Evaluating progress in radon control activities for lung cancer prevention in National Comprehensive Cancer Control Program Plans, 2011-2015
Acree P , Puckett M , Neri A . J Community Health 2017 42 (5) 962-967 Radon is the second leading cause of lung cancer among smokers and the leading cause among nonsmokers. The Centers for Disease Control and Prevention's National Comprehensive Cancer Control Program (NCCCP) funds every state, seven tribes, seven territories and the District of Columbia to develop formal cancer plans that focus efforts in cancer control. A 2010 review of cancer plans identified radon-related activities in 27 (42%) plans. Since then, 37 coalitions have updated their plans with new or revised cancer control objectives. There has also been recent efforts to increase awareness about radon among cancer coalitions. This study assesses NCCCP grantees current radon activities and changes since the 2010 review. We reviewed all 65 NCCCP grantee cancer plans created from 2005 to 2015 for radon related search terms and categorized plans by radon activities. The program's most recent annual progress report to CDC was also reviewed. We then compared the results from the updated plans with the findings from the 2010 review to assess changes in radon activities among cancer coalitions. Changes in state radon laws between 2010 and 2015 were also assessed. While a number of cancer plans have added or expanded radon-specific activities since 2010, approximately one-third of NCCCP grantees still do not include radon in their cancer plans. Cancer programs can consider addressing radon through partnership with existing radon control programs to further reduce the risk of lung cancer, especially among non-smokers. |
Home blood pressure monitoring among adults-American Heart Association Cardiovascular Health Consumer Survey, 2012
Ayala C , Tong X , Neeley E , Lane R , Robb K , Loustalot F . J Clin Hypertens (Greenwich) 2017 19 (6) 584-591 Home blood pressure monitoring (HBPM) among hypertensive adults was assessed using the 2012 American Heart Association Cardiovascular Health Consumer Survey. The prevalence of hypertension was 25.5% and 53.8% of those reported HBPM. Approximately 63% of hypertensive adults 65 years and older reported HBPM followed by 51% and 34.6% (35-64 and 18-34 years, respectively; P=.001). Those who had seen a healthcare professional within a year reported HBPM compared with those who had not (54.8% vs 32.8%, P=.047). Those who believed that lowering blood pressure can reduce risk of heart attack and stroke had a higher percentage of HBPM compared with those who did not (55.5% vs 33.1%, P=.01). Age and the belief that lowering blood pressure could reduce cardiovascular disease risk were significant factors associated with HBPM. Half of the adult hypertensive patients reported HBPM and its use was greater among those who reported a positive attitude toward lowering blood pressure to reduce cardiovascular disease risk. |
Annual Report to the Nation on the Status of Cancer, 1975-2014, featuring survival
Jemal A , Ward EM , Johnson CJ , Cronin KA , Ma J , Ryerson B , Mariotto A , Lake AJ , Wilson R , Sherman RL , Anderson RN , Henley SJ , Kohler BA , Penberthy L , Feuer EJ , Weir HK . J Natl Cancer Inst 2017 109 (9) Background: The American Cancer Society (ACS), the Centers for Disease Control and Prevention (CDC), the National Cancer Institute (NCI), and the North American Association of Central Cancer Registries (NAACCR) collaborate to provide annual updates on cancer occurrence and trends in the United States. This Annual Report highlights survival rates. Data were from the CDC- and NCI-funded population-based cancer registry programs and compiled by NAACCR. Trends in age-standardized incidence and death rates for all cancers combined and for the leading cancer types by sex were estimated by joinpoint analysis and expressed as annual percent change. We used relative survival ratios and adjusted relative risk of death after a diagnosis of cancer (hazard ratios [HRs]) using Cox regression model to examine changes or differences in survival over time and by sociodemographic factors. Results: Overall cancer death rates from 2010 to 2014 decreased by 1.8% (95% confidence interval [CI] = -1.8 to -1.8) per year in men, by 1.4% (95% CI = -1.4 to -1.3) per year in women, and by 1.6% (95% CI = -2.0 to -1.3) per year in children. Death rates decreased for 11 of the 16 most common cancer types in men and for 13 of the 18 most common cancer types in women, including lung, colorectal, female breast, and prostate, whereas death rates increased for liver (men and women), pancreas (men), brain (men), and uterine cancers. In contrast, overall incidence rates from 2009 to 2013 decreased by 2.3% (95% CI = -3.1 to -1.4) per year in men but stabilized in women. For several but not all cancer types, survival statistically significantly improved over time for both early and late-stage diseases. Between 1975 and 1977, and 2006 and 2012, for example, five-year relative survival for distant-stage disease statistically significantly increased from 18.7% (95% CI = 16.9% to 20.6%) to 33.6% (95% CI = 32.2% to 35.0%) for female breast cancer but not for liver cancer (from 1.1%, 95% CI = 0.3% to 2.9%, to 2.3%, 95% CI = 1.6% to 3.2%). Survival varied by race/ethnicity and state. For example, the adjusted relative risk of death for all cancers combined was 33% (HR = 1.33, 95% CI = 1.32 to 1.34) higher in non-Hispanic blacks and 51% (HR = 1.51, 95% CI = 1.46 to 1.56) higher in non-Hispanic American Indian/Alaska Native compared with non-Hispanic whites. Conclusions: Cancer death rates continue to decrease in the United States. However, progress in reducing death rates and improving survival is limited for several cancer types, underscoring the need for intensified efforts to discover new strategies for prevention, early detection, and treatment and to apply proven preventive measures broadly and equitably. |
Ebola Virus RNA in Semen from an HIV-Positive Survivor of Ebola.
Purpura LJ , Rogers E , Baller A , White S , Soka M , Choi MJ , Mahmoud N , Wasunna C , Massaquoi M , Kollie J , Dweh S , Bemah P , Ladele V , Kpaka J , Jawara M , Mugisha M , Subah O , Faikai M , Bailey JA , Rollin P , Marston B , Nyenswah T , Gasasira A , Knust B , Nichol S , Williams D . Emerg Infect Dis 2017 23 (4) 714-715 Ebola virus is known to persist in semen of male survivors of Ebola virus disease (EVD). However, maximum duration of, or risk factors for, virus persistence are unknown. We report an EVD survivor with preexisting HIV infection, whose semen was positive for Ebola virus RNA 565 days after recovery from EVD. |
Surveillance Systems to Track Progress Toward Polio Eradication - Worldwide, 2015-2016.
Maes EF , Diop OM , Jorba J , Chavan S , Tangermann RH , Wassilak SG . MMWR Morb Mortal Wkly Rep 2017 66 (13) 359-365 Global measures to eradicate polio began in 1988; as of 2014, four of six World Health Organization (WHO) regions have been certified polio-free. Within the two endemic regions (African and Eastern Mediterranean), Nigeria, Afghanistan, and Pakistan have never interrupted transmission of wild poliovirus (WPV) (1). The primary means of detecting poliovirus transmission is surveillance for acute flaccid paralysis (AFP) among children aged <15 years, combined with collection and testing of stool specimens from persons with AFP for detection of WPV and vaccine-derived polioviruses (VDPVs) (viruses that differ genetically from vaccine viruses and can emerge in areas with low vaccination coverage and cause paralysis) in WHO-accredited laboratories within the Global Polio Laboratory Network (2,3). AFP surveillance is supplemented by environmental surveillance for polioviruses in sewage from selected locations (4). Genomic sequencing of the VP1-coding region of isolated polioviruses enables mapping transmission by time and place, assessment of potential gaps in surveillance, and identification of the emergence of VDPVs. This report presents poliovirus surveillance data from 2015 and 2016, with particular focus on 20 countries in the African Region and six in the Eastern Mediterranean Region that reported WPV or circulating VDPVs (cVDPVs) during 2011-2016, as well as the three countries most affected by the 2014-2015 Ebola virus disease (Ebola) outbreak (Guinea, Liberia, and Sierra Leone). During 2016, 12 (60%) of the 20 African Region countries and all six of the Eastern Mediterranean Region countries met both surveillance quality indicators (nonpolio AFP rates of ≥2 per 100,000 persons aged <15 years per year and ≥80% of AFP cases with adequate stool specimens [stool adequacy]) at the national level; however, provincial-level variation was seen. To complete and certify polio eradication, surveillance gaps must be identified and surveillance activities, including supervision, monitoring, and specimen collection and handling, further strengthened. |
Molecular epidemiology of influenza A(H1N1)PDM09 hemagglutinin gene circulating in São Paulo State , Brazil: 2016 anticipated influenza season.
Santos KC , Silva DB , Sasaki NA , Benega MA , Garten R , Paiva TM . Rev Inst Med Trop Sao Paulo 2017 59 e9 Compared to previous years, seasonal influenza activity commenced early in Sao Paulo State, Brazil, Southern hemisphere during the 2016 year. In order to investigate the genetic pattern of influenza A(H1N1)pdm09 in the State of Sao Paulo a total of 479 respiratory samples, collected in January by Sentinel Surveillance Units, were screened by real-time RT-PCR. A total of 6 Influenza viruses A(H1N1)pdm09 presenting ct values ≤ 30 were sequenced following phylogenetic analysis. The present study identified the circulation of the new 6B.1 subgroup (A/Sao Paulo/10-118/2016 and A/Sao Paulo/3032/2016). In addition, influenza A(H1N1)pdm09 group 6B has also been identified during January in the State of Sao Paulo. Despite amino acid changes and changes in potential glycosylation motifs, 6B.1 viruses were well inhibited by the reference ferret antiserum against A/California/07/2009 virus, the A(H1N1)pdm09 component of the vaccine for the 2016 influenza season. |
Mutational Correlates of Virological Failure in Individuals Receiving a WHO-Recommended Tenofovir-Containing First-Line Regimen: An International Collaboration.
