Increases in Human Papillomavirus Testing Preceding Diagnosis of Cervical Precancer in 5 US States, 2008-2016
Cleveland AA , Gargano JW , Griffin MR , Park IU , Niccolai LM , Bennett NM , Pemmaraju M , Fink D , Brackney M , Scahill M , Ehlers SJ , Unger ER , Markowitz LE . J Low Genit Tract Dis 2021 25 (3) 192-198 OBJECTIVE: The aim of the study was to describe trends in human papillomavirus (HPV) testing preceding diagnosis of cervical precancer during a time of changing screening recommendations. MATERIALS AND METHODS: We conducted a cross-sectional analysis of data from active, population-based, laboratory surveillance among 1.5 million residents of 5 areas in the United States. We included women aged 21-39 years diagnosed with cervical intraepithelial neoplasia grades 2, 2/3, or 3 or adenocarcinoma in situ (collectively, CIN2+) during 2008-2016, who had a cytology and/or HPV test before diagnosis (n = 16,359). RESULTS: The proportion of women with an HPV test preceding CIN2+ increased from 42.9% in 2008 to 73.3% in 2016 (p < .01); testing increased in all age groups (21-24 y: 35.3% to 47.6%, 25-29 y: 40.9% to 64.1%, 30-39 y: 51.7% to 85.9%, all p < .01). The HPV testing varied by cytology result and was highest among women with atypical squamous cells of unknown significance (n = 4,310/4,629, 93.1%), negative for intraepithelial lesion or malignancy (n = 446/517, 86.3%), and atypical glandular cells (n = 145/257, 56.4%). By 2016, at least half of all cases in every surveillance area had an HPV test before diagnosis. CONCLUSIONS: During 2008-2016, the proportion of women with an HPV test preceding CIN2+ increased significantly for all age groups, cytology results, and surveillance areas. By 2016, most (85.9%) women aged 30-39 years had an HPV test, consistent with recommendations. Increasing utilization of HPV tests, which have demonstrated improved sensitivity for detecting cervical disease, may in part explain increasing rates of cervical precancer among women 30 years and older. |
Utility of State-Based Basic Screening Survey Reports for National Oral Health Surveillance in Older Adults
Linabarger M , Griffin SO , Hamilton EK . Prev Chronic Dis 2021 18 E31 INTRODUCTION: Untreated dental disease and resulting tooth loss can diminish quality of life for older adults by limiting food choices and discouraging social interaction. Before the Basic Screening Survey (BSS) for older adults, no clinical data were available to monitor the oral health of older adults in long-term care (LTC) facilities at the national level or older adults overall at the state level. Although BSS is widely used, no guidelines exist to ensure the validity, reliability, and comparability of survey information across states. We examined BSS content to help establish reporting guidelines and synthesized findings across states for older adults living in LTC. METHODS: We systematically reviewed BSS reports published from 2011-2019, assessing how oral health outcomes were measured and reported. For reports that included statewide estimates for LTC residents, we calculated the mean, median, and ranges of 3 preventable oral health conditions and 4 indicators of tooth loss. RESULTS: We found wide variation in reporting of sampling, screening, and statistical methods, as well as in indicators of tooth loss. Median prevalence of untreated tooth decay and edentulism (total tooth loss) among LTC adults in 11 states was almost twice that for community-dwelling adults in a national survey. CONCLUSIONS: The substantial variation in BSS reporting highlights the potential benefits of adopting standardized guidance, which could improve the utility of BSS. Poor oral health outcomes among LTC residents underscore the importance of systematic monitoring of the oral health of this vulnerable population. |
Trends in Nontraumatic Lower-Extremity Amputation Among Privately Insured Adults With Diabetes in the U.S., 2004-2018
Zhou X , Andes LJ , Rolka DB , Imperatore G , Benoit SR . Diabetes Care 2021 44 (5) e93-e94 Estimates based on the National Inpatient Sample (NIS) showed that diabetes-related nontraumatic lower- extremity amputation (NLEA) rates declined among hospitalized patients between 2000 and 2009, followed by an increasing NLEA rate between 2009 and 2015 (1). The increase was largely observed in young and middle-aged adults (1). However, the NIS dataset includes only inpatient admissions; minor amputation surgeries that were performed in ambulatory settings were not included in these estimates. In addition, NIS data are event-based, and multiple amputations in the same person are considered as a new event each time. In the current study, we used the IBM MarketScan Commercial Database to examine NLEA occurring in inpatient and outpatient settings among privately insured adults 18–64 years of age with diabetes. |
Rotavirus Genotype Trends and Gastrointestinal Pathogen Detection in the United States, 2014-16: Results from the New Vaccine Surveillance Network.
Esona MD , Ward ML , Wikswo ME , Rustempasic SM , Gautam R , Perkins C , Selvarangan R , Harrison CJ , Boom JA , Englund JA , Klein EJ , Staat MA , McNeal MM , Halasa N , Chappell J , Weinberg GA , Payne DC , Parashar UD , Bowen MD . J Infect Dis 2021 224 (9) 1539-1549 BACKGROUND: Following the implementation of rotavirus vaccination in 2006, severe acute gastroenteritis (AGE) due to group A rotavirus (RVA) has substantially declined in USA (US) children. We report the RVA genotype prevalence as well as co-infection data from seven US New Vaccine Surveillance Network (NVSN) sites during three consecutive RVA seasons, 2014-2016. METHODS: A total of 1041 stool samples that tested positive for RVA by Rotaclone enzyme immunoassay (EIA) were submitted to the Centers for Disease Control and Prevention (CDC) for RVA genotyping and multipathogen testing. RESULTS: A total of 795 (76%) contained detectable RVA at CDC. Rotavirus disease was highest in children < 3 years of age. Four G types (G1, G2, G9, and G12) accounted for 94.6% of strains while two P types (P[4] and P[8]) accounted 94.7% of the strains. Overall, G12P[8] was the most common genotype detected in all three seasons. Stepwise conditional logistic analysis found year and study site were significant predictors of genotype. Twenty four percent (24%) of RVA-positive specimens contained other AGE pathogens. CONCLUSIONS: G12P[8] predominated over three seasons, but strain predominance varied by year and study site. Ongoing surveillance provides continuous tracking and monitoring of US genotypes during the post vaccine era. |
Increasing Capacity to Detect Clusters of Rapid HIV Transmission in Varied Populations-United States.
Oster AM , Panneer N , Lyss SB , McClung RP , Watson M , Saduvala N , Ocfemia MCB , Linley L , Switzer WM , Wertheim JO , Campbell E , Hernandez AL , France AM . Viruses 2021 13 (4) Molecular cluster detection analyzes HIV sequences to identify rapid HIV transmission and inform public health responses. We describe changes in the capability to detect molecular clusters and in geographic variation in transmission dynamics. We examined the reporting completeness of HIV-1 polymerase sequences in quarterly National HIV Surveillance System datasets from December 2015 to December 2019. Priority clusters were identified quarterly. To understand populations recently affected by rapid transmission, we described the transmission risk and race/ethnicity of people in clusters first detected in 2018-2019. During December 2015 to December 2019, national sequence completeness increased from 26% to 45%. Of the 1212 people in the 136 clusters first detected in 2018-2019, 69% were men who have sex with men (MSM) and 11% were people who inject drugs (PWID). State-by-state analysis showed substantial variation in transmission risk and racial/ethnic groups in clusters of rapid transmission. HIV sequence reporting has increased nationwide. Molecular cluster analysis identifies rapid transmission in varied populations and identifies emerging patterns of rapid transmission in specific population groups, such as PWID, who, in 2015-2016, comprised only 1% of people in such molecular clusters. These data can guide efforts to focus, tailor, and scale up prevention and care services for these populations. |
Use of Stay-at-Home Orders and Mask Mandates to Control COVID-19 Transmission - Blackfeet Tribal Reservation, Montana, June-December 2020.
