Enhancing screening and early detection among women transitioning to Medicare from the NBCCEDP in Georgia
Adams EK , Bayakly AR , Berzen AK , Blake S , Joski P , Li C , Hall IJ , Sabatino SA . Cancer Causes Control 2015 26 (5) 795-803 PURPOSE: The National Breast and Cervical Cancer Early Detection Program through each state's administration serves millions of low-income and uninsured women aged 40-64. Our purpose was to assess whether cases screened through Georgia's Breast and Cervical Cancer Program (BCCP) were diagnosed at an earlier stage of disease and whether those who used the state's program regularly continued to obtain age-appropriate screens as they aged out of BCCP into Medicare between 2000 and 2005. METHODS: We used BCCP screening data to identify women with more than one screen and an interval of 18 months or less between screens as "regular" users of BCCP. Using the linked BCCP and Medicare enrollment/claims data, we tested whether women with any BCCP use (n = 3,134) or "regular" users (n = 1,590) were more likely than women not using BCCP (n = 10,086) to exhibit regular screening under Medicare. We used linked BCCP and Georgia Cancer Registry data to examine breast cancer incidence and stage at diagnosis of BCCP women compared to the Georgia population. RESULTS: Under Medicare, almost 63 % of women with any BCCP use were re-screened versus 51 % of non-BCCP users. The probability of being screened within 18 months of Medicare enrollment was 3.5 % points higher for any BCCP user and 17.7 points higher for "regular" BCCP users, compared to nonusers. Among Black non-Hispanics, the difference for any BCCP user was 13.7 % points and for regular users, 22.4 % points. A larger percentage of BCCP users were diagnosed at in situ or localized disease stage than overall. CONCLUSIONS: The majority of women aging out of the GA BCCP 2000-2005 had used the program to obtain regular mammography. Regular users of GA BCCP continued to be screened within appropriate intervals once enrolled in Medicare due perhaps to educational and support components of BCCP. |
Annual Report to the Nation on the Status of Cancer, 1975-2011, featuring incidence of breast cancer subtypes by race/ethnicity, poverty, and state
Kohler BA , Sherman RL , Howlader N , Jemal A , Ryerson AB , Henry KA , Boscoe FP , Cronin KA , Lake A , Noone AM , Henley SJ , Eheman CR , Anderson RN , Penberthy L . J Natl Cancer Inst 2015 107 (6) djv048 BACKGROUND: The American Cancer Society (ACS), Centers for Disease Control and Prevention (CDC), National Cancer Institute (NCI), and North American Association of Central Cancer Registries (NAACCR) collaborate annually to produce updated, national cancer statistics. This Annual Report includes a focus on breast cancer incidence by subtype using new, national-level data. METHODS: Population-based cancer trends and breast cancer incidence by molecular subtype were calculated. Breast cancer subtypes were classified using tumor biomarkers for hormone receptor (HR) and human growth factor-neu receptor (HER2) expression. RESULTS: Overall cancer incidence increased for men by 1.8% annually from 2007 to 2011. Rates for women were stable from 1998 to 2011. Within these trends there was racial/ethnic variation, and some sites have increasing rates. Among children, incidence rates continued to increase by 0.8% per year over the past decade while, like adults, mortality declined. HR+/HER2- breast cancers, the subtype with the best prognosis, were the most common for all races/ethnicities with highest rates among non-Hispanic white women, local stage cases, and low poverty areas (92.7, 63.51, and 98.69 per 100000 non-Hispanic white women, respectively). HR+/HER2- breast cancer incidence rates were strongly, positively correlated with mammography use, particularly for non-Hispanic white women (Pearson 0.57, two-sided P < .001). Triple-negative breast cancers, the subtype with the worst prognosis, were highest among non-Hispanic black women (27.2 per 100000 non-Hispanic black women), which is reflected in high rates in southeastern states. CONCLUSIONS: Progress continues in reducing the burden of cancer in the United States. There are unique racial/ethnic-specific incidence patterns for breast cancer subtypes; likely because of both biologic and social risk factors, including variation in mammography use. Breast cancer subtype analysis confirms the capacity of cancer registries to adjust national collection standards to produce clinically relevant data based on evolving medical knowledge. |
CDC Grand Rounds: the future of cancer screening
Thomas CC , Richards TB , Plescia M , Wong FL , Ballard R , Levin TR , Calonge BN , Brawley OW , Iskander J . MMWR Morb Mortal Wkly Rep 2015 64 (12) 324-7 Cancer is the second leading cause of death in the United States, with 52% of deaths caused by cancers of the lung and bronchus, female breast, uterine cervix, colon and rectum, oral cavity and pharynx, prostate, and skin (melanoma). In the 1930s, uterine cancer, including cancer of the uterine cervix, was the leading cause of cancer deaths among women in the United States. With the advent of the Papanicolaou (Pap) test in the 1950s to detect cellular level changes in the cervix, cervical cancer death rates declined significantly. Since this first cancer screening test, others have been developed that detect the presence of cancer through imaging procedures (e.g., mammography, endoscopy, and computed tomography) and laboratory tests (e.g., fecal occult blood tests). |
Targeted hepatitis C antibody testing interventions: a systematic review and meta-analysis
Aspinall EJ , Doyle JS , Corson S , Hellard ME , Hunt D , Goldberg D , Nguyen T , Falck-Ytter Y , Morgan RL , Smith B , Stoove M , Wiktor SZ , Hutchinson S . Eur J Epidemiol 2015 30 (2) 115-29 Testing for hepatitis C virus (HCV) infection may reduce the risk of liver-related morbidity, by facilitating earlier access to treatment and care. This review investigated the effectiveness of targeted testing interventions on HCV case detection, treatment uptake, and prevention of liver-related morbidity. A literature search identified studies published up to 2013 that compared a targeted HCV testing intervention (targeting individuals or groups at increased risk of HCV) with no targeted intervention, and results were synthesised using meta-analysis. Exposure to a targeted testing intervention, compared to no targeted intervention, was associated with increased cases detected [number of studies (n) = 14; pooled relative risk (RR) 1.7, 95 % CI 1.3, 2.2] and patients commencing therapy (n = 4; RR 3.3, 95 % CI 1.1, 10.0). Practitioner-based interventions increased test uptake and cases detected (n = 12; RR 3.5, 95 % CI 2.5, 4.8; and n = 10; RR 2.2, 95 % CI 1.4, 3.5, respectively), whereas media/information-based interventions were less effective (n = 4; RR 1.5, 95 % CI 0.7, 3.0; and n = 4; RR 1.3, 95 % CI 1.0, 1.6, respectively). This meta-analysis provides for the first time a quantitative assessment of targeted HCV testing interventions, demonstrating that these strategies were effective in diagnosing cases and increasing treatment uptake. Strategies involving practitioner-based interventions yielded the most favourable outcomes. It is recommended that testing should be targeted at and offered to individuals who are part of a population with high HCV prevalence, or who have a history of HCV risk behaviour. |
Variability of hepatitis E serologic assays in a pediatric liver transplant recipient: challenges to diagnosing hepatitis E virus infection in the United States
Sue PK , Pisanic N , Heaney CD , Mixson-Hayden T , Kamili S , Nelson K , Schwarz KB , Forman M , Valsamakis A , Ticehurst J , Karnsakul W . Transpl Infect Dis 2015 17 (2) 284-8 Hepatitis E virus (HEV) is an emerging cause of viral hepatitis among immunocompromised individuals in developed countries. Yet the diagnosis of HEV infection in the United States remains challenging, because of the variable sensitivity and specificity of currently available tests, and the lack of a US Food and Drug Administration-approved test. We report a case of multiple discordant HEV serology results in a pediatric liver transplant recipient with idiopathic hepatitis, and review the challenges to diagnosis of HEV infection in the United States. |
Men who have sex with men in Mozambique: identifying a hidden population at high-risk for HIV
Nala R , Cummings B , Horth R , Inguane C , Benedetti M , Chissano M , Sathane I , Young P , da Silva D , Mirjahangir J , Grasso M , Fisher Raymond H , McFarland W , Lane T . AIDS Behav 2015 19 (2) 393-404 The population of men who have sex with men (MSM) has been largely ignored in HIV-related policies and programming in Mozambique and there is little information about the contribution of MSM to the HIV epidemic. An integrated biological and behavioral study among MSM using respondent-driven sampling was conducted in 2011 in Maputo, Beira and Nampula/Nacala. Men who reported engaging in oral or anal sex with other men in the last 12 months answered a questionnaire and provided a blood sample for HIV testing. The prevalence of HIV was 8.2 % (Maputo, n = 496), 9.1 % (Beira, n = 584) and 3.1 % (Nampula/Nacala, n = 353). Prevalence was higher among MSM ≥ 25 vs. 18-24 years: 33.8 % vs. 2.4 % (p < 0.001), 32.1 vs. 2.8 % (p < 0.001), and 10.3 vs. 2.7 % (p < 0.06), in each city respectively. The difference in prevalence demonstrates the need to increase prevention for younger MSM at risk for HIV and ensure care and treatment for older HIV-infected MSM. |
Phase 1 trials of rVSV Ebola vaccine in Africa and Europe
Agnandji ST , Huttner A , Zinser ME , Njuguna P , Dahlke C , Fernandes JF , Yerly S , Dayer JA , Kraehling V , Kasonta R , Adegnika AA , Altfeld M , Auderset F , Bache EB , Biedenkopf N , Borregaard S , Brosnahan JS , Burrow R , Combescure C , Desmeules J , Eickmann M , Fehling SK , Finckh A , Goncalves AR , Grobusch MP , Hooper J , Jambrecina A , Kabwende AL , Kaya G , Kimani D , Lell B , Lemaitre B , Lohse AW , Massinga-Loembe M , Matthey A , Mordmuller B , Nolting A , Ogwang C , Ramharter M , Schmidt-Chanasit J , Schmiedel S , Silvera P , Stahl FR , Staines HM , Strecker T , Stubbe HC , Tsofa B , Zaki S , Fast P , Moorthy V , Kaiser L , Krishna S , Becker S , Kieny MP , Bejon P , Kremsner PG , Addo MM , Siegrist CA . N Engl J Med 2015 374 (17) 1647-60 BACKGROUND: The replication-competent recombinant vesicular stomatitis virus (rVSV)-based vaccine expressing a Zaire ebolavirus (ZEBOV) glycoprotein was selected for rapid safety and immunogenicity testing before its use in West Africa. METHODS: We performed three open-label, dose-escalation phase 1 trials and one randomized, double-blind, controlled phase 1 trial to assess safety, side-effect profile, and immunogenicity of rVSV-ZEBOV at various doses in 158 healthy adults in Europe and Africa. All participants were injected with doses of vaccine ranging from 300,000 to 50 million plaque-forming units (PFU) or placebo. RESULTS: No serious vaccine-related adverse events were reported. Mild-to-moderate early-onset reactogenicity was frequent but transient (median, 1 day). Fever was observed in up to 35% of vaccinees. Vaccine viremia was detected within 3 days in 103 of 110 participants (94%) receiving 3 million PFU or more; rVSV was not detected in saliva or urine. In the second week after injection, arthritis affecting one to four joints developed in 11 of 51 participants (22%) in Geneva, with pain lasting a median of 8 days; 2 self-limited cases occurred in 40 participants (5%) in Hamburg, Germany, and Kilifi, Kenya. The virus was identified in one synovial-fluid aspirate and in skin vesicles of 2 other vaccinees, showing peripheral viral replication in the second week after immunization. ZEBOV-glycoprotein-specific antibody responses were detected in all the participants, with similar glycoprotein-binding antibody titers but significantly higher neutralizing antibody titers at higher doses. CONCLUSIONS: In these studies, rVSV-ZEBOV was reactogenic but immunogenic after a single dose and warrants further evaluation for safety and efficacy. (Funded by the Wellcome Trust and others; ClinicalTrials.gov numbers, NCT02283099 , NCT02287480 , and NCT02296983 ; Pan African Clinical Trials Registry number, PACTR201411000919191 .). |