Rhee SY , Varghese V , Holmes SP , Van Zyl GU , Steegen K , Boyd MA , Cooper DA , Nsanzimana S , Saravanan S , Charpentier C , de Oliveira T , Etiebet MA , Garcia F , Goedhals D , Gomes P , Gunthard HF , Hamers RL , Hoffmann CJ , Hunt G , Jiamsakul A , Kaleebu P , Kanki P , Kantor R , Kerschberger B , Marconi VC , D'Amour Ndahimana J , Ndembi N , Ngo-Giang-Huong N , Rokx C , Santoro MM , Schapiro JM , Schmidt D , Seu L , Sigaloff KC , Sirivichayakul S , Skhosana L , Sunpath H , Tang M , Yang C , Carmona S , Gupta RK , Shafer RW . EBioMedicine 2017 18 225-235 Tenofovir disoproxil fumarate (TDF) genotypic resistance defined by K65R/N and/or K70E/Q/G occurs in 20% to 60% of individuals with virological failure (VF) on a WHO-recommended TDF-containing first-line regimen. However, the full spectrum of reverse transcriptase (RT) mutations selected in individuals with VF on such a regimen is not known. To identify TDF regimen-associated mutations (TRAMs), we compared the proportion of each RT mutation in 2873 individuals with VF on a WHO-recommended first-line TDF-containing regimen to its proportion in a cohort of 50,803 antiretroviral-naive individuals. To identify TRAMs specifically associated with TDF-selection pressure, we compared the proportion of each TRAM to its proportion in a cohort of 5805 individuals with VF on a first-line thymidine analog-containing regimen. We identified 83 TRAMs including 33 NRTI-associated, 40 NNRTI-associated, and 10 uncommon mutations of uncertain provenance. Of the 33 NRTI-associated TRAMs, 12 - A62V, K65R/N, S68G/N/D, K70E/Q/T, L74I, V75L, and Y115F - were more common among individuals receiving a first-line TDF-containing compared to a first-line thymidine analog-containing regimen. These 12 TDF-selected TRAMs will be important for monitoring TDF-associated transmitted drug-resistance and for determining the extent of reduced TDF susceptibility in individuals with VF on a TDF-containing regimen. |
The role of family planning in achieving safe pregnancy for serodiscordant couples: commentary from the United States government's interagency task force on family planning and HIV service integration
Mason J , Medley A , Yeiser S , Nightingale VR , Mani N , Sripipatana T , Abutu A , Johnston B , Watts DH . J Int AIDS Soc 2017 20 4-11 INTRODUCTION: People living with HIV (PLHIV) have the right to exercise voluntary choices about their health, including their reproductive health. This commentary discusses the integral role that family planning (FP) plays in helping PLHIV, including those in serodiscordant relationships, achieve conception safely. The United States (US) President's Emergency Plan for AIDS Relief (PEPFAR) is committed to meeting the reproductive health needs of PLHIV by improving their access to voluntary FP counselling and services, including prevention of unintended pregnancy and counselling for safer conception. DISCUSSION: Inclusion of preconception care and counselling (PCC) as part of routine HIV services is critical to preventing unintended pregnancies and perinatal infections among PLHIV. PLHIV not desiring a current pregnancy should be provided with information and counselling on all available FP methods and then either given the method onsite or through a facilitated referral process. PLHIV, who desire children should be offered risk reduction counselling, support for HIV status disclosure and partner testing, information on safer conception options to reduce the risk of HIV transmission to the partner and the importance of adhering to antiretroviral treatment during pregnancy and breastfeeding to reduce the risk of vertical transmission to the infant. Integration of PCC, HIV and FP services at the same location is recommended to improve access to these services for PLHIV. Other considerations to be addressed include the social and structural context, the health system capacity to offer these services, and stigma and discrimination of providers. CONCLUSION: Evaluation of innovative service delivery models for delivering PCC services is needed, including provision in community-based settings. The US Government will continue to partner with local organizations, Ministries of Health, the private sector, civil society, multilateral and bilateral donors, and other key stakeholders to strengthen both the policy and programme environment to ensure that all PLHIV and serodiscordant couples have access to FP services, including prevention of unintended pregnancy and safer conception counselling. |
Severe parechovirus 3 infections in young infants - Kansas and Missouri, 2014
Midgley CM , Jackson MA , Selvarangan R , Franklin P , Holzschuh EL , Lloyd J , Scaletta J , Straily A , Tubach S , Willingham A , Nix WA , Oberste MS , Harrison CJ , Hunt C , Turabelidze G , Gerber SI , Watson JT . J Pediatric Infect Dis Soc 2017 7 (2) 104-112 Background: Infection with parechovirus type 3 (PeV3) can cause severe neurologic and sepsis-like illness in young infants; clinical and epidemiologic descriptions have been limited. We aimed to characterize PeV3 illness and explore risk factors for acquisition in a cluster of neonatal cases at Children's Mercy Hospital in Kansas City, Missouri. Methods: Cerebrospinal fluid specimens were obtained from infants aged <180 days who were hospitalized with sepsis-like illness or meningitis between June 1 and November 1, 2014. PeV-positive specimens were sequenced at the Centers for Disease Control and Prevention. We reviewed the medical and birth charts of the infants and performed face-to-face parent interviews. We analyzed characteristics according to infant age and intensive care admission status. Results: We identified 35 cases of PeV infection in infants aged 5 to 56 days. Seven infants required intensive care (median age, 11 days vs 27 days among those who did not require intensive care; P = .0044). Six of these 7 infants had neurologic manifestations consistent with seizures, and all 6 of them were treated with acyclovir but subsequently tested negative for herpes simplex virus. Virus sequences formed 2 lineages, both of which were associated with severe illness. Half of the infants were reported to have household contacts who were ill during the week before onset. Infants aged ≤7 days at onset were more likely to have been delivered at the same hospital. Conclusions: PeV3 can cause severe neurologic illness in neonates, and younger infants are more likely to require intensive care. PeV3 should be considered along with herpes simplex virus and other pathogens when evaluating young infants with sepsis-like illness or meningitis. More widespread testing for PeV3 would enable us to gain a better understanding of the clinical scope and circulation of this virus. |
State-specific rates of primary and secondary syphilis among men who have sex with men - United States, 2015
de Voux A , Kidd S , Grey JA , Rosenberg ES , Gift TL , Weinstock H , Bernstein KT . MMWR Morb Mortal Wkly Rep 2017 66 (13) 349-354 In 2015, the rate of reported primary and secondary syphilis in the United States was 7.5 cases per 100,000 population, nearly four times the previous lowest documented rate of 2.1 in 2000. In 2015, 81.7% of male primary and secondary syphilis cases with information on the sex of the sex partner were among gay, bisexual, and other men who have sex with men (collectively referred to as MSM) (1). These data suggest a disproportionate incidence of disease among MSM. However, attempts to quantify this disparity have been hindered by limited data on the size of the MSM population at the state level. To produce the first estimates of state-specific rates of primary and secondary syphilis among MSM, CDC used MSM population estimates based on a new methodology and primary and secondary syphilis case counts reported in 2015 to the National Notifiable Diseases Surveillance System. Among 44 states reporting information on the sex of sex partners for ≥70% of male cases, the overall rate of primary and secondary syphilis among all men (aged ≥18 years) in the United States in 2015 was 17.5 per 100,000, compared with 309.0 among MSM and 2.9 among men who reported sex with women only. The overall rate of primary and secondary syphilis among MSM was 106.0 times the rate among men who have sex with women only and 167.5 times the rate among women.* These data highlight the disproportionate impact of syphilis among MSM and underscore the need for innovative and targeted syphilis prevention measures at the state and local level, especially among MSM. It is important that health care providers recognize the signs and symptoms of syphilis, screen sexually active MSM for syphilis at least annually, and provide timely treatment according to national sexually transmitted diseases treatment guidelines. |
Status and methodology of publicly available national HIV care continua and 90-90-90 targets: A systematic review
Granich R , Gupta S , Hall I , Aberle-Grasse J , Hader S , Mermin J . PLoS Med 2017 14 (4) e1002253 BACKGROUND: In 2014, the Joint United Nations Program on HIV/AIDS (UNAIDS) issued treatment goals for human immunodeficiency virus (HIV). The 90-90-90 target specifies that by 2020, 90% of individuals living with HIV will know their HIV status, 90% of people with diagnosed HIV infection will receive antiretroviral treatment (ART), and 90% of those taking ART will be virally suppressed. Consistent methods and routine reporting in the public domain will be necessary for tracking progress towards the 90-90-90 target. METHODS AND FINDINGS: For the period 2010-2016, we searched PubMed, UNAIDS country progress reports, World Health Organization (WHO), UNAIDS reports, national surveillance and program reports, United States President's Emergency Plan for AIDS Relief (PEPFAR) Country Operational Plans, and conference presentations and/or abstracts for the latest available national HIV care continuum in the public domain. Continua of care included the number and proportion of people living with HIV (PLHIV) who are diagnosed, on ART, and virally suppressed out of the estimated number of PLHIV. We ranked the described methods for indicators to derive high-, medium-, and low-quality continuum. For 2010-2016, we identified 53 national care continua with viral suppression estimates representing 19.7 million (54%) of the 2015 global estimate of PLHIV. Of the 53, 6 (with 2% of global burden) were high quality, using standard surveillance methods to derive an overall denominator and program data from national cohorts for estimating steps in the continuum. Only nine countries in sub-Saharan Africa had care continua with viral suppression estimates. Of the 53 countries, the average proportion of the aggregate of PLHIV from all countries on ART was 48%, and the proportion of PLHIV who were virally suppressed was 40%. Seven countries (Sweden, Cambodia, United Kingdom, Switzerland, Denmark, Rwanda, and Namibia) were within 12% and 10% of achieving the 90-90-90 target for "on ART" and for "viral suppression," respectively. The limitations to consider when interpreting the results include significant variation in methods used to determine national continua and the possibility that complete continua were not available through our comprehensive search of the public domain. CONCLUSIONS: Relatively few complete national continua of care are available in the public domain, and there is considerable variation in the methods for determining progress towards the 90-90-90 target. Despite bearing the highest HIV burden, national care continua from sub-Saharan Africa were less likely to be in the public domain. A standardized monitoring and evaluation approach could improve the use of scarce resources to achieve 90-90-90 through improved transparency, accountability, and efficiency. |
Surveillance and testing for Middle East Respiratory Syndrome Coronavirus, Saudi Arabia, April 2015-February 2016
Saeed AA , Abedi GR , Alzahrani AG , Salameh I , Abdirizak F , Alhakeem R , Algarni H , El Nil OA , Mohammed M , Assiri AM , Alabdely HM , Watson JT , Gerber SI . Emerg Infect Dis 2017 23 (4) 682-685 Saudi Arabia has reported >80% of the Middle East respiratory syndrome coronavirus (MERS-CoV) cases worldwide. During April 2015-February 2016, Saudi Arabia identified and tested 57,363 persons (18.4/10,000 residents) with suspected MERS-CoV infection; 384 (0.7%) tested positive. Robust, extensive, and timely surveillance is critical for limiting virus transmission. |
Updated data on linkage to human immunodeficiency virus care and antiretroviral treatment among men who have sex with men - 20 cities, United States
Hoots BE , Finlayson TJ , Wejnert C , Paz-Bailey G . J Infect Dis 2017 216 (7) 808-812 We examined differences in prevalence of linkage to care and antiretroviral (ARV) treatment among human immunodeficiency virus (HIV)-positive men who have sex with men (MSM) between 2008 and 2014 in National HIV Behavioral Surveillance. Prevalence of linkage to care increased from 79% in 2008 to 87% in 2014 (prevalence ratio [PR], 1.05; 95% confidence interval [CI], 1.03-1.07). ARV treatment increased from 69% in 2008 to 88% in 2014 (adjusted PR, 1.15; 95% CI, 1.12-1.18). Despite these increases, a large disparity in ARV treatment between white and black MSM remains. Increased resources are needed to support immediate referrals for ARV treatment for all MSM newly diagnosed with HIV. |
Measles and rubella elimination in the WHO Region for Europe: progress and challenges
O'Connor P , Jankovic D , Muscat M , Ben-Mamou M , Reef S , Papania M , Singh S , Kaloumenos T , Butler R , Datta S . Clin Microbiol Infect 2017 23 (8) 504-510 Globally measles remains one of the leading causes of death among young children even though a safe and cost-effective vaccine is available. The World Health Organization (WHO) European Region has seen a decline in measles and rubella cases in recent years. The recent outbreaks have primarily affected adolescents and young adults with no vaccination or an incomplete vaccination history. Eliminating measles and rubella is one of the top immunization priorities of the European Region as outlined in the European Vaccine Action Plan 2015-2020. Following the 2010 decision by the Member States in the Region to initiate the process of verifying elimination, the European Regional Verification Commission for Measles and Rubella Elimination (RVC) was established in 2011. The RVC meets every year to evaluate the status of measles and rubella elimination in the Region based on documentation submitted by each country's National Verification Committees. The verification process was however modified in late 2014 to assess the elimination status at the individual country level instead of at regional level. The WHO European Region has made substantial progress towards measles and rubella elimination over the past 5 years. The RVC's conclusion in 2016 that 70% and 66% of the 53 Member States in the Region had interrupted the endemic transmission of measles and rubella, respectively, by 2015 is a testament to this progress. Nevertheless, where measles and rubella remain endemic, challenges in vaccination service delivery and disease surveillance will need to be addressed through focused technical assistance from WHO and development partners. |
Performance evaluation of the point-of-care INSTI HIV-1/2 antibody test in early and established HIV infections
Adams S , Luo W , Wesolowski L , Cohen SE , Peters PJ , Owen SM , Masciotra S . J Clin Virol 2017 91 90-94 BACKGROUND: The flow-through INSTI HIV-1/HIV-2 Rapid Antibody (INSTI) test is a 60s FDA-approved test for HIV-1 and HIV-2 antibody testing using whole blood and plasma. OBJECTIVE: We evaluated the performance of INSTI using plasma and simulated whole blood specimens. STUDY DESIGN: INSTI's performance in plasma specimens from commercial seroconversion panels was assessed by estimating the relative sensitivity using a 50% cumulative frequency analysis and by comparing its performance with other FDA-approved rapid tests (RTs). INSTI was further evaluated using 320 HIV-1 plasma specimens collected during a cross-sectional study and with 107 HIV-1 and 24 HIV-2 simulated whole blood specimens. Sensitivity and specificity were calculated using 615 known HIV-1 group M/O and 80 HIV-2 (Western blot (WB)-positive), and 497 HIV-negative plasma specimens, respectively. RESULTS: In HIV-1 seroconversion panels, INSTI became reactive 9days before a positive WB. When compared to FDA-approved antibody-based lateral flow RTs, INSTI detected significantly more early infections. Among HIV-1-infected cross-sectional plasma samples, INSTI detected 23 (27%) of 85 Architect-positive/Multispot-negative or indeterminate specimens. For plasma specimens, the sensitivity was 99.84% for HIV-1 and 100% for HIV-2, and the specificity was 99.80%. Using simulated whole blood from seroconverters, INSTI performed similarly to plasma. CONCLUSIONS: INSTI performed significantly better than antibody-based lateral flow RTs during early stages of seroconversion. Sensitivity and specificity were within the manufacturer's reported ranges. Considering the observed test performance and the almost immediate results, INSTI is an accurate option to detect HIV-1/HIV-2 antibodies in point-of-care settings where lab testing is not feasible. |