Pratt CQ , Chard AN , LaPine R , Galbreath KW , Crawford C , Plant A , Stiffarm G , Rhodes NS , Hannon L , Dinh TH . MMWR Morb Mortal Wkly Rep 2021 70 (14) 514-518 COVID-19 has disproportionately affected persons who identify as non-Hispanic American Indian or Alaska Native (AI/AN) (1). The Blackfeet Tribal Reservation, the northern Montana home of the sovereign Blackfeet Nation, with an estimated population of 10,629 (2), detected the first COVID-19 case in the community on June 16, 2020. Following CDC guidance,* and with free testing widely available, the Indian Health Service and Blackfeet Tribal Health Department began investigating all confirmed cases and their contacts on June 25. The relationship between three community mitigation resolutions passed and enforced by the Blackfeet Tribal Business Council and changes in the daily COVID-19 incidence and in the distributions of new cases was assessed. After the September 28 issuance of a strictly enforced stay-at-home order and adoption of a mask use resolution, COVID-19 incidence in the Blackfeet Tribal Reservation decreased by a factor of 33 from its peak of 6.40 cases per 1,000 residents per day on October 5 to 0.19 on November 7. Other mitigation measures the Blackfeet Tribal Reservation used included closing the east gate of Glacier National Park for the summer tourism season, instituting remote learning for public school students throughout the fall semester, and providing a Thanksgiving meal to every household to reduce trips to grocery stores. CDC has recommended use of routine public health interventions for infectious diseases, including case investigation with prompt isolation, contact tracing, and immediate quarantine after exposure to prevent and control transmission of SARS-CoV-2, the virus that causes COVID-19 (3). Stay-at-home orders, physical distancing, and mask wearing indoors, outdoors when physical distancing is not possible, or when in close contact with infected or exposed persons are also recommended as nonpharmaceutical community mitigation measures (3,4). Implementation and strict enforcement of stay-at-home orders and a mask use mandate likely helped reduce the spread of COVID-19 in the Blackfeet Tribal Reservation. |
Notes from the Field: COVID-19 Case Investigation and Contact Tracing Program - Spirit Lake Tribe, North Dakota, September-November 2020.
Matthias J , Charboneau T , Schaffer C , Rusten J , Whitmer S , de la Paz J , Dykstra J , Pathmanathan I , Stowell D . MMWR Morb Mortal Wkly Rep 2021 70 (14) 533-534 In late September 2020, the incidence of confirmed COVID-19* in North Dakota began increasing rapidly, from approximately 300 new cases per day to approximately 2,260 cases on November 13, 2020 (1). On October 20, the North Dakota Department of Health reported that contact tracing notification efforts were delayed. Because of the delay, COVID-19 patients were asked to notify their own contacts about potential exposure and encourage them to seek testing for SARS-CoV-2, the virus that causes COVID-19 (2). The Spirit Lake sovereign nation in east central North Dakota is home to approximately 7,500 members of the Spirit Lake Tribe. In response to increasing incidence of COVID-19 on the Spirit Lake Reservation, CDC assisted the Spirit Lake Tribe in building a tribally managed program for comprehensive COVID-19 case investigations, case notification, contact tracing, contact testing, and contact management to ensure timely implementation of these critical epidemic control measures. |
Death Certificate-Based ICD-10 Diagnosis Codes for COVID-19 Mortality Surveillance - United States, January-December 2020.
Gundlapalli AV , Lavery AM , Boehmer TK , Beach MJ , Walke HT , Sutton PD , Anderson RN . MMWR Morb Mortal Wkly Rep 2021 70 (14) 523-527 Approximately 375,000 deaths during 2020 were attributed to COVID-19 on death certificates reported to CDC (1). Concerns have been raised that some deaths are being improperly attributed to COVID-19 (2). Analysis of International Classification of Diseases, Tenth Revision (ICD-10) diagnoses on official death certificates might provide an expedient and efficient method to demonstrate whether reported COVID-19 deaths are being overestimated. CDC assessed documentation of diagnoses co-occurring with an ICD-10 code for COVID-19 (U07.1) on U.S. death certificates from 2020 that had been reported to CDC as of February 22, 2021. Among 378,048 death certificates listing U07.1, a total of 357,133 (94.5%) had at least one other ICD-10 code; 20,915 (5.5%) had only U07.1. Overall, 97.3% of 357,133 death certificates with at least one other diagnosis (91.9% of all 378,048 death certificates) were noted to have a co-occurring diagnosis that was a plausible chain-of-event condition (e.g., pneumonia or respiratory failure), a significant contributing condition (e.g., hypertension or diabetes), or both. Overall, 70%-80% of death certificates had both a chain-of-event condition and a significant contributing condition or a chain-of-event condition only; this was noted for adults aged 18-84 years, both males and females, persons of all races and ethnicities, those who died in inpatient and outpatient or emergency department settings, and those whose manner of death was listed as natural. These findings support the accuracy of COVID-19 mortality surveillance in the United States using official death certificates. High-quality documentation of co-occurring diagnoses on the death certificate is essential for a comprehensive and authoritative public record. Continued messaging and training (3) for professionals who complete death certificates remains important as the pandemic progresses. Accurate mortality surveillance is critical for understanding the impact of variants of SARS-CoV-2, the virus that causes COVID-19, and of COVID-19 vaccination and for guiding public health action. |
Community Transmission of SARS-CoV-2 Associated with a Local Bar Opening Event - Illinois, February 2021.
Sami S , Turbyfill CR , Daniel-Wayman S , Shonkwiler S , Fisher KA , Kuhring M , Patrick AM , Hinton S , Minor AS , Ricaldi JN , Ezike N , Kauerauf J , Duffus WA . MMWR Morb Mortal Wkly Rep 2021 70 (14) 528-532 During February 2021, an opening event was held indoors at a rural Illinois bar that accommodates approximately 100 persons. The Illinois Department of Public Health (IDPH) and local health department staff members investigated a COVID-19 outbreak associated with this opening event. Overall, 46 COVID-19 cases were linked to the event, including cases in 26 patrons and three staff members who attended the opening event and 17 secondary cases. Four persons with cases had COVID-19-like symptoms on the same day they attended the event. Secondary cases included 12 cases in eight households with children, two on a school sports team, and three in a long-term care facility (LTCF). Transmission associated with the opening event resulted in one school closure affecting 650 children (9,100 lost person-days of school) and hospitalization of one LTCF resident with COVID-19. These findings demonstrate that opening up settings such as bars, where mask wearing and physical distancing are challenging, can increase the risk for community transmission of SARS-CoV-2, the virus that causes COVID-19. As community businesses begin to reopen, a multicomponent approach should be emphasized in settings such as bars to prevent transmission* (1). This includes enforcing consistent and correct mask use, maintaining ≥6 ft of physical distance between persons, reducing indoor bar occupancy, prioritizing outdoor seating, improving building ventilation, and promoting behaviors such as staying at home when ill, as well as implementing contact tracing in combination with isolation and quarantine when COVID-19 cases are diagnosed. |
Characteristics and Risk Factors of Hospitalized and Nonhospitalized COVID-19 Patients, Atlanta, Georgia, USA, March-April 2020.
Pettrone K , Burnett E , Link-Gelles R , Haight SC , Schrodt C , England L , Gomes DJ , Shamout M , O'Laughlin K , Kimball A , Blau EF , Ladva CN , Szablewski CM , Tobin-D'Angelo M , Oosmanally N , Drenzek C , Browning SD , Bruce BB , da Silva J , Gold JAW , Jackson BR , Morris SB , Natarajan P , Fanfair RN , Patel PR , Rogers-Brown J , Rossow J , Wong KK , Murphy DJ , Blum JM , Hollberg J , Lefkove B , Brown FW , Shimabukuro T , Midgley CM , Tate JE , Killerby ME . Emerg Infect Dis 2021 27 (4) 1164-1168 We compared the characteristics of hospitalized and nonhospitalized patients who had coronavirus disease in Atlanta, Georgia, USA. We found that risk for hospitalization increased with a patient's age and number of concurrent conditions. We also found a potential association between hospitalization and high hemoglobin A1c levels in persons with diabetes. |
Outbreak of COVID-19 and Interventions in a Large Jail - Cook County, IL, United States, 2020.