Prevalence of HIV, sexually transmitted infections, and risk behaviours among female sex workers in Nairobi, Kenya: results of a respondent driven sampling study
Musyoki H , Kellogg TA , Geibel S , Muraguri N , Okal J , Tun W , Fisher Raymond H , Dadabhai S , Sheehy M , Kim AA . AIDS Behav 2015 19 Suppl 1 46-58 We conducted a respondent driven sampling survey to estimate HIV prevalence and risk behavior among female sex workers (FSWs) in Nairobi, Kenya. Women aged 18 years and older who reported selling sex to a man at least once in the past 3 months were eligible to participate. Consenting FSWs completed a behavioral questionnaire and were tested for HIV and sexually transmitted infections (STIs). Adjusted population-based prevalence and 95 % confidence intervals (CI) were estimated using RDS analysis tool. Factors significantly associated with HIV infection were assessed using log-binomial regression analysis. A total of 596 eligible participants were included in the analysis. Overall HIV prevalence was 29.5 % (95 % CI 24.7-34.9). Median age was 30 years (IQR 25-38 years); median duration of sex work was 12 years (IQR 8-17 years). The most frequent client-seeking venues were bars (76.6 %) and roadsides (29.3 %). The median number of clients per week was seven (IQR 4-18 clients). HIV testing was high with 86.6 % reported ever been tested for HIV and, of these, 63.1 % testing within the past 12 months. Of all women, 59.7 % perceived themselves at 'great risk' for HIV infection. Of HIV-positive women, 51.0 % were aware of their infection. In multivariable analysis, increasing age, inconsistent condom use with paying clients, and use of a male condom as a method of contraception were independently associated with unrecognized HIV infection. Prevalence among STIs was low, ranging from 0.9 % for syphilis, 1.1 % for gonorrhea, and 3.1 % for Chlamydia. The data suggest high prevalence of HIV among FSWs in Nairobi. Targeted and routine HIV and STI combination prevention strategies need to be scaled up or established to meet the needs of this population. |
Ebola virus disease in a humanitarian aid worker - New York City, October 2014
Yacisin K , Balter S , Fine A , Weiss D , Ackelsberg J , Prezant D , Wilson R , Starr D , Rakeman J , Raphael M , Quinn C , Toprani A , Clark N , Link N , Daskalakis D , Maybank A , Layton M , Varma JK . MMWR Morb Mortal Wkly Rep 2015 64 (12) 321-3 In late October 2014, Ebola virus disease (Ebola) was diagnosed in a humanitarian aid worker who recently returned from West Africa to New York City (NYC). The NYC Department of Health and Mental Hygiene (DOHMH) actively monitored three close contacts of the patient and 114 health care personnel. No secondary cases of Ebola were detected. In collaboration with local and state partners, DOHMH had developed protocols to respond to such an event beginning in July 2014. These protocols included safely transporting a person at the first report of symptoms to a local hospital prepared to treat a patient with Ebola, laboratory testing for Ebola, and monitoring of contacts. In response to this single case of Ebola, initial health care worker active monitoring protocols needed modification to improve clarity about what types of exposure should be monitored. The response costs were high in both human resources and money: DOHMH alone spent $4.3 million. However, preparedness activities that include planning and practice in effectively monitoring the health of workers involved in Ebola patient care can help prevent transmission of Ebola. |
Effect of HIV diagnosis disclosure on psychosocial outcomes in Thai children with perinatal HIV-Infection
Boon-Yasidhi V , Naiwatanakul T , Chokephaibulkit K , Lolekha R , Leowsrisook P , Chotpitayasunond T , Wolfe M . Int J STD AIDS 2015 27 (4) 288-95 A provider-assisted, counseling-based, pediatric HIV disclosure model was developed and implemented at two tertiary-care hospitals in Bangkok, Thailand. All undisclosed perinatally acquired HIV-infected children, ages 7-18 years, and their caretakers were offered the four-step disclosure service, including: screening, readiness assessments and preparation, disclosure sessions, and follow-up evaluations. To assess psychosocial outcomes of disclosure, we compared the scores of the Children Depression Inventory and the PedsQL 4.0 at baseline and at 2-month and 6-month follow-up visits, and compared the scores of the Child Behavioral Checklist at baseline and at 6-month follow-up. Disclosure was made to 186 children, 160 of whom completed post-disclosure assessments. The median Children's Depression Inventory score in 135 children decreased significantly from 11 at baseline to 8 at 2-month and 6-month follow-up (p < 0.01). The median PedsQL 4.0 scores in 126 children increased significantly from 78 at baseline to 80 at 2-month and 84 at 6-month follow-up (p = 0.04). The median Child Behavioral Checklist scores were not significantly changed. In conclusion, pediatric HIV diagnosis disclosure using this model was found to have positive effect on the children's mood and quality of life, and no negative effect on children's behaviours. This disclosure program should be expanded to improve psychosocial health of HIV-infected children. |
Effects of source- versus household contamination of tubewell water on child diarrhea in rural Bangladesh: a randomized controlled trial
Ercumen A , Naser AM , Unicomb L , Arnold BF , Colford JM Jr , Luby SP . PLoS One 2015 10 (3) e0121907 BACKGROUND: Shallow tubewells are the primary drinking water source for most rural Bangladeshis. Fecal contamination has been detected in tubewells, at low concentrations at the source and at higher levels at the point of use. We conducted a randomized controlled trial to assess whether improving the microbiological quality of tubewell drinking water by household water treatment and safe storage would reduce diarrhea in children <2 years in rural Bangladesh. METHODS: We randomly assigned 1800 households with a child aged 6-18 months (index child) into one of three arms: chlorine plus safe storage, safe storage and control. We followed households with monthly visits for one year to promote the interventions, track their uptake, test participants' source and stored water for fecal contamination, and record caregiver-reported child diarrhea prevalence (primary outcome). To assess reporting bias, we also collected data on health outcomes that are not expected to be impacted by our interventions. FINDINGS: Both interventions had high uptake. Safe storage, alone or combined with chlorination, reduced heavy contamination of stored water. Compared to controls, diarrhea in index children was reduced by 36% in the chlorine plus safe storage arm (prevalence ratio, PR = 0.64, 0.55-0.73) and 31% in the safe storage arm (PR = 0.69, 0.60-0.80), with no difference between the two intervention arms. One limitation of the study was the non-blinded design with self-reported outcomes. However, the prevalence of health outcomes not expected to be impacted by water interventions did not differ between study arms, suggesting minimal reporting bias. CONCLUSIONS: Safe storage significantly improved drinking water quality at the point of use and reduced child diarrhea in rural Bangladesh. There was no added benefit from combining safe storage with chlorination. Efforts should be undertaken to implement and evaluate long-term efforts for safe water storage in Bangladesh. TRIAL REGISTRATION: ClinicalTrials.gov NCT01350063. |
Evaluation of two influenza surveillance systems in South Africa
Budgell E , Cohen AL , McAnerney J , Walaza S , Madhi SA , Blumberg L , Dawood H , Kahn K , Tempia S , Venter M , Cohen C . PLoS One 2015 10 (3) e0120226 BACKGROUND: The World Health Organisation recommends outpatient influenza-like illness (ILI) and inpatient severe acute respiratory illness (SARI) surveillance. We evaluated two influenza surveillance systems in South Africa: one for ILI and another for SARI. METHODOLOGY: The Viral Watch (VW) programme has collected virological influenza surveillance data voluntarily from patients with ILI since 1984 in private and public clinics in all 9 South African provinces. The SARI surveillance programme has collected epidemiological and virological influenza surveillance data since 2009 in public hospitals in 4 provinces by dedicated personnel. We compared nine surveillance system attributes from 2009-2012. RESULTS: We analysed data from 18,293 SARI patients and 9,104 ILI patients. The annual proportion of samples testing positive for influenza was higher for VW (mean 41%) than SARI (mean 8%) and generally exceeded the seasonal threshold from May to September (VW: weeks 21-40; SARI: weeks 23-39). Data quality was a major strength of SARI (most data completion measures >90%; adherence to definitions: 88-89%) and a relative weakness of the VW programme (62% of forms complete, with limited epidemiologic data collected; adherence to definitions: 65-82%). Timeliness was a relative strength of both systems (e.g. both collected >93% of all respiratory specimens within 7 days of symptom onset). ILI surveillance was more nationally representative, financially sustainable and expandable than the SARI system. Though the SARI programme is not nationally representative, the high quality and detail of SARI data collection sheds light on the local burden and epidemiology of severe influenza-associated disease. CONCLUSIONS: To best monitor influenza in South Africa, we propose that both ILI and SARI should be under surveillance. Improving ILI surveillance will require better quality and more systematic data collection, and SARI surveillance should be expanded to be more nationally representative, even if this requires scaling back on information gathered. |
HIV and STI prevalence and injection behaviors among people who inject drugs in Nairobi: results from a 2011 bio-behavioral study using respondent-driven sampling
Tun W , Sheehy M , Broz D , Okal J , Muraguri N , Raymond HF , Musyoki H , Kim AA , Muthui M , Geibel S . AIDS Behav 2015 19 Suppl 1 24-35 There is a dearth of evidence on injection drug use and associated HIV infections in Kenya. To generate population-based estimates of characteristics and HIV/STI prevalence among people who inject drugs (PWID) in Nairobi, a cross-sectional study was conducted with 269 PWID using respondent-driven sampling. PWID were predominantly male (92.5 %). An estimated 67.3 % engaged in at least one risky injection practice in a typical month. HIV prevalence was 18.7 % (95 % CI 12.3-26.7), while STI prevalence was lower [syphilis: 1.7 % (95 % CI 0.2-6.0); gonorrhea: 1.5 % (95 % CI 0.1-4.9); and Chlamydia: 4.2 % (95 % CI 1.2-7.8)]. HIV infection was associated with being female (aOR, 3.5; p = 0.048), having first injected drugs 5 or more years ago (aOR, 4.3; p = 0.002), and ever having practiced receptive syringe sharing (aOR, 6.2; p = 0.001). Comprehensive harm reduction programs tailored toward PWID and their sex partners must be fully implemented as part of Kenya's national HIV prevention strategy. |
HIV prevalence and risk behaviors among Mozambicans working in South African mines
Baltazar CS , Horth R , Inguane C , Sathane I , Cesar F , Ricardo H , Botao C , Augusto A , Cooley L , Cummings B , Raymond HF , Young PW . AIDS Behav 2015 19 Suppl 1 59-67 Mineworkers are considered a population at risk for HIV due to risk behaviors associated with migratory work patterns. This was the first study in Mozambique to determine the prevalence of HIV and associated demographic and risk behaviors, and assess use and access to prevention and healthcare services among Mozambicans working in South African mines. Men who had worked in a South African mine in the past 12 months were recruited between February and May 2012 using time location sampling (TLS) at the Ressano Garcia border between Mozambique and South Africa. Demographic and behavioral data were collected through a standardized questionnaire, and HIV prevalence was estimated by testing dried blood spots (DBS) with two enzyme immunoassays. In total, 432 eligible mine workers were recruited. Mean age was 43 years. Most were married or cohabitating; among them, 12.6 % had two or more wives/marital partners in Mozambique. In the 12 months preceding the survey, 24.7 % had an occasional sexual partner, and 6.6 % had at least one partner who was a female sex worker. Only one in five (18.5 %) used a condom during last sex. HIV prevalence among mineworkers was 22.3 %, and 74.6 % of those who tested positive as part of the survey did not know their status. HIV prevalence was significantly higher (p = 0.018) among those that were uncircumcised (31.2 %) than those who were circumcised (18.5 %). Multiple partners (multiple spouses, cross-border relations, and multiple occasional partnerships), inconsistent condom use, and a high proportion of infected mineworkers who do not know their HIV status increases the risk of HIV transmission in this population. Combination strategies involving the promotion of condom use, HIV testing, and male circumcision should be strengthened among mineworkers. |
