-November 2015
Huang JY , Louis FJ , Dixon MG , Sefu M , Kightlinger L , Martel LD , Jayaraman GC , Gueye AS . MMWR Morb Mortal Wkly Rep 2016 65 (12) 328-329 The Ebola virus disease (Ebola) epidemic in West Africa began in Guinea in early 2014. The reemergence of Ebola and risk of ongoing, undetected transmission continues because of the potential for sexual transmission and other as yet unknown transmission pathways. On March 17, 2016, two new cases of Ebola in Guinea were confirmed by the World Health Organization. This reemergence of Ebola in Guinea is the first since the original outbreak in the country was declared over on December 29, 2015. The prefecture of Forecariah, in western Guinea, was considerably affected by Ebola in 2015, with an incidence rate of 159 cases per 100,000 persons. Guinea also has a high prevalence of malaria; in a nationwide 2012 survey, malaria prevalence was reported to be 44% among healthy children aged ≤5 years. Malaria is an important reason for seeking health care; during 2014, 34% of outpatient consultations were related to malaria. |
Pediatric norovirus in developing countries: a picture slowly comes into focus
Lopman BA , Grassly NC . Clin Infect Dis 2016 62 (10) 1218-20 A consensus is emerging that norovirus is a pathogen of considerable global health importance and one that will require sustained investment to generate tools for targeted control. Globally, norovirus is among the most common causes of diarrheal disease, associated with approximately one-fifth of cases worldwide and estimated to cause 685 million episodes and 212 000 deaths annually across the age range [1, 2]. In high- and middle-income countries with successful rotavirus vaccination programs, norovirus is the most common cause of pediatric gastroenteritis requiring medical care [3, 4]. However, fundamental questions about norovirus persist, especially in low-income countries where the epidemiology, disease burden, and potential benefits for vaccines that are in the pipeline are not well defined. | Efforts to characterize the epidemiology of norovirus have faced many obstacles. Until fairly recently, inadequacies of detection methods were chief among these. Electron microscopy, followed by antigen-capture enzyme immunoassay, was insensitive, often unable to detect virus when it was present in stool. Now, with highly sensitive real-time reverse-transcription polymerase chain reaction (PCR) assays, norovirus is frequently detected in stool from children without diarrhea and therefore we face a reciprocal challenge: knowing when detection of virus in stool is indicative of disease-causing infection. |
Epidemiology of acute lower respiratory tract infection in HIV-exposed uninfected infants
Cohen C , Moyes J , Tempia S , Groome M , Walaza S , Pretorius M , Naby F , Mekgoe O , Kahn K , von Gottberg A , Wolter N , Cohen AL , von Mollendorf C , Venter M , Madhi SA . Pediatrics 2016 137 (4) BACKGROUND: Increased morbidity and mortality from lower respiratory tract infection (LRTI) has been suggested in HIV-exposed uninfected (HEU) children; however, the contribution of respiratory viruses is unclear. We studied the epidemiology of LRTI hospitalization in HIV-unexposed uninfected (HUU) and HEU infants aged <6 months in South Africa. METHODS: We prospectively enrolled hospitalized infants with LRTI from 4 provinces from 2010 to 2013. Using polymerase chain reaction, nasopharyngeal aspirates were tested for 10 viruses and blood for pneumococcal DNA. Incidence for 2010-2011 was estimated at 1 site with population denominators. RESULTS: We enrolled 3537 children aged <6 months. HIV infection and exposure status were determined for 2507 (71%), of whom 211 (8%) were HIV infected, 850 (34%) were HEU, and 1446 (58%) were HUU. The annual incidence of LRTI was elevated in HEU (incidence rate ratio [IRR] 1.4; 95% confidence interval [CI] 1.3-1.5) and HIV infected (IRR 3.8; 95% CI 3.3-4.5), compared with HUU infants. Relative incidence estimates were greater in HEU than HUU, for respiratory syncytial virus (RSV; IRR 1.4; 95% CI 1.3-1.6) and human metapneumovirus-associated (IRR 1.4; 95% CI 1.1-2.0) LRTI, with a similar trend observed for influenza (IRR 1.2; 95% CI 0.8-1.8). HEU infants overall, and those with RSV-associated LRTI had greater odds (odds ratio 2.1, 95% CI 1.1-3.8, and 12.2, 95% CI 1.7-infinity, respectively) of death than HUU. CONCLUSIONS: HEU infants were more likely to be hospitalized and to die in-hospital than HUU, including specifically due to RSV. This group should be considered a high-risk group for LRTI. |
Factors associated with loss to follow-up during treatment for multidrug-resistant tuberculosis, the Philippines, 2012-2014
Tupasi TE , Garfin AM , Kurbatova EV , Mangan JM , Orillaza-Chi R , Naval LC , Balane GI , Basilio R , Golubkov A , Joson ES , Lew WJ , Lofranco V , Mantala M , Pancho S , Sarol JN Jr . Emerg Infect Dis 2016 22 (3) 491-502 To identify factors associated with loss to follow-up during treatment for multidrug-resistant (MDR) tuberculosis (TB) in the Philippines, we conducted a case-control study of adult patients who began receiving treatment for rifampin-resistant TB during July 1-December 31, 2012. Among 91 case-patients (those lost to follow-up) and 182 control-patients (those who adhered to treatment), independent factors associated with loss to follow-up included patients' higher self-rating of the severity of vomiting as an adverse drug reaction and alcohol abuse. Protective factors included receiving any type of assistance from the TB program, better TB knowledge, and higher levels of trust in and support from physicians and nurses. These results provide insights for designing interventions aimed at reducing patient loss to follow-up during treatment for MDR TB. |
Hepatitis C treatment failure is associated with increased risk of hepatocellular carcinoma
Lu M , Li J , Rupp LB , Holmberg SD , Moorman AC , Spradling PR , Teshale EH , Zhou Y , Boscarino JA , Schmidt MA , Lamerato LE , Trinacty C , Trudeau S , Gordon SC . J Viral Hepat 2016 23 (9) 718-29 Sustained virological response (SVR) to antiviral therapy for hepatitis C (HCV) reduces risk of hepatocellular carcinoma (HCC), but there is little information regarding how treatment failure (TF) compares to lack of treatment. We evaluated the impact of treatment status on risk of HCC using data from the Chronic Hepatitis Cohort Study (CHeCS-an observational study based in four large US health systems, with up to 7 years of follow-up on patients). Multivariable analyses were used to adjust for bias in treatment selection, as well as other covariates, followed by sensitivity analyses. Among 10 091 HCV patients, 3681 (36%) received treatment, 2099 (57%) experienced treatment failure (TF), and 1582 (43%) of these achieved sustained virological response (SVR). TF patients demonstrated almost twice the risk of HCC than untreated patients [adjusted hazard ratio (aHR) = 1.95, 95% confidence interval (CI) 1.50-2.53]; this risk persisted across all stages of fibrosis. Several sensitivity analyses validated these results. Although African Americans were at increased risk of treatment failure, they were at lower risk for HCC and all-cause mortality compared to White patients. SVR patients had lower risk of HCC than TF patients (aHR = 0.48, CI 0.31-0.73), whereas treatment - regardless of outcome - reduced all-cause mortality (aHR = 0.45, CI 0.34-0.60 for SVR patients; aHR = 0.78, CI 0.65-0.93 for TF patients). |
Human immunodeficiency virus prevention with preexposure prophylaxis in sexually transmitted disease clinics
Hoover KW , Ham DC , Peters PJ , Smith DK , Bernstein KT . Sex Transm Dis 2016 43 (5) 277-82 Preexposure prophylaxis (PrEP) is an human immunodeficiency virus (HIV) prevention intervention that has been available since the Food and Drug Administration approved the antiretroviral (ARV) medication Truvada for a prevention indication in July 2012, and since the Centers for Disease Control and Prevention (CDC) issued clinical practice guidelines for its use to reduce the risk of acquiring HIV infection for persons at substantial risk in May 2014.1 Clinical trials, demonstration projects, and implementation studies have demonstrated its effectiveness in reducing the risk of HIV acquisition.2–9 Although PrEP has been available for several years, its uptake in the United States has been low but increasing.10,11 Because sexually transmitted diseases (STDs) have been found to be associated with HIV acquisition, they serve as objective markers of HIV risk and can identify STD patients who might benefit from PrEP.12–16 In this article, we aim to increase PrEP awareness among STD health care providers, a group of clinicians who provide prevention services for many persons at substantial risk of HIV acquisition, and we describe models for implementing PrEP in the STD clinic setting. | Human immunodeficiency virus prevention efforts, including ARV treatment as prevention and condom promotion, over the past several years have resulted in the incidence of HIV infection remaining stable or decreasing in many US subpopulations.17 Despite these prevention efforts, incidence continues to increase among men who have sex with men (MSM), with the steepest increases among young black MSM.17 Although HIV diagnosis rates decreased among women from 2010 through 2014, 19% of new diagnoses in 2014 were in women, and black women accounted for 62% of these diagnoses.18 Because of high rates of continuing transmission in some populations, it is especially important to target persons in these key populations, such as young MSM and females with high-risk sexual behaviors, for HIV testing with linkage to HIV prevention and care services. Existing disparities in the incidence of HIV infections might worsen if access and utilization of prevention services, such as PrEP, are not targeted for the most-at-risk populations, especially young black MSM.19 |
Community-acquired pneumonia hospitalization among children with neurologic disorders