Zawitz C , Welbel S , Ghinai I , Mennella C , Levin R , Samala U , Smith MB , Gubser J , Jones B , Varela K , Kirbiyik U , Rafinski J , Fitzgerald A , Orris P , Bahls A , Black SR , Binder AM , Armstrong PA . Am J Infect Control 2021 49 (9) 1129-1135 BACKGROUND: Correctional and detention facilities are disproportionately affected by COVID-19 due to shared space, contact between staff and detained persons, and movement within facilities. On March 18, 2020, Cook County Jail, one of the United States' largest, identified its first suspected case of COVID-19 in a detained person. METHODS: This analysis includes SARS-CoV-2 cases confirmed by molecular detection among detained persons and Cook County Sheriff's Office staff. We examined occurrence of symptomatic cases in each building and proportions of asymptomatic detained persons testing positive, and timing of interventions including social distancing, mask use, and expanded testing and show outbreak trajectory in the jail compared to case counts in Chicago. RESULTS: During March 1-April 30, 907 symptomatic and asymptomatic cases of SARS-CoV-2 infection were detected among detained persons (n = 628) and staff (n = 279). Among asymptomatic detained persons in quarantine, 23.6% tested positive. Programmatic activity and visitation stopped March 9, cells were converted into single occupancy beginning March 26, and universal masking was implemented for staff (April 2) and detained persons (April 13). Cases at the jail declined while cases in Chicago increased. DISCUSSION/CONCLUSIONS: Aggressive intervention strategies coupled with widespread diagnostic testing of detained and staff populations can limit introduction and mitigate transmission of SARS-CoV-2 infection in correctional and detention facilities. |
Trends in Geographic and Temporal Distribution of US Children With Multisystem Inflammatory Syndrome During the COVID-19 Pandemic.
Belay ED , Abrams J , Oster ME , Giovanni J , Pierce T , Meng L , Prezzato E , Balachandran N , Openshaw JJ , Rosen HE , Kim M , Richardson G , Hand J , Tobin-D'Angelo M , Wilson S , Hartley A , Jones C , Kolsin J , Mohamed H , Colles Z , Hammett T , Patel P , Stierman B , Campbell AP , Godfred-Cato S . JAMA Pediatr 2021 175 (8) 837-845 IMPORTANCE: Multiple inflammatory syndrome in children (MIS-C) occurs in association with the COVID-19 pandemic. OBJECTIVE: To describe the clinical characteristics and geographic and temporal distribution of the largest cohort of patients with MIS-C in the United States to date. DESIGN, SETTING, AND PARTICIPANTS: Cross-sectional analysis was conducted on clinical and laboratory data collected from patients with MIS-C. The analysis included patients with illness onset from March 2020 to January 2021 and met MIS-C case definition. MAIN OUTCOMES AND MEASURES: Geographic and temporal distribution of MIS-C was compared with that of COVID-19 nationally, by region, and level of urbanicity by county. Clinical and laboratory findings and changes over time were described by age group and by presence or absence of preceding COVID-19. RESULTS: A total of 1733 patients with MIS-C were identified; 994 (57.6%) were male and 1117 (71.3%) were Hispanic or non-Hispanic Black. Gastrointestinal symptoms, rash, and conjunctival hyperemia were reported by 53% (n = 931) to 67% (n = 1153) of patients. A total of 937 patients (54%) had hypotension or shock, and 1009 (58.2%) were admitted for intensive care. Cardiac dysfunction was reported in 484 patients (31.0%), pericardial effusion in 365 (23.4%), myocarditis in 300 (17.3%), and coronary artery dilatation or aneurysms in 258 (16.5%). Patients aged 0 to 4 years had the lowest proportion of severe manifestations, although 171 patients (38.4%) had hypotension or shock and 197 (44.3%) were admitted for intensive care. Patients aged 18 to 20 years had the highest proportions with myocarditis (17 [30.9%]), pneumonia (20 [36.4%]), acute respiratory distress syndrome (10 [18.2%]), and polymerase chain reaction positivity (39 [70.9%]). These older adolescents also had the highest proportion reporting preceding COVID-19-like illness (63%). Nationally, the first 2 MIS-C peaks followed the COVID-19 peaks by 2 to 5 weeks. The cumulative MIS-C incidence per 100 000 persons younger than 21 years was 2.1 and varied from 0.2 to 6.3 by state. Twenty-four patients (1.4%) died. CONCLUSIONS AND RELEVANCE: In this cross-sectional study of a large cohort of patients with MIS-C, 2 peaks that followed COVID-19 peaks by 2 to 5 weeks were identified. The geographic and temporal association of MIS-C with the COVID-19 pandemic suggested that MIS-C resulted from delayed immunologic responses to SARS-CoV-2 infection. The clinical manifestations varied by age and by presence or absence of preceding COVID-19. |
The first sixty days of COVID-19 in a humanitarian response setting: a descriptive epidemiological analysis of the outbreak in South Sudan.
Waya JLL , Lako R , Bunga S , Chun H , Mize V , Ambani B , Wamala JF , Guyo AG , Gray JH , Gai M , Maleghemi S , Kol M , Rumunu J , Tukuru M , Olu OO . Pan Afr Med J 2020 37 384 INTRODUCTION: the coronavirus disease 2019 (COVID-19) was declared a pandemic on March 11, 2020. South Sudan, a low-income and humanitarian response setting, reported its first case of COVID-19 on April 5, 2020. We describe the socio-demographic and epidemiologic characteristics of COVID-19 cases in this setting. METHODS: we conducted a cross-sectional descriptive analysis of data for 1,330 confirmed COVID-19 cases from the first 60 days of the outbreak. RESULTS: among the 1,330 confirmed cases, the mean age was 37.1 years, 77% were male, 17% were symptomatic with 95% categorized as mild, and the case fatality rate was 1.1%. Only 24.7% of cases were detected through alerts and sentinel site surveillance, with 95% of the cases reported from the capital, Juba. Epidemic doubling time averaged 9.8 days (95% confidence interval [CI] 7.7 - 13.4), with an attack rate of 11.5 per 100,000 population. Test positivity rate was 18.2%, with test rate per 100,000 population of 53 and mean test turn-around time of 9 days. The case to contact ratio was 1: 2.2. CONCLUSION: this 2-month initial period of COVID-19 in South Sudan demonstrated mostly young adults and men affected, with most cases reported as asymptomatic. Systems´ limitations highlighted included a small proportion of cases detected through surveillance, low testing rates, low contact elicitation, and long collection to test turn-around times limiting the country´s ability to effectively respond to the outbreak. A multi-pronged response including greater access to testing, scale-up of surveillance, contact tracing and community engagement, among other interventions are needed to improve the COVID-19 response in this setting. |
Diagnosed and Undiagnosed COVID-19 in US Emergency Department Health Care Personnel: A Cross-sectional Analysis.
Mohr NM , Harland KK , Krishnadasan A , Eyck PT , Mower WR , Willey J , Chisolm-Straker M , Lim SC , McDonald LC , Kutty PK , Hesse E , Santibanez S , Talan DA . Ann Emerg Med 2020 78 (1) 27-34 STUDY OBJECTIVE: We determine the percentage of diagnosed and undiagnosed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection among a sample of US emergency department (ED) health care personnel before July 2020. METHODS: This was a cross-sectional analysis of ED health care personnel in 20 geographically diverse university-affiliated EDs from May 13, to July 8, 2020, including case counts of prior laboratory-confirmed coronavirus disease 2019 (COVID-19) diagnoses among all ED health care personnel, and then point-in-time serology (with confirmatory testing) and reverse transcriptase-polymerase chain reaction testing in a sample of volunteers without a previous COVID-19 diagnosis. Health care staff were categorized as clinical (physicians, advanced practice providers, and nurses) and nonclinical (clerks, social workers, and case managers). Previously undiagnosed infection was based on positive SARS-CoV-2 serology or reverse transcriptase-polymerase chain reaction result among health care personnel without prior diagnosis. RESULTS: Diagnosed COVID-19 occurred in 2.8% of health care personnel (193/6,788), and the prevalence was similar for nonclinical and clinical staff (3.8% versus 2.7%; odds ratio 1.5; 95% confidence interval 0.7 to 3.2). Among 1,606 health care personnel without previously diagnosed COVID-19, 29 (1.8%) had evidence of current or past SARS-CoV-2 infection. Most (62%; 18/29) who were seropositive did not think they had been infected, 76% (19/25) recalled COVID-19-compatible symptoms, and 89% (17/19) continued to work while symptomatic. Accounting for both diagnosed and undiagnosed infections, 4.6% (95% confidence interval 2.8% to 7.5%) of ED health care personnel were estimated to have been infected with SARS-CoV-2, with 38% of those infections undiagnosed. CONCLUSION: In late spring and early summer 2020, the estimated prevalence of severe acute respiratory syndrome coronavirus 2 infection was 4.6%, and greater than one third of infections were undiagnosed. Undiagnosed SARS-CoV-2 infection may pose substantial risk for transmission to other staff and patients. |
Progression and transmission of HIV (PATH 4.0)-A new agent-based evolving network simulation for modeling HIV transmission clusters.