Impact evaluation of a community-based intervention to reduce risky sexual behaviour among female sex workers in Shanghai, China
Liu J , Calzavara L , Mendelsohn JB , O'Leary A , Kang L , Pan Q , Myers T , Ren J , Cha Y , Shi G , Liu X , Tian X , Fan H , Ni Y , Remis RS . BMC Public Health 2015 15 147 BACKGROUND: Female sex workers (FSWs) are at risk for sexually transmitted infections (STIs), including HIV. We implemented an HIV/STI preventive intervention among FSWs in Shanghai that aimed to increase condom use, improve HIV knowledge, and reduce STI and HIV incidence. METHODS: From six districts in Shanghai, 750 randomly selected venue-based FSWs were allocated to either a behavioural intervention or control group. In the intervention and control groups, 221 and 278 participants, respectively, had at least one follow-up at three or six months. In analysis, we randomly selected 57 lost to follow-up cases in the intervention group and imputed baseline values to equalize the arms at n=278 (74.1% follow-up rate in each group). The impacts of the intervention on condom use, HIV/STI risk perception and knowledge, and STI incidence were assessed using either a logistic or linear model, adjusting for the baseline measure of the outcome and venue type. RESULTS: The intervention improved consistent condom use with any partner type in the previous month (AOR=2.09, 95% CI, 1.43-3.04, p=0.0001). Consistent condom use with clients in the three most recent sex acts increased in both arms, and with primary partners in the intervention arm, but there was no difference between groups after adjusting for baseline condom use and venue type. There were no differences in cumulative incidence of any STI (i.e., chlamydia, gonorrhoea, syphilis) between groups. HIV transmission knowledge (p=0.0001), condom use skill (p=0.0421), and self-efficacy for using condoms (p=0.0071) were improved by the intervention. HIV-related stigma declined (p=0.0119) and HIV and STI risk perception were improved (4.6 to 13.9%, and 9.4 to 20.0%, respectively). The intervention was associated with these improvements after adjusting for the baseline measure and venue type. CONCLUSION: Following a preventive intervention among Shanghai FSWs, our findings demonstrate that a simple, community-based educational intervention improved overall condom use, HIV and STI knowledge, and attitudes in relation to HIV/AIDS. The intervention should be implemented widely after tailoring educational materials regarding condom negotiation with different partner types (i.e., commercial sex clients and primary partners). |
Importation and domestic transmission of Shigella sonnei resistant to ciprofloxacin - United States, May 2014-February 2015
Bowen A , Hurd J , Hoover C , Khachadourian Y , Traphagen E , Harvey E , Libby T , Ehlers S , Ongpin M , Norton JC , Bicknese A , Kimura A . MMWR Morb Mortal Wkly Rep 2015 64 (12) 318-20 In December 2014, PulseNet, the national molecular subtyping network for foodborne disease, detected a multistate cluster of Shigella sonnei infections with an uncommon pulsed-field gel electrophoresis (PFGE) pattern. CDC's National Antimicrobial Resistance Monitoring System (NARMS) laboratory determined that isolates from this cluster were resistant to ciprofloxacin, the antimicrobial medication recommended to treat adults with shigellosis. To understand the scope of the outbreak and to try to identify its source, CDC and state and local health departments conducted epidemiologic and laboratory investigations. During May 2014-February 2015, PulseNet identified 157 cases in 32 states and Puerto Rico; approximately half were associated with international travel. Nine of the cases identified by PulseNet, and another 86 cases without PFGE data, were part of a related outbreak of ciprofloxacin-resistant shigellosis in San Francisco, California. Of 126 total isolates with antimicrobial susceptibility information, 109 (87%) were nonsusceptible to ciprofloxacin (108 were resistant, and one had intermediate susceptibility). Travelers need to be aware of the risks of acquiring multidrug-resistant pathogens, carefully wash their hands, and adhere to food and water precautions during international travel. Clinicians should request stool cultures and antimicrobial susceptibilities when they suspect shigellosis, and counsel shigellosis patients to follow meticulous hygiene regimens while ill. |
Intraventricular granulomatous mass associated with Mycobacterium haemophilum: a rare central nervous system manifestation in a patient with human immunodeficiency virus infection
Barr LK , Sharer LR , Khadka Kunwar E , Kapila R , Zaki SR , Drew CP , Bhatnagar J , Liu JK , Chew D . J Clin Neurosci 2015 22 (6) 1057-60 We report a rare case of Mycobacterium haemophilum presenting as an intraventricular granulomatous mass with loculated hydrocephalus and seizures in a patient with human immunodeficiency virus. M. haemophilum, a slow-growing mycobacteria, causes localized and disseminated disease among immunocompromised hosts. Central nervous system infection with M. haemophilum is extremely rare. Preoperative laboratory testing of our patient for tuberculosis, toxoplasmosis, sarcoidosis and histoplasmosis were negative. Surgical resection of the mass revealed a caseating granuloma that stained positive for acid-fast bacillus suggesting possible tuberculoma. Despite negative testing for tuberculosis, a polymerase chain reaction analysis was ultimately performed from the resected mass which revealed M. haemophilum. To our knowledge, this is the first case of M. haemophilum presenting as an intraventricular mass. We review the clinical manifestations of this pathogen and discuss the medical and surgical management. |
Characterizing the epidemiology, virology, and clinical features of influenza in China's first severe acute respiratory infection sentinel surveillance system, February 2011 - October 2013
Peng Z , Feng L , Green CM , Wang K , Zhu G , Zhang Y , Hu J , Huang Y , Pan H , Guo N , Xing C , Chu Y , Cao Z , Yu D , Liu L , Chen Z , Zeng F , Xu W , Xiong X , Cheng X , Guo H , Chen W , Li L , Jiang H , Zheng J , Xu Z , Yu H . BMC Infect Dis 2015 15 143 BACKGROUND: After the 2009 influenza A(H1N1)pdm09 pandemic, China established its first severe acute respiratory infections (SARI) sentinel surveillance system. METHODS: We analyzed data from SARI cases in 10 hospitals in 10 provinces in China from February 2011 to October 2013. RESULTS: Among 5,644 SARI cases, 330 (6%) were influenza-positive. Among these, 62% were influenza A and 38% were influenza B. Compared with influenza-negative cases, influenza-positive SARI cases had a higher median age (20.0 years vs.11.0, p=0.003) and were more likely to have at least one underlying chronic medical condition (age adjusted percent: 28% vs. 25%, p<0.001). The types/subtypes of dominant strains identified by SARI surveillance was almost always among dominant strains identified by the influenza like illness (ILI) surveillance system and influenza activity in both systems peaked at the same time. CONCLUSIONS: Data from China's first SARI sentinel surveillance system suggest that types/subtypes of circulating influenza strains and epidemic trends among SARI cases were similar to those among ILI cases. |
Prevalence of elevated blood lead levels and risk factors among residents younger than 6 years, Puerto Rico-2010
Dignam T , Rivera Garcia B , De Leon M , Curtis G , Creanga AA , Azofeifa A , O'Neill M , Blanton C , Kennedy C , Rullan M , Caldwell K , Rullan J , Brown MJ . J Public Health Manag Pract 2015 22 (1) E22-35 CONTEXT: Limited data exist about blood lead levels (BLLs) and potential exposures among children living in Puerto Rico. The Puerto Rico Department of Health has no formal blood lead surveillance program. OBJECTIVES: We assessed the prevalence of elevated BLLs (≥5 micrograms of lead per deciliter of blood), evaluated household environmental lead levels, and risk factors for BLL among children younger than 6 years of age living in Puerto Rico in 2010. METHODS: We used a population-based, cross-sectional sampling strategy to enroll an island-representative sample of Puerto Rican children younger than 6 years. We estimated the island-wide weighted prevalence of elevated BLLs and conducted bivariable and multivariable linear regression analyses to ascertain risk factors for elevated BLLs. RESULTS: The analytic data set included 355 households and 439 children younger than 6 years throughout Puerto Rico. The weighted geometric mean BLL of children younger than 6 years was 1.57 mug/dL (95% confidence interval [CI], 1.27-1.88). The weighted prevalence of children younger than 6 years with BLLs of 5 mug/dL or more was 3.18% (95% CI, 0.93-5.43) and for BLLs of 10 mug/dL or more was 0.50% (95% CI, 0-1.31). Higher mean BLLs were significantly associated with data collection during the summer months, a lead-related activity or hobby of anyone in the residence, and maternal education of less than 12 years. Few environmental lead hazards were identified. CONCLUSIONS: The prevalence of elevated BLLs among Puerto Rican children younger than 6 years is comparable with the most recent (2007-2010) US national estimate (BLLs ≥5 mug/dL = 2.6% [95% CI = 1.6-4.0]). Our findings suggest that targeted screening of specific higher-risk groups of children younger than 6 years can replace island-wide or insurance-specific policies of mandatory blood lead testing in Puerto Rico. |
Cyanobacteria and algae blooms: review of health and environmental data from the Harmful Algal Bloom-Related Illness Surveillance System (HABISS) 2007-2011
Backer LC , Manassaram-Baptiste D , LePrell R , Bolton B . Toxins (Basel) 2015 7 (4) 1048-64 Algae and cyanobacteria are present in all aquatic environments. We do not have a good sense of the extent of human and animal exposures to cyanobacteria or their toxins, nor do we understand the public health impacts from acute exposures associated with recreational activities or chronic exposures associated with drinking water. We describe the Harmful Algal Bloom-related Illness Surveillance System (HABISS) and summarize the collected reports describing bloom events and associated adverse human and animal health events. For the period of 2007-2011, Departments of Health and/or Environment from 11 states funded by the National Center for Environmental Health (NCEH), Centers for Disease Control and Prevention contributed reports for 4534 events. For 2007, states contributed 173 reports from historical data. The states participating in the HABISS program built response capacity through targeted public outreach and prevention activities, including supporting routine cyanobacteria monitoring for public recreation waters. During 2007-2010, states used monitoring data to support 196 public health advisories or beach closures. The information recorded in HABISS and the application of these data to develop a wide range of public health prevention and response activities indicate that cyanobacteria and algae blooms are an environmental public health issue that needs continuing attention. |
A linear mitochondrial genome of Cyclospora cayetanensis (Eimeriidae, Eucoccidiorida, Coccidiasina, Apicomplexa) suggests the ancestral start position within mitochondrial genomes of eimeriid coccidia.