Enterovirus D68 infection among children with medically attended acute respiratory illness, Cincinnati, Ohio, July-October, 2014
Biggs HM , McNeal M , Nix WA , Kercsmar C , Curns AT , Connelly B , Rice M , Chern SW , Prill MM , Back N , Oberste MS , Gerber SI , Staat MA . Clin Infect Dis 2017 65 (2) 315-323 Background: Enterovirus D68 (EV-D68) caused a widespread outbreak of respiratory illness in the United States in 2014, predominantly affecting children. We describe EV-D68 rates, spectrum of illness and risk factors from prospective, population-based acute respiratory illness (ARI) surveillance at a large U.S. pediatric hospital. Methods: Children <13 years of age with ARI and residence in Hamilton County, Ohio were enrolled from the inpatient and emergency department (ED) settings at a children's hospital in Cincinnati, Ohio, from July 1-October 31, 2014. For each participant, we interviewed parents, reviewed medical records, and tested nasal and throat swabs for EV-D68 using real-time RT-PCR assay. Results: EV-D68 infection was detected in 51/207 (25%) inpatients and 58/505 (11%) ED patients. Rates of EV-D68 hospitalization and ED visit were 1.3 (95% CI: 1.0-1.6) and 8.4 per 1,000 children <13 years of age, respectively. Pre-existing asthma was associated with EV-D68 infection (aOR 3.2; 95 %CI 2.0-5.1). Compared with other ARI, children with EV-D68 were more likely to be admitted from the ED (p=<0.001), receive supplemental oxygen (p=0.001), and require ICU admission (p=0.04); however, mechanical ventilation was uncommon (2/51 inpatients, p=0.64), and no deaths occurred. Conclusions: During the 2014 EV-D68 epidemic, high rates of pediatric hospitalizations and ED visits were observed. Children with asthma were at increased risk for medically attended EV-D68 illness. Preparedness planning for a high-activity EV-D68 season in the U.S. should take into account increased healthcare utilization, particularly among children with asthma, during the late summer and early fall. |
Factors associated with condom use among sexually active US adults, National Survey of Family Growth, 2006-2010 and 2011-2013
Nasrullah M , Oraka E , Chavez PR , Johnson CH , DiNenno E . J Sex Med 2017 14 (4) 541-550 BACKGROUND: Condom-less sex can increase the risk of acquiring or transmitting HIV. AIM: To characterize the prevalence of condom use at the most recent sex act and identify factors associated with use of a condom at the most recent sex act in adults in the United States. METHODS: Data from the cross-sectional National Survey of Family Growth from cycles 2006 through 2010 and 2011 through 2013 were analyzed for sexually active men and women 18 to 44 years old who reported having sex (vaginal, anal, or oral) with an opposite-sex partner in the past 12 months. HIV-related sexual risk behaviors (SRBs) in the past 12 months included sex with at least four opposite-sex partners; exchanging sex for money or drugs; sex with an injection drug user; sex with an HIV-positive person; sex with a man who previously had sex with a man (women only); sex with a man (men only); or sex with a partner who had sex with other partners. OUTCOMES: The outcome for this analysis was condom use at the most recent anal or vaginal sex act. RESULTS: Overall prevalence of condom use was 24.8%; only 33.8% of adults with at least one SRB reported the use of a condom. Only 46.4% of unmarried or single men (vs 14.7% married or cohabitating men) and 32.3% unmarried or single women (vs 14.1% married or cohabitating women) with SRBs reported using a condom at the most recent sexual encounter and were less likely to use a condom at the most recent sexual encounter compared with those who did not report SRBs. We did not find a significant relation between using a condom and SRBs in married or cohabitating men and women. STRENGTHS AND LIMITATIONS: Our analysis adds to the literature on how condom use varies by marital status. We measured the use of condoms at the most recent sexual act, which might not reflect an individual's previous behavior of condom use. Nonetheless, condom use at the most recent sexual act has been documented in previous studies as a valid proxy of condom use over time. CONCLUSION: Continued efforts are needed to promote condom use in heterosexual adults in the United States, particularly those at high risk for HIV, namely individuals engaging in anal sexual acts and with multiple sex partners. Nasrullah M, Oraka E, Chavez PR, et al. Factors Associated With Condom Use Among Sexually Active US Adults, National Survey of Family Growth, 2006-2010 and 2011-2013. J Sex Med 2017;14:541-550. |
High prevalence of abacavir-associated L74V/I mutations in Kenyan children failing antiretroviral therapy
Dziuban EJ , DeVos J , Ngeno B , Ngugi E , Zhang G , Sabatier J , Wagar N , Diallo K , Nganga L , Katana A , Yang C , Rivadeneira ED , Mukui I , Odhiambo F , Redfield R , Raizes E . Pediatr Infect Dis J 2017 36 (8) 758-760 A survey of 461 HIV-infected Kenyan children receiving antiretroviral therapy found 143 (31%) failing virologically. Drug resistance mutations were found in 121; 37 had L74V/I mutations, with 95% receiving abacavir-containing regimens. L74V/I was associated with current abacavir usage (p=0.0001). L74V/I may be more prevalent than previously realized in children failing abacavir-containing regimens, even when time on treatment has been short. Ongoing rigorous pediatric drug resistance surveillance is needed. |
HIV services provided by STD programs in state and local health departments - United States, 2013-2014
Cuffe KM , Esie P , Leichliter JS , Gift TL . MMWR Morb Mortal Wkly Rep 2017 66 (13) 355-358 The incidence of human immunodeficiency virus (HIV) infection in the United States is higher among persons with other sexually transmitted diseases (STDs), and the incidence of other STDs is increased among persons with HIV infection (1). Because infection with an STD increases the risk for HIV acquisition and transmission (1-4), successfully treating STDs might help reduce the spread of HIV among persons at high risk (1-4). Because health department STD programs provide services to populations who are at risk for HIV, ensuring service integration and coordination could potentially reduce the incidence of STDs and HIV. Program integration refers to the combining of STD and HIV prevention programs through structural, service, or policy-related changes such as combining funding streams, performing STD and HIV case matching, or integrating staff members (5). Some STD programs in U.S. health departments are partially or fully integrated with an HIV program (STD/HIV program), whereas other STD programs are completely separate. To assess the extent of provision of HIV services by state and local health department STD programs, CDC analyzed data from a sample of 311 local health departments and 56 state and directly funded city health departments derived from a national survey of STD programs. CDC found variation in the provision of HIV services by STD programs at the state and local levels. Overall, 73.1% of state health departments and 16.1% of local health departments matched STD case report data with HIV data to analyze possible syndemics (co-occurring epidemics that exacerbate the negative health effects of any of the diseases) and overlaps. Similarly, 94.1% of state health departments and 46.7% of local health departments performed site visits to HIV care providers to provide STD information or public health updates. One fourth of state health departments and 39.4% of local health departments provided HIV testing in nonclinical settings (field testing) for STD contacts, and all of these programs linked HIV cases to care. STD programs are providing some HIV services; however, delivery of certain specific services could be improved. |
Antiviral drug-resistant influenza B viruses carrying H134N substitution in neuraminidase, Laos, February 2016
Baranovich T , Vongphrachanh P , Ketmayoon P , Sisouk T , Chomlasack K , Khanthamaly V , Nguyen HT , Mishin VP , Marjuki H , Barnes JR , Garten RJ , Stevens J , Wentworth DE , Gubareva LV . Emerg Infect Dis 2017 23 (4) 686-690 In February 2016, three influenza B/Victoria/2/87 lineage viruses exhibiting 4- to 158-fold reduced inhibition by neuraminidase inhibitors were detected in Laos. These viruses had an H134N substitution in the neuraminidase and replicated efficiently in vitro and in ferrets. Current antiviral drugs may be ineffective in controlling infections caused by viruses harboring this mutation. |
Challenges and strategies for prevention of multidrug-resistant organism transmission in nursing homes
Dumyati G , Stone ND , Nace DA , Crnich CJ , Jump RL . Curr Infect Dis Rep 2017 19 (4) 18 PURPOSE OF REVIEW: Nursing home residents are at high risk for colonization and infection with bacterial pathogens that are multidrug-resistant organisms (MDROs). We discuss challenges and potential solutions to support implementing effective infection prevention and control practices in nursing homes. RECENT FINDINGS: Challenges include a paucity of evidence that addresses MDRO transmission during the care of nursing home residents, limited staff resources in nursing homes, insufficient infection prevention education in nursing homes, and perceptions by nursing home staff that isolation and contact precautions negatively influence the well being of their residents. A small number of studies provide evidence that specifically address these challenges. Their outcomes support a paradigm shift that moves infection prevention and control practices away from a pathogen-specific approach and toward one that focuses on resident risk factors. |
Clinical features of human metapneumovirus infection in ambulatory children aged 5-13 years
Howard LM , Edwards KM , Zhu Y , Griffin MR , Weinberg GA , Szilagyi PG , Staat MA , Payne DC , Williams JV . J Pediatric Infect Dis Soc 2017 7 (2) 165-168 We detected human metapneumovirus (HMPV) in 54 (5%) of 1055 children aged 5 to 13 years with acute respiratory illness (ARI) identified by outpatient and emergency department surveillance between November and May 2003-2009. Its clinical features were similar to those of HMPV-negative ARI, except a diagnosis of pneumonia was more likely (13% vs 4%, respectively; P = .005) and a diagnosis of pharyngitis (7% vs 24%, respectively; P = .005) was less likely in patients with HMPV- positive ARI than those with HMPV-negative ARI. |
Demographic transition and the dynamics of measles in six provinces in China: A modeling study
Li S , Ma C , Hao L , Su Q , An Z , Ma F , Xie S , Xu A , Zhang Y , Ding Z , Li H , Cairns L , Wang H , Luo H , Wang N , Li L , Ferrari MJ . PLoS Med 2017 14 (4) e1002255 BACKGROUND: Industrialization and demographic transition generate nonstationary dynamics in human populations that can affect the transmission and persistence of infectious diseases. Decades of increasing vaccination and development have led to dramatic declines in the global burden of measles, but the virus remains persistent in much of the world. Here we show that a combination of demographic transition, as a result of declining birth rates, and reduced measles prevalence, due to improved vaccination, has shifted the age distribution of susceptibility to measles throughout China. METHODS AND FINDINGS: We fit a novel time-varying catalytic model to three decades of age-specific measles case reporting in six provinces in China to quantify the change in the age-specific force of infection for measles virus over time. We further quantified the impact of supplemental vaccination campaigns on the reduction of susceptible individuals. The force of infection of measles has declined dramatically (90%-97% reduction in transmission rate) in three industrialized eastern provinces during the last decade, driving a concomitant increase in both the relative proportion and absolute number of adult cases, while three central and western provinces exhibited dynamics consistent with endemic persistence (24%-73% reduction in transmission rate). The reduction in susceptible individuals due to supplemental vaccination campaigns is frequently below the nominal campaign coverage, likely because campaigns necessarily vaccinate those who may already be immune. The impact of these campaigns has significantly improved over time: campaigns prior to 2005 were estimated to have achieved less than 50% reductions in the proportion susceptible in the target age classes, but campaigns from 2005 onwards reduced the susceptible proportion by 32%-87%. A limitation of this study is that it relies on case surveillance, and thus inference may be biased by age-specific variation in measles reporting. CONCLUSIONS: The age distribution of measles cases changes in response to both demographic and vaccination processes. Combining both processes in a novel catalytic model, we illustrate that age-specific incidence patterns reveal regional differences in the progress to measles elimination and the impact of vaccination controls in China. The shift in the age distribution of measles susceptibility in response to demographic and vaccination processes emphasizes the importance of progressive control strategies and measures to evaluate program success that anticipate and react to this transition in observed incidence. |
Sustained use in a relief-to-recovery household water chlorination program in Haiti: Comparing external evaluation findings with internal supervisor and community health worker monitoring data
Wilner L , Wells E , Ritter M , Casimir JM , Chui K , Lantagne D . J Water Sanit Hyg Dev 2017 7 (1) 56-66 After the January 2010 earthquake in Haiti, an existing development program promoting household water treatment with chlorine rapidly expanded and provided relief to 15,000 earthquake-affected households. Initially, 157 community health workers (CHWs) distributed chlorine tablets; ten months later, CHWs began selling locally manufactured solution. The program was externally evaluated in March and November 2010; 77–90% of recipients had free chlorine residual (FCR) in household water. Internal monitoring by three supervisors and 157 CHWs also began in 2010. We analyzed results from 9,832 supervisor and 80,371 CHW monitoring visits conducted between 2010 and 2014 to assess: whether success continued in the rehabilitation phase; internal data validity; and factors impacting adoption. In 2010, 72.7% of supervisor visits documented total chlorine residual (TCR) comparable to external evaluation results. TCR presence was associated with certain supervisors/ CHWs, earlier program year and month (in 2014, supervisor visits TCR presence dropped to 52.1%), living in plains (not mountainous) regions, and certain calendar months. CHW visits recorded 18.1% higher TCR presence than supervisor visits, indicating bias. Our results document a program with sustained (although slightly declining) household chlorination use, provide insight into validity in internal monitoring, and inform discussions on the value of linking successful development programs to emergency relief, rehabilitation, and development. |
Antimony and sleep-related disorders: NHANES 2005-2008
Scinicariello F , Buser MC , Feroe AG , Attanasio R . Environ Res 2017 156 247-252 BACKGROUND: Antimony is used as a flame-retardant in textiles and plastics, in semiconductors, pewter, and as pigments in paints, lacquers, glass and pottery. Subacute or chronic antimony poisoning has been reported to cause sleeplessness. The prevalence of short sleep duration (<7h/night) has been reported to be 37.1% in the general US population, and obstructive sleep apnea (OSA) affects 12-28 million US adults. Insufficient sleep and OSA have been linked to the development of several chronic conditions including diabetes, cardiovascular disease, obesity and depression, conditions that pose serious public health threats. OBJECTIVE: To investigate whether there is an association between antimony exposure and sleep-related disorders in the US adult population using the National Health and Nutrition Examination Survey (NHANES) 2005-2008. METHODS: We performed multivariate logistic regression to analyze the association of urinary antimony with several sleep disorders, including insufficient sleep and OSA, in adult (ages 20 years and older) participants of NHANES 2005-2008 (n=2654). RESULT: We found that participants with higher urinary antimony levels had higher odds to experience insufficient sleep (≤6h/night) (OR 1.73; 95%CI; 1.04, 2.91) as well as higher odds to have increased sleep onset latency (>30min/night). Furthermore, we found that higher urinary antimony levels in participants were associated with OSA (OR 1.57; 95%CI; 1.05, 2.34), sleep problems, and day-time sleepiness. CONCLUSION: In this study, we found that urinary antimony was associated with higher odds to have insufficient sleep and OSA. Because of the public health implications of sleep disorders, further studies, especially a prospective cohort study, are warranted to evaluate the association between antimony exposure and sleep-related disorders. |
Evolution and Transmission of Carbapenem-Resistant Klebsiella pneumoniae Expressing the blaOXA-232 Gene During an Institutional Outbreak Associated With Endoscopic Retrograde Cholangiopancreatography.