Singh S , France AM , Chen YH , Farnham PG , Oster AM , Gopalappa C . Math Biosci Eng 2021 18 (3) 2150-2181 We present the Progression and Transmission of HIV (PATH 4.0), a simulation tool for analyses of cluster detection and intervention strategies. Molecular clusters are groups of HIV infections that are genetically similar, indicating rapid HIV transmission where HIV prevention resources are needed to improve health outcomes and prevent new infections. PATH 4.0 was constructed using a newly developed agent-based evolving network modeling (ABENM) technique and evolving contact network algorithm (ECNA) for generating scale-free networks. ABENM and ECNA were developed to facilitate simulation of transmission networks for low-prevalence diseases, such as HIV, which creates computational challenges for current network simulation techniques. Simulating transmission networks is essential for studying network dynamics, including clusters. We validated PATH 4.0 by comparing simulated projections of HIV diagnoses with estimates from the National HIV Surveillance System (NHSS) for 2010-2017. We also applied a cluster generation algorithm to PATH 4.0 to estimate cluster features, including the distribution of persons with diagnosed HIV infection by cluster status and size and the size distribution of clusters. Simulated features matched well with NHSS estimates, which used molecular methods to detect clusters among HIV nucleotide sequences of persons with HIV diagnosed during 2015-2017. Cluster detection and response is a component of the U.S. Ending the HIV Epidemic strategy. While surveillance is critical for detecting clusters, a model in conjunction with surveillance can allow us to refine cluster detection methods, understand factors associated with cluster growth, and assess interventions to inform effective response strategies. As surveillance data are only available for cases that are diagnosed and reported, a model is a critical tool to understand the true size of clusters and assess key questions, such as the relative contributions of clusters to onward transmissions. We believe PATH 4.0 is the first modeling tool available to assess cluster detection and response at the national-level and could help inform the national strategic plan. © 2021 the Author(s), licensee AIMS Press. This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0) |
Environmental Surveillance for Polioviruses in Hati (2017-2019): The Dynamic Process for the Establishment and Monitoring of Sampling Sites
Alleman MM , Coulliette-Salmond AD , Wilnique P , Belgasmi-Wright H , Sayyad L , Wong K , Gue E , Barrais R , Rey-Benito G , Burns CC , Vega E . Viruses 2021 13 (3) Haïti is at risk for wild poliovirus (WPV) importation and circulation, as well as vaccine-derived poliovirus (VDPV) emergence. Environmental surveillance (ES) for polioviruses was established in Port au Prince and Gonaïves in 2016. During 2017-2019, initial ES sites were re-evaluated, and ES was expanded into Cap Haïtien and Saint Marc. Wastewater samples and data on weather, hour of collection, and sample temperature and pH were collected every 4 weeks during March 2017-December 2019 (272 sampling events) from 21 sites in Cap Haïtien, Gonaïves, Port au Prince, and Saint Marc. Samples were processed for the detection of polio and non-polio enteroviruses using the two-phase and "Concentration and Filter Elution" methodologies. Polioviruses were serotyped and underwent intra-typic characterization. No WPV or VDPVs were isolated. Sabin-like polioviruses (oral vaccine strain) of serotypes 1 and 3 were sporadically detected. Five of six (83%), one of six (17%), five of six (83%), and two of three (67%) sites evaluated in Cap Haïtien, Gonaïves, Port au Prince, and Saint Marc, respectively, had enterovirus isolation from >50% of sampling events; these results and considerations, such as watershed population size and overlap, influence of sea water, and excessive particulates in samples, were factors in site retention or termination. The evaluation of 21 ES sampling sites in four Haïtian cities led to the termination of 11 sites. Every-four-weekly sampling continues at the remaining 10 sites across the four cities as a core Global Polio Eradication Initiative activity. |
Blastomycosis Surveillance in 5 States, United States, 1987-2018
Benedict K , Gibbons-Burgener S , Kocharian A , Ireland M , Rothfeldt L , Christophe N , Signs K , Jackson BR . Emerg Infect Dis 2021 27 (4) 999-1006 Blastomycosis is caused by inhalation of Blastomyces spp. fungi. Limited data are available on the incidence and geographic range of blastomycosis in the United States. To better characterize its epidemiologic features, we analyzed combined surveillance data from the 5 states in which blastomycosis is reportable: Arkansas, Louisiana, Michigan, Minnesota, and Wisconsin. Surveillance identified 4,441 cases during 1987–2018, a mean of 192 cases per year. The mean annual incidence was <1 case/100,000 population in most areas but >20 cases/100,000 population in some northern counties of Wisconsin. Median patient age was 46 years, 2,892 (65%) patients were male, 1,662 (57%) were hospitalized, and 278 (8%) died. The median time from symptom onset to diagnosis was 33 days. The severity of illness and diagnostic delays suggest that surveillance underestimates the true number of cases. More in-depth surveillance in additional states could elucidate blastomycosis incidence and inform efforts to increase awareness. | The median time from symptom onset to diagnosis and the severity of illness suggest that surveillance underestimates the true number of cases. | eng |
Cholera outbreak associated with contaminated water sources in paddy fields, Mandla District, Madhya Pradesh, India
Dutta BP , Kumar N , Meshram KC , Yadav R , Sodha SV , Gupta S . Indian J Public Health 2021 65 S46-s50 BACKGROUND: Mandla District in Madhya Pradesh, India, reported a suspected cholera outbreak from Ghughri subdistrict on August 18, 2016. OBJECTIVE: We investigated to determine risk factors and recommend control and prevention measures. METHODS: We defined a case as >3 loose stools in 24 h in a Ghughri resident between July 20 and August 19, 2016. We identified cases by passive surveillance in health facilities and by a house-to-house survey in 28 highly affected villages. We conducted a 1:2 unmatched case-control study, collected stool samples for culture, and tested water sources for fecal contamination. RESULTS: We identified 628 cases (61% female) from 96 villages; the median age was 27 years (range: 1 month-76 years). Illnesses began 7 days after rainfall with 259 (41%) hospitalizations and 14 (2%) deaths in people from remote villages who died before reaching a health facility; 12 (86%) worked in paddy fields. Illness was associated with drinking well water within paddy fields (odds ratio [OR] = 4.0, 95% confidence interval [CI] = 1.4-8.0) and not washing hands with soap after defecation (OR = 6.1, CI = 1.7-21). Of 34 stool cultures, 11 (34%) tested positive for Vibrio cholerae O1 Ogawa. We observed open defecation in affected villages around paddy fields. Of 16 tested water sources in paddy fields, eight (50%) were protected, but 100% had fecal contamination. CONCLUSION: We recommended education regarding pit latrine sanitation and safe water, especially in paddy fields, provision of oral rehydration solution in remote villages, and chlorine tablets for point-of-use treatment of drinking water. |
A decision analytics model to optimize investment in interventions targeting the HIV PrEP cascade of care
Jenness SM , Knowlton G , Smith DK , Marcus JL , Anderson EJ , Siegler AJ , Jones J , Sullivan PS , Enns E . AIDS 2021 35 (9) 1479-1489 OBJECTIVES: Gaps between recommended and actual levels of HIV preexposure prophylaxis (PrEP) use remain among men who have sex with men (MSM). Interventions can address these gaps, but it is unknown how public health initiatives should invest prevention funds into these interventions to maximize their population impact. DESIGN: We used a stochastic network-based HIV transmission model for MSM in the Atlanta area paired with an economic budget optimization model. METHODS: The model simulated MSM participating in up to three real-world PrEP cascade interventions designed to improve initiation, adherence, or persistence. The primary outcome was infections averted over 10 years. The budget optimization model identified the investment combination under different budgets that maximized this outcome given intervention costs from a payer perspective. RESULTS: From the base 15% PrEP coverage level, the three interventions could increase coverage to 27%, resulting in 12.3% of infections averted over 10 years. Uptake of each intervention was interdependent: maximal use of the adherence and persistence interventions depended on new PrEP users generated by the initiation intervention. As the budget increased, optimal investment involved a mixture of the initiation and persistence interventions, but not the adherence intervention. If adherence intervention costs were halved, the optimal investment was roughly equal across interventions. CONCLUSIONS: Investments into the PrEP cascade through initiatives should account for the interactions of the interventions as they are collectively deployed. Given current intervention efficacy estimates, the total population impact of each intervention may be improved with greater total budgets or reduced intervention costs. |