Millman AJ , Finelli L , Bramley AM , Peacock G , Williams DJ , Arnold SR , Grijalva CG , Anderson EJ , McCullers JA , Ampofo K , Pavia AT , Edwards KM , Jain S . J Pediatr 2016 173 188-195 e4 OBJECTIVE: To describe and compare the clinical characteristics, outcomes, and etiology of pneumonia among children hospitalized with community-acquired pneumonia (CAP) with neurologic disorders, non-neurologic underlying conditions, and no underlying conditions. STUDY DESIGN: Children <18 years old hospitalized with clinical and radiographic CAP were enrolled at 3 US children's hospitals. Neurologic disorders included cerebral palsy, developmental delay, Down syndrome, epilepsy, non-Down syndrome chromosomal abnormalities, and spinal cord abnormalities. We compared the epidemiology, etiology, and clinical outcomes of CAP in children with neurologic disorders with those with non-neurologic underlying conditions, and those with no underlying conditions using bivariate, age-stratified, and multivariate logistic regression analyses. RESULTS: From January 2010-June 2012, 2358 children with radiographically confirmed CAP were enrolled; 280 (11.9%) had a neurologic disorder (52.1% of these individuals also had non-neurologic underlying conditions), 934 (39.6%) had non-neurologic underlying conditions only, and 1144 (48.5%) had no underlying conditions. Children with neurologic disorders were older and more likely to require intensive care unit (ICU) admission than children with non-neurologic underlying conditions and children with no underlying conditions; similar proportions were mechanically ventilated. In age-stratified analysis, children with neurologic disorders were less likely to have a pathogen detected than children with non-neurologic underlying conditions. In multivariate analysis, having a neurologic disorder was associated with ICU admission for children ≥2 years of age. CONCLUSIONS: Children with neurologic disorders hospitalized with CAP were less likely to have a pathogen detected and more likely to be admitted to the ICU than children without neurologic disorders. |
Deletion variants of Middle East respiratory syndrome coronavirus from humans, Jordan, 2015
Lamers MM , Raj VS , Shafei M , Ali SS , Abdallh SM , Gazo M , Nofal S , Lu X , Erdman DD , Koopmans MP , Abdallat M , Haddadin A , Haagmans BL . Emerg Infect Dis 2016 22 (4) 716-9 We characterized Middle East respiratory syndrome coronaviruses from a hospital outbreak in Jordan in 2015. The viruses from Jordan were highly similar to isolates from Riyadh, Saudi Arabia, except for deletions in open reading frames 4a and 3. Transmissibility and pathogenicity of this strain remains to be determined. |
Habitat suitability model for the distribution of Ixodes scapularis (Acari: Ixodidae) in Minnesota
Johnson TL , Bjork JK , Neitzel DF , Dorr FM , Schiffman EK , Eisen RJ . J Med Entomol 2016 53 (3) 598-606 Ixodes scapularisSay, the black-legged tick, is the primary vector in the eastern United States of several pathogens causing human diseases including Lyme disease, anaplasmosis, and babesiosis. Over the past two decades,I. scapularis-borne diseases have increased in incidence as well as geographic distribution. Lyme disease exists in two major foci in the United States, one encompassing northeastern states and the other in the Upper Midwest. Minnesota represents a state with an appreciable increase in counties reportingI. scapularis-borne illnesses, suggesting geographic expansion of vector populations in recent years. Recent tick distribution records support this assumption. Here, we used those records to create a fine resolution, subcounty-level distribution model forI. scapularisusing variable response curves in addition to tests of variable importance. The model identified 19% of Minnesota as potentially suitable for establishment of the tick and indicated with high accuracy (AUC = 0.863) that the distribution is driven by land cover type, summer precipitation, maximum summer temperatures, and annual temperature variation. We provide updated records of established populations near the northwestern species range limit and present a model that increases our understanding of the potential distribution ofI. scapularisin Minnesota. |
Surface wipe sampling for antineoplastic (chemotherapy) and other hazardous drug residue in healthcare settings: Methodology and recommendations
Connor TH , Zock MD , Snow AH . J Occup Environ Hyg 2016 13 (9) 1-33 PURPOSE: Surface wipe sampling for various hazardous agents has been employed in many occupational settings over the years for various reasons such as evaluation of potential dermal exposure and health risk, source determination, quality or cleanliness, compliance, and others. Wipe sampling for surface residue of antineoplastic and other hazardous drugs in healthcare settings is currently the method of choice to determine surface contamination of the workplace with these drugs. The purpose of this article is to review published studies of wipe sampling for antineoplastic and other hazardous drugs, to summarize the methods in use by various organizations and researchers, and to provide some basic guidance for conducting surface wipe sampling for these drugs in healthcare settings. METHODS: Recommendations on wipe sampling methodology from several government agencies and organizations were reviewed. Published reports on wipe sampling for hazardous drugs in numerous studies were also examined. The critical elements of a wipe sampling program and related limitations were reviewed and summarized. RESULTS: Recommendations and guidance are presented concerning the purposes of wipe sampling for antineoplastic and other hazardous drugs in the healthcare setting, technical factors and variables, sampling strategy, materials required, and limitations. The reporting and interpretation of wipe sample results is also discussed. CONCLUSIONS: It is recommended that all healthcare settings where antineoplastic and other hazardous drugs are handled consider wipe sampling as part of a comprehensive hazardous drug 'safe handling' program. Although no standards exist for acceptable or allowable surface concentrations for these drugs in the healthcare setting, wipe sampling may be used as a method to characterize potential occupational dermal exposure risk and to evaluate the effectiveness of implemented controls and the overall the safety program. A comprehensive safe-handling program for antineoplastic drugs may utilize wipe sampling as a screening tool to evaluate environmental contamination and strive to reduce contamination levels as much as possible, using the industrial hygiene hierarchy of controls. |
A generic schema and data collection forms applicable to diverse entomological studies of mosquitoes
Kiware SS , Russell TL , Mtema ZJ , Malishee AD , Chaki P , Lwetoijera D , Chanda J , Chinula D , Majambere S , Gimnig JE , Smith TA , Killeen GF . Source Code Biol Med 2016 11 4 BACKGROUND: Standardized schemas, databases, and public data repositories are needed for the studies of malaria vectors that encompass a remarkably diverse array of designs and rapidly generate large data volumes, often in resource-limited tropical settings lacking specialized software or informatics support. RESULTS: Data from the majority of mosquito studies conformed to a generic schema, with data collection forms recording the experimental design, sorting of collections, details of sample pooling or subdivision, and additional observations. Generically applicable forms with standardized attribute definitions enabled rigorous, consistent data and sample management with generic software and minimal expertise. Forms use now includes 20 experiments, 8 projects, and 15 users at 3 research and control institutes in 3 African countries, resulting in 11 peer-reviewed publications. CONCLUSION: We have designed generic data schema that can be used to develop paper or electronic based data collection forms depending on the availability of resources. We have developed paper-based data collection forms that can be used to collect data from majority of entomological studies across multiple study areas using standardized data formats. Data recorded on these forms with standardized formats can be entered and linked with any relational database software. These informatics tools are recommended because they ensure that medical entomologists save time, improve data quality, and data collected and shared across multiple studies is in standardized formats hence increasing research outputs. |
Comparison of measured multi-decadal rainfall variability with farmers’ perceptions of and responses to seasonal changes in western Uganda
Diem JE , Hartter J , Salerno J , McIntyre E , Stuart Grandy A . Reg Environ Change 2016 17 (4) 1127–1140 Smallholder farmers in Sub-Saharan Africa (SSA) are not only dealing with decreased production from land degradation, but are also impacted heavily by climate variability. Farmers perceive decreased rainfall or shortened rainy seasons throughout SSA; however, the link between perceptions and climate variability is complex, especially in areas with increasing land degradation. Moreover, little is known about climate variability and farmers’ perceptions in central equatorial Africa. The purpose of this study is to quantify interannual rainfall variability from 1983 to 2014 in western Uganda and to relate the rainfall variability and associated changes in soil moisture to perceptions and coping strategies of local farmers. Surveys of 308 farming households and 14 group interviews were conducted near Kibale National Park, and daily satellite-based rainfall data for the region were extracted from the African Rainfall Climatology version 2 database. Results indicate a decrease in the long rains by approximately 3 weeks throughout much of the region; thus, soil-water deficits have intensified. Farmers perceived later onsets of both the short rains and long rains, while also reporting decreasing soil fertility and crop yields. Therefore, farmers’ perceptions of rainfall variability in the Kibale region may reflect more the decrease in soil fertility than the shortened rainy seasons and decreased soil moisture. Expanding croplands has been the farmers’ most prevalent coping strategy to decreased yields; however, nearly all the unfarmed land in western Uganda is now in protected areas. Consequently, western Uganda is facing a crisis at the nexus of population growth, land use change, and climate change. |