Yang S , Hemarajata P , Hindler J , Li F , Adisetiyo H , Aldrovandi G , Sebra R , Kasarskis A , MacCannell D , Didelot X , Russell D , Rubin Z , Humphries R . Clin Infect Dis 2017 64 (7) 894-901 Background: Whole-genome sequencing (WGS) is an emerging and powerful technique by which to perform epidemiological studies in outbreak situations. Methods: WGS was used to identify and evaluate an outbreak of OXA-232-expressing carbapenem-resistant Klebsiella pneumoniae (CRKP) transmitted to 16 patients over the course of 40 weeks via endoscopic retrograde cholangiopancreatography procedures at a single institution. WGS was performed on 32 OXA-232 CRKP isolates (1-7 per patient) and single-nucleotide variants (SNVs) were analyzed, with reference to the index patient's isolate. Results: Interhost genetic diversity of isolates was between 0 and 15 SNVs during the outbreak; molecular clock calculations estimated 12.31 substitutions per genome per year (95% credibility interval, 7.81-17.05). Both intra- and interpatient diversification at the plasmid and transposon level was observed, significantly impacting the antibiogram of outbreak isolates. The majority of isolates evaluated (n = 27) harbored a blaCTX-M-15 gene, but some (n = 5) lacked the transposon carrying this gene, which resulted in susceptibility to aztreonam and third- and fourth-generation cephalosporins. Similarly, an isolate from a colonized patient lacked the transposon carrying rmtF and aac(6')lb genes, resulting in susceptibility to aminoglycosides. Conclusions: This study broadens the understanding of how bacteria diversify at the genomic level over the course of a defined outbreak and provides reference for future outbreak investigations. |
Safety of a meningococcal group B vaccine used in response to two university outbreaks
Duffy J , Johnsen P , Ferris M , Miller M , Leighton K , McGilvray M , McNamara L , Breakwell L , Yu Y , Bhavsar T , Briere E , Patel M . J Am Coll Health 2017 65 (6) 0 OBJECTIVE: To assess the safety of MenB-4C vaccine. PARTICIPANTS: Undergraduates, dormitory residents, and persons with high-risk medical conditions received the MenB-4C vaccine two-dose series during mass vaccination clinics from 12/2013 through 11/2014. METHODS: Adverse events (AEs) were identified by 15 minutes of observation post-vaccination, spontaneous reports, surveys, and hospital surveillance. Causality was assessed for serious adverse events (SAEs). RESULTS: 16,974 persons received 31,313 MenB-4C doses. The incidence of syncope during the 15 minutes post-dose 1 was 0.88/1000 persons. 2% of participants spontaneously reported an AE (most common were arm pain and fever). 3 SAEs were suspected of being caused by the vaccine, including one case of anaphylaxis. CONCLUSIONS: Most AEs reported were non-serious and consistent with previous clinical trial findings. Measures to prevent injury from syncope and to treat anaphylaxis should be available wherever vaccines are administered. Our safety evaluation supports the use of MenB-4C in response to outbreaks. |
Use of internet search data to monitor rotavirus vaccine impact in the United States, United Kingdom, and Mexico
Shah MP , Lopman BA , Tate JE , Harris J , Esparza-Aguilar M , Sanchez-Uribe E , Richardson V , Steiner CA , Parashar UD . J Pediatric Infect Dis Soc 2017 7 (1) 56-63 Background.: Previous studies have found a strong correlation between internet search and public health surveillance data. Less is known about how search data respond to public health interventions, such as vaccination, and the consistency of responses in different countries. In this study, we aimed to study the correlation between internet searches for "rotavirus" and rotavirus disease activity in the United States, United Kingdom, and Mexico before and after introduction of rotavirus vaccine. Methods.: We compared time series of internet searches for "rotavirus" from Google Trends with rotavirus laboratory reports from the United States and United Kingdom and with hospitalizations for acute gastroenteritis in the United States and Mexico. Using time and location parameters, Google quantifies an internet query share (IQS) to measure the relative search volume for specific terms. We analyzed the correlation between IQS and laboratory and hospitalization data before and after national vaccine introductions. Results.: There was a strong positive correlation between the rotavirus IQS and laboratory reports in the United States (R2 = 0.79) and United Kingdom (R2 = 0.60) and between the rotavirus IQS and acute gastroenteritis hospitalizations in the United States (R2 = 0.87) and Mexico (R2 = 0.69) (P < .0001 for all correlations). The correlations were stronger in the prevaccine period than in the postvaccine period. After vaccine introduction, the mean rotavirus IQS decreased by 40% (95% confidence interval [CI], 25%-55%) in the United States and by 70% (95% CI, 55%-86%) in Mexico. In the United Kingdom, there was a loss of seasonal variation after vaccine introduction. Conclusions.: Rotavirus internet search data trends mirrored national rotavirus laboratory trends in the United States and United Kingdom and gastroenteritis-hospitalization data in the United States and Mexico; lower correlations were found after rotavirus vaccine introduction. |
Noninitiation and Noncompletion of HPV Vaccine Among English- and Spanish-Speaking Parents of Adolescent Girls: A Qualitative Study
Albright K , Barnard J , O'Leary S , Lockhart S , Jimenez-Zambrano A , Stokley S , Dempsey A , Kempe A . Acad Pediatr 2017 17 (7) 778-784 OBJECTIVE: The Advisory Committee on Immunization Practices recommends routine human papillomavirus (HPV) vaccination for females aged 11-12 years, yet vaccination rates remain low. We conducted a qualitative study to understand English- and Spanish-speaking parents' reasons for non-initiation or non-completion of the HPV vaccine series for their daughters. METHODS: Parents of females aged 12-15 years who had not initiated or not completed the HPV vaccine series were identified through administrative data in two large urban safety net health care systems in Colorado. Focus groups and in-depth interviews were conducted with English-speaking parents and in-depth interviews were conducted with Spanish-speaking parents. All data were recorded, transcribed, and analyzed for thematic content by experienced analysts using established qualitative content analysis techniques. RESULTS: Forty-one parents participated in the study. Thirty parents participated in individual interviews and 11 parents participated in one of two focus groups. The most common reasons for non-initiation and non-completion among English-speakers included a low perceived risk of HPV infection, vaccine safety concerns, and distrust of government and/or medicine. In contrast, Spanish-speaking parents most often reported that providers had either not encouraged initiation of the HPV vaccine series or had not explained the necessity of completing the series. Some non-initiating parents, particularly Spanish-speaking ones, also cited concerns that vaccination would encourage sexual activity. CONCLUSIONS: The reasons for non-initiation and non-completion of the HPV vaccine series differed substantially between English- and Spanish-speaking parents. To maximize uptake of HPV vaccine, varying approaches may be needed to effectively target specific populations. WHAT'S NEW: This is the first study to explore reasons for non-initiation and non-completion of the HPV vaccine series among English- and Spanish-speaking parents of adolescent girls. Substantial differences emerged by language preference, suggesting that varying approaches may be necessary to maximize uptake. |
Effectiveness and duration of protection provided by the live-attenuated herpes zoster vaccine in the Medicare population ages 65 years and older
Izurieta HS , Wernecke M , Kelman J , Wong S , Forshee R , Pratt D , Lu Y , Sun Q , Jankosky C , Krause P , Worrall C , MaCurdy T , Harpaz R . Clin Infect Dis 2017 64 (6) 785-793 Background: Tens of millions of seniors are at risk of herpes zoster (HZ) and its complications. Live attenuated herpes zoster vaccine (HZV) reduces that risk, although questions regarding effectiveness and durability of protection in routine clinical practice remain. We used Medicare data to investigate HZV effectiveness (VE) and its durability. Methods: This retrospective cohort study included beneficiaries ages ≥65 years during January 2007 through July 2014. Multiple adjustments to account for potential bias were made. HZV-vaccinated beneficiaries were matched to unvaccinated beneficiaries (primary analysis) and to HZV-unvaccinated beneficiaries who had received pneumococcal vaccination (secondary analysis). HZ outcomes in community and hospital settings were analyzed, including ophthalmic zoster (OZ) and postherpetic neuralgia (PHN). Results: Among eligible beneficiaries (average age 77 years), the primary analysis found VE for community HZ of 33% (95% CI: 32%-35%) and 19% (95% CI: 17%-22%), for the first 3, and subsequent 4+ years postvaccination, respectively. In the secondary analysis, VE was, respectively, 37% (95% CI: 36%-39%) and 22% (95% CI: 20%-25%). In the primary analysis, VE for PHN was 57% (95% CI: 52%-61%) and 45% (95% CI: 36%-53%) in the first 3 and subsequent 4+ years, respectively; VE for hospitalized HZ was, respectively, 74% (95% CI: 67%-79%) and 55% (95% CI: 39%-67%). Differences in VE by age group were not significant. Conclusions: In both the primary and secondary analyses, HZV provided protection against HZ across all ages, but effectiveness declined over time. VE was higher and better preserved over time for PHN and HZ-associated hospitalizations than for community HZ. |
Influenza vaccination among workers - 21 U.S. states, 2013
O'Halloran AC , Lu PJ , Williams WW , Schumacher P , Sussell A , Birdsey J , Boal WL , Sweeney MH , Luckhaupt SE , Black CL , Santibanez TA . Am J Infect Control 2017 45 (4) 410-416 BACKGROUND: Influenza illnesses can result in missed days at work and societal costs, but influenza vaccination can reduce the risk of disease. Knowledge of vaccination coverage by industry and occupation can help guide prevention efforts and be useful during influenza pandemic planning. METHODS: Data from 21 states using the 2013 Behavioral Risk Factor Surveillance System industry-occupation module were analyzed. Influenza vaccination coverage was reported by select industry and occupation groups, including health care personnel (HCP) and other occupational groups who may have first priority to receive influenza vaccination during a pandemic (tier 1). The t tests were used to make comparisons between groups. RESULTS: Influenza vaccination coverage varied by industry and occupation, with high coverage among persons in health care industries and occupations. Approximately half of persons classified as tier 1 received influenza vaccination, and vaccination coverage among tier 1 and HCP groups varied widely by state. CONCLUSIONS: This report points to the particular industries and occupations where improvement in influenza vaccination coverage is needed. Prior to a pandemic event, more specificity on occupational codes to define exact industries and occupations in each tier group would be beneficial in implementing pandemic influenza vaccination programs and monitoring the success of these programs. |
Are children's vitamin D levels and BMI associated with antibody titers produced in response to 2014-2015 influenza vaccine?