Intimate Partner Violence Experienced by Adults With Diagnosed HIV in the U.S
Lemons-Lyn AB , Baugher AR , Dasgupta S , Fagan JL , Smith SG , Shouse RL . Am J Prev Med 2021 60 (6) 747-756 INTRODUCTION: Intimate partner violence is associated with adverse health consequences among people with diagnosed HIV, which could have implications for disease progression and transmission. However, nationally representative estimates of intimate partner violence among people with diagnosed HIV are lacking. Investigators used nationally representative data to estimate the prevalence of physical violence by an intimate partner among adults with diagnosed HIV and examine the differences by selected characteristics. METHODS: This analysis included interview and medical record data from the 2015-2017 cycles of the Medical Monitoring Project, analyzed in 2019. Weighted percentages and 95% CIs were used to report the prevalence of intimate partner violence among people with diagnosed HIV (N=11,768). Bivariate and multivariate differences in intimate partner violence by sociodemographic, behavioral, and clinical characteristics were examined using Rao-Scott chi-square tests (p<0.05). RESULTS: Among people with diagnosed HIV, 26.3% reported having ever experienced intimate partner violence, and 4.4% reported having experienced intimate partner violence in the past 12 months. The prevalence of intimate partner violence differed by gender and gender/sexual identity. People who experienced intimate partner violence in the past 12 months were more likely to engage in behaviors associated with elevated HIV transmission risk and have unmet needs for supportive services. People who recently experienced intimate partner violence were less likely to be engaged in routine HIV care but were more likely to seek emergency care services and have poor HIV clinical outcomes. CONCLUSIONS: This study's findings support the need for screening people with diagnosed HIV for intimate partner violence and offering linkage to supportive services. Screening for intimate partner violence among people with diagnosed HIV, coupled with supportive services and counseling, may lead to improved safety and HIV clinical outcomes and decreased need for emergency and inpatient medical services. |
Systematic Review of Reported HIV Outbreaks, Pakistan, 2000-2019
Rabold EM , Ali H , Fernandez D , Knuth M , Schenkel K , Asghar RJ , Baig MA , Shaikh S , Morgan O . Emerg Infect Dis 2021 27 (4) 1039-1047 Unsafe injection practices and injection drug use have been linked to multiple HIV outbreaks in Pakistan since 2003; however, few studies have systematically analyzed the causes of these outbreaks. We conducted a systematic review of published English-language literature indexed in bibliographic databases and search engines and a focused gray literature review to collate and analyze all reported HIV outbreaks in Pakistan during 2000–2019. Of 774 unique publications reviewed, we identified 25 eligible publications describing 7 outbreaks. More than half occurred during 2016–2019. The primary sources of transmission were iatrogenic transmission, affecting children, persons with chronic medical conditions, and the general population (4 outbreaks); injection drug use (2 outbreaks); and a combination of both (1 outbreak). In the absence of robust HIV testing and surveillance in Pakistan, timely and detailed outbreak reporting is important to understand the epidemiology of HIV in the country. | In the absence of robust testing programs, timely and detailed outbreak reporting is essential for HIV control. | eng |
Who Are the Men Who Pay for Sex in Mozambique Results from the National HIV/AIDS Indicator Survey 2015
Semá Baltazar C , Mehta N , Juga A , Boothe M , Chitsondzo Langa D , Simbine P , Kellogg TA . Arch Sex Behav 2021 50 (5) 2057-2065 Mozambique has one of the highest burdens of HIV in the world, where the prevalence is estimated at 13.2% among adults aged 15-49 years. Men who pay for sex (MPS) are considered a bridging population for HIV infection. However, the characteristics of MPS in Mozambique are poorly understood. The objective of this study was to estimate the prevalence of paid sex among men 15-49 years and investigate risk factors associated with paid sex. We analyzed data collected from 4724 men, aged 15-49 years, as part of the 2015 Mozambique AIDS Indicator Survey. Chi-squared tests and logistic regression models accounting for survey design were used to assess the associations between paying for sex and demographic characteristics and the number of lifetime and recent sex partners, condom use at last sex, and self-reported sexually transmitted infection symptoms. The prevalence of paid sex in the last 12 months was 10.4% (95% CI 9.0-12.1), with Cabo Delgado province having the highest prevalence (38.8%). MPS in the last 12 months were most frequently between the ages of 20-24 years (13.5%), not in a relationship (17.8%), had a primary education (11.9%), from poor households (14.0%), had more than three sexual partners excluding their spouse in the last 12 months (44.7%), and self-reported a STI in the past 12 months (44.2%). HIV prevalence was higher among men who ever paid for sex compared with men who did not (13.1% vs. 9.4%, p = .02). Men who reported 10+ lifetime partner (aOR 7.7; 95% CI 4.5-13.0; p < .001), from Cabo Delgado (aOR 4.0; 95% CI 2.2-7.4; p < .001), who reported STI symptoms in the past 12 months (aOR 2.7; 95% CI 1.7-4.2; p < .001), and HIV positive (aOR 1.6; 95% CI 1.0-3.7; p = .05) were more likely to have paid for sex in the last 12 months. These findings present the HIV prevalence among Mozambican MPS and highlight the need for a comprehensive behavioral, structural, and biomedical approach to interventions to reduce the risks of commercial and transactional sex. |
Neisseria meningitidis urethritis in a Thai male
Tongtoyai J , Tatakham N , Cherdtrakulkiat T , Sirivongrangson P , Hickey A . J Health Sci Med Res 2021 39 (3) 251-255 Although Neisseria meningitidis (N. meningitidis) urogenital infections have been reported widely, meningococcal urethritis has not been reported previously in Thailand. A 42-year-old Thai male presented at a sexual health clinic with dysuria and urethral discharge following oral and insertive anal intercourse. N. meningitidis, serogroup C was cultured from a urethral discharge specimen and the patient was treated successfully with standard treatment for gonococcal urethritis. This case reflects a growing trend of reports describing meningococcal urethritis, likely resulting from sexual contact. © 2020 JHSMR. Hosting by Prince of Songkla University. |
STI Prevalence, Incidence, and Costs in the United States: New Estimates, New Approach
Weinstock HS , Kreisel KM , Spicknall IH , Chesson HW , Miller WC . Sex Transm Dis 2021 48 (4) 207 The field of sexually transmitted infection (STI) prevention depends heavily on having current estimates of the health and economic burden of STIs. These estimates guide priorities in research, public health decisions, and governmental policies. Recent estimates have been cited in crucial public health and policy documents, such as STI treatment guidelines,1 STI surveillance reports,2 public health recommendations,3,4 and government budget justifications and priorities.5 Publishing these estimates is one of the most important contributions of the journal, Sexually Transmitted Diseases (STD), to the field. |
Place-Based Correlates of Exchange Sex Among People Who Inject Drugs in 19 U.S. Metropolitan Areas, 2012
Wise A , Kianian B , Chang H , Linton S , Wolfe ME , Smith J , Tempalski B , Des Jarlais D , Ross Z , Semaan S , Wejnert C , Broz D , Cooper H . Arch Sex Behav 2021 50 (7) 2897-2909 This study examined overall and gender-specific associations between place-based characteristics and opposite-sex exchange sex among people who inject drugs (PWID) in the U.S. PWID were recruited from 19 metropolitan statistical areas (MSAs) for the Centers for Disease Control and Prevention's 2012 National HIV Behavioral Surveillance. Administrative data were used to describe the economic, social, and political features of the ZIP codes, MSAs, counties, and states where PWID lived. Multilevel modeling estimated associations of place characteristics and exchange sex. We found that 52% of women and 23% of men reported past-year opposite-sex exchange sex (N = 7599). Female PWID living in states with stronger policies supporting working caregivers had lower odds of exchange sex (aOR = 0.80; 95% CI 0.69, 0.94). PWID living in ZIP codes with greater economic deprivation had higher odds of exchange sex (aOR = 1.10; 95% CI 1.03, 1.17). We found that a high percentage of male PWID exchanged sex with women; determinants and risks of this group merit exploration. If future research establishes that the relationships identified here are causal, interventions to reduce exchange sex among PWID should include policies supporting working caregivers and reducing poverty rates. |
Prevalence and molecular characterization of novel species of the Diplomonad genus