Leveraging health-related quality of life in population health management: the case for Healthy Days
Slabaugh SL , Shah M , Zack M , Happe L , Cordier T , Havens E , Davidson E , Miao M , Prewitt T , Jia H . Popul Health Manag 2016 20 (1) 13-22 Measuring population health with morbidity and mortality data, often collected at the site of care, fails to capture the individual's perspective on health and well-being. Because health happens outside the walls of medical facilities, a holistic and singular measure of health that can easily be captured for an entire population could aid in understanding the well-being of communities. This paper postulates that Healthy Days, a health-related quality of life measure developed and validated by the Centers for Disease Control and Prevention, is an ideal survey instrument to advance population health. A systematic literature review was conducted and revealed a strong evidence base using Healthy Days with significant correlations to chronic disease conditions. Building on the literature base and experience, methods for analyzing Healthy Days data are discussed, including stratified sampling techniques, statistical measures to account for variance, and modeling techniques for skewed distributions. Using such analytic techniques, Healthy Days has been used extensively in national health surveillance. As the health care system faces increasing costs and constrained resources, the Healthy Days survey instrument can be used to inform public policies and allocate health service resources. Because Healthy Days captures broad dimensions of health from the individual's perspective, it is a simple way to holistically measure the health and well-being of a population and its trend over time. Expanded use of Healthy Days can aid population health managers and contribute to the understanding of the broader determinants of the nation's and individual community's health and aid in evaluating progress toward health goals. (Population Health Management 2016;xx:xxx-xxx). |
Retail deli slicer cleaning frequency - six selected sites, United States, 2012
Brown LG , Hoover ER , Ripley D , Matis B , Nicholas D , Hedeen N , Faw B . MMWR Morb Mortal Wkly Rep 2016 65 (12) 306-310 Listeria monocytogenes (Listeria) causes the third highest number of foodborne illness deaths (an estimated 255) in the United States annually, after nontyphoidal Salmonella species and Toxoplasma gondii. Deli meats are a major source of listeriosis illnesses, and meats sliced and packaged at retail delis are the major source of listeriosis illnesses attributed to deli meat (4). Mechanical slicers pose cross-contamination risks in delis and are an important source of Listeria cross-contamination. Reducing Listeria contamination of sliced meats in delis will likely reduce Listeria illnesses and outbreaks (6). Good slicer cleaning practices can reduce this foodborne illness risk. CDC's Environmental Health Specialists Network (EHS-Net) studied how often retail deli slicers were fully cleaned (disassembled, cleaned, and sanitized) at the Food and Drug Administration (FDA) Food Code-specified minimum frequency of every 4 hours and examined deli and staff characteristics related to slicer cleaning frequency. Interviews with staff members in 298 randomly-selected delis in six EHS-Net sites showed that approximately half of delis fully cleaned their slicers less often than FDA's specified minimum frequency. Chain-owned delis and delis with more customers, more slicers, required manager food safety training, food safety-knowledgeable workers, written slicer-cleaning policies, and food safety-certified managers fully cleaned their slicers more frequently than did other types of delis, according to deli managers or workers. States and localities should require deli manager training and certification, as specified in the FDA Food Code. They should also consider encouraging or requiring delis to have written slicer-cleaning policies. Retail food industry leaders can also implement these prevention efforts to reduce risk in their establishments. Because independent and smaller delis had lower frequencies of slicer cleaning, prevention efforts should focus on these types of delis. |
Campylobacter jejuni infections associated with raw milk consumption - Utah, 2014
Davis KR , Dunn AC , Burnett C , McCullough L , Dimond M , Wagner J , Smith L , Carter A , Willardson S , Nakashima AK . MMWR Morb Mortal Wkly Rep 2016 65 (12) 301-305 In May 2014, the Utah Public Health Laboratory (UPHL) notified the Utah Department of Health (UDOH) of specimens from three patients infected with Campylobacter jejuni yielding indistinguishable pulsed-field gel electrophoresis (PFGE) patterns. All three patients had consumed raw (unpasteurized and nonhomogenized) milk from dairy A. In Utah, raw milk sales are legal from farm to consumer with a sales permit from the Utah Department of Agriculture and Food (UDAF). Raw milk dairies are required to submit monthly milk samples to UDAF for somatic cell and coliform counts, both of which are indicators of raw milk contamination. Before this cluster's identification, dairy A's routine test results were within acceptable levels (<400,000 somatic cells/mL and <10 coliform colony forming units/mL). Subsequent enhanced testing procedures recovered C. jejuni, a fastidious organism, in dairy A raw milk; the isolate matched the cluster pattern. UDAF suspended dairy A's raw milk permit during August 4-October 1, and reinstated the permit when follow-up cultures were negative. Additional cases of C. jejuni infection were identified in October, and UDAF permanently revoked dairy A's permit to sell raw milk on December 1. During May 9-November 6, 2014, a total of 99 cases of C. jejuni infection were identified. Routine somatic cell and coliform counts of raw milk do not ensure its safety. Consumers should be educated that raw milk might be unsafe even if it meets routine testing standards. |
Occupational exposure to bloodborne pathogens among health care workers in Botswana: Reporting and utilization of postexposure prophylaxis
Kassa G , Selenic D , Lahuerta M , Gaolathe T , Liu Y , Letang G , Courtenay-Quirk C , Mwaniki NK , Gaolekwe S , Bock N . Am J Infect Control 2016 44 (8) 879-85 BACKGROUND: This study assessed reporting behavior and satisfaction with postexposure prophylaxis (PEP) systems among health care workers (HCWs) at risk for occupational bloodborne pathogen exposure (BPE) in 3 public hospitals in Botswana. METHODS: A cross-sectional survey among HCWs provided information on perceptions, attitudes, and experiences with occupational exposures, reporting, and postexposure care. HCWs potentially in contact with blood or body fluids were surveyed using audio computer-assisted self-interview. RESULTS: Between August 2012 and April 2013, 1,624 HCWs completed the survey; most were women (72%), and almost half (48%) were nurses. Sixty-seven percent of them had ever received training related to BPE management; 62% perceived themselves to be at high risk for BPE. Among the 426 HCWs who were exposed to sharps injuries or splashes in the last 6 months, 160 (37%) reported the exposure. Of these, 111 of the 160 (69%) received PEP, and 79 of the 111 (71%) completed their medication. Whereas >92% of the total HCWs had ever been tested for HIV, only 557 (37%) were tested in their own health facility. Most HCWs (87%, n = 1,406) reported they would be interested in testing themselves. Of HCWs who reported an exposure, less than half (49%, n = 78) were satisfied with existing reporting systems. CONCLUSIONS: Underreporting of occupational exposures and dissatisfaction with PEP management is common among HCWs. Improved PEP management strategies and regular monitoring are needed. |
The dawning of microbiome remediation for addressing antibiotic resistance
Halpin AL , McDonald LC . Clin Infect Dis 2016 62 (12) 1487-8 The Centers for Disease Control and Prevention estimates that over two million infections in the United States each year are caused by antibiotic-resistant pathogens described as urgent, serious, and concerning threats, leading to 23,000 deaths and billions of dollars in excess medical costs [1]. Nearly half of these 18 antibiotic resistant threats are health care-associated pathogens and at least five frequently colonize the lower intestinal microbiota of patients. Among the many host and environmental factors that influence the composition of our microbiota, the most significant is the receipt of antibiotics [2–4]. Treatment with antibiotics eliminates not only pathogenic but also beneficial bacteria, resulting in severe disruption of the intestinal microbiota for an extended period of time (>6 months) [2]. This loss of diversity in the intestinal microbial composition places individuals at increased risk for poor outcomes, including colonization by pathogens, such as C. difficile and other multidrug-resistant organisms (MDROs), which can give way to their expansion, dominance, and infection and bacteremia [5–8]. | Among the almost 500,000 cases of Clostridium difficile infection (CDI) that occur each year, there are an estimated 83,000 recurrences of infection annually [9]. In recent years, the use of fecal microbiota transplantation (FMT) has garnered attention as a method for treating recurrent CDI by restoring the intestinal microbiota to a healthy state, preventing further recurrences [10]. The FDA has determined that FMTs are a biological product and a drug, and an investigational new drug (IND) application is required to use FMT for clinical indications, except for recurrent CDI for which an application is encouraged, but not required (http://www.regulations.gov/#!documentDetail;D=FDA-2013-D-0811-0002). This leaves a window open to use FMT for eradication of other MDROs, provided an IND application is submitted. Efforts to treat recurrent CDI have found concomitant eradication of other MDROs [11] and other groups have demonstrated clearance of ongoing colonization or recurrent infection by MDROs through FMT [12, 13]. |
Post-licensure surveillance of quadrivalent inactivated influenza (IIV4) vaccine in the United States, Vaccine Adverse Event Reporting System (VAERS), July 1, 2013-May 31, 2015.