Lin CJ , Martin JM , Cole KS , Zimmerman RK , Susick M , Moehling KK , Levine MZ , Spencer S , Flannery B , Nowalk MP . Hum Vaccin Immunother 2017 13 (7) 0 BACKGROUND: Vitamin D is an immunomodulating hormone which has been associated with susceptibility to infectious diseases. METHODS: Serum vitamin D levels in 135 children ages 3-17 years were measured at baseline and hemagglutinin influenza antibody titers were measured pre- and 21 days post influenza vaccination with live attenuated influenza vaccine (LAIV) or inactivated influenza vaccine (IIV). Height and weight were derived from the electronic medical record and were used to calculate body mass index (BMI). RESULTS: Thirty-nine percent of children were ages 3-8 years; 75% were black, 34% were obese (BMI ≥95th percentile); vitamin D levels were >20 ng/ml in 55%. In linear regression analyses, post vaccination antibody titers for LAIV B lineages (B Brisbane and B Massachusetts) were significantly higher among those with lower vitamin D levels and among younger participants (P<0.05). No associations between vitamin D levels and responses to LAIV strains (A/H1N1 and A/H3N2) or to any IIV strains or lineages were found. CONCLUSION: Low vitamin D levels were associated with higher response to LAIV B lineages in the 2014-2015 LAIV, but not related to LAIV A or any IIV strains. |
Assessment of virus interference in a test-negative study of influenza vaccine effectiveness
Feng S , Fowlkes AL , Steffens A , Finelli L , Cowling BJ . Epidemiology 2017 28 (4) 514-524 BACKGROUND: The observational test-negative study design is used to estimate vaccine effectiveness against influenza virus infection. An important assumption of the test-negative design is that vaccination does not affect the risk of infection with another virus. If such virus interference occurred, detection of other respiratory viruses would be more common among influenza vaccine recipients and vaccine effectiveness estimates could differ. We evaluated the potential for virus interference using data from the Influenza Incidence Surveillance Project. METHODS: From 2010 to 2013, outpatients presenting to clinics in 13 US jurisdictions with acute respiratory infections were tested for influenza and other respiratory viruses. We investigated whether virus interference might affect vaccine effectiveness estimates by first evaluating the sensitivity of estimates using alternative control groups that include or exclude patients with other respiratory virus detections by age group and early/middle/late stage of influenza seasons. Second, we evaluated the association between influenza vaccination receipt and other respiratory virus detection among influenza test negative patients. RESULTS: Influenza was detected in 3,743/10,650 patients (35%), and overall vaccine effectiveness was 47% (95% CI: 42%, 52%). Estimates using each control group were consistent overall or when stratified by age groups, and there were no differences among early, middle, or late phase during influenza season. We found no associations between detection of other respiratory viruses and receipt of influenza vaccination. CONCLUSIONS: In this 3-year test-negative design study in an outpatient setting in the United States, we found no evidence of virus interference or impact on influenza vaccine effectiveness estimation. |
Viral Pathogen Detection by Metagenomics and Pan Viral Group PCR in Children with Pneumonia Lacking Identifiable Etiology.
Schlaberg R , Queen K , Simmon K , Tardif K , Stockmann C , Flygare S , Kennedy B , Voelkerding K , Bramley A , Zhang J , Eilbeck K , Yandell M , Jain S , Pavia AT , Tong S , Ampofo K . J Infect Dis 2017 215 (9) 1407-1415 Background: Community-acquired pneumonia (CAP) is a leading cause of pediatric hospitalization. Pathogen identification fails in ~20% of children but is critical for optimal treatment and prevention of hospital-acquired infections. We used two broad-spectrum detection strategies to identify pathogens in test-negative children with CAP and asymptomatic controls. Methods: Nasopharyngeal/oropharyngeal (NP/OP) swabs from 70 children <5 years with CAP of unknown etiology and 90 asymptomatic controls were tested by next-generation sequencing (RNA-seq) and pan viral group (PVG) PCR for 19 viral families. Association of viruses with CAP was assessed by adjusted odds ratios (aOR) and 95% confidence intervals controlling for season and age group. Results: RNA-seq/PVG PCR detected previously missed, putative pathogens in 34% of patients. Putative viral pathogens included human parainfluenza virus 4 (aOR 9.3, p=0.12), human bocavirus (aOR 9.1, p<0.01), Coxsackieviruses (aOR 5.1, p=0.09), rhinovirus A (aOR 3.5, p=0.34), and rhinovirus C (aOR 2.9, p=0.57). RNA-seq was more sensitive for RNA viruses whereas PVG PCR detected more DNA viruses. Conclusion: RNA-seq and PVG PCR identified additional viruses, some known to be pathogenic, in NP/OP specimens from one-third of children hospitalized with CAP without a previously identified etiology. Both broad-range methods could be useful tools in future epidemiologic and diagnostic studies. |
Emergence of a new Neisseria meningitidis clonal complex 11 lineage 11.2 clade as an effective urogenital pathogen.
Tzeng YL , Bazan JA , Turner AN , Wang X , Retchless AC , Read TD , Toh E , Nelson DE , Del Rio C , Stephens DS . Proc Natl Acad Sci U S A 2017 114 (16) 4237-4242 Neisseria meningitidis (Nm) clonal complex 11 (cc11) lineage is a hypervirulent pathogen responsible for outbreaks of invasive meningococcal disease, including among men who have sex with men, and is increasingly associated with urogenital infections. Recently, clusters of Nm urethritis have emerged primarily among heterosexual males in the United States. We determined that nonencapsulated meningococcal isolates from an ongoing Nm urethritis outbreak among epidemiologically unrelated men in Columbus, Ohio, are linked to increased Nm urethritis cases in multiple US cities, including Atlanta and Indianapolis, and that they form a unique clade (the US Nm urethritis clade, US_NmUC). The isolates belonged to the cc11 lineage 11.2/ET-15 with fine type of PorA P1.5-1, 10-8; FetA F3-6; PorB 2-2 and express a unique FHbp allele. A common molecular fingerprint of US_NmUC isolates was an IS1301 element in the intergenic region separating the capsule ctr-css operons and adjacent deletion of cssA/B/C and a part of csc, encoding the serogroup C capsule polymerase. This resulted in the loss of encapsulation and intrinsic lipooligosaccharide sialylation that may promote adherence to mucosal surfaces. Furthermore, we detected an IS1301-mediated inversion of an approximately 20-kb sequence near the cps locus. Surprisingly, these isolates had acquired by gene conversion the complete gonococcal denitrification norB-aniA gene cassette, and strains grow well anaerobically. The cc11 US_NmUC isolates causing urethritis clusters in the United States may have adapted to a urogenital environment by loss of capsule and gene conversion of the Neisseria gonorrheae norB-aniA cassette promoting anaerobic growth. |
Matrix-assisted laser desorption/ionization time-of-flight mass spectrometry for the identification of Burkholderia pseudomallei from Asia and Australia and differentiation between Burkholderia species
Suttisunhakul V , Pumpuang A , Ekchariyawat P , Wuthiekanun V , Elrod MG , Turner P , Currie BJ , Phetsouvanh R , Dance DA , Limmathurotsakul D , Peacock SJ , Chantratita N . PLoS One 2017 12 (4) e0175294 Matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) is increasingly used for rapid bacterial identification. Studies of Burkholderia pseudomallei identification have involved small isolate numbers drawn from a restricted geographic region. There is a need to expand the reference database and evaluate B. pseudomallei from a wider geographic distribution that more fully captures the extensive genetic diversity of this species. Here, we describe the evaluation of over 650 isolates. Main spectral profiles (MSP) for 26 isolates of B. pseudomallei (N = 5) and other Burkholderia species (N = 21) were added to the Biotyper database. MALDI-TOF MS was then performed on 581 B. pseudomallei, 19 B. mallei, 6 B. thailandensis and 23 isolates representing a range of other bacterial species. B. pseudomallei originated from northeast and east Thailand (N = 524), Laos (N = 12), Cambodia (N = 14), Hong Kong (N = 4) and Australia (N = 27). All 581 B. pseudomallei were correctly identified, with 100% sensitivity and specificity. Accurate identification required a minimum inoculum of 5 x 107 CFU/ml, and identification could be performed on spiked blood cultures after 24 hours of incubation. Comparison between a dendrogram constructed from MALDI-TOF MS main spectrum profiles and a phylogenetic tree based on recA gene sequencing demonstrated that MALDI-TOF MS distinguished between B. pseudomallei and B. mallei, while the recA tree did not. MALDI-TOF MS is an accurate method for the identification of B. pseudomallei, and discriminates between this and other related Burkholderia species. |
Modified Carbapenem Inactivation Method for Phenotypic Detection of Carbapenemase Production among Enterobacteriaceae
Pierce VM , Simner PJ , Lonsway DR , Roe-Carpenter DE , Johnson JK , Brasso WB , Bobenchik AM , Lockett ZC , Charnot-Katsikas A , Ferraro MJ , Thomson RB Jr , Jenkins SG , Limbago BM , Das S . J Clin Microbiol 2017 55 (8) 2321-2333 The ability of clinical microbiology laboratories to reliably detect carbapenemase-producing carbapenem-resistant Enterobacteriaceae (CP-CRE) is an important element of the effort to prevent and contain the spread of these pathogens and an integral part of antimicrobial stewardship. Existing methods each have limitations. A new, straightforward, inexpensive, and specific phenotypic method for the detection of carbapenemase production, the carbapenem inactivation method (CIM), was recently described. Here we describe a two-stage evaluation of a modified carbapenem inactivation method (mCIM), in which tryptic soy broth was substituted for water during the inactivation step and the length of this incubation was extended. A validation study was performed in a single clinical laboratory to determine the accuracy of the mCIM, followed by a nine-laboratory study to verify the reproducibility of these results and define the zone size cut-off that best discriminated between CP-CRE and Enterobacteriaceae that do not produce carbapenemases. Bacterial isolates previously characterized through whole genome sequencing or targeted PCR as to the presence or absence of carbapenemase genes were tested for carbapenemase production using the mCIM; isolates with Ambler class A, B, and D carbapenemases, non-CP-CRE isolates, and carbapenem-susceptible isolates were included. The sensitivity of the mCIM observed in the validation study was 99% (95% confidence interval [CI], 93 to 100) and the specificity was 100% (95% CI, 82 to 100). In the second stage of the study, the range of sensitivities observed across nine laboratories was 93% to 100%, with a mean of 97%; the range of specificities was 97% to 100%, with a mean of 99%. The mCIM was easy to perform and interpret for Enterobacteriaceae, with results in less than 24 hours and excellent reproducibility across laboratories. |
Performance evaluation of the FDA-approved Determine HIV-1/2 Ag/Ab Combo assay using plasma and whole blood specimens
Masciotra S , Luo W , Westheimer E , Cohen SE , Gay CL , Hall L , Pan Y , Peters PJ , Owen SM . J Clin Virol 2017 91 95-100 BACKGROUND: The Determine HIV-1/2 Ag/Ab Combo (DC) rapid test can identify HIV-1 infection earlier than rapid antibody-only tests in plasma specimens. OBJECTIVES: We compared the performance of DC with a laboratory-based antigen/antibody (Ag/Ab) combo assay in plasma and evaluated antigen reactivity in whole blood specimens. STUDY DESIGN: We tested by DC 508 plasma specimens collected in a prospective study and 107 sequential plasma and simulated whole blood specimens from 20 seroconversion panels. Previous results using the ARCHITECT (ARC) Ag/Ab combo assay were compared to DC results. In seroconversion panels, the days from the first HIV1 RNA-positive test to first DC-reactive in plasma and whole blood was compared. McNemar's and Wilcoxon signed rank tests were used for statistical analysis. RESULTS: Of 415 HIV-positive samples, ARC detected 396 (95.4%) and DC 337 (81.2%) (p<0.0001). DC was reactive in 50.0% of ARC-reactive/MS-negative, 78.6% of ARC-reactive/MS-indeterminate, and 99.6% of ARC-reactive/MS-HIV-1-positive or -undifferentiated specimens. DC antigen reactivity was higher among ARC-reactive/MS-negative than MS-indeterminate samples. In 20 HIV-1 seroconversion panels, there was a significant difference between DC reactivity in plasma (91.1%) and whole blood (56.4%) (p<0.0001). DC with whole blood showed a significant delay in reactivity compared to plasma (p=0.008). CONCLUSIONS: In plasma, DC was significantly less sensitive than an instrumented laboratory-based Ag/Ab combo assay. DC in plasma was significantly more sensitive compared to whole blood in early HIV-1 infections. With the U.S. laboratory-based diagnostic algorithm, DC as the first step would likely miss a high proportion of HIV-1 infections in early stages of seroconversion. |
Evaluation of dried blood spot protocols with the Bio-Rad GS HIV Combo Ag/Ab EIA and Geenius HIV 1/2 Supplemental Assay
Luo W , Davis G , Li L , Shriver MK , Mei J , Styer LM , Parker MM , Smith A , Paz-Bailey G , Ethridge S , Wesolowski L , Owen SM , Masciotra S . J Clin Virol 2017 91 84-89 OBJECTIVE: FDA-approved antigen/antibody combo and HIV-1/2 differentiation supplemental tests do not have claims for dried blood spot (DBS) use. We compared two DBS-modified protocols, the Bio-Rad GS HIV Combo Ag/Ab (BRC) EIA and Geenius HIV-1/2 (Geenius) Supplemental Assay, to plasma protocols and evaluated them in the CDC/APHL HIV diagnostic algorithm. METHODS: BRC-DBS p24 analytical sensitivity was calculated from serial dilutions of p24. DBS specimens included 11 HIV-1 seroconverters, 151 HIV-1-positive individuals, including 20 on antiretroviral therapy, 31 HIV-2-positive and one HIV-1/HIV-2-positive individuals. BRC-reactive specimens were tested with Geenius using the same DBS eluate. Matched plasma specimens were tested with BRC, an IgG/IgM immunoassay and Geenius. DBS and plasma results were compared using the McNemar's test. A DBS-algorithm applied to 348 DBS from high-risk individuals who participated in surveillance was compared to HIV status based on local testing algorithms. RESULTS: BRC-DBS detects p24 at a concentration 18 times higher than in plasma. In seroconverters, BRC-DBS detected more infections than the IgG/IgM immunoassay in plasma (p=0.0133), but fewer infections than BRC-plasma (p=0.0133). In addition, the BRC/Geenius-plasma algorithm identified more HIV-1 infections than the BRC/Geenius-DBS algorithm (p=0.0455). The DBS protocols correctly identified HIV status for established HIV-1 infections, including those on therapy, HIV-2 infections, and surveillance specimens. CONCLUSIONS: The DBS protocols exhibited promising performance and allowed rapid supplemental testing. Although the DBS algorithm missed some early infections, it showed similar results when applied to specimens from a high-risk population. Implementation of a DBS algorithm would benefit testing programs without capacity for venipuncture. |