Ogedengbe ME , Qvarnstrom Y , da Silva AJ , Arrowood MJ , Barta JR . Int J Parasitol 2015 45 (6) 361-5 The near complete mitochondrial genome for Cyclospora cayetanensis is 6184bp in length with three protein-coding genes (Cox1, Cox3, CytB) and numerous lsrDNA and ssrDNA fragments. Gene arrangements were conserved with other coccidia in the Eimeriidae, but the C. cayetanensis mitochondrial genome is not circular-mapping. Terminal transferase tailing and nested PCR completed the 5'-terminus of the genome starting with a 21bp A/T-only region that forms a potential stem-loop. Regions homologous to the C. cayetanensis mitochondrial genome 5'-terminus are found in all eimeriid mitochondrial genomes available and suggest this may be the ancestral start of eimeriid mitochondrial genomes. |
Telomere Length as an Indicator of the Robustness of B- and T-Cell Response to Influenza in Older Adults.
Najarro K , Nguyen H , Chen G , Xu M , Alcorta S , Yao X , Zukley L , Metter EJ , Truong T , Lin Y , Li H , Oelke M , Xu X , Ling SM , Longo DL , Schneck J , Leng S , Ferrucci L , Weng NP . J Infect Dis 2015 212 (8) 1261-9 BACKGROUND: Telomeres provide a key mechanism for protecting the integrity of chromosomes and their attrition after cell division and during aging are evident in lymphocytes. However, the significance of telomere shortening in age-associated decline of immune function is unknown. METHODS: We selected 22 HLA-A2+ healthy older adults who have relatively short or long telomere lengths to compare their antibody response against the influenza vaccine, and their CD8+ T cell response against an influenza antigen. RESULTS: B cells from individuals with a robust antibody response to the influenza vaccine had significantly longer telomeres than those with a poor antibody response. Monocyte-derived antigen-presenting cells of both short and long telomere groups induced similar expansions of influenza M1-specific CD8+ T cells. Vaccination did not increase M1-specific CD8+ T cells in blood, however, M1-specific CD8+ T cells from the long telomere group exhibited significantly better expansion in vitro compared to those from the short telomere group. Finally, M1-specific CD8+ T cells that underwent more expansions had significantly longer telomeres compared to cells with fewer divisions. CONCLUSIONS: Telomere length is positively associated with a robust lymphocyte response and telomere attrition may contribute to the age-associated decline of adaptive immunity. |
Comparison of whole genome sequences from human and non-human Escherichia coli O26 strains.
Norman KN , Clawson ML , Strockbine NA , Mandrell RE , Johnson R , Ziebell K , Zhao S , Fratamico PM , Stones R , Allard MW , Bono JL . Front Cell Infect Microbiol 2015 5 21 Shiga toxin-producing Escherichia coli (STEC) O26 is the second leading E. coli serogroup responsible for human illness outbreaks behind E. coli O157:H7. Recent outbreaks have been linked to emerging pathogenic O26:H11 strains harboring stx 2 only. Cattle have been recognized as an important reservoir of O26 strains harboring stx 1; however the reservoir of these emerging stx 2 strains is unknown. The objective of this study was to identify nucleotide polymorphisms in human and cattle-derived strains in order to compare differences in polymorphism derived genotypes and virulence gene profiles between the two host species. Whole genome sequencing was performed on 182 epidemiologically unrelated O26 strains, including 109 human-derived strains and 73 non-human-derived strains. A panel of 289 O26 strains (241 STEC and 48 non-STEC) was subsequently genotyped using a set of 283 polymorphisms identified by whole genome sequencing, resulting in 64 unique genotypes. Phylogenetic analyses identified seven clusters within the O26 strains. The seven clusters did not distinguish between isolates originating from humans or cattle; however, clusters did correspond with particular virulence gene profiles. Human and non-human-derived strains harboring stx 1 clustered separately from strains harboring stx 2, strains harboring eae, and non-STEC strains. Strains harboring stx 2 were more closely related to non-STEC strains and strains harboring eae than to strains harboring stx 1. The finding of human and cattle-derived strains with the same polymorphism derived genotypes and similar virulence gene profiles, provides evidence that similar strains are found in cattle and humans and transmission between the two species may occur. |
Development and Application of a gp60-Based Typing Assay for Cryptosporidium viatorum.
Stensvold CR , Elwin K , Winiecka-Krusnell J , Chalmers RM , Xiao L , Lebbad M . J Clin Microbiol 2015 53 (6) 1891-7 The apicomplexan intestinal parasite Cryptosporidium takes a major toll on human and animal health and is a frequent cause of waterborne outbreaks. Several species and genotypes can infect humans, including Cryptosporidium viatorum, which, to date, has only been found in humans. Molecular characterization of Cryptosporidium spp., critical to epidemiological analyses, is commonly based on gp60 gene analysis, which appears to require bespoke species- or group-specific PCR primers due to extensive genetic diversity across the genus. In this study, we amplified, sequenced, and characterized the gp60 gene of C. viatorum for the first time. Moreover, a gp60 typing assay for this species was developed, validated, and applied to 27 isolates originating from Asia, Africa, and Central America. One single subtype family, XVa, was identified containing multiple alleles. |
Life cycle of television public service announcements disseminated through donated airtime
Cooper CP , Gelb CA , Chu J . Prev Med Rep 2015 2 202-205 OBJECTIVE: To investigate the longevity and reach of television public service announcements (PSAs) developed by the Centers for Disease Control and Prevention's Screen for Life: National Colorectal Cancer Action Campaign. METHODS: Television airtime donated to Screen for Life PSAs was tracked, and the impressions (a broadcasting metric for audience size) generated by PSAs in circulation ≥ 5 years were analyzed in 2014. The sample consisted of 8 PSAs, including English and Spanish PSAs, PSAs featuring celebrities, and PSAs redistributed multiple times after their initial release. RESULTS: During the most recent year of circulation (5-9 years after initial release), each PSA generated 15.7 million to 251.7 million impressions. Peak annual impressions were achieved as late as 9 years after a PSA's initial release. When PSAs were redistributed 2 years or longer after the prior distribution, annual impressions increased over the preceding year by > 20 million in 80.0% of instances. Among English PSAs, those featuring celebrities produced the highest mean and peak annual impressions. CONCLUSIONS: Donated-placement television PSAs can be a long-lived health promotion strategy. Redistribution may enhance PSA longevity, and featuring celebrities, particularly in English PSAs, may expand reach. |
Endoscopic retrograde cholangiopancreatography-associated AmpC Escherichia coli outbreak
Wendorf KA , Kay M , Baliga C , Weissman SJ , Gluck M , Verma P , D'Angeli M , Swoveland J , Kang MG , Eckmann K , Ross AS , Duchin J . Infect Control Hosp Epidemiol 2015 36 (6) 1-9 BACKGROUND: We identified an outbreak of AmpC-producing Escherichia coli infections resistant to third-generation cephalosporins and carbapenems (CR) among 7 patients who had undergone endoscopic retrograde cholangiopancreatography at hospital A during November 2012-August 2013. Gene sequencing revealed a shared novel mutation in a bla CMY gene and a distinctive fumC/ fimH typing profile. OBJECTIVE: To determine the extent and epidemiologic characteristics of the outbreak, identify potential sources of transmission, design and implement infection control measures, and determine the association between the CR E. coli and AmpC E. coli circulating at hospital A. METHODS: We reviewed laboratory, medical, and endoscopy reports, and endoscope reprocessing procedures. We obtained cultures from endoscopes after reprocessing as well as environmental samples and conducted pulsed-field gel electrophoresis and gene sequencing on phenotypic AmpC isolates from patients and endoscopes. Cases were those infected with phenotypic AmpC isolates (both carbapenem-susceptible and CR) and identical bla CMY-2, fumC, and fimH alleles or related pulsed-field gel electrophoresis patterns. RESULTS: Thirty-five of 49 AmpC E. coli tested met the case definition, including all CR isolates. All cases had complicated biliary disease and had undergone at least 1 endoscopic retrograde cholangiopancreatography at hospital A. Mortality at 30 days was 16% for all patients and 56% for CR patients. Two of 8 reprocessed endoscopic retrograde cholangiopancreatography scopes harbored AmpC that matched case isolates by pulsed-field gel electrophoresis. Environmental cultures were negative. No breaches in infection control were identified. Endoscopic reprocessing exceeded manufacturer's recommended cleaning guidelines. CONCLUSION: Recommended reprocessing guidelines are not sufficient. |
Enhancing resident safety by preventing healthcare-associated infection: a national initiative to reduce catheter-associated urinary tract infections in nursing homes
Mody L , Meddings J , Edson BS , McNamara SE , Trautner BW , Stone ND , Krein SL , Saint S . Clin Infect Dis 2015 61 (1) 86-94 Preventing healthcare-associated infection (HAI) is a key contributor to enhancing resident safety in nursing homes. In 2013, the U.S. Department of Health and Human Services approved a plan to enhance resident safety by reducing HAIs in nursing homes, with particular emphasis on reducing indwelling catheter use and catheter-associated urinary tract infection (CAUTI). Lessons learned from a recent multimodal Targeted Infection Prevention (TIP) program in a group of nursing homes as well as a national initiative to prevent CAUTI in over 950 acute care hospitals called "On the CUSP: STOP CAUTI" will now be implemented in nearly 500 nursing homes in all 50 states through a project funded by the Agency for Healthcare Research and Quality (AHRQ). This "AHRQ Safety Program in Long-Term Care: HAIs/CAUTI" will emphasize professional development in catheter utilization, catheter care and maintenance, and antimicrobial stewardship as well as promoting patient safety culture, team building, and leadership engagement. We anticipate that an approach integrating technical and socio-adaptive principles will serve as a model for future initiatives to reduce other infections, multi-drug resistant organisms, and non-infectious adverse events among nursing home residents. |