Haber P , Moro PL , Lewis P , Woo EJ , Jankosky C , Cano M . Vaccine 2016 34 (22) 2507-12 BACKGROUND: Quadrivalent inactivated influenza vaccines (IIV4) were first available for use during 2013-14 influenza season for individuals aged ≥6 months. IIV4 is designed to protect against four different flu viruses; two influenza A viruses and two influenza B viruses. METHODS: We searched the Vaccine Adverse Event Reporting System (VAERS) for US reports after IIV4 and trivalent inactivated influenza vaccine (IIV3) from 7/1/2013-5/31/2015. Medical records were requested for non-manufacturer reports classified as serious (i.e. death, hospitalization, prolonged hospitalization, life-threatening illness, permanent disability). The review included automated data analysis, clinical review of all serious reports, reports of special interest, and empirical Bayesian data mining. RESULTS: VAERS received 1,838 IIV4 reports; 512 (28%) in persons aged 6 months-17 years of which 42 (8.2%) were serious reports; 1,265 (69%) in persons aged >18 years of which 84 (6.6%) were serious reports; two in children <6 months and 59 in persons of unknown age. Injection site erythema (24%), fever (14%) and injection site swelling (17%) were the most frequent adverse events among persons aged 6 months-17 years, while injection site pain (16%), pain (15%) and pain in extremity (13%) were the most frequent among persons aged 18-64 years given the vaccine alone. Among non-death serious reports, injection site reactions, constitutional symptoms, Guillain-Barre syndrome, seizures, and anaphylaxis were the most frequently reported adverse events. Data mining detected disproportional reporting for incorrect vaccine administration with no associated adverse events. Adverse events following IIV4 reported to VAERS were similar to those following IIV3. CONCLUSIONS: In our review of VAERS reports, IIV4 had a similar safety profile to IIV3. Most of the reported AEs were non-serious. Our findings are consistent with data from pre-licensure studies of IIV4. |
Seasonal influenza vaccine effectiveness against medically attended influenza illness among children aged 6-59 months, October 2011-September 2012: a matched test-negative case-control study in Suzhou, China
Wang Y , Zhang T , Chen L , Greene C , Ding Y , Cheng Y , Yang C , Zeng S , Hua J , Zhou S , Song Y , Luan L , Zhang J , Zhao G . Vaccine 2016 34 (21) 2460-2465 BACKGROUND: Seasonal influenza infections among young children in China lead to substantial numbers of hospitalizations and financial burden. This study assessed the seasonal influenza vaccine effectiveness (VE) against laboratory confirmed medically attended influenza illness among children in Suzhou, China, from October 2011-September 2012. METHODS: We conducted a test-negative case-control study among children aged 6-59 months who sought care at Soochow University Affiliated Children's Hospital (SCH) from October 2011-September 2012. A case was defined as a child with influenza-like illness (ILI) or severe acute respiratory infection (SARI) with an influenza-positive nasopharyngeal swab by rRT-PCR. Controls were selected from children presenting with ILI or SARI without laboratory confirmed influenza. We conducted 1:1 matching by age and admission date. Vaccination status was verified from the citywide immunization system database. VE was calculated with conditional logistic regression: (1-OR)x100%. RESULT: During the study period, 2634 children aged 6-59 months presented to SCH with ILI (1975) or SARI (659) and were tested for influenza. The vaccination records were available for 69% (1829; ILI: 1354, SARI: 475). Among those, 23% (427) tested positive for influenza, and were included as cases. Among influenza positive cases, the vaccination rates were 3.2% for SARI and 4.5% for ILI. Among controls, the vaccination rates were 13% for SARI, and 11% for ILI. The overall VE against lab-confirmed medically attended influenza virus infection was 67% (95% CI: 41-82). The VE for SARI was 75% (95% CI: 11-93) and for ILI was 64% (95% CI: 31-82). CONCLUSIONS: The seasonal influenza vaccine was effective against medically attended lab-confirmed influenza infection in children aged 6-59 months in Suzhou, China in the 2011-12 influenza season. Increasing seasonal influenza vaccination among young children in Suzhou may decrease medically attended influenza-associated ILI and SARI cases in this population. |
Sudden-onset sensorineural hearing loss after immunization: A case-centered analysis
Baxter R , Lewis N , Bohrer P , Harrington T , Aukes L , Klein NP . Otolaryngol Head Neck Surg 2016 155 (1) 81-6 OBJECTIVE: Case reports of sudden sensorineural hearing loss (SSHL) following vaccines have led to concerns that vaccines may rarely cause hearing loss. Because of this concern, we analyzed for an association between SSHL and vaccinations. STUDY DESIGN: We used a case-centered method, equivalent to a case control design using immunization dates from all matched members of the population to calculate exposure to vaccines, rather than sampling. SETTING: Kaiser Permanente Northern California (KPNC), 2007 to 2013. SUBJECTS AND METHODS: We searched KPNC databases from 2007 to 2013 for all first-time diagnoses of SSHL. We used the date of any hearing- or ear-related visit in the 60 days prior to the first SSHL diagnosis as the onset date. Using only SSHL cases immunized in the prior 9 months, we compared the vaccine exposure in several risk intervals prior to onset with the exposure to the same vaccine during the same time period in all KPNC membership, matched to sex and age. RESULTS: During the study period, >20 million vaccines were administered at KPNC. In all risk intervals prior to onset of SSHL, we found no evidence of increased risk of immunization compared with matched controls. The odds ratios for vaccination 1 week prior to SSHL were 0.965 (95% confidence interval, 0.61-1.50) for trivalent inactivated influenza vaccine (TIV); 0.842 (0.39-1.62) for tetanus, reduced diphtheria, and reduced acellular pertussis; and 0.454 (0.08-1.53) for zoster vaccine. CONCLUSION: A large-scale analysis applying a case-centered method did not detect any association between SSHL and previous receipt of TIV or other vaccines. |
Temporal patterns of influenza A and B in tropical and temperate countries: What are the lessons for influenza vaccination?