An improved finite element modeling of the cerebrospinal fluid layer in the head impact analysis
Wu JZ , Pan CS , Wimer BM , Rosen CL . Biomed Mater Eng 2017 28 (2) 187-199 The finite element (FE) method has been widely used to investigate the mechanism of traumatic brain injuries (TBIs), because it is technically difficult to quantify the responses of the brain tissues to the impact in experiments. One of technical challenges to build a FE model of a human head is the modeling of the cerebrospinal fluid (CSF) of the brain. In the current study, we propose to use membrane elements to construct the CSF layer. Using the proposed approach, we demonstrate that a head model can be built by using existing meshes available in commercial databases, without using any advanced meshing software tool, and with the sole use of native functions of the FE package Abaqus. The calculated time histories of the intracranial pressures at frontal, posterior fossa, parietal, and occipital positions agree well with the experimental data and the simulations in the literature, indicating that the physical effects of the CSF layer have been accounted for in the proposed modeling approach. The proposed modeling approach would be useful for bioengineers to solve practical problems. |
Analysis of false-negative HIV rapid tests performed on oral fluid in three international clinical research studies
Curlin ME , Gvetadze R , Leelawiwat W , Martin M , Rose C , Niska RW , Segolodi TM , Choopanya K , Tongtoyai J , Holtz TH , Samandari T , McNicholl JM . Clin Infect Dis 2017 64 (12) 1663-1669 Objective: The OraQuick Advance Rapid HIV-1/2 Test is a point-of-care test capable of detecting HIV-specific antibodies in blood and oral fluid. To understand test performance and factors contributing to false-negative (FN) results in longitudinal studies, we examined results of participants enrolled in the TDF2 study, the Bangkok Tenofovir Study, and the Bangkok MSM Cohort Study (BMCS), three separate clinical studies of high-risk, HIV-negative persons conducted in Botswana and Thailand. Design: Retrospective observational analysis. Methods: We compared oral fluid OraQuick (OFOQ) results among participants becoming HIV-infected to results obtained retrospectively using enzyme immunoassay and nucleic acid amplification tests on stored specimens. We categorized negative OFOQ results as true-negative or false-negative relative to NAAT and/or EIA, and determined the delay in OFOQ conversion relative to the estimated time of infection. We used generalized estimating equations to examine the association between FN results and participant, clinical and testing-site factors. Results: Two-hundred and thirty-three FN OFOQ results occurred in 80 of 287 seroconverting individuals. Estimated OFOQ conversion delay ranged from 14.5-547.5 (median 98.5) days. Delayed OFOQ conversion was associated with clinical site and test operator (p<0.05), pre-exposure prophylaxis (p=0.01), low plasma viral load (p<0.02) and time to kit expiration (p<0.01). Participant age, gender, and HIV subtype were not associated with FN results. Long OFOQ conversion delay time was associated with antiretroviral exposure and low PVL. Conclusions: Failure of OFOQ to detect HIV-1 infection was frequent, and multifactorial in origin. In longitudinal trials, negative oral fluid results should be confirmed by testing blood samples. |
Carbon nanotubes induced fibrogenesis on nanostructured substrates
Wang K , He X , Linthicum W , Mezan R , Wang L , Rojanasakul Y , Wen Q , Yang Y . Environ Sci Nano 2017 4 (3) 689-699 While the rapidly evolving nanotechnology has shown promise in electronics, energy, healthcare and many other fields, there is increasing concern about the adverse health consequences of engineered nanomaterials. To accurately evaluate the toxicity of nanomaterials, in vitro models incorporated with in vivo microenvironment characteristics are desirable. This study aims to delineate the influence of nanotopography on the fibrogenic response of normal human lung fibroblasts to multi-walled carbon nanotubes (MWCNTs). Nanoscale gratings and pillars of various heights were fabricated on polydimethylsiloxane substrates. Cell spreading and biomechanics were measured, and fibrogenic responses including proliferation, collagen production and reactive oxygen species generation of the fibroblasts grown on the nanostructured substrates in response to MWCNTs were assessed. It was observed that the cells could be largely stretched on shallow nanogratings, leading to a stiffer cytoskeleton and nucleus, enhanced cell proliferation and collagen production, and consequently, the toxic response sensitivity of the fibroblasts was undermined. In contrast, the cell spreading and stiffness could be reduced using tall, isotropic nanopillars, which significantly improved the cell toxic sensitivity to the MWCNTs. In addition to highlighting the significant influence of cell-nanotopography interactions on cell sensing CNTs, this study contributed to the development of physiologically relevant in vitro models for nanotoxicology studies. |
Development of an enzyme immunoassay for detection of antibodies against Coccidioides in dogs and other mammalian species
Chow NA , Lindsley MD , McCotter OZ , Kangiser D , Wohrle RD , Clifford WR , Yaglom HD , Adams LE , Komatsu K , Durkin MM , Baker RJ , Shubitz LF , Derado G , Chiller TM , Litvintseva AP . PLoS One 2017 12 (4) e0175081 Coccidioides is a soil-dwelling fungus that causes coccidioidomycosis, a disease also known as Valley fever, which affects humans and a variety of animal species. Recent findings of Coccidioides in new, unexpected areas of the United States have demonstrated the need for a better understanding of its geographic distribution. Large serological studies on animals could provide important information on the geographic distribution of this pathogen. To facilitate such studies, we used protein A/G, a recombinant protein that binds IgG antibodies from a variety of mammalian species, to develop an enzyme immunoassay (EIA) that detects IgG antibodies against Coccidioides in a highly sensitive and high-throughput manner. We showed the potential of this assay to be adapted to multiple animal species by testing a collection of serum and/or plasma samples from dogs, mice, and humans with or without confirmed coccidioidomycosis. We then evaluated the performance of the assay in dogs, using sera from dogs residing in a highly endemic area, and found seropositivity rates significantly higher than those in dogs of non-endemic areas. We further evaluated the specificity of the assay in dogs infected with other fungal pathogens known to cross-react with Coccidioides. Finally, we used the assay to perform a cross-sectional serosurvey investigating dogs from Washington, a state in which infection with Coccidioides has recently been documented. In summary, we have developed a Coccidioides EIA for the detection of antibodies in canines that is more sensitive and has higher throughput than currently available methods, and by testing this assay in mice and humans, we have shown a proof of principle of its adaptability for other animal species. |
Long-term outcomes of children with symptomatic congenital cytomegalovirus disease
Lanzieri TM , Leung J , Caviness AC , Chung W , Flores M , Blum P , Bialek SR , Miller JA , Vinson SS , Turcich MR , Voigt RG , Demmler-Harrison G . J Perinatol 2017 37 (7) 875-880 OBJECTIVE: To assess long-term outcomes of children with symptomatic congenital cytomegalovirus (CMV) disease detected at birth. STUDY DESIGN: We used Cox regression to assess risk factors for intellectual disability (intelligence quotient <70), sensorineural hearing loss (SNHL; hearing level 25 dB in any audiometric frequency) and vision impairment (best corrected visual acuity >20 or based on ophthalmologist report). RESULTS: Among 76 case-patients followed through median age of 13 (range: 0-27) years, 56 (74%) had SNHL, 31 (43%, n=72) had intellectual disability and 18 (27%, n=66) had vision impairment; 28 (43%, n=65) had intellectual disability and SNHL with/without vision impairment. Microcephaly was significantly associated with each of the three outcomes. Tissue destruction and dysplastic growth on head computed tomography scan at birth was significantly associated with intellectual disability and SNHL. CONCLUSION: Infants with symptomatic congenital CMV disease may develop moderate to severe impairments that were associated with presence of microcephaly and brain abnormalities. |
Modeling and measurement of radio propagation in tunnel environments
Zhou C , Jacksha R . IEEE Antennas Wirel Propag Lett 2017 16 141-144 A simple radio frequency (RF) testing system that can be conveniently built and used for measuring radio propagation in tunnels is introduced. With the proposed testing system, RF power attenuation with distance in a train tunnel was measured at four frequencies (455, 915, 2450, and 5800 MHz) for both horizontal and vertical polarizations. Two analytical modeling methods-the ray tracing and modal methods-are applied to model RF propagation in the tunnel. The theoretical predictions based on both methods are compared to field measurements and find good agreement. |
Reported motivations for and locations of healthy eating among Georgia high school students
Kumar GS , Bryan M , Bayakly R , Drenzek C , Merlo C , Perry GS . J Sch Health 2017 87 (5) 353-362 BACKGROUND: Understanding how youth perceive eating healthy foods can inform programs and policies that aim to improve healthy eating. We assessed the reasons for and the most common locations of eating healthy foods among Georgia's (GA) high school (HS) students. METHODS: Using the 2013 GA HS Youth Risk Behavior Survey, we examined motivations for and locations of eating healthy foods by sociodemographic characteristics and daily fruit and vegetable intake. Weighted chi-square tests were used to examine differences in responses for each perception. RESULTS: Nineteen percent of GA HS students consumed fruit ≥3 times/day and 11% consumed vegetables ≥3 times/day. The most frequently chosen response to motivations for eating healthy foods was the desire to be healthy (42%), followed by enjoying their taste (18%). The most likely location to eat healthy foods was at home (80%), followed by at school (13%). CONCLUSIONS: GA HS students are most motivated to eat healthy foods by the desire to be healthy and their enjoyment of the taste of healthy foods. Incorporating messages that align with students' motivations to eat healthy foods could be considered when developing promotional programs/policies targeting healthy eating. |
Plasma trans fatty acid concentrations in fasting adults declined from NHANES 1999-2000 to 2009-2010
Vesper HW , Caudill SP , Kuiper HC , Yang Q , Ahluwalia N , Lacher DA , Pirkle JL . Am J Clin Nutr 2017 105 (5) 1063-1069 Background: The consumption of trans fatty acids (TFAs) is associated with an increased risk of cardiovascular disease, and reducing their consumption is a major public health objective. Food intake studies have provided estimates for TFA concentrations in the US population; however, there is a need for data on TFA blood concentrations in the population.Objective: The objective of this study was to determine plasma TFA concentrations in a nationally representative group of fasted adults in the US population in NHANES samples from 1999-2000 and 2009-2010.Design: Four major TFAs [palmitelaidic acid (C16:1n-7t), trans vaccenic acid (C18:1n-7t), elaidic acid (C18:1n-9t), and linoelaidic acid (C18:2n-6t,9t)] were measured in plasma in 1613 subjects from NHANES 1999-2000 and 2462 subjects from NHANES 2009-2010 by gas chromatography-mass spectrometry. Geometric means and distribution percentiles were calculated for each TFA and their sum by age, sex, and race/ethnicity (non-Hispanic white, non-Hispanic black, Mexican American), and covariate-adjusted geometric means were computed by using a model that included these demographic and other dietary factors, as well as survey year and any significant interaction terms.Results: These nationally representative data for the adult US population show that TFA concentrations were 54% lower in NHANES 2009-2010 than in NHANES 1999-2000. Covariate-adjusted geometric means for the sum of the 4 TFAs were 81.4 mumol/L (95% CI: 77.3, 85.6 mumol/L) and 37.8 mumol/L (95% CI: 36.4, 39.4 mumol/L) in NHANES 1999-2000 and 2009-2010, respectively. Even with the large decline in TFA concentrations, differences between demographic subgroups were comparable in the 2 surveys.Conclusion: The results indicate an overall reduction in TFA concentrations in the US population and provide a valuable baseline to evaluate the impact of the recent regulation categorizing TFAs as food additives. |
Plasma trans-fatty acid concentrations continue to be associated with serum lipid and lipoprotein concentrations among US adults after reductions in trans-fatty acid intake
Yang Q , Zhang Z , Loustalot F , Vesper H , Caudill SP , Ritchey M , Gillespie C , Merritt R , Hong Y , Bowman BA . J Nutr 2017 147 (5) 896-907 Background: High intakes of trans-fatty acids (TFAs), especially industrially produced TFAs, can lead to unfavorable lipid and lipoprotein concentrations and an increased risk of cardiovascular disease. It is unknown how this relation might change in a population after significant reductions in TFA intake.Objective: This study, which used a new analytical method for measuring plasma TFA concentrations, clarified the association between plasma TFA and serum lipid and lipoprotein concentrations before and after the US FDA enacted TFA food-labeling regulations in 2006.Methods: Data were selected from the NHANES of 1999-2000 and 2009-2010. Findings on 1383 and 2155 adults, respectively, aged ≥20 y, were evaluated. Multivariable linear regressions were used to examine the associations between plasma TFA concentration and lipid and lipoprotein concentrations. The outcome measures were serum concentrations of total cholesterol (TC), LDL cholesterol, HDL cholesterol, and triglycerides and the ratio of TC to HDL cholesterol.Results: The median plasma TFA concentration decreased from 80.6 mumol/L in 1999-2000 to 37.0 mumol/L in 2009-2010. Plasma TFA concentration continued to be associated with serum lipid and lipoprotein concentrations after significant reductions in TFA intake in the population. For example, by comparing the lowest with the highest quintiles of TFA concentration in 1999-2000, adjusted mean (95% CI) LDL-cholesterol concentrations increased from 118 mg/dL (112, 123 mg/dL) to 135 mg/dL (130, 141 mg/dL) (P-trend < 0.001). The corresponding values for 2009-2010 were 102 mg/dL (97.4, 107 mg/dL) and 129 mg/dL (125, 133 mg/dL) for LDL cholesterol (P-trend < 0.001). Differences between the highest and lowest quintiles were consistent across age groups, sexes, races/ethnicities, and other covariates.Conclusions: Despite a 54% reduction in plasma TFA concentrations in US adults from 1999-2000 to 2009-2010, concentrations remained significantly associated with serum lipid and lipoprotein concentrations. There does not appear to be a threshold under which the association between plasma TFA concentration and lipid profiles might become undetectable. |
Defining the next generation of Plasmodium vivax diagnostic tests for control and elimination: Target product profiles.