Declining incidence of candidemia and the shifting epidemiology of Candida resistance in two US netropolitan areas, 2008-2013: results from population-based surveillance
Cleveland AA , Harrison LH , Farley MM , Hollick R , Stein B , Chiller TM , Lockhart SR , Park BJ . PLoS One 2015 10 (3) e0120452 BACKGROUND: Recent reports have demonstrated a decline in bacterial bloodstream infections (BSIs) following adherence to central line insertion practices; however, declines have been less evident for BSIs due to Candida species. METHODS: We conducted active, population-based laboratory surveillance for candidemia in metropolitan Atlanta, GA and Baltimore, MD over a 5-year period. We calculated annual candidemia incidence and antifungal drug resistance rates. RESULTS: We identified 3,848 candidemia cases from 2008-2013. Compared with 2008, candidemia incidence per 100,000 person-years decreased significantly by 2013 in both locations (GA: 14.1 to 9.5, p<0.001; MD: 30.9 to 14.4, p<0.001). A total of 3,255 cases (85%) had a central venous catheter (CVC) in place within 2 days before the BSI culture date. In both locations, the number of CVC-associated cases declined (GA: 473 to 294; MD: 384 to 151). Candida albicans (CA, 36%) and Candida glabrata (CG, 27%) were the most common species recovered. In both locations, the proportion of cases with fluconazole resistance decreased (GA: 8.0% to 7.1%, -10%; MD: 6.6% to 4.9%, -25%), while the proportion of cases with an isolate resistant to an echinocandin increased (GA: 1.2% to 2.9%, +147%; MD: 2.0% to 3.5%, +77%). Most (74%) echinocandin-resistant isolates were CG; 17 (<1%) isolates were resistant to both drug categories (multidrug resistant [MDR], 16/17 were CG). The proportion of CG cases with MDR Candida increased from 1.8% to 2.6%. CONCLUSIONS: We observed a significant decline in the incidence of candidemia over a five-year period, and increases in echinocandin-resistant and MDR Candida. Efforts to strengthen infection control practices may be preventing candidemia among high-risk patients. Further surveillance for resistant Candida is warranted. |
Deaths averted by influenza vaccination in the U.S. during the seasons 2005/06 through 2013/14.
Foppa IM , Cheng PY , Reynolds SB , Shay DK , Carias C , Bresee JS , Kim IK , Gambhir M , Fry AM . Vaccine 2015 33 (26) 3003-9 BACKGROUND: Excess mortality due to seasonal influenza is substantial, yet quantitative estimates of the benefit of annual vaccination programs on influenza-associated mortality are lacking. METHODS: We estimated the numbers of deaths averted by vaccination in four age groups (0.5 to 4, 5 to 19, 20 to 64 and ≥65 yrs.) for the nine influenza seasons from 2005/6 through 2013/14. These estimates were obtained using a Monte Carlo approach applied to weekly U.S. age group-specific estimates of influenza-associated excess mortality, monthly vaccination coverage estimates and summary seasonal influenza vaccine effectiveness estimates to obtain estimates of the number of deaths averted by vaccination. The estimates are conservative as they do not include indirect vaccination effects. RESULTS: From August, 2005 through June, 2014, we estimated that 40,127 (95% confidence interval [CI] 25,694 to 59,210) deaths were averted by influenza vaccination. We found that of all studied seasons the most deaths were averted by influenza vaccination during the 2012/13 season (9398; 95% CI 2,386 to 19,897) and the fewest during the 2009/10 pandemic (222; 95% CI 79 to 347). Of all influenza-associated deaths averted, 88.9% (95% CI 83 to 92.5%) were in people ≥65 yrs. old. CONCLUSIONS: The estimated number of deaths averted by the US annual influenza vaccination program is considerable, especially among elderly adults and even when vaccine effectiveness is modest, such as in the 2012/13 season. As indirect effects ("herd immunity") of vaccination are ignored, these estimates represent lower bound estimates and are thus conservative given valid excess mortality estimates. |
Anthrax vaccine recipients lack antibody against the loop neutralizing determinant: a protective neutralizing epitope from Bacillus anthracis protective antigen
Oscherwitz J , Quinn CP , Cease KB . Vaccine 2015 33 (20) 2342-6 BACKGROUND: Epitope-focused immunogens can elicit antibody against the loop neutralizing determinant (LND), a neutralizing epitope found within the 2beta2-2beta3 loop of protective antigen (PA), which can protect rabbits from high-dose inhalation challenge with Bacillus anthracis Ames strain. Interestingly, data suggests that this epitope is relatively immunosilent in rabbits and non-human primates immunized with full length PA. METHODS: To determine whether the LND is immunosilent among humans vaccinated with PA, we screened antisera from AVA- or placebo-vaccinees from a clinical trial for antibody reactive with the LND. RESULTS: AVA-vaccinee sera had significant PA-specific antibody compared to placebo-vaccinee sera; however, sera from the two cohorts were indistinguishable with regard to the frequency of individuals with antibody specific for the LND. CONCLUSIONS: AVA-vaccinees have a low frequency of antibody reactive with the LND. As with rabbits and non-human primates, the elicitation of LND-specific antibody in humans appears to require immunization with an epitope-focused vaccine. |
Does influenza vaccination modify influenza disease severity? Data on older adults hospitalized with influenza during the 2012-13 season in the United States
Arriola CS , Anderson EJ , Baumbach J , Bennett N , Bohm S , Hill M , Lindegren ML , Lung K , Meek J , Mermel E , Miller L , Monroe ML , Morin C , Oni O , Reingold A , Schaffner W , Thomas A , Zansky SM , Finelli L , Chaves SS . J Infect Dis 2015 212 (8) 1200-8 BACKGROUND: Some studies suggest that influenza vaccination might be protective against severe influenza outcomes in vaccinated persons who become infected. We used data from a large surveillance network to further investigate the effect of influenza vaccination on influenza disease severity in adults aged ≥50 years hospitalized with laboratory-confirmed influenza. METHODS: We analyzed influenza vaccination and influenza severity using Influenza Hospitalization Surveillance Network (FluSurv-NET) data for the 2012-13 influenza season. Intensive care unit (ICU) admission, death, diagnosis of pneumonia, and hospital and ICU lengths of stay served as measures of disease severity. Data were analyzed by multivariable logistic regression, parametric survival models and propensity score matching (PSM). RESULTS: Overall, no differences in severity were observed in the multivariable logistic regression model. Using PSM, adults aged 50-64 years (but not other age groups) who were vaccinated against influenza had a shorter ICU length of stay compared to those unvaccinated (HR for discharge=1.84, 95% CI: 1.12-3.01). CONCLUSION: Our findings show a modest effect of influenza vaccination on disease severity. Analysis of data from seasons with different predominant strains and higher estimates of vaccine effectiveness are needed. |
Preventing unintentional injuries in the home using the Health Impact Pyramid
Mack KA , Liller KD , Baldwin G , Sleet D . Health Educ Behav 2015 42 115s-22s Injuries continue to be the leading cause of death for the first four decades of life. These injuries result from a confluence of behavioral, physical, structural, environmental, and social factors. Taken together, these illustrate the importance of taking a broad and multileveled approach to injury prevention. Using examples from fall, fire, scald, and poisoning-related injuries, this article illustrates the utility of an approach that incorporates a social-environmental perspective in identifying and selecting interventions to improve the health and safety of individuals. Injury prevention efforts to prevent home injuries benefit from multilevel modifications of behavior, public policy, laws and enforcement, the environment, consumer products and engineering standards, as demonstrated with Frieden's Health Impact Pyramid. A greater understanding, however, is needed to explain the associations between tiers. While interventions that include modifications of the social environment are being field-tested, much more work needs to be done in measuring social-environmental change and in evaluating these programs to disentangle what works best. |
Driving among high school students - United States, 2013
Shults RA , Olsen E , Williams AF . MMWR Morb Mortal Wkly Rep 2015 64 (12) 313-7 During 2004-2013, the number of passenger vehicle drivers aged 16-19 years involved in fatal crashes in the United States declined by 55% from 5,724 to 2,568. In addition to graduated driver licensing (GDL) programs and safer vehicles,dagger other possible contributors to the decline include adolescents waiting longer to get their driver licenses and driving less. The crash risk for drivers of any age is highest during the first months of independent driving, and this risk is highest for the youngest teenage drivers. To estimate the percentage of high school students aged ≥16 years who have driven during the past 30 days, by age, race/ethnicity, and location, CDC analyzed 2013 data from the national Youth Risk Behavior Survey (YRBS) and YRBS data collected by 42 states and 21 large urban school districts. Nationwide, 76.3% of high school students aged ≥16 years reported having driven during the 30 days before the survey; 83.2% of white students had driven compared with <70% of black and Hispanic students. Across 42 states, the percentage of students who drove ranged from 53.8% to 90.2%. Driving prevalence was higher in the midwestern and mountain states. Across the 21 large urban school districts, the percentage of drivers varied more than twofold from 30.2% to 76.0%. This report provides the most detailed evidence to date that the percentage of students who drive varies substantially depending on where they live. Such information will be vital as states and communities consider potential ways to improve safety for older teenage novice drivers and plan for safe, affordable transportation options for those who do not drive. |
High-resolution metabolomics to discover potential parasite-specific biomarkers in a Plasmodium falciparum erythrocytic stage culture system.