Caini S , Andrade W , Badur S , Balmaseda A , Barakat A , Bella A , Bimohuen A , Brammer L , Bresee J , Bruno A , Castillo L , Ciblak MA , Clara AW , Cohen C , Cutter J , Daouda C , de Lozano C , De Mora D , Dorji K , Emukule GO , Fasce RA , Feng L , Ferreira de Almeida WA , Guiomar R , Heraud JM , Holubka O , Huang QS , Kadjo HA , Kiyanbekova L , Kosasih H , Kusznierz G , Lara J , Li M , Lopez L , Mai Hoang PV , Pessanha Henriques CM , Matute ML , Mironenko A , Moreno B , Mott JA , Njouom R , Nurhayati , Ospanova A , Owen R , Pebody R , Pennington K , Puzelli S , Quynh Le MT , Razanajatovo NH , Rodrigues A , Rudi JM , Tzer Pin Lin R , Venter M , Vernet MA , Wangchuk S , Yang J , Yu H , Zambon M , Schellevis F , Paget J . PLoS One 2016 11 (3) e0152310 INTRODUCTION: Determining the optimal time to vaccinate is important for influenza vaccination programmes. Here, we assessed the temporal characteristics of influenza epidemics in the Northern and Southern hemispheres and in the tropics, and discuss their implications for vaccination programmes. METHODS: This was a retrospective analysis of surveillance data between 2000 and 2014 from the Global Influenza B Study database. The seasonal peak of influenza was defined as the week with the most reported cases (overall, A, and B) in the season. The duration of seasonal activity was assessed using the maximum proportion of influenza cases during three consecutive months and the minimum number of months with ≥80% of cases in the season. We also assessed whether co-circulation of A and B virus types affected the duration of influenza epidemics. RESULTS: 212 influenza seasons and 571,907 cases were included from 30 countries. In tropical countries, the seasonal influenza activity lasted longer and the peaks of influenza A and B coincided less frequently than in temperate countries. Temporal characteristics of influenza epidemics were heterogeneous in the tropics, with distinct seasonal epidemics observed only in some countries. Seasons with co-circulation of influenza A and B were longer than influenza A seasons, especially in the tropics. DISCUSSION: Our findings show that influenza seasonality is less well defined in the tropics than in temperate regions. This has important implications for vaccination programmes in these countries. High-quality influenza surveillance systems are needed in the tropics to enable decisions about when to vaccinate. |
Quadrivalent HPV vaccine safety review and US safety monitoring plans for nine-valent HPV vaccine
Gee J , Weinbaum C , Sukumaran L , Markowitz LE . Hum Vaccin Immunother 2016 12 (6) 0 Quadrivalent human papillomavirus (4vHPV) vaccine was licensed for use in the United States in 2006 and through 2015 was the predominate HPV vaccine used. With the exception of syncope, a known preventable adverse event after any injected vaccination, both pre-licensure and post-licensure 4vHPV safety data have been reassuring with no confirmed safety signals identified. Nine-valent HPV vaccine (9vHPV) was licensed in 2014. This review includes post-licensure 4vHPV safety findings published to date that have informed the US vaccination program; these data will inform US safety monitoring and evaluation for 9vHPV. |
Impact of tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis vaccinations on reported pertussis cases among those 11 to 18 years of age in an era of waning pertussis immunity: a follow-up analysis
Skoff TH , Martin SW . JAMA Pediatr 2016 170 (5) 453-8 IMPORTANCE: There is accumulating literature on waning acellular pertussis vaccine-induced immunity, confirming the results of studies assessing the duration of protection of pertussis vaccines. OBJECTIVE: To evaluate the tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccine's effect over time among those 11 to 18 years old, while accounting for the transition from whole-cell to acellular pertussis vaccines for the childhood primary series. DESIGN, SETTING, AND PARTICIPANTS: Extended, retrospective analysis of reported pertussis cases between January 1, 1990, and December 31, 2014, in the United States. The analysis included all nationally reported pertussis cases. Exposure: US Tdap vaccination program and the transition from whole-cell to acellular pertussis vaccines. MAIN OUTCOMES AND MEASURES: Rate ratios of reported pertussis incidence (defined as incidence among 11- to 18-year-old individuals divided by the combined incidence in all other age groups) modeled with segmented regression analysis and age-specific trends in reported pertussis incidence over time. RESULTS: Between 1990 and 2014, 356557 pertussis cases were reported in the United States. Of those, 191914 (53.8%) were female and 240665 (67.5%) were white. Overall incidence increased from 1.7 in 100000 to 4.0 in 100000 between 1990 and 2003, while latter years were dominated by epidemic peaks. Incidence was highest among infants younger than 1 year throughout the analysis period. Pertussis rates were comparable among all other age groups until the late 2000s, when an increased burden of pertussis emerged among children 1 to 10 years old, resulting in the second highest age-specific incidence. By 2014, 11- to 18-year-old individuals once again had the second highest incidence. While slope coefficients from segmented regression analysis showed a positive impact of Tdap immediately following introduction (slope, -0.4959; P < .001), a reversal in trends was observed in 2010 when rates of disease among 11- to 18-year-old individuals increased at a faster rate than all other age groups combined (slope, 0.5727; P < .001). CONCLUSIONS AND RELEVANCE: While the impact of Tdap among adolescents looked promising following vaccine introduction, our extended analysis found that trends in adolescent disease were abruptly reversed in 2010, corresponding directly to the aging of acellular pertussis-vaccinated cohorts. Despite the apparent limitations of Tdap, it remains the best prevention against disease in adolescents. |
Prevalence of drink-driving among adults in China: a nationally representative survey in 2010
Xiao D , Pengpeng Y , Yichong L , Leilei D , Limin W , Shults RA , Roehler DR , Yee SL . Traffic Inj Prev 2016 18 (8) 0 OBJECTIVE: We examined the prevalence of and characteristics associated with drink-driving in China. We compared this study's drink-driving findings with those from the United States to explore how effective traffic safety interventions from Western cultures might be adapted for use in China. METHODS: Data from the 2010 China Chronic Disease and Risk Factor Survey were analyzed to describe the prevalence and characteristics associated with drink-driving in China. RESULTS: Overall, 1.5% of Chinese adults reported drink-driving in the past 30 days-3% of males and 0.1% of females. However, among males who had driven a vehicle in the past 30 days and consumed at least one alcoholic beverage in the past 30 days, 19% reported drink-driving during the 30-day period. Excessive drinking, binge drinking, nonuse of seat belts, and having been injured in a road traffic crash in the past year were most strongly associated with drink-driving among males. CONCLUSION: Drink-driving is prevalent among male drivers in China. Although large differences exist between China and the United States in the proportion of adults who drive, the proportion who consume alcohol, and some of the personal characteristics of those who drink and drive, similarities between the two countries are present in patterns of risk behaviours among drink-driving. To reduce injuries and deaths from drink-driving, effective interventions from Western cultures need to be tailored for adoption in China. |
Implementing and evaluating comprehensive evidence-based approaches to prevent youth violence: partnering to create communities where youth are safe from violence
Matjasko JL , Massetti GM , Bacon S . J Prim Prev 2016 37 (2) 109-19 Violence, including its occurrence among youth, results in considerable physical, emotional, social, and economic consequences in the U.S. Youth violence prevention work at the Division of Violence Prevention (DVP) at the Centers for Disease Control and Prevention (CDC) emphasizes preventing youth violence-related behaviors, injuries, and deaths by collaborating with academic and community partners and stakeholders. Since 2000, DVP has funded three rounds of CDC's National Centers of Excellence in Youth Violence Prevention (YVPCs) in 5-year cycles, with the goal of supporting university-community partnerships so that the best science can be utilized in order to prevent youth violence. The current YVPCs focus on: (a) partnering with communities to identify community needs; (b) selecting and implementing the best comprehensive evidence-based programs to meet those needs; and (c) rigorously evaluating whether those efforts have a community-level impact on youth violence rates. The introduction to this special issue on the current YVPCs provides a brief historical overview on the YVPC Program; outlines the YVPCs' accomplishments to date; and describes the current YVPCs, their community partners, and their activities. The introduction concludes with an overview of the special issue. |
The Center for Disease Control and Prevention's (CDC) Youth Violence Prevention Centers: paving the way to prevention
Mercy JA , Vivolo-Kantor AM . J Prim Prev 2016 37 (2) 209-14 When you think about violence in the United States in recent years, it is clear that we have been transfixed by a seemingly unending series of tragedies associated with mass shootings. While those events deserve our utmost attention, what has been largely ignored is the fact that we lose an average of 12 youth 10–24 years of age to homicide each day in this country [Centers for Disease Control and Prevention (CDC), 2014]. In effect, every day in the United States we lose more young people to “unrelated” homicides than occur in a typical mass shooting. The health burden of these “unrelated” homicides and associated nonfatal violence dwarfs that of the mass shootings of which we, as a society, have been so acutely aware. All the while, in the dark, the broader and much larger problem of youth violence continues, largely unacknowledged and unaddressed. However, despite the relative obscurity this issue has faced, great progress is being made in understanding how communities can work together to prevent it. |
The Evolution of Advanced Molecular Diagnostics for the Detection and Characterization of Mycoplasma pneumoniae.