Seabolt MH , Alderisio KA , Xiao L , Roellig DM . Int J Parasitol Parasites Wildl 2021 14 267-272 Octomitus is a diplomonad genus known to inhabit the intestinal tracts of rodents. Ultrastructural morphology and 18S rDNA gene sequence analysis support the placement of Octomitus as the closest sister lineage to Giardia, a parasite which causes diarrheal disease in humans and animals worldwide. However, further information on the ecology and diversity of Octomitus is currently scarce. Expanding the available database of characterized sequences for this organism would therefore be helpful to studies of Diplomonad ecology, evolution, and epidemiology, particularly related to the evolution of parasitism in Giardia and Spironucleus, another related Diplomonad common in commercial fish farming. In order to study the prevalence and genotypic diversity of Octomitus, we developed a nested PCR assay specific to Octomitus and optimized to detect genotypes in fecal samples collected from wildlife in a New York watershed, and sequenced a portion of the small subunit ribosomal DNA (18S rDNA) gene to identify samples to species level. Molecular evidence suggested that Octomitus genotypes display similar prevalence to Cryptosporidium and microsporidian pathogens in wildlife as well as strong host preference for rodent and opossum hosts. Phylogenetic analysis showed strong support for 14 Octomitus genotypes, 13 of these novel, and patterns of host-parasite co-evolution. © 2021 |
Susceptibility of Ixodes scapularis (Acari: Ixodidae) to Permethrin Under a Long-Term 4-Poster Deer Treatment Area on Shelter Island, NY
Burtis JC , Poggi JD , Payne B , Campbell SR , Harrington LC . J Med Entomol 2021 58 (4) 1966-1969 Pesticide resistance in medically significant disease vectors can negatively impact the efficacy of control efforts. Resistance research on ticks has focused primarily on species of veterinary significance that experience relatively high degrees of control pressure. Resistance in tick vectors of medical significance has received little attention, in part because area-wide pesticide applications are not used to control these generalist tick species. One of the few effective methods currently used for area-wide control of medically important ticks, including Ixodes scapularis Say (Acari: Ixodidae), is deployment of 4-poster devices. Deer self-apply a topical acaricide (permethrin) while feeding on corn from the devices. A 4-poster program using permethrin has been deployed on Shelter Island, NY to control I. scapularis populations since 2008. We collected engorged female ticks from deer in this management area and a location in the Mid-Hudson River Valley, NY without area-wide tick control. Larvae were reared from egg masses and their susceptibility to permethrin was tested. Larvae originating from a long-term laboratory colony were used as a susceptible baseline for comparison. Compared against the laboratory colony, resistance ratios at LC-50 for Shelter Island and Hudson Valley I. scapularis were 1.87 and 1.51, respectively. The susceptibilities of the field populations to permethrin were significantly lower than that of the colony ticks. We provide the first data using the larval packet test to establish baseline susceptibility for I. scapularis to permethrin along with information relevant to understanding resistance emergence in tick populations under sustained control pressure from 4-poster devices. |
Molecular Confirmation of Anopheles melas (Diptera: Culicidae) in Democratic Republic of Congo
Moyo M , Lawrence GG , Bobanga T , Irish SR . Afr Entomol 2021 29 (1) 298-300 Anopheles melas Theobald had been reported from coastal areas of the Democratic Republic of Congo (DRC), but molecular methods had never previously been used to confirm this identification. To see if An. melas was indeed present in the coastal area of DRC, Anopheles mosquitoes were collected in larval collections. Those morphologically identified as belonging to the Anopheles gambiae complex as adults were identified to species using polymerase chain reaction methods. The identity of those found to be Anopheles melas were confirmed through sequencing of the DNA. As Anopheles melas has been found to be a competent malaria vector elsewhere (Akogbeto & Romano 1999), these mosquitoes and their habitat should be considered in malaria control activities. |
Marginal warming associated with a COVID-19 quarantine and the implications for disease transmission.
Miller PW , Reesman C , Grossman MK , Nelson SA , Liu V , Wang P . Sci Total Environ 2021 780 146579 During January-February 2020, parts of China faced restricted mobility under COVID-19 quarantines, which have been associated with improved air quality. Because particulate pollutants scatter, diffuse, and absorb incoming solar radiation, a net negative radiative forcing, decreased air pollution can yield surface warming. As such, this study (1) documents the evolution of China's January-February 2020 air temperature and concurrent particulate changes; (2) determines the temperature response related to reduced particulates during the COVID-19 quarantine (C19Q); and (3) discusses the conceptual implications for temperature-dependent disease transmission. C19Q particulate evolution is monitored using satellite analyses, and concurrent temperature anomalies are diagnosed using surface stations and Aqua AIRS imagery. Meanwhile, two WRF-Chem simulations are forced by normal emissions and the satellite-based urban aerosol changes, respectively. Urban aerosols decreased from 27.1% of pre-C19Q aerosols to only 17.5% during C19Q. WRF-Chem resolved ~0.2 °C warming across east-central China, that represented a minor, though statistically significant contribution to C19Q temperature anomalies. The largest area of warming is concentrated south of Chengdu and Wuhan where temperatures increased between +0.2-0.3 °C. The results of this study are important for understanding the anthropogenic forcing on regional meteorology. Epidemiologically, the marginal, yet persistent, warming during C19Q may retard temperature-dependent disease transmission, possibly including SARS-CoV-2. |
Acceptability of urine diversion dry toilets in Dollo Ado refugee camp, Ethiopia
Patrick M , Tsige Y , Adow A , Abdirashid M , Yunis H , Githiri D , Hulland E , Murphy J , Akers P , Brown TW , Blanton C , Handzel T . Int J Hyg Environ Health 2021 234 113745 Given the increasing frequency and duration of humanitarian emergencies worldwide, there is a need to identify a greater range of effective and contextually appropriate water, sanitation and hygiene (WASH) interventions. Typical sanitation systems may be poorly suited for some of the conditions in which humanitarian emergencies can occur, such as in drought-prone regions. Urine-diversion dry toilets (UDDTs) are one potential alternative sanitation option which can be used in these conditions. Between 2014 and 2016, the U.S. Centers for Disease Control and Prevention (CDC) partnered with local agencies to evaluate the acceptability of UDDTs in a refugee camp in Ethiopia. The overall goals were to provide evidence regarding the level of adoption and satisfaction with UDDTs in this emergency context and the factors associated with satisfaction. Two cross-sectional surveys were conducted 18-months apart, using a stratified design to sample UDDT and latrine users for comparison. The proportion who reported to use their UDDT consistently was 88.8% (95% CI 85.1-92.5) in the first survey and 93.4% (95% CI 90.6-96.2) in the second survey. Reported satisfaction levels were significantly higher among respondents in the second survey (p < 0.0001), where 97.0% (95% CI 95.1-98.9) of respondents stated either that they were mostly or very satisfied with their UDDT. There was no significant difference detected in satisfaction between UDDT and latrine users (p = 0.28). Using a multivariable logistic regression model, we identified several factors associated with a higher level of satisfaction with UDDTs. Those who had previously (before coming to the camp) used a pit latrine (AOR = 4.2; 95% CI 1.4-12.7) or had no sanitation system (AOR = 2.4; 95% CI 1.3-4.4) relative to a pour-flush toilet, had a clean UDDT (AOR = 2.8; 95% CI 1.7-4.6), had been in the camp for a longer time period (AOR = 2.3; 95% CI 1.7-3.0), did not share their UDDT (AOR = 1.8; 95% CI 1.0-3.0) and had used their UDDT for a longer time period (AOR = 1.7; 95% CI 1.2-2.4) had higher odds of satisfaction. The findings demonstrate that UDDTs have been effectively introduced and utilized in this context and this may have implications for other humanitarian settings where they can be similarly managed. |
Advancing per- and polyfluoroalkyl substances (PFAS) research: an overview of ATSDR and NCEH activities and recommendations
Rogers RD , Reh CM , Breysse P . J Expo Sci Environ Epidemiol 2021 31 (6) 1-11 The National Center for Environmental Health (NCEH), part of the Centers for Disease Control and Prevention (CDC), and the Agency for Toxic Substances and Disease Registry (ATSDR) support and conduct research advancing national, state, and local public health response to per- and polyfluoroalkyl substances (PFAS). PFAS are a group of manufactured chemicals used in industry and consumer products that persist in the environment. Given the growing evidence linking PFAS with adverse health effects in humans, NCEH and ATSDR developed a public health research framework to capture the broad range of PFAS research activities being conducted and supported by the agency to determine future research priorities and identify opportunities for interagency collaboration. The framework was conceptualized via a multidisciplinary visioning process designed to identify compelling questions and research activities that span five scientific domains: toxicology, exposure, human health, public health action, and cross-cutting priorities. This paper presents a framework, compelling questions and research activities to help NCEH and ATSDR advance scientific discovery in partnership with federal, state, and local stakeholders as part of a comprehensive public health response to PFAS contamination. |