Park YH , Shi YP , Liang B , Medriano CAD , Jeon YH , Torres E , Uppal K , Slutsker L , Jones DP . Malar J 2015 14 122 BACKGROUND: Current available malaria diagnostic methods each have some limitations to meet the need for real-time and large-scale screening of asymptomatic and low density malaria infection at community level. It was proposed that malaria parasite-specific low molecular-weight metabolites could be used as biomarkers for the development of a malaria diagnostic tool aimed to address this diagnostic challenge. In this study, high resolution metabolomics (HRM) was employed to identify malaria parasite-specific metabolites in Plasmodium falciparum in vitro culture samples. METHODS: Supernatants were collected at 12 hours interval from 3% haematocrit in vitro 48-hour time-course asynchronized culture system of P. falciparum. Liquid chromatography coupled with high resolution mass spectrometry was applied to discover potential parasite-specific metabolites in the cell culture supernatant. A metabolome-wide association study was performed to extract metabolites using Manhattan plot with false discovery rate (FDR) and hierarchical cluster analysis. The significant metabolites based on FDR cutoff were annotated using Metlin database. Standard curves were created using corresponding chemical compounds to accurately quantify potential Plasmodium-specific metabolites in culture supernatants. RESULTS: The number of significant metabolite features was 1025 in the supernatant of the Plasmodium infected culture based on Manhattan plot with FDR q=0.05. A two way hierarchical cluster analysis showed a clear segregation of the metabolic profile of parasite infected supernatant from non-infected supernatant at four time points during the 48 hour culture. Among the 1025 annotated metabolites, the intensities of four molecules were significantly increased with culture time suggesting a positive association between the quantity of these molecules and level of parasitaemia: i) 3-methylindole, a mosquito attractant, ii) succinylacetone, a haem biosynthesis inhibitor, iii) S-methyl-L-thiocitrulline, a nitric oxide synthase inhibitor, and iv) O-arachidonoyl glycidol, a fatty acid amide hydrolase inhibitor, The highest concentrations of 3-methylindole and succinylacetone were 178 +/- 18.7 pmoles at 36 hours and 157 +/- 30.5 pmoles at 48 hours respectively in parasite infected supernatant. CONCLUSION: HRM with bioinformatics identified four potential parasite-specific metabolite biomarkers using in vitro culture supernatants. Further study in malaria infected human is needed to determine presence of the molecules and its relationship with parasite densities. |
Rabies vaccine preserved by vaporization is thermostable and immunogenic
Smith TG , Siirin M , Wu X , Hanlon CA , Bronshtein V . Vaccine 2015 33 (19) 2203-2206 A rabies vaccine that is thermostable over a range of ambient environmental temperatures would be highly advantageous, especially for tropical regions with challenging cold-chain storage where canine rabies remains enzootic resulting in preventable human mortality. Live attenuated rabies virus (RABV) strain ERAg333 (R333E) was preserved by vaporization (PBV) in a dry, stable foam. RABV stabilized using this process remains viable for at least 23 months at 22 degrees C, 15 months at 37 degrees C, and 3h at 80 degrees C. An antigen capture assay revealed RABV PBV inactivated by irradiation contained similar levels of antigen as a commercial vaccine. Viability and antigen capture testing confirmed that the PBV process stabilized RABV with no significant loss in titer or antigen content. Live attenuated and inactivated RABV PBV both effectively induced RABV neutralizing antibodies and protected mice from peripheral rabies virus challenge. These results demonstrate that PBV is an efficient method for RABV stabilization. |
Stimulus and transducer effects on threshold
Flamme GA , Geda K , McGregor KD , Wyllys K , Deiters KK , Murphy WJ , Stephenson MR . Int J Audiol 2015 54 Suppl 1 S19-29 OBJECTIVE: This study examined differences in thresholds obtained under Sennheiser HDA200 circumaural earphones using pure tone, equivalent rectangular noise bands, and 1/3 octave noise bands relative to thresholds obtained using Telephonics TDH-39P supra-aural earphones. DESIGN: Thresholds were obtained via each transducer and stimulus condition six times within a 10-day period. STUDY SAMPLE: Forty-nine adults were selected from a prior study to represent low, moderate, and high threshold reliability. RESULTS: The results suggested that (1) only small adjustments were needed to reach equivalent TDH-39P thresholds, (2) pure-tone thresholds obtained with HDA200 circumaural earphones had reliability equal to or better than those obtained using TDH-39P earphones, (3) the reliability of noise-band thresholds improved with broader stimulus bandwidth and was either equal to or better than pure-tone thresholds, and (4) frequency-specificity declined with stimulus bandwidths greater than one equivalent rectangular band, which could complicate early detection of hearing changes that occur within a narrow frequency range. CONCLUSIONS: These data suggest that circumaural earphones such as the HDA200 headphones provide better reliability for audiometric testing as compared to the TDH-39P earphones. These data support the use of noise bands, preferably ERB noises, as stimuli for audiometric monitoring. |
Structure and receptor binding preferences of recombinant hemagglutinins from avian and human h6 and h10 influenza A virus subtypes
Yang H , Carney PJ , Chang JC , Villanueva JM , Stevens J . J Virol 2015 89 (8) 4612-23 During 2013, three new avian influenza A virus subtypes, A(H7N9), A(H6N1), and A(H10N8), resulted in human infections. While the A(H7N9) virus resulted in a significant epidemic in China across 19 provinces and municipalities, both A(H6N1) and A(H10N8) viruses resulted in only a few human infections. This study focuses on the major surface glycoprotein hemagglutinins from both of these novel human viruses. The detailed structural and glycan microarray analyses presented here highlight the idea that both A(H6N1) and A(H10N8) virus hemagglutinins retain a strong avian receptor binding preference and thus currently pose a low risk for sustained human infections. IMPORTANCE: Human infections with zoonotic influenza virus subtypes continue to be a great public health concern. We report detailed structural analysis and glycan microarray data for recombinant hemagglutinins from A(H6N1) and A(H10N8) viruses, isolated from human infections in 2013, and compare them with hemagglutinins of avian origin. This is the first structural report of an H6 hemagglutinin, and our results should further the understanding of these viruses and provide useful information to aid in the continuous surveillance of these zoonotic influenza viruses. |
Total cholesterol performance of Abell-Levy-Brodie-Kendall reference measurement procedure: certification of Japanese in-vitro diagnostic assay manufacturers through CDC's Cholesterol Reference Method Laboratory Network
Nakamura M , Iso H , Kitamura A , Imano H , Kiyama M , Yokoyama S , Kayamori Y , Koyama I , Nishimura K , Nakai M , Dasti M , Vesper HW , Miyamoto Y . Clin Chim Acta 2015 445 127-32 BACKGROUND: Accurate measurement of total cholesterol (TC) is important for cardiovascular disease risk management. The US Centers for Disease Control and Prevention (CDC) and Cholesterol Reference Method Laboratory Network (CRMLN) perform Abell-Levy-Brodie-Kendall (AK) reference measurement procedure (RMP) for TC as a secondary reference method, and implement Certification Protocol for Manufacturers. Japanese CRMLN laboratory at Osaka performed the AK RMP for 22 years, and conducted TC certification for reagent/calibrator/instrument systems of six Japanese manufacturers every 2 years for 16 years. Osaka TC performance was examined and compared to CDC's reference values. METHODS: AK RMP involved sample hydrolysis, cholesterol extraction, and determination of cholesterol levels by spectrophotometry. The Certification Protocol for Manufacturers includes comparison with AK RMP using at least 40 fresh specimens. Demonstration of average bias ≤3% and total coefficient of variation ≤3% qualified an analytical system for certification. RESULTS: In the AK RMP used in the Osaka CRMLN laboratory, the regression equation for measuring TC was y (Osaka)=1.000x (CDC)+0.032 (n=619, R2=1.000). Six Japanese manufacturers had allowable performance for certification. CONCLUSIONS: The AK RMP for TC measurement was accurate, precise, and stable for 22 years. Six Japanese manufacturers were certified for 16years. |
Update on progress in electronic reporting of laboratory results to public health agencies - United States, 2014
Lamb E , Satre J , Hurd-Kundeti G , Liscek B , Hall CJ , Pinner RW , Conn L , Zajac J , Smallwood M , Smith K . MMWR Morb Mortal Wkly Rep 2015 64 (12) 328-30 Since 2010, CDC has provided resources from the Prevention and Public Health Fund of the Affordable Care Act to 57 state, local, and territorial health departments through the Epidemiology and Laboratory Capacity for Infectious Diseases cooperative agreement to assist with implementation of electronic laboratory reporting (ELR) from clinical and public health laboratories to public health agencies. To update information from a previous report about the progress in implementing ELR in the United States, CDC examined regular communications between the agency and the 57 health departments during 2012-2014. The results indicated that, as of July 2014, 67% of the approximately 20 million laboratory reports received annually for notifiable conditions were received electronically, compared with 62% in July 2013. These electronic reports were received by 55 of the 57 jurisdictions and came from 3,269 (up from nearly 2,900 in July 2013) of approximately 10,600 reporting laboratories. The proportion of laboratory reports received electronically varied by jurisdiction. In 2014, compared with 2013, the number of jurisdictions receiving >75% of laboratory reports electronically was higher (21 versus 14), and the number of jurisdictions receiving <25% of reports electronically was lower (seven versus nine). National implementation of ELR continues to increase and appears it might reach 80% of total laboratory report volume by 2016. |
Methods for detection of West Nile virus antibodies in mosquito blood meals
Komar N , Panella NA , Young GR , Basile AJ . J Am Mosq Control Assoc 2015 31 (1) 1-6 We describe and compare 2 qualitative serologic techniques for detecting West Nile virus (WNV)-specific antibodies in mosquito blood meals. The techniques are the biotin microsphere immunoassay (b-MIA) and the inhibition platform of the VectorTest WNV antigen assay (VecTest-inhibition). To demonstrate the ability of these tests to detect WNV-neutralizing antibodies, we experimentally exposed feeding mosquitoes to blood containing 5 concentrations of 6B6C-1, a flavivirus-neutralizing monoclonal antibody. Antibody concentrations were quantified using the 90% plaque-reduction neutralization test (PRNT90). After 24 h of blood-meal digestion at 22.5°C, the threshold PRNT90 titer of detection was ≤18 for b-MIA and ≤50 for VecTest-inhibition. Both tests reliably detected antibodies in 3 of 3 blood meals that had been digested for up to 30 h, or were about 25% digested. The b-MIA was also applied to mosquitoes that had engorged on avian blood in Arizona following a WNV epidemic in 2010. There was no significant difference in the WNV antibody prevalence determined by b-MIA (52% of 71 avian blood meals) compared to the WNV-neutralizing antibody prevalence in birds determined by direct sampling (49% of 234 birds). VecTest-inhibition requires fewer resources and may be used in the field without a laboratory, but consumes the entire blood meal and relies on subjective interpretation of results. The b-MIA requires a laboratory and sophisticated equipment and reagents. Results for b-MIA are analyzed objectively and can be applied to mosquito blood meals with greater confidence than the VecTest-inhibition method and thus can contribute substantially to research and surveillance programs that would benefit from the detection of specific WNV antibodies in mosquito blood meals. |