Diaz MH , Winchell JM . Front Microbiol 2016 7 232 Over the past decade there have been significant advancements in the methods used for detecting and characterizing Mycoplasma pneumoniae, a common cause of respiratory illness and community-acquired pneumonia worldwide. The repertoire of available molecular diagnostics has greatly expanded from nucleic acid amplification techniques (NAATs) that encompass a variety of chemistries used for detection, to more sophisticated characterizing methods such as multi-locus variable-number tandem-repeat analysis (MLVA), Multi-locus sequence typing (MLST), matrix-assisted laser desorption ionization-time-of-flight mass spectrometry (MALDI-TOF MS), single nucleotide polymorphism typing, and numerous macrolide susceptibility profiling methods, among others. These many molecular-based approaches have been developed and employed to continually increase the level of discrimination and characterization in order to better understand the epidemiology and biology of M. pneumoniae. This review will summarize recent molecular techniques and procedures and lend perspective to how each has enhanced the current understanding of this organism and will emphasize how Next Generation Sequencing may serve as a resource for researchers to gain a more comprehensive understanding of the genomic complexities of this insidious pathogen. |
Strengthening the tuberculosis specimen referral network in Uganda: The role of public-private partnerships
Joloba M , Mwangi C , Alexander H , Nadunga D , Bwanga F , Modi N , Downing R , Nabasirye A , Adatu FE , Shrivastava R , Gadde R , Nkengasong JN . J Infect Dis 2016 213 Suppl 2 S41-6 BACKGROUND: Diagnosis of multidrug-resistant tuberculosis and prompt initiation of effective treatment rely on access to rapid and reliable drug-susceptibility testing. Efficient specimen transport systems and appropriate training on specimen referral contribute to optimal and timely access to tuberculosis diagnostic services. METHODS: With support and technical assistance from a public-private partnership (PPP) between Becton Dickinson and the US President's Emergency Plan for AIDS Relief, the Uganda National TB Reference Laboratory (NTRL) and National TB and Leprosy Program redesigned the tuberculosis specimen transport network and trained healthcare workers with the goal of improving multidrug-resistant tuberculosis detection. RESULTS: Between 2008 and 2011, the PPP mapped 93% of health facilities and trained 724 healthcare and postal staff members covering 72% of districts. Strengthening the tuberculosis specimen referral system increased referrals from presumptive multidrug-resistant tuberculosis cases by >10-fold, with 94% of specimens reaching the NTRL within the established target transport time. CONCLUSIONS: This study demonstrates the potential of PPP collaborations with ministries of health to positively influence patient care by strengthening laboratory systems through increased access to drug-susceptibility testing in Uganda. Ongoing efforts to integrate specimen transport networks will maximize resources and improve patient management. |
Method for quantification of insecticide in mosquito netting using ion implantation and ToF-SIMS analysis
Zhou C , Stevie FA , Smith SC . J Vac Sci Technol B Nanotechnol Microelectron 2016 34 (3) Permethrin is used worldwide as a mosquito insecticide for netting and fabric. Permethrin is a contact insecticide so only the permethrin on the surface can directly impact the mosquito. Therefore, knowledge of the surface concentration of the insecticide is essential to measure the effectiveness of the treated material. Time-of-flight secondary ion mass spectrometry analysis of permethrin showed Cl- as the predominant species in the negative ion mass spectrum. The netting material in this study is composed of high density polyethylene (HDPE). Ion implantation was used to place a known amount of chlorine into the netting material, sheet HDPE, and silicon samples. Depth profile analysis of the implanted samples showed distinct chlorine implant profiles, with the silicon sample used to verify implant dose. Quantification and detection limit for chlorine have been obtained for HDPE sheet and netting. The chlorine detection limit in HDPE is approximately 2 × 1018 atoms/cm3, and the chlorine concentration in netting fibers ranged from 4 × 1019 to 1.2 × 1020 atoms/cm3, which compares very well with the amount of insecticide put into the netting during fabrication. The results make possible the study of insecticide content at the surface and in the bulk of the netting. Investigation is in progress for the effect of washing mosquito nets on surface chlorine concentration. © 2016 American Vacuum Society. |
Implementing laboratory quality management systems in Mozambique: the Becton Dickinson-US President's Emergency Plan for AIDS Relief Public-Private Partnership initiative
Skaggs B , Pinto I , Masamha J , Turgeon D , Gudo ES . J Infect Dis 2016 213 Suppl 2 S47-52 BACKGROUND: Mozambique's ministry of health (MOH) recognized the need to establish a national laboratory quality assurance (NLQA) program to improve the reliability and accuracy of laboratory testing. The Becton Dickinson-US President's Emergency Plan for AIDS Relief Public-Private Partnership (PPP) was used to garner MOH commitment and train a cadre of local auditors and managers to support sustainability and country ownership of a NLQA program. METHODS: From January 2011 to April 2012, the World Health Organization Regional Office for Africa Stepwise Laboratory Quality Improvement Process Towards Accreditation (SLIPTA) checklist and the Strengthening Laboratory Management Towards Accreditation (SLMTA) curriculum were used in 6 MOH laboratories. PPP volunteers provided training and mentorship to build the capacity of local auditors and program managers to promote institutionalization and sustainability of the program within the MOH. RESULTS: SLIPTA was launched in 6 MOH laboratories, and final audits demonstrated improvements across the 13 quality system essentials, compared with baseline. Training and mentorship of MOH staff by PPP volunteers resulted in 18 qualified auditors and 28 managers/quality officers capacitated to manage the improvement process in their laboratories. CONCLUSIONS: SLIPTA helps laboratories improve the quality and reliability of their service even in the absence of full accreditation. Local capacity building ensures sustainability by creating country buy-in, reducing costs of audits, and institutionalizing program management. |
Importance of public-private partnerships: strengthening laboratory medicine systems and clinical practice in Africa
Shrivastava R , Gadde R , Nkengasong JN . J Infect Dis 2016 213 Suppl 2 S35-40 After the launch of the US President's Emergency Plan for AIDS Relief in 2003, it became evident that inadequate laboratory systems and services would severely limit the scale-up of human immunodeficiency virus infection prevention, care, and treatment programs. Thus, the Office of the US Global AIDS Coordinator, Centers for Disease Control and Prevention, and Becton, Dickinson and Company developed a public-private partnership (PPP). Between October 2007 and July 2012, the PPP combined the competencies of the public and private sectors to boost sustainable laboratory systems and develop workforce skills in 4 African countries. Key accomplishments of the initiative include measurable and scalable outcomes to strengthen national capacities to build technical skills, develop sample referral networks, map disease prevalence, support evidence-based health programming, and drive continuous quality improvement in laboratories. This report details lessons learned from our experience and a series of recommendations on how to achieve successful PPPs. |
Improved specimen-referral system and increased access to quality laboratory services in Ethiopia: The role of the public-private partnership
Kebede Y , Fonjungo PN , Tibesso G , Shrivastava R , Nkengasong JN , Kenyon T , Kebede A , Gadde R , Ayana G . J Infect Dis 2016 213 Suppl 2 S59-64 BACKGROUND: Nonstandardized specimen-transport logistics, lack of laboratory personnel to transport specimens, lack of standard specimen containers, and long turnaround time (TAT) hindered access to quality laboratory services. The objective of the Becton, Dickinson, and Company (BD)-US President's Emergency Plan for AIDS Relief (PEPFAR) Public-Private Partnership (PPP) was to support country-specific programs to develop integrated laboratory systems, services, and quality improvement strategies, with an emphasis on strengthening the specimen-referral system (SRS). METHODS: In 2007, through the Centers for Disease Control and Prevention (CDC), the Ethiopian Public Health Institute (EPHI) joined with the BD-PEPFAR PPP to strengthen laboratory systems. A joint planning and assessment committee identified gaps in the SRS for prioritization and intervention and piloted the system in Addis Ababa and Amhara Region. RESULTS: The PPP established standardized, streamlined specimen logistics, using the Ethiopian Postal Service Enterprise to support a laboratory network in which 554 facilities referred specimens to 160 laboratories. The PPP supported procuring 400 standard specimen containers and the training of 586 laboratory personnel and 81 postal workers. The average TAT was reduced from 7 days (range, 2-14 days) to 2 days (range, 1-3 days) in Addis Ababa and from 10 days (range, 6-21 days) to 5 days (range, 2-6 days) in Amhara Region. CONCLUSIONS: This study highlights the feasibility and untapped potential of PPPs to strengthen laboratory systems. This planned and structured approach to improving specimen referral enhanced access to quality laboratory services. |
Biological matrix effects in quantitative tandem mass spectrometry-based analytical methods: advancing biomonitoring