Chronic environmental contamination: A narrative review of psychosocial health consequences, risk factors, and pathways to community resilience
Sullivan D , Schmitt HJ , Calloway EE , Clausen W , Tucker P , Rayman J , Gerhardstein B . Soc Sci Med 2021 276 113877 A body of psychological and social scientific evidence suggests that the experience of technological disaster or long-term exposure to environmental contamination can be psychologically stressful. Addressing the psychosocial impact in communities living with chronic contamination is therefore a vital part of improving their resilience. Guided by a synthetic theoretical model of the unique psychosocial impact of chronic environmental contamination (in contrast to natural and technological disasters, and background pollution), we undertook a narrative review to assess the current research on this important social problem. Relevant qualitative peer-reviewed studies and grey literature were examined to derive a model identifying likely factors increasing risk for distress in chronic contamination experience and actions that may be taken by public health professionals and local leaders to enhance community resilience and take health-protective actions. Based on our initial theoretical model and the literature reviewed, we emphasize the importance of considering both the material and social dimensions of chronic environmental contamination experience. For instance, our review of the qualitative literature suggests that individuals who attribute material health impacts to contamination, and who have the social experience of their concerns being delegitimized by responsible institutions, are most at risk for psychological stress. Psychological stress in the context of chronic contamination is an important potential public health burden and a key area for additional research. |
Rare Norovirus GIV Foodborne Outbreak, Wisconsin, USA
Barclay L , Davis T , Vinjé J . Emerg Infect Dis 2021 27 (4) 1151-1154 We report a norovirus GIV outbreak in the United States, 15 years after the last reported outbreak. During May 2016 in Wisconsin, 53 persons, including 4 food handlers, reported being ill. The outbreak was linked to individually prepared fruit consumed as a fruit salad. The virus was phylogenetically classified as a novel GIV genotype. |
Candida auris Whole-Genome Sequence Benchmark Dataset for Phylogenomic Pipelines
Welsh RM , Misas E , Forsberg K , Lyman M , Chow NA . J Fungi (Basel) 2021 7 (3) Candida auris is a multidrug-resistant pathogen that represents a serious public health threat due to its rapid global emergence, increasing incidence of healthcare-associated outbreaks, and high rates of antifungal resistance. Whole-genome sequencing and genomic surveillance have the potential to bolster C. auris surveillance networks moving forward. Laboratories conducting genomic surveillance need to be able to compare analyses from various national and international surveillance partners to ensure that results are mutually trusted and understood. Therefore, we established an empirical outbreak benchmark dataset consisting of 23 C. auris genomes to help validate comparisons of genomic analyses and facilitate communication among surveillance networks. Our outbreak benchmark dataset represents a polyclonal phylogeny with three subclades. The genomes in this dataset are from well-vetted studies that are supported by multiple lines of evidence, which demonstrate that the whole-genome sequencing data, phylogenetic tree, and epidemiological data are all in agreement. This C. auris benchmark set allows for standardized comparisons of phylogenomic pipelines, ultimately promoting effective C. auris collaborations. |
Applying a One Health Approach in Global Health and Medicine: Enhancing Involvement of Medical Schools and Global Health Centers
Machalaba C , Raufman J , Anyamba A , Berrian AM , Berthe FCJ , Gray GC , Jonas O , Karesh WB , Larsen MH , Laxminarayan R , Madoff LC , Martin K , Mazet JAK , Mumford E , Parker T , Pintea L , Rostal MK , de Castañeda RR , Vora NM , Wannous C , Weiss LM . Ann Glob Health 2021 87 (1) 30 BACKGROUND: Multidisciplinary and multisectoral approaches such as One Health and related concepts (e.g., Planetary Health, EcoHealth) offer opportunities for synergistic expertise to address complex health threats. The connections between humans, animals, and the environment necessitate collaboration among sectors to comprehensively understand and reduce risks and consequences on health and wellbeing. One Health approaches are increasingly emphasized for national and international plans and strategies related to zoonotic diseases, food safety, antimicrobial resistance, and climate change, but to date, the possible applications in clinical practice and benefits impacting human health are largely missing. METHODS: In 2018 the "Application of the One Health Approach to Global Health Centers" conference held at the Albert Einstein College of Medicine convened experts involved in One Health policy and practice. The conference examined issues relevant to One Health approaches, sharing examples of challenges and successes to guide application to medical school curricula and clinical practice for human health. This paper presents a synthesis of conference proceedings, framed around objectives identified from presentations and audience feedback. FINDINGS AND RECOMMENDATIONS: The following objectives provide opportunities for One Health involvement and benefits for medical schools and global health centers by: 1) Improving One Health resource sharing in global health and medical education; 2) Creating pathways for information flow in clinical medicine and global health practice; 3) Developing innovative partnerships for improved health sector outcomes; and 4) Informing and empowering health through public outreach. These objectives can leverage existing resources to deliver value to additional settings and stakeholders through resource efficiency, more holistic and effective service delivery, and greater ability to manage determinants of poor health status. We encourage medical and global health educators, practitioners, and students to explore entry points where One Health can add value to their work from local to global scale. |
Sexual Behavior Among US Adults: New Sex Partners and Number of Lifetime Sex Partners, NHANES 20132016 and NSFG 20112015
Lewis RM , Leichliter JS , Chesson HW , Markowitz LE . Sex Res Social Policy 2021 19 (2) 530-540 Introduction: Sexual behavior information can provide context for understanding rates of sexually transmitted infections (STI) and inform potential impact of interventions. Methods: We used 20132016 National Health and Nutrition Examination Survey (n=4930) and 20112015 National Survey of Family Growth (n=16,643) data from sexually experienced 2044-year old US females and males to estimate the number of lifetime and past year partners and percent with a new past year partner overall and by marital status, in 5-year age groups. Group differences were qualitatively assessed. Results: Estimates from both surveys were comparable. The median number of lifetime sex partners ranged from 4.2 to 5.2 across age groups among females and was higher among older (9.1) than younger (4.6) males, persons with a new past year partner than those without, and persons widowed/divorced/separated/never married than those married/living with partner. Percents with 2 past year partners and a new past year partner were highest in the youngest age group and lower with age. Percent with a new past year partner was 1946 percentage points higher in persons widowed/divorced/separated/never married (range 21.756.4%) compared to persons married/living with partner (range 2.712.4%). Conclusions: In the USA, there are differences in sexual behaviors by gender, age, and marital status. The percent of adults with a new sex partner is lower with increasing age; however, a portion of all subgroups reported having had a new sex partner in the past year indicating some adults remain at risk of acquiring an STI. Policy Implications: These data can help inform policies for STI screening and other interventions. 2021, This is a U.S. government work and not under copyright protection in the U.S.; foreign copyright protection may apply. |
The Estimated Lifetime Medical Cost of Chlamydia, Gonorrhea, and Trichomoniasis in the United States, 2018