Pan-Plasmodium band sensitivity for Plasmodium falciparum detection in combination malaria rapid diagnostic tests and implications for clinical management
Gatton ML , Rees-Channer RR , Glenn J , Barnwell JW , Cheng Q , Chiodini PL , Incardona S , González IJ , Cunningham J . Malar J 2015 14 115 BACKGROUND: Malaria rapid diagnostic tests (RDTs) are appropriate for case management, but persistent antigenaemia is a concern for HRP2-detecting RDTs in endemic areas. It has been suggested that pan-pLDH test bands on combination RDTs could be used to distinguish persistent antigenaemia from active Plasmodium falciparum infection, however this assumes all active infections produce positive results on both bands of RDTs, an assertion that has not been demonstrated. METHODS: In this study, data generated during the WHO-FIND product testing programme for malaria RDTs was reviewed to investigate the reactivity of individual test bands against P. falciparum in 18 combination RDTs. Each product was tested against multiple wild-type P. falciparum only samples. Antigen levels were measured by quantitative ELISA for HRP2, pLDH and aldolase. RESULTS: When tested against P. falciparum samples at 200 parasites/microL, 92% of RDTs were positive; 57% of these on both the P. falciparum and pan bands, while 43% were positive on the P. falciparum band only. There was a relationship between antigen concentration and band positivity; ≥4 ng/mL of HRP2 produced positive results in more than 95% of P. falciparum bands, while ≥45 ng/mL of pLDH was required for at least 90% of pan bands to be positive. CONCLUSIONS: In active P. falciparum infections it is common for combination RDTs to return a positive HRP2 band combined with a negative pan-pLDH band, and when both bands are positive, often the pan band is faint. Thus active infections could be missed if the presence of a HRP2 band in the absence of a pan band is interpreted as being caused solely by persistent antigenaemia. |
Effect of time at temperature on wild poliovirus titers in stool specimens
Walker AT , Williams AJ , Gary HE Jr , Pallansch MA , Wassilak SG , Oberste MS . Virology 2015 482 28-31 BACKGROUND: The effect of transport temperature on the viability of poliovirus in stool specimens from paralyzed cases has not been tested. Quality assurance of programmatic indicators will be necessary in the final phase of polio eradication. OBJECTIVE: To estimate the effect of time at elevated temperatures on wild poliovirus titers in stool specimens. METHODS: We exposed aliquots of pooled wild poliovirus type 1 specimens to elevated temperatures (27 degrees C, 31 degrees C, and 35 degrees C) for varying time periods up to 14 days. We determined the virus titer of these aliquots and created decay curves at each temperature to estimate the relationship between time at temperature and virus titer. RESULTS: We found significantly different slopes of decay at each temperature. The negative slopes increased as the temperature increased. CONCLUSIONS: While poliovirus in stool remains relatively stable at moderately elevated temperature, transport at higher temperatures could impact sample integrity and virus isolation results. |
Evaluation of household bleach as an ovicide for the control of Aedes aegypti
Mackay AJ , Amador M , Felix G , Acevedo V , Barrera R . J Am Mosq Control Assoc 2015 31 (1) 77-84 Accumulations of dormant eggs in container habitats allow Aedes aegypti populations to survive harsh environmental conditions and may frustrate control interventions directed at larval and adult life stages. While sodium hypochlorite solutions (NaOCl) have long been recognized as ovicides for use against dengue vectors, the susceptibility of eggs to spray applications has not been robustly evaluated on substrate materials representative of the most frequently utilized artificial container habitats. Experiments were performed under controlled and natural conditions by applying dilutions of household bleach (52.5 ppt NaOCl) as a spray to eggs on plastic, rubber, and concrete surfaces, with and without a smectite clay thickener. Laboratory assays identified the minimum NaOCl concentrations required to eliminate eggs on plastic (10 ppt), rubber (20 ppt) and concrete (20 ppt) surfaces. Addition of smectite clay reduced the minimum effective concentration to 10 ppt NaOCl for all 3 substrates. A minimum exposure period of 24 h was required to completely eliminate egg viability on concrete surfaces, even at the highest NaOCl concentration (52.5 ppt). Field experiments verified that spray application of a 13 dilution of household bleach mixed with smectite clay can reduce egg hatching by ≥ 99% in shaded and sun-exposed plastic containers. Similarly, 41 dilution of household bleach (with or without smectite clay) eliminated ≥ 98% of eggs from concrete surfaces in outdoor, water-filled drums. In this study, we propose a practical, effective and safe strategy for using household bleach to eliminate Ae. aegypti eggs in a range of artificial container habitats. |
Investigations of immunotoxicity and allergic potential induced by topical application of triclosan in mice
Anderson SE , Meade BJ , Long CM , Lukomska E , Marshall NB . J Immunotoxicol 2015 13 (2) 1-8 Triclosan is an antimicrobial chemical commonly used occupationally and by the general public. Using select immune function assays, the purpose of these studies was to evaluate the immunotoxicity of triclosan following dermal exposure using a murine model. Triclosan was not identified to be a sensitizer in the murine local lymph node assay (LLNA) when tested at concentrations ranging from 0.75-3.0%. Following a 28-day exposure, triclosan produced a significant increase in liver weight at concentrations of ≥ 1.5%. Exposure to the high dose (3.0%) also produced a significant increase in spleen weights and number of platelets. The absolute number of B-cells, T-cells, dendritic cells and NK cells were significantly increased in the skin draining lymph node, but not the spleen. An increase in the frequency of dendritic cells was also observed in the lymph node following exposure to 3.0% triclosan. The IgM antibody response to sheep red blood cells (SRBC) was significantly increased at 0.75% - but not at the higher concentrations - in the spleen and serum. These results demonstrate that dermal exposure to triclosan induces stimulation of the immune system in a murine model and raise concerns about potential human exposure. |
Collection and laboratory methods for dried blood spots for hemoglobin A1c and total and high-density lipoprotein cholesterol in population based surveys
Miller IM , Lacher DA , Chen TC , Zipf GW , Gindi RM , Galinsky AM , Nwankwo T , Terry AL . Clin Chim Acta 2015 445 143-54 BACKGROUND: The Health Measures at Home Study was a study designed to evaluate the feasibility of incorporating dried blood spots (DBS) collection into the National Health Interview Survey and to compare the proficiencies between field interviewers and health technicians in obtaining DBS. METHODS: DBS collection and venipuncture were attempted on 125 participants. The DBS were collected in the participant's home and venous blood was collected in the National Health and Nutrition Examination Survey (NHANES) mobile examination center. The DBS results were compared to venous results in the NHANES for the measurements of hemoglobin A1c (HbA1c) and total and high-density lipoprotein (HDL) cholesterol. RESULTS: Field interviewers and health technicians were able to collect the DBS for greater than 95% of participants. For DBS, health technicians and field interviewers were highly correlated for HbA1c (r=0.92) and total cholesterol (r=0.89), but not for HDL cholesterol (r=0.72). The DBS results of interviewers and health technicians compared to the venous method for HbA1c (r=0.90), but did not compare well for HDL cholesterol (r=0.64-0.66) and total cholesterol (r=0.65-0.67). CONCLUSION: DBS was comparable to venous HbA1c, but not for total and HDL cholesterol. Health technicians and field interviewers had similar performance for DBS methods, except HDL cholesterol. |
Detection of human exposure to saxitoxin and neosaxitoxin in urine by online-solid phase extraction-liquid chromatography-tandem mass spectrometry
Bragg WA , Lemire SW , Coleman RM , Hamelin EI , Johnson RC . Toxicon 2015 99 118-24 Saxitoxin (STX) and neosaxitoxin (NEO) are potent neurotoxins that cause paralytic shellfish poisoning (PSP). PSP typically occurs through the ingestion of bivalve shellfish that have consumed toxin producing dinoflagellates. Due to initial presentation of symptoms being nonspecific, a clinical measurement is needed to confirm exposure to these toxins. Our group has developed an online solid phase extraction hydrophilic interaction liquid chromatography (HILIC) method for the analysis of STX and NEO in human urine with tandem mass spectrometry. A unique feature of this online method is the incorporation of a new synthetic 15N4-STX labeled internal standard used for quantitation. Manual sample preparation time was reduced by approximately 70% for 98 urine samples as compared to a previously reported method. The lowest reportable limit for STX was improved from 5.0 ng/mL to 1.01 ng/mL and from 10.0 ng/mL to 2.62 ng/mL for NEO. Three analysts validated the method with 20 calibration curves total over 30 days with precision and accuracy within +/-15% for all QCs. This new online method rapidly identifies STX and NEO exposure with improved sensitivity, which can facilitate the work of public health authorities to confirm the cases of PSP, complementing the many shellfish monitoring programs worldwide. |
Survey of American obstetricians regarding group B streptococcus: opinions and practice patterns
Edwards RK , Tang Y , Raglan GB , Szychowski JM , Schulkin J , Schrag SJ . Am J Obstet Gynecol 2015 213 (2) 229 e1-7 OBJECTIVE: To evaluate attitudes and practice patterns of obstetricians related to screening for group B streptococcal colonization and providing intrapartum antibiotic prophylaxis against early-onset neonatal infections with group B streptococcus. STUDY DESIGN: We mailed a survey to 546 members of the American College of Obstetricians and Gynecologists, including members of the Collaborative Ambulatory Research Network and non-Collaborative Ambulatory Research Network members. Stratified random selection was used to generate samples from both of these groups. RESULTS: The survey response rate was 60% for Collaborative Ambulatory Research Network members and 42% for non-Collaborative Ambulatory Research Network members. Of the 206 respondents who reported providing prenatal care, 97% collect screening samples at 35-37 weeks gestational age. Anatomic sites used to collect samples were more variable-62% lower vagina and rectum, 26% lower vagina and perianal skin but not rectum, and 5% include neither the perianal skin nor the rectum. "First line" agents for intrapartum antibiotic prophylaxis were penicillin (71%), ampicillin (27%) and cefazolin (2%). For patients reporting a non-anaphylactic penicillin allergy, drugs used for intrapartum antibiotic prophylaxis were more varied-cefazolin (51%), clindamycin (36%), vancomycin (8%), and erythromycin (5%). For patients undergoing a labor induction starting with a cervical ripening agent, <40% typically give the first dose of intrapartum antibiotic prophylaxis before or at the time of cervical ripening agent administration, and 15% wait until the patient reaches the active phase of labor. CONCLUSIONS: Gaps in knowledge and reported practice related to prevention of early-onset neonatal GBS infections were similar to gaps in implementation of guidelines demonstrated in past studies. New approaches to improve implementation are warranted. |