Panuwet P , Hunter RE Jr , D'Souza PE , Chen X , Radford SA , Cohen JR , Marder ME , Kartavenka K , Ryan PB , Barr DB . Crit Rev Anal Chem 2016 46 (2) 93-105 The ability to quantify levels of target analytes in biological samples accurately and precisely in biomonitoring involves the use of highly sensitive and selective instrumentation such as tandem mass spectrometers and a thorough understanding of highly variable matrix effects. Typically, matrix effects are caused by co-eluting matrix components that alter the ionization of target analytes as well as the chromatographic response of target analytes, leading to reduced or increased sensitivity of the analysis. Thus, before the desired accuracy and precision standards of laboratory data are achieved, these effects must be characterized and controlled. Here we present our review and observations of matrix effects encountered during the validation and implementation of tandem mass spectrometry-based analytical methods. We also provide systematic, comprehensive laboratory strategies needed to control challenges posed by matrix effects in order to ensure delivery of the most accurate data for biomonitoring studies assessing exposure to environmental toxicants. |
Comparative yield of different diagnostic tests for tuberculosis among people living with HIV in Western Kenya
Cavanaugh JS , Modi S , Musau S , McCarthy K , Alexander H , Burmen B , Heilig CM , Shiraishi RW , Cain K . PLoS One 2016 11 (3) e0152364 BACKGROUND: Diagnosis followed by effective treatment of tuberculosis (TB) reduces transmission and saves lives in persons living with HIV (PLHIV). Sputum smear microscopy is widely used for diagnosis, despite limited sensitivity in PLHIV. Evidence is needed to determine the optimal diagnostic approach for these patients. METHODS: From May 2011 through June 2012, we recruited PLHIV from 15 HIV treatment centers in western Kenya. We collected up to three sputum specimens for Ziehl-Neelsen (ZN) and fluorescence microscopy (FM), GeneXpert MTB/RIF (Xpert), and culture, regardless of symptoms. We calculated the incremental yield of each test, stratifying results by CD4 cell count and specimen type; data were analyzed to account for complex sampling. RESULTS: From 778 enrolled patients, we identified 88 (11.3%) laboratory-confirmed TB cases. Of the 74 cases who submitted 2 specimens for microscopy and Xpert testing, ZN microscopy identified 25 (33.6%); Xpert identified those plus an additional 18 (incremental yield = 24.4%). Xpert testing of spot specimens identified 48 (57.0%) of 84 cases; whereas Xpert testing of morning specimens identified 50 (66.0%) of 76 cases. Two Xpert tests detected 22/24 (92.0%) TB cases with CD4 counts <100 cells/muL and 30/45 (67.0%) of cases with CD4 counts ≥100 cells/mul. CONCLUSIONS: In PLHIV, Xpert substantially increased diagnostic yield compared to smear microscopy and had the highest yield when used to test morning specimens and specimens from PLHIV with CD4 count <100 cells/muL. TB programs unable to replace smear microscopy with Xpert for all symptomatic PLHIV should consider targeted replacement and using morning specimens. |
Prevalence and characteristics of autism spectrum disorder among children aged 8 years - Autism and Developmental Disabilities Monitoring Network, 11 sites, United States, 2012
Christensen DL , Baio J , Braun KV , Bilder D , Charles J , Constantino JN , Daniels J , Durkin MS , Fitzgerald RT , Kurzius-Spencer M , Lee LC , Pettygrove S , Robinson C , Schulz E , Wells C , Wingate MS , Zahorodny W , Yeargin-Allsopp M . MMWR Surveill Summ 2016 65 (3) 1-23 PROBLEM/CONDITION: Autism spectrum disorder (ASD). PERIOD COVERED: 2012. DESCRIPTION OF SYSTEM: The Autism and Developmental Disabilities Monitoring (ADDM) Network is an active surveillance system that provides estimates of the prevalence and characteristics of ASD among children aged 8 years whose parents or guardians reside in 11 ADDM Network sites in the United States (Arkansas, Arizona, Colorado, Georgia, Maryland, Missouri, New Jersey, North Carolina, South Carolina, Utah, and Wisconsin). Surveillance to determine ASD case status is conducted in two phases. The first phase consists of screening and abstracting comprehensive evaluations performed by professional service providers in the community. Data sources identified for record review are categorized as either 1) education source type, including developmental evaluations to determine eligibility for special education services or 2) health care source type, including diagnostic and developmental evaluations. The second phase involves the review of all abstracted evaluations by trained clinicians to determine ASD surveillance case status. A child meets the surveillance case definition for ASD if one or more comprehensive evaluations of that child completed by a qualified professional describes behaviors that are consistent with the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision diagnostic criteria for any of the following conditions: autistic disorder, pervasive developmental disorder-not otherwise specified (including atypical autism), or Asperger disorder. This report provides ASD prevalence estimates for children aged 8 years living in catchment areas of the ADDM Network sites in 2012, overall and stratified by sex, race/ethnicity, and the type of source records (education and health records versus health records only). In addition, this report describes the proportion of children with ASD with a score consistent with intellectual disability on a standardized intellectual ability test, the age at which the earliest known comprehensive evaluation was performed, the proportion of children with a previous ASD diagnosis, the specific type of ASD diagnosis, and any special education eligibility classification. RESULTS: For 2012, the combined estimated prevalence of ASD among the 11 ADDM Network sites was 14.6 per 1,000 (one in 68) children aged 8 years. Estimated prevalence was significantly higher among boys aged 8 years (23.6 per 1,000) than among girls aged 8 years (5.3 per 1,000). Estimated ASD prevalence was significantly higher among non-Hispanic white children aged 8 years (15.5 per 1,000) compared with non-Hispanic black children (13.2 per 1,000), and Hispanic (10.1 per 1,000) children aged 8 years. Estimated prevalence varied widely among the 11 ADDM Network sites, ranging from 8.2 per 1,000 children aged 8 years (in the area of the Maryland site where only health care records were reviewed) to 24.6 per 1,000 children aged 8 years (in New Jersey, where both education and health care records were reviewed). Estimated prevalence was higher in surveillance sites where education records and health records were reviewed compared with sites where health records only were reviewed (17.1 per 1,000 and 10.7 per 1,000 children aged 8 years, respectively; p<0.05). Among children identified with ASD by the ADDM Network, 82% had a previous ASD diagnosis or educational classification; this did not vary by sex or between non-Hispanic white and non-Hispanic black children. A lower percentage of Hispanic children (78%) had a previous ASD diagnosis or classification compared with non-Hispanic white children (82%) and with non-Hispanic black children (84%). The median age at earliest known comprehensive evaluation was 40 months, and 43% of children had received an earliest known comprehensive evaluation by age 36 months. The percentage of children with an earliest known comprehensive evaluation by age 36 months was similar for boys and girls, but was higher for non-Hispanic white children (45%) compared with non-Hispanic black children (40%) and Hispanic children (39%). INTERPRETATION: Overall estimated ASD prevalence was 14.6 per 1,000 children aged 8 years in the ADDM Network sites in 2012. The higher estimated prevalence among sites that reviewed both education and health records suggests the role of special education systems in providing comprehensive evaluations and services to children with developmental disabilities. Disparities by race/ethnicity in estimated ASD prevalence, particularly for Hispanic children, as well as disparities in the age of earliest comprehensive evaluation and presence of a previous ASD diagnosis or classification, suggest that access to treatment and services might be lacking or delayed for some children. PUBLIC HEALTH ACTION: The ADDM Network will continue to monitor the prevalence and characteristics of ASD among children aged 8 years living in selected sites across the United States. Recommendations from the ADDM Network include enhancing strategies to 1) lower the age of first evaluation of ASD by community providers in accordance with the Healthy People 2020 goal that children with ASD are evaluated by age 36 months and begin receiving community-based support and services by age 48 months; 2) reduce disparities by race/ethnicity in identified ASD prevalence, the age of first comprehensive evaluation, and presence of a previous ASD diagnosis or classification; and 3) assess the effect on ASD prevalence of the revised ASD diagnostic criteria published in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. |
Impact of missing data for body mass index in an epidemiologic study
Razzaghi H , Tinker SC , Herring AH , Howards PP , Waller DK , Johnson CY . Matern Child Health J 2016 20 (7) 1497-505 OBJECTIVE: To assess the potential impact of missing data on body mass index (BMI) on the association between prepregnancy obesity and specific birth defects. METHODS: Data from the National Birth Defects Prevention Study (NBDPS) were analyzed. We assessed the factors associated with missing BMI data among mothers of infants without birth defects. Four analytic methods were then used to assess the impact of missing BMI data on the association between maternal prepregnancy obesity and three birth defects; spina bifida, gastroschisis, and cleft lip with/without cleft palate. The analytic methods were: (1) complete case analysis; (2) assignment of missing values to either obese or normal BMI; (3) multiple imputation; and (4) probabilistic sensitivity analysis. Logistic regression was used to estimate crude and adjusted odds ratios (aOR) and 95 % confidence intervals (CI). RESULTS: Of NBDPS control mothers 4.6 % were missing BMI data, and most of the missing values were attributable to missing height (~90 %). Missing BMI data was associated with birth outside of the US (aOR 8.6; 95 % CI 5.5, 13.4), interview in Spanish (aOR 2.4; 95 % CI 1.8, 3.2), Hispanic ethnicity (aOR 2.0; 95 % CI 1.2, 3.4), and <12 years education (aOR 2.3; 95 % CI 1.7, 3.1). Overall the results of the multiple imputation and probabilistic sensitivity analysis were similar to the complete case analysis. CONCLUSIONS: Although in some scenarios missing BMI data can bias the magnitude of association, it does not appear likely to have impacted conclusions from a traditional complete case analysis of these data. |