Ding XC , Ade MP , Baird JK , Cheng Q , Cunningham J , Dhorda M , Drakeley C , Felger I , Gamboa D , Harbers M , Herrera S , Lucchi N , Mayor A , Mueller I , Sattabongkot J , Ratsimbason A , Richards J , Tanner M , Gonzalez IJ . PLoS Negl Trop Dis 2017 11 (4) e0005516 The global prevalence of malaria has decreased over the past fifteen years, but similar gains have not been realized against Plasmodium vivax because this species is less responsive to conventional malaria control interventions aimed principally at P. falciparum. Approximately half of all malaria cases outside of Africa are caused by P. vivax. This species places dormant forms in human liver that cause repeated clinical attacks without involving another mosquito bite. The diagnosis of acute patent P. vivax malaria relies primarily on light microscopy. Specific rapid diagnostic tests exist but typically perform relatively poorly compared to those for P. falciparum. Better diagnostic tests are needed for P. vivax. To guide their development, FIND, in collaboration with P. vivax experts, identified the specific diagnostic needs associated with this species and defined a series of three distinct target product profiles, each aimed at a particular diagnostic application: (i) point-of-care of acutely ill patients for clinical care purposes; (ii) point-of-care asymptomatic and otherwise sub-patent residents for public health purposes, e.g., mass screen and treat campaigns; and (iii) ultra-sensitive not point-of-care diagnosis for epidemiological research/surveillance purposes. This report presents and discusses the rationale for these P. vivax-specific diagnostic target product profiles. These contribute to the rational development of fit-for-purpose diagnostic tests suitable for use the clinical management, control and elimination of P. vivax malaria. |
Resurgence of malaria following discontinuation of indoor residual spraying of insecticide in a previously high transmission intensity area of Uganda
Raouf S , Mpimbaza A , Kigozi R , Sserwanga A , Rubahika D , Katamba H , Lindsay SW , Kapella BK , Belay KA , Kamya MR , Staedke SG , Dorsey G . Clin Infect Dis 2017 65 (3) 453-460 Background: Indoor residual spraying (IRS) and long-lasting insecticidal nets (LLINs) are the primary tools for malaria prevention in Africa. It is not known whether reductions in malaria can be sustained after IRS is discontinued. The aim of this study was to assess changes in malaria morbidity in a historically high transmission area of Uganda where IRS was discontinued after a four-year period of effective control followed by a universal LLIN distribution campaign. Methods: Individual-level malaria surveillance data were collected from one outpatient department and one inpatient setting in Apac District, Uganda from July 2009 through November 2015. Rounds of IRS were delivered approximately every six months from February 2010 through May 2014 followed by universal LLIN distribution in June 2014. Temporal changes in the malaria test positivity rate (TPR) were estimated during and after IRS using interrupted time series analyses, controlling for age, rainfall, and autocorrelation. Results: Data include 65,421 outpatient visits and 13,955 pediatric inpatient admissions for which a diagnostic test for malaria was performed. In outpatients under five years, baseline TPR was 60-80% followed by a rapid and then sustained decrease to 15-30%. Over 4-18 months following discontinuation of IRS, absolute TPR values increased by an average of 3.29% per month (95% CI 2.01-4.57%), returning to baseline levels. Similar trends were seen in outpatients over five years of age and pediatric admissions. Conclusions: Discontinuation of IRS in a historically high transmission intensity area was associated with a rapid increase in malaria morbidity to pre-IRS levels. |
A full-scale study of Cryptosporidium parvum oocyst and Cryptosporidium-sized microsphere removals from swimming pools via sand filtration
Lu P , Amburgey JE , Hill VR , Murphy JL , Schneeberger C , Arrowood MJ . Water Quality Research Journal 2017 52 (1) 18-25 Removal of Cryptosporidium parvum oocysts and Cryptosporidium-sized microspheres was evaluated in full-scale swimming pools via high-rate sand filtration (31–34 m/h) with coagulation. Results showed that at least 90% of C. parvum oocysts and microspheres were removed by filtration with an initial dosage of coagulant B (1.56 mg/L), D (1.9 mg/L or 305 g/m2), or F (1.56 mg/L) from each swimming pool. Filtration with an initial dosage of coagulant E (0.1 mg·Al/L) achieved 82% C. parvum oocyst removal and 97% microsphere removal. Coagulants B and F had a tendency to overdose over time with continuous feeding (based on corresponding pilot-scale experiments) and did not consistently achieve removals greater than 90% in the full-scale trials. As high as 99% of C. parvum oocysts and 98% of microspheres were removed with a continuous dosage of coagulant D. Up to 98% (1.7 log) of C. parvum oocysts and 93% (1.1 log) of microspheres were removed by continuous dosing of coagulant E at 27 m/h. Consistent oocyst and microsphere removal by aluminum-based coagulants (D and E) was achieved under the tested swimming pool conditions. |
Gender and international clinician educators
Stadler DJ , Archuleta S , Ibrahim H , Shah NG , Al-Mohammed AA , Cofrancesco J Jr . Postgrad Med J 2017 93 (1106) 719-724 OBJECTIVES: To describe gender differences of international clinician educators (CEs) and leaders, and CEs' perceptions by gender of preparation, roles, rewards and factors affecting job satisfaction and retention in emerging international competency-based residency programmes. METHODS: Cross-sectional surveys of CEs and leadership were conductedJune 2013-June 2014 at institutions that had adopted competency-based graduate medical education and were accredited by the Accreditation Council for Graduate Medical Education-International. RESULTS: 274 (76.3%) of 359 eligible participants responded; 69 (25.2%) were female. Two (18%) of 11 chief executive officers and 1 (9%) of 11 chief medical officers were women. Female CEs were younger, more likely to be single and childless. They were less likely to hold academic appointments, despite no gender differences in length of time at current institution or in current position. A greater proportion of female CEs felt they were 'never' rewarded by academic promotion. Satisfaction rates were similar between the genders. Single female CEs were five times as likely to report being 'extremely likely' to stay in the country. Female CEs with children <21 were less likely to report high likelihood of staying in academia. Marital status and children were not associated with outcomes for male CEs. CONCLUSIONS: In the international academic medicine programmes studied, there were fewer female CEs in the pipeline and they perceived a gender gap in appointment and advancement. Stakeholders at international programmes need to develop contextualised strategies to expand entry and decrease attrition of women into CE tracks, and promote gender equity. |
Residual hormone levels in used contraceptive rings as a measurement of adherence to vaginal ring use
Haaland RE , Holder A , Evans-Strickfaden T , Nyagol B , Makanga M , Oyaro B , Humwa F , Williams T , McLellan-Lemal E , Desai M , Huey MJ . Contraception 2017 95 (6) 602-604 OBJECTIVE: This study sought to measure residual contraceptive hormone levels in vaginal rings as an adherence marker for monitoring product use in clinical trials. STUDY DESIGN: Residual etonogestrel and ethinyl estradiol levels from used NuvaRings(R) of 26 self-reported adherent women enrolled in a clinical trial of vaginal ring acceptability were compared to those from 16 women who used NuvaRing(R) as their contraceptive choice. RESULTS: Twenty-one (81%) clinical trial rings had contraceptive hormone levels within the range of those used as a contraceptive choice. Five returned rings had unused or discordant levels of residual contraceptive hormones. CONCLUSION: Residual vaginal ring drug levels could help assess adherence in clinical trials. |
Smoking behavior and exposure: Results of a menthol cigarette cross-over study
Watson CV , Richter P , de Castro BR , Sosnoff C , Potts J , Clark P , McCraw J , Yan X , Chambers D , Watson C . Am J Health Behav 2017 41 (3) 309-319 OBJECTIVE: Our objective was to improve understanding of the differences in use behavior and exposure when smoking menthol and non-menthol cigarettes using a 2-part cross-over design. METHODS: Adult daily smokers were assigned randomly to alternate between 2 weeks of exclusively smoking a menthol test cigarette or a non-menthol test cigarette. Urine and saliva were collected for biomarker measurements; carbon monoxide (CO) was measured, and participants smoked test cigarettes through a CreSS(R) smoking topography device during 3 clinic visits. Participants turned in their cigarette butts from the test periods for determination of mouth level nicotine and completed subjective questionnaires related to the test cigarettes. RESULTS: Regardless of cigarette preference, participants had higher salivary cotinine when smoking the non-menthol test cigarette, but there were no significant differences detected in urine 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol between the 2 test cigarettes. Mouth level nicotine, puff volume, and puff duration were significantly higher when smoking the menthol brand. Both menthol and non-menthol smokers reported significantly lower enjoyment and satisfaction scores for test cigarettes compared with their brand of choice. CONCLUSIONS: Our results suggest that mentholation has an effect on measures of smoking behavior and that mouth level nicotine is a useful indicator of between-brand smoke exposure. |
Electronic nicotine delivery system (ENDS) use during smoking cessation: a qualitative study of 40 Oklahoma quitline callers
Vickerman KA , Beebe LA , Schauer GL , Magnusson B , King BA . BMJ Open 2017 7 (4) e013079 OBJECTIVES: Approximately 10% (40 000) of US quitline enrollees who smoke cigarettes report current use of electronic nicotine delivery systems (ENDS); however, little is known about callers' ENDS use. Our aim was to describe why and how quitline callers use ENDS, their beliefs about ENDS and the impact of ENDS use on callers' quit processes and use of FDA-approved cessation medications. DESIGN: Qualitative interviews conducted 1-month postregistration. Interviews were recorded, transcribed, double-coded and analysed to identify themes. SETTING: Oklahoma Tobacco Helpline. PARTICIPANTS: 40 callers aged ≥18 who were seeking help to quit smoking were using ENDS at registration and completed ≥1 programme calls. RESULTS: At 1-month postregistration interview, 80% of callers had smoked cigarettes in the last 7 days, almost two-thirds were using ENDS, and half were using cessation medications. Nearly all believed ENDS helped them quit or cut down on smoking; however, participants were split on whether they would recommend cessation medications, ENDS or both together for quitting. Confusion and misinformation about potential harms of ENDS and cessation medications were reported. Participants reported using ENDS in potentially adaptive ways (eg, using ENDS to cut down and nicotine replacement therapy to quit, and stepping down nicotine in ENDS to wean off ENDS after quitting) and maladaptive ways (eg, frequent automatic ENDS use, using ENDS in situations they did not previously smoke, cutting down on smoking using ENDS without a schedule or plan to quit), which could impact the likelihood of quitting smoking or continuing ENDS use. CONCLUSIONS: These qualitative findings suggest quitline callers who use ENDS experience confusion and misinformation about ENDS and FDA-approved cessation medications. Callers also use ENDS in ways that may not facilitate quitting smoking. Opportunities exist for quitlines to educate ENDS users and help them create a coordinated plan most likely to result in completely quitting combustible tobacco. |
Rocky Mountain spotted fever in Mexico: past, present, and future