Urine excretion of caffeine and select caffeine metabolites is common in the US population and associated with caffeine intake
Rybak ME , Sternberg MR , Pao CI , Ahluwalia N , Pfeiffer CM . J Nutr 2015 145 (4) 766-774 BACKGROUND: Caffeine is a widely consumed psychoactive stimulant and is of epidemiologic interest. Major sources of caffeine are challenging to standardize, and the use of biomarkers is proposed as an alternative means of assessing intake. OBJECTIVE: We described urine caffeine and caffeine metabolite concentrations (n = 2466) and excretion rates (n = 2261) in the US population ≥6 y by age, sex, race-ethnicity, and caffeine intake (from foods, beverages, and dietary supplements). METHODS: We measured caffeine and 14 of its metabolites in spot urine samples from the cross-sectional NHANES 2009-2010 by use of LC-tandem mass spectrometry. RESULTS: Caffeine and its metabolites were detectable in the urine of most persons, generally at concentrations ≥1 mumol/L. Median concentrations (95% CI) ranged from 0.560 (0.497, 0.620) micromol/L to 58.6 (48.6, 67.2) micromol/L; median excretion rates from 0.423 (0.385, 0.468) nmol/min to 46.0 (40.7, 50.2) nmol/min. Urine concentrations and excretion rates for 9 analytes (caffeine, theophylline, paraxanthine, 1-methylxanthine, 1-methyluric acid, 1,3-dimethyluric acid, 1,7-dimethyluric acid, 1,3,7-trimethyluric acid, and 5-acetylamino-6-amino-3-methyluracil) had moderate correlations with caffeine intake (Spearman rho = 0.55-0.68, P < 0.0001); the remaining analytes had low correlations (rho = 0.15-0.33, P < 0.0001). We observed larger differences in geometric mean concentrations and excretion rates between the highest vs. lowest quartiles of caffeine intake for these 9 compounds than the rest. Consistent with dietary caffeine intake, we observed that urine concentrations and excretion rates for most compounds were significantly (P < 0.05) higher in men than women, non-Hispanic whites than Hispanics and non-Hispanic blacks, and highest in persons aged 40-59 y. CONCLUSION: Excretion of caffeine and its metabolites in urine is common in the US population. According to the observed associations between spot urine concentrations or excretion rates with caffeine intake, several of these compounds show promise as potential biomarkers of caffeine intake. |
Mothers' child-feeding practices are associated with children's sugar-sweetened beverage intake
Park S , Li R , Birch L . J Nutr 2015 145 (4) 806-812 BACKGROUND: Sugar-sweetened beverage (SSB) intake is a substantial source of energy in the diet of US children. OBJECTIVE: We examined the associations between mothers' child-feeding practices and SSB intake among 6-y-old children. METHODS: We analyzed data from the Year 6 Follow-up of the Infant Feeding Practices Study II in 1350 US children aged 6 y. The outcome variable was child's SSB intake. The exposure variables were 4 child-feeding practices of mothers: setting limits on sweets or junk foods, regulating their child's favorite food intake to prevent overconsumption, pressuring their child to eat enough, and pressuring their child to "clean the plate." We used multinomial logistic regression and controlled for child and maternal characteristics. Analyses were stratified on child weight status. RESULTS: The consumption of SSBs ≥1 time/d was observed among 17.1% of underweight/normal-weight children and in 23.2% of overweight/obese children. Adjusted ORs (aORs) of consuming SSBs ≥1 time/d (vs. no SSB consumption) were significantly lower in children whose mothers reported setting limits on sweets/junk foods (aOR: 0.29; 95% CI: 0.15, 0.58 for underweight/normal-weight children; aOR: 0.16; 95% CI: 0.03, 0.79 for overweight/obese children). SSB intake was higher among underweight/normal-weight children whose mothers reported trying to keep the child from eating too much of their favorite foods (aOR: 2.03; 95% CI: 1.25, 3.29). Mothers' tendency to pressure their children to consume more food or to "clean the plate" was not associated with child's SSB intake. CONCLUSIONS: SSBs were commonly consumed by young children. The odds of daily SSB intake were lower among children whose mothers set limits on sweets/junk foods regardless of child's weight but were higher among underweight/normal-weight children whose mothers restricted the child's favorite food intake. Future studies can investigate the impact of alternatives to restrictive feeding practices that could reduce children's SSB intake. |
Estimating the population distribution of usual 24-hour sodium excretion from timed urine void specimens using a statistical approach accounting for correlated measurement errors
Wang CY , Carriquiry AL , Chen TC , Loria CM , Pfeiffer CM , Liu K , Sempos CT , Perrine CG , Cogswell ME . J Nutr 2015 145 (5) 1017-24 BACKGROUND: High US sodium intake and national reduction efforts necessitate developing a feasible and valid monitoring method across the distribution of low-to-high sodium intake. OBJECTIVE: We examined a statistical approach using timed urine voids to estimate the population distribution of usual 24-h sodium excretion. METHODS: A sample of 407 adults, aged 18-39 y (54% female, 48% black), collected each void in a separate container for 24 h; 133 repeated the procedure 4-11 d later. Four timed voids (morning, afternoon, evening, overnight) were selected from each 24-h collection. We developed gender-specific equations to calibrate total sodium excreted in each of the one-void (e.g., morning) and combined two-void (e.g., morning + afternoon) urines to 24-h sodium excretion. The calibrated sodium excretions were used to estimate the population distribution of usual 24-h sodium excretion. Participants were then randomly assigned to modeling (n = 160) or validation (n = 247) groups to examine the bias in estimated population percentiles. RESULTS: Median bias in predicting selected percentiles (5th, 25th, 50th, 75th, 95th) of usual 24-h sodium excretion with one-void urines ranged from -367 to 284 mg (-7.7 to 12.2% of the observed usual excretions) for men and -604 to 486 mg (-14.6 to 23.7%) for women, and with two-void urines from -338 to 263 mg (-6.9 to 10.4%) and -166 to 153 mg (-4.1 to 8.1%), respectively. Four of the 6 two-void urine combinations produced no significant bias in predicting selected percentiles. CONCLUSIONS: Our approach to estimate the population usual 24-h sodium excretion, which uses calibrated timed-void sodium to account for day-to-day variation and covariance between measurement errors, produced percentile estimates with relatively low biases across low-to-high sodium excretions. This may provide a low-burden, low-cost alternative to 24-h collections in monitoring population sodium intake among healthy young adults and merits further investigation in other population subgroups. This study was registered at clinicaltrials.gov as NCT01631240. |
Personal protective equipment for filovirus epidemics: a call for better evidence
Sprecher AG , Caluwaerts A , Draper M , Feldmann H , Frey CP , Funk RH , Kobinger G , Le Duc JW , Spiropoulou C , Williams WJ . J Infect Dis 2015 212 Suppl 2 S98-S100 Personal protective equipment (PPE) is an important part of worker protection during filovirus outbreaks. The need to protect against a highly virulent fluid-borne pathogen in the tropical environment imposes a heat stress on the wearer that is itself a safety risk. No evidence supports the choice of PPE employed in recent outbreaks, and standard testing procedures employed by the protective garment industry do not well simulate filovirus exposure. Further research is needed to determine the appropriate PPE for filoviruses and the heat stress that it imposes. |
The effects of operator position, pallet orientation, and palletizing condition on low back loads in manual bag palletizing operations
Gallagher S , Heberger JR . Int J Ind Ergon 2015 47 84-92 Many mining commodities are packaged and shipped using bags. Small bags are typically loaded onto pallets for transport and require a significant amount of manual handling by workers. This specific task of manual bag handling has been associated with the development of musculoskeletal disorders (MSDs), especially low back disorders. This study evaluates the biomechanical demands of different work layouts when performing manual palletizing of small bags, and evaluates the biomechanical stresses associated with different stacking techniques. Results indicate that peak forward bending moments as well as spinal compression and shear forces are higher when the pallet is situated at the side of the conveyor as opposed to the end of the conveyor. At low levels of the pallet, controlled bag placement results in higher peak forward bending moments than stacking at higher levels and when dropping the bag to lower levels. The results of this study will be used to inform the development of an audit tool for bagging operations in the mining industry. Relevance to industry: In many cases for workers loading small bags, compression forces exceed the NIOSH criterion of 3400N. Orientation of the pallet has a significant impact on spinal compression, and positioning the pallet at the end of the conveyor reduces the estimated compressive loading on the lumbar spine by approximately 800N. |
A hybrid approach for efficient modeling of medium-frequency propagation in coal mines
Brocker DE , Sieber PE , Waynert JA , Li J , Werner PL , Werner DH . IEEE Antennas Propag Mag 2015 57 (1) 164-176 An efficient procedure for modeling medium frequency (MF) communications in coal mines is introduced. In particular, a hybrid approach is formulated and demonstrated utilizing ideal transmission line equations to model MF propagation in combination with full-wave sections used for accurate simulation of local antenna-line coupling and other near-field effects. This work confirms that the hybrid method accurately models signal propagation from a source to a load for various system geometries and material compositions, while significantly reducing computation time. With such dramatic improvement to solution times, it becomes feasible to perform large-scale optimizations with the primary motivation of improving communications in coal mines both for daily operations and emergency response. Furthermore, it is demonstrated that the hybrid approach is suitable for modeling and optimizing large communication networks in coal mines that may otherwise be intractable to simulate using traditional full-wave techniques such as moment methods or finite-element analysis. |
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