School district policies and adolescents' soda consumption
Miller GF , Sliwa S , Brener ND , Park S , Merlo CL . J Adolesc Health 2016 59 (1) 17-23 PURPOSE: Sugar-sweetened beverages (SSBs) are a significant source of calories and added sugars for youth ages 14-18 years in the United States. This study examined the relationship between district-level policies and practices and students' consumption of regular soda, one type of SSB, in 12 large urban school districts. METHODS: Data from the 2012 School Health Policies and Practices Study and 2013 Youth Risk Behavior Surveillance System were linked by district. The outcome variable was soda consumption and exposure variables were district policies. We used multivariable logistic regression analyses to calculate adjusted odds ratios (AORs) and 95% confidence intervals (CIs) after controlling for student characteristics and district free/reduced-price meal eligibility. RESULTS: About 18% of students reported consuming regular soda at least once per day. Most districts required high schools to have nutrition education, maintain closed campuses, and required/recommended that schools restrict promotional products and sale of beverages. Fewer districts required/recommended that schools offer healthful alternative beverages. Students in districts that restricted promotional products had lower odds of regular soda consumption (AOR = .84, 95% CI = .71-1.00), as did students in districts that restricted access to SSBs and offered healthful beverages when other beverages were available (AOR = .72, 95% CI = .54-.93, AOR = .76, 95% CI = .63-.91). CONCLUSIONS: This study demonstrates that certain district-level policies are associated with student consumption of regular soda. These findings add to a growing consensus that policies and practices that influence the availability of healthier foods and beverages are needed across multiple settings. |
Common ways Americans are incorporating fruits and vegetables into their diet: intake patterns by meal, source and form, National Health and Nutrition Examination Survey 2007-2010
Moore LV , Hamner HC , Kim SA , Dalenius K . Public Health Nutr 2016 19 (14) 1-5 OBJECTIVE: We explored how Americans aged ≥2 years who consumed the recommended amount of fruits and vegetables on a given day incorporated fruits and vegetables into their diet compared with those who did not consume recommended amounts. DESIGN: We used 1 d of dietary recall data from the National Health and Nutrition Examination Survey (NHANES) 2007-2010 to examine cross-sectional differences in mean intakes of fruits and vegetables in cup-equivalents by meal, source and form between the two groups. SETTING: USA. SUBJECTS: NHANES 2007-2010 participants aged ≥2 years (n 17 571) with 1 d of reliable 24 h recall data. RESULTS: On a given day, the proportions of fruits and vegetables consumed at different meals were similar between those who consumed recommended amounts and those who did not. Among adults, 59-64 % of their intake of fruits was consumed at breakfast or as a snack and almost 90 % came from retail outlets regardless of whether they consumed the recommended amount or not. Adults who consumed the recommended amount of fruits ate more fruits in raw form and with no additions than those who did not. Among children and adults, 52-57 % of vegetables were consumed at dinner by both groups. Retail outlets were the main source of vegetables consumed (60-68 %). CONCLUSIONS: Our findings indicate that habits of when, where and how consumers eat fruits and vegetables might not need to change but increasing the amount consumed would help those not currently meeting the recommendation. |
Refinement of the nanoparticle emission assessment technique into the Nanomaterial Exposure Assessment Technique (NEAT 2.0)
Eastlake AC , Beaucham C , Martinez KF , Dahm MM , Sparks C , Hodson LL , Geraci CL . J Occup Environ Hyg 2016 13 (9) 0 Engineered nanomaterial emission and exposure characterization studies have been completed at more than 60 different facilities by the National Institute for Occupational Safety and Health (NIOSH). These experiences have provided NIOSH the opportunity to refine an earlier published technique, the Nanoparticle Emission Assessment Technique (NEAT 1.0), into a more comprehensive technique for assessing worker and workplace exposures to engineered nanomaterials. This change is reflected in the new name Nanomaterial Exposure Assessment Technique (NEAT 2.0) which distinguishes it from NEAT 1.0. NEAT 2.0 places a stronger emphasis on time-integrated, filter-based sampling (i.e., elemental mass analysis and particle morphology) in the worker's breathing zone (full shift and task specific) and area samples to develop job exposure matrices. NEAT 2.0 includes a comprehensive assessment of emissions at processes and job tasks, using direct-reading instruments (i.e., particle counters) in data-logging mode to better understand peak emission periods. Evaluation of worker practices, ventilation efficacy, and other engineering exposure control systems and risk management strategies serve to allow for a comprehensive exposure assessment. |
Potential explosion hazard of carbonaceous nanoparticles: screening of allotropes
Turkevich LA , Fernback J , Dastidar AG , Osterberg P . Combust Flame 2016 167 218-227 There is a concern that engineered carbon nanoparticles, when manufactured on an industrial scale, will pose an explosion hazard. Explosion testing has been performed on 20 codes of carbonaceous powders. These include several different codes of SWCNTs (single-walled carbon nanotubes), MWCNTs (multi-walled carbon nanotubes) and CNFs (carbon nanofibers), graphene, diamond, fullerene, as well as several different control carbon blacks and graphites. Explosion screening was performed in a 20L explosion chamber (ASTM E1226 protocol), at a concentration of 500g/m3, using a 5kJ ignition source. Time traces of overpressure were recorded. Samples typically exhibited overpressures of 5-7 bar, and deflagration index K St = V 1/3 (dP/dt)max ∼10-80barm/s, which places these materials in European Dust Explosion Class St-1. There is minimal variation between these different materials. The explosive characteristics of these carbonaceous powders are uncorrelated with primary particle size (BET specific surface area). © 2016. |
Assessment of airborn multiwalled carbon nanotubes in a manufactoring environment
Fatkhutdinova LM , Khaliullin TO , Zalyalov RR , Tkachev AG , Birch ME , Shvedova AA . Nanotechnol Russ 2016 11 (1) 110-116 This study was carried out in a factory producing multiwalled carbon nanotubes (MWCNTs) by the catalytic chemical vapor deposition method in a pyrolysis reactor. Air samples of the personal breathing areas were collected simultaneously on mixed cellulose ester filters, for analysis by transmission electron s (TEM), and on high-purity quartz filters for thermal-optical analysis of elemental carbon (EC). It is found that the production of MWCNTs is accompanied by the release of the MWCNT structures in the air of different working zones. The concentration of respirable aerosol in the personal breathing areas, averaged over an 8-hour period, ranges from 0.54 to 6.11 μg/m3 based on EC. Airborne MWCNTs were found in the form of agglomerates that range in size from about 1 to 10 μm. These data are consistent with measurements in different plants by two other international groups (from the United States and Sweden) using similar methodology (TEM in combination with EC analysis). In the absence of convincing data on the potential health risks of MWCNTs, and following the principle of reasonable precautions, preventive measures should be taken to minimize exposure to these materials. |
Notes from the field: Imported cases of malaria - Puerto Rico, July-October 2015
Dirlikov E , Rodriguez C , Morales S , Martinez LC , Mendez JB , Sanchez AC , Burgos JH , Santiago Z , Cuevas-Ruis RI , Camacho SA , Mercado ER , Guzman JF , Ryff K , Luna-Pinto C , Arguin PM , Chenet SM , Silva-Flannery L , Ljolje D , Velazquez JC , Thomas D , Garcia BR . MMWR Morb Mortal Wkly Rep 2016 65 (12) 326-327 On July 16 2015, the Puerto Rico Department of Health (PRDH) was notified of a case of malaria, diagnosed by a hospital parasitology laboratory in a student who had traveled to Punta Cana, Dominican Republic, during late June for a school-organized graduation trip. Malaria is a mosquito-borne parasitic infection, characterized by fever, shaking chills, headaches, muscle pains, nausea, general malaise, and vomiting. Malaria can be clinically difficult to distinguish from other acute febrile illnesses, and a definitive diagnosis requires demonstration of malaria parasites using microscopy or molecular diagnostic tests. The student's initial diagnosis on July 10 was suspected dengue virus infection. Puerto Rico eliminated local malaria transmission during the mid-1950s; however, reintroduction remains a risk because of the presence of a competent vector (Anopheles albimanus) and ease of travel to areas where the disease is endemic, including Hispaniola, the island shared by the Dominican Republic and Haiti, and the only island in the Caribbean with endemic malaria. During 2014, the Dominican Republic reported 496 confirmed malaria cases and four associated deaths; Haiti reported 17,662 confirmed cases and nine deaths. During 2000-2014, Puerto Rico reported a total of 35 imported malaria cases (range = 0-7 per year); three cases were imported from Hispaniola. During June-August 2015, eight confirmed malaria cases among travelers to the Dominican Republic were reported to CDC's National Malaria Surveillance System (CDC, unpublished data, 2015). |
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