Alvarez-Hernandez G , Roldan JF , Milan NS , Lash RR , Behravesh CB , Paddock CD . Lancet Infect Dis 2017 17 (6) e189-e196 Rocky Mountain spotted fever, a tick-borne zoonosis caused by Rickettsia rickettsii, is among the most lethal of all infectious diseases in the Americas. In Mexico, the disease was first described during the early 1940s by scientists who carefully documented specific environmental determinants responsible for devastating outbreaks in several communities in the states of Sinaloa, Sonora, Durango, and Coahuila. These investigators also described the pivotal roles of domesticated dogs and Rhipicephalus sanguineus sensu lato (brown dog ticks) as drivers of epidemic levels of Rocky Mountain spotted fever. After several decades of quiescence, the disease re-emerged in Sonora and Baja California during the early 21st century, driven by the same environmental circumstances that perpetuated outbreaks in Mexico during the 1940s. This Review explores the history of Rocky Mountain spotted fever in Mexico, current epidemiology, and the multiple clinical, economic, and social challenges that must be considered in the control and prevention of this life-threatening illness. |
Tick-borne zoonoses in the United States: Persistent and emerging threats to human health
Eisen RJ , Kugeler KJ , Eisen L , Beard CB , Paddock CD . ILAR J 2017 58 (3) 1-17 In the United States, ticks transmit the greatest diversity of arthropod-borne pathogens and are responsible for the most cases of all vector-borne diseases. In recent decades, the number of reported cases of notifiable tick-borne diseases has steadily increased, geographic distributions of many ticks and tick-borne diseases have expanded, and new tick-borne disease agents have been recognized. In this review, we (1) describe the known disease agents associated with the most commonly human-biting ixodid ticks, (2) review the natural histories of these ticks and their associated pathogens, (3) highlight spatial and temporal changes in vector tick distributions and tick-borne disease occurrence in recent decades, and (4) identify knowledge gaps and barriers to more effective prevention of tick-borne diseases. We describe 12 major tick-borne diseases caused by 15 distinct disease agents that are transmitted by the 8 most commonly human-biting ixodid ticks in the United States. Notably, 40% of these pathogens were described within the last two decades. Our assessment highlights the importance of animal studies to elucidate how tick-borne pathogens are maintained in nature, as well as advances in molecular detection of pathogens which has led to the discovery of several new tick-borne disease agents. |
Unique case of disseminated plague with multifocal osteomyelitis
Tovar Padua L , Kamali A , Kim H , Green NM , Civen R , Schwartz B , Krogstad P , Deville J , Yeganeh N , Lugo D , Baker A , Soni P , Cho C , Svircic N , Dry S , Seeger L , Lloyd J , Deukmedjian G , Bowen R , Hale G , Zaki SR , Mead P , Nielsen-Saines K . J Pediatric Infect Dis Soc 2017 6 (3) e165-e168 Plague is a disease caused by Yersinia pestis. Septicemic and pneumonic plague have a high mortality rate if untreated. Here we describe the challenges of accurately diagnosing a nonfatal pediatric case of septicemic plague with involvement of multiple organs; to our knowledge, the first documented case of multifocal plague osteomyelitis. |
Vital Signs: Update on Zika virus-associated birth defects and evaluation of all U.S. Infants with congenital Zika virus exposure - U.S. Zika Pregnancy Registry, 2016
Reynolds MR , Jones AM , Petersen EE , Lee EH , Rice ME , Bingham A , Ellington SR , Evert N , Reagan-Steiner S , Oduyebo T , Brown CM , Martin S , Ahmad N , Bhatnagar J , Macdonald J , Gould C , Fine AD , Polen KD , Lake-Burger H , Hillard CL , Hall N , Yazdy MM , Slaughter K , Sommer JN , Adamski A , Raycraft M , Fleck-Derderian S , Gupta J , Newsome K , Baez-Santiago M , Slavinski S , White JL , Moore CA , Shapiro-Mendoza CK , Petersen L , Boyle C , Jamieson DJ , Meaney-Delman D , Honein MA . MMWR Morb Mortal Wkly Rep 2017 66 (13) 366-373 BACKGROUND: In collaboration with state, tribal, local, and territorial health departments, CDC established the U.S. Zika Pregnancy Registry (USZPR) in early 2016 to monitor pregnant women with laboratory evidence of possible recent Zika virus infection and their infants. METHODS: This report includes an analysis of completed pregnancies (which include live births and pregnancy losses, regardless of gestational age) in the 50 U.S. states and the District of Columbia (DC) with laboratory evidence of possible recent Zika virus infection reported to the USZPR from January 15 to December 27, 2016. Birth defects potentially associated with Zika virus infection during pregnancy include brain abnormalities and/or microcephaly, eye abnormalities, other consequences of central nervous system dysfunction, and neural tube defects and other early brain malformations. RESULTS: During the analysis period, 1,297 pregnant women in 44 states were reported to the USZPR. Zika virus-associated birth defects were reported for 51 (5%) of the 972 fetuses/infants from completed pregnancies with laboratory evidence of possible recent Zika virus infection (95% confidence interval [CI] = 4%-7%); the proportion was higher when restricted to pregnancies with laboratory-confirmed Zika virus infection (24/250 completed pregnancies [10%, 95% CI = 7%-14%]). Birth defects were reported in 15% (95% CI = 8%-26%) of fetuses/infants of completed pregnancies with confirmed Zika virus infection in the first trimester. Among 895 liveborn infants from pregnancies with possible recent Zika virus infection, postnatal neuroimaging was reported for 221 (25%), and Zika virus testing of at least one infant specimen was reported for 585 (65%). CONCLUSIONS AND IMPLICATIONS FOR PUBLIC HEALTH PRACTICE: These findings highlight why pregnant women should avoid Zika virus exposure. Because the full clinical spectrum of congenital Zika virus infection is not yet known, all infants born to women with laboratory evidence of possible recent Zika virus infection during pregnancy should receive postnatal neuroimaging and Zika virus testing in addition to a comprehensive newborn physical exam and hearing screen. Identification and follow-up care of infants born to women with laboratory evidence of possible recent Zika virus infection during pregnancy and infants with possible congenital Zika virus infection can ensure that appropriate clinical services are available. |
Persistent arthralgia associated with chikungunya virus outbreak, US Virgin Islands, December 2014-February 2016
Feldstein LR , Rowhani-Rahbar A , Staples JE , Weaver MR , Halloran ME , Ellis EM . Emerg Infect Dis 2017 23 (4) 673-676 After the 2014-2015 outbreak of chikungunya virus in the US Virgin Islands, we compared the prevalence of persistent arthralgia among case-patients and controls. Prevalence was higher in case-patients than controls 6 and 12 months after disease onset. Continued vaccine research to prevent acute illness and long-term sequelae is essential. |
The history of rabies in the Western Hemisphere
Velasco-Villa A , Mauldin MR , Shi M , Escobar LE , Gallardo-Romero NF , Damon I , Olson VA , Streicker DG , Emerson G . Antiviral Res 2017 146 221-232 Before the introduction of control programs in the 20th century, rabies in domestic dogs occurred throughout the Western Hemisphere. However, historical records and phylogenetic analysis of multiple virus isolates indicate that, before the arrival of the first European colonizers, rabies virus was likely present only in bats and skunks. Canine rabies was either rare or absent among domestic dogs of Native Americans, and first arrived when many new dog breeds were imported during the period of European colonization. The introduction of the cosmopolitan dog rabies lyssavirus variant and the marked expansion of the dog population provided ideal conditions for the flourishing of enzootic canine rabies. The shift of dog-maintained viruses into gray foxes, coyotes, skunks and other wild mesocarnivores throughout the Americas and to mongooses in the Caribbean has augmented the risk of human rabies exposures and has complicated control efforts. At the same time, the continued presence of bat rabies poses novel challenges in the absolute elimination of canine and human rabies. This article compiles existing historical and phylogenetic evidence of the origins and subsequent dynamics of rabies in the Western Hemisphere, from the era preceding the arrival of the first European colonizers through the present day. A companion article reviews the current status of canine rabies control throughout the Western Hemisphere and steps that will be required to achieve and maintain its complete elimination (Velasco-Villa et al., in press). |
An inter- laboratory proficiency testing exercise for rabies diagnosis in Latin America and the Caribbean
Clavijo A , Freire de Carvalho MH , Orciari LA , Velasco-Villa A , Ellison J , Greenberg L , Yager PA , Green DB , Vigilato MA , Cosivi O , Del Rio-Vilas VJ . PLoS Negl Trop Dis 2017 11 (4) e0005427 The direct fluorescent antibody test (DFA), is performed in all rabies reference laboratories across Latin America and the Caribbean (LAC). Despite DFA being a critical capacity in the control of rabies, there is not a standardized protocol in the region. We describe the results of the first inter-laboratory proficiency exercise of national rabies laboratories in LAC countries as part of the regional efforts towards dog-maintained rabies elimination in the American region. Twenty three laboratories affiliated to the Ministries of Health and Ministries of Agriculture participated in this exercise. In addition, the laboratories completed an online questionnaire to assess laboratory practices. Answers to the online questionnaire indicated large variability in the laboratories throughput, equipment used, protocols availability, quality control standards and biosafety requirements. Our results will inform actions to improve and harmonize laboratory rabies capacities across LAC in support for the regional efforts towards elimination of dog-maintained rabies. |
Risk factors for influenza A(H7N9) Disease in China, a matched case control study, October 2014 to April 2015
Zhou L , Ren R , Ou J , Kang M , Wang X , Havers F , Huo X , Liu X , Sun Q , He Y , Liu B , Wu S , Wang Y , Sui H , Zhang Y , Tang S , Chang C , Xiang L , Wang D , Zhao S , Zhou S , Chen T , Xiang N , Greene CM , Zhang Y , Shu Y , Feng Z , Li Q . Open Forum Infect Dis 2016 3 (3) ofw182 Background. Human infections with avian influenza A(H7N9) virus have been associated with exposure to poultry and live poultry markets (LPMs). We conducted a case-control study to identify additional and more specific risk factors. Methods. Cases were laboratory-confirmed A(H7N9) infections in persons in China reported from October 1, 2014 to April 30, 2015. Poultry workers, those with insufficient data, and those refusing participation were excluded. We matched up to 4 controls per case by sex, age, and residential community. Using conditional logistic regression, we examined associations between A(H7N9) infection and potential risk factors. Results. Eighty-five cases and 334 controls were enrolled with similar demographic characteristics. Increased risk of A(H7N9) infection was associated with the following: visiting LPMs (adjusted odds ratio [aOR], 6.3; 95% confidence interval [CI], 2.6-15.3), direct contact with live poultry in LPMs (aOR, 4.1; 95% CI, 1.1-15.6), stopping at a live poultry stall when visiting LPMs (aOR, 2.7; 95% CI, 1.1-6.9), raising backyard poultry at home (aOR, 7.7; 95% CI, 2.0-30.5), direct contact with backyard poultry (aOR, 4.9; 95% CI, 1.1-22.1), and having ≥1 chronic disease (aOR, 3.1; 95% CI, 1.5-6.5). Conclusions. Our study identified raising backyard poultry at home as a risk factor for illness with A(H7N9), suggesting the need for enhanced avian influenza surveillance in rural areas. |
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