Kumar S , Chesson HW , Spicknall IH , Kreisel KM , Gift TL . Sex Transm Dis 2021 48 (4) 238-246 BACKGROUND: The purpose of this study was to provide updated estimates of the average lifetime medical cost per infection for chlamydia, gonorrhea, and trichomoniasis. METHODS: We adapted a published decision tree model that allowed for 7 possible outcomes of infection: (1) symptomatic infection, treated, no sequelae; (2) symptomatic infection, not treated, sequelae; (3) symptomatic infection, not treated, no sequelae; (4) asymptomatic infection, treated, sequelae; (5) asymptomatic infection, treated, no sequelae; (6) asymptomatic infection, not treated, sequelae; and (7) asymptomatic infection, not treated, no sequelae. The base case values and ranges we applied for the model inputs (i.e., the probability and cost assumptions) were based on published studies. RESULTS: The estimated lifetime medical costs per infection for men and women, respectively, were $46 (95% credibility interval, $32-$62) and $262 ($127-$483) for chlamydia, $78 ($36-$145) and $254 ($96-$518) for gonorrhea, and $5 ($1-$14) and $36 ($17-$58) for trichomoniasis. Cost estimates for men were most sensitive to assumptions regarding the probability that the infection is symptomatic, the probability of treatment if asymptomatic, and the cost of treatment of infection. Cost estimates for chlamydia and gonorrhea in women were most sensitive to assumptions regarding the probability and cost of subsequent pelvic inflammatory disease. CONCLUSIONS: These estimates of the lifetime medical cost per infection can inform updated estimates of the total annual cost of sexually transmitted infections in the United States, as well as analyses of the value and cost-effectiveness of sexually transmitted infection prevention interventions. |
Antimicrobial Use in a Cohort of US Nursing Homes, 2017
Thompson ND , Stone ND , Brown CJ , Penna AR , Eure TR , Bamberg WM , Barney GR , Barter D , Clogher P , DeSilva MB , Dumyati G , Frank L , Felsen CB , Godine D , Irizarry L , Kainer MA , Li L , Lynfield R , Mahoehney JP , Maloney M , Nadle J , Ocampo VLS , Pierce R , Ray SM , Davis SS , Sievers M , Srinivasan K , Wilson LE , Zhang AY , Magill SS . JAMA 2021 325 (13) 1286-1295 IMPORTANCE: Controlling antimicrobial resistance in health care is a public health priority, although data describing antimicrobial use in US nursing homes are limited. OBJECTIVE: To measure the prevalence of antimicrobial use and describe antimicrobial classes and common indications among nursing home residents. DESIGN, SETTING, AND PARTICIPANTS: Cross-sectional, 1-day point-prevalence surveys of antimicrobial use performed between April 2017 and October 2017, last survey date October 31, 2017, and including 15 276 residents present on the survey date in 161 randomly selected nursing homes from selected counties of 10 Emerging Infections Program (EIP) states. EIP staff reviewed nursing home records to collect data on characteristics of residents and antimicrobials administered at the time of the survey. Nursing home characteristics were obtained from nursing home staff and the Nursing Home Compare website. EXPOSURES: Residence in one of the participating nursing homes at the time of the survey. MAIN OUTCOMES AND MEASURES: Prevalence of antimicrobial use per 100 residents, defined as the number of residents receiving antimicrobial drugs at the time of the survey divided by the total number of surveyed residents. Multivariable logistic regression modeling of antimicrobial use and percentages of drugs within various classifications. RESULTS: Among 15 276 nursing home residents included in the study (mean [SD] age, 77.6 [13.7] years; 9475 [62%] women), complete prevalence data were available for 96.8%. The overall antimicrobial use prevalence was 8.2 per 100 residents (95% CI, 7.8-8.8). Antimicrobial use was more prevalent in residents admitted to the nursing home within 30 days before the survey date (18.8 per 100 residents; 95% CI, 17.4-20.3), with central venous catheters (62.8 per 100 residents; 95% CI, 56.9-68.3) or with indwelling urinary catheters (19.1 per 100 residents; 95% CI, 16.4-22.0). Antimicrobials were most often used to treat active infections (77% [95% CI, 74.8%-79.2%]) and primarily for urinary tract infections (28.1% [95% CI, 15.5%-30.7%]). While 18.2% (95% CI, 16.1%-20.1%) were for medical prophylaxis, most often use was for the urinary tract (40.8% [95% CI, 34.8%-47.1%]). Fluoroquinolones were the most common antimicrobial class (12.9% [95% CI, 11.3%-14.8%]), and 33.1% (95% CI, 30.7%-35.6%) of antimicrobials used were broad-spectrum antibiotics. CONCLUSIONS AND RELEVANCE: In this cross-sectional survey of a cohort of US nursing homes in 2017, prevalence of antimicrobial use was 8.2 per 100 residents. This study provides information on the patterns of antimicrobial use among these nursing home residents. |
Invasive Aspergillosis After Influenza and Other Viral Respiratory Infections Among Intensive Care Unit Patients in a Commercially Insured Population in the United States, 2013-2018
Toda M , Benedict K , Jackson BR . Open Forum Infect Dis 2021 8 (3) ofab091 Influenza-associated aspergillosis (IAA) is an emerging phenomenon in intensive care unit patients with severe influenza. In a large US health insurance claims database, IAA was uncommon (0.3%) during 2013-2018. The low IAA frequency likely reflects underdiagnosis and differences in medical practices or epidemiologic differences. |
Reactogenicity Following Receipt of mRNA-Based COVID-19 Vaccines.
Chapin-Bardales J , Gee J , Myers T . JAMA 2021 325 (21) 2201-2202 In December 2020, 2 mRNA-based COVID-19 vaccines (Pfizer-BioNTech and Moderna) were granted Emergency Use Authorization by the US Food and Drug Administration as 2-dose series and recommended for use by the Advisory Committee on Immunization Practices.1-3 In late February 2021, the US Food and Drug Administration granted Emergency Use Authorization for a third COVID-19 vaccine, a single-dose adenovirus vector-based vaccine from Janssen (Johnson & Johnson). | | In clinical trials of the mRNA-based 2-dose vaccines, participants reported local and systemic reactions (reactogenicity).4,5 Frequently reported reactions included injection site pain, fatigue, and headache; greater reactogenicity was reported following the second dose.4,5 Continued monitoring of reactogenicity of COVID-19 vaccines outside of clinical trial settings may provide additional information for health care practitioners and the public about transient local and systemic reactions following COVID-19 vaccination. |
Association of Inadvertent 9-Valent Human Papillomavirus Vaccine in Pregnancy With Spontaneous Abortion and Adverse Birth Outcomes
Kharbanda EO , Vazquez-Benitez G , DeSilva MB , Naleway AL , Klein NP , Hechter RC , Glanz JM , Donahue JG , Jackson LA , Sheth SS , Greenberg V , Panagiotakopoulos L , Mba-Jonas A , Lipkind HS . JAMA Netw Open 2021 4 (4) e214340 IMPORTANCE: The 9-valent human papillomavirus (9vHPV) vaccine is recommended for individuals through age 26 years and may be administered to women up to age 45 years. Data on 9vHPV vaccine exposures during pregnancy are limited. OBJECTIVE: To evaluate the associations between 9vHPV vaccine exposures during pregnancy or peripregnancy and selected pregnancy and birth outcomes (spontaneous abortion [SAB], preterm birth, small-for-gestational age [SGA] birth, and major structural birth defect). DESIGN, SETTING, AND PARTICIPANTS: This cohort study analyzed data from 7 participating health systems in the Vaccine Safety Datalink. The cohort comprised pregnancies among girls and women aged 12 to 28 years that ended between October 26, 2015, and November 15, 2018. Singleton pregnancies that ended in a live birth, stillbirth, or SAB were included. EXPOSURES: Vaccine exposure windows were distal (9vHPV or 4vHPV vaccine administered from 22 to 16 weeks before last menstrual period [LMP]), peripregnancy (9vHPV vaccine administered from 42 days before LMP until LMP), and during pregnancy (9vHPV vaccine administered from LMP to 19 completed weeks' gestation). Primary comparisons were (1) girls and women with 9vHPV vaccine exposures during pregnancy vs those with 4vHPV or 9vHPV distal vaccine exposures, (2) girls and women with vaccine exposures peripregnancy vs those with 4vHPV or 9vHPV distal vaccine exposures, and (3) girls and women with 9vHPV vaccine exposures during pregnancy or peripregnancy vs those with 4vHPV or 9vHPV distal vaccine exposure. MAIN OUTCOMES AND MEASURES: Spontaneous abortions were confirmed based on medical record review and adjudication. Preterm and SGA births were identified from electronic health record and birth data. Major structural birth defects were based on diagnostic codes using a validated algorithm. Inverse probability weighting was used to balance the covariates. Time-dependent covariate Cox proportional hazards regression models and Poisson regression were used to estimate the associations between 9vHPV vaccine exposures and pregnancy and birth outcomes. RESULTS: The final cohort included 1493 pregnancies among girls and women with a mean (SD) maternal age of 23.9 (2.9) years. Of these pregnancies, 445 (29.8%) had exposures to the 9vHPV vaccine during pregnancy, 496 (33.2%) had exposures to the 9vHPV vaccine peripregnancy, and 552 (37.0%) had 4vHPV or 9vHPV distal vaccine exposures. The 9vHPV vaccine administered during pregnancy was not associated with increased risk for SAB (hazard ratio, 1.12; 95% CI, 0.66-1.93) compared with distal vaccine exposures. Findings were similar for 9vHPV vaccine exposures peripregnancy (relative risk [RR], 0.72; 95% CI, 0.42-1.24). Among live births (n = 1409), 9vHPV vaccine exposures during pregnancy were not associated with increased risks for preterm birth (RR, 0.73; 95% CI, 0.44-1.20) or SGA birth (RR, 1.31; 95% CI, 0.78-2.20). Results were similar regarding the association between 9vHPV vaccine exposures peripregnancy and preterm birth (RR, 0.72; 95% CI, 0.45-1.17) and SGA birth (RR, 1.10; 95% CI, 0.65-1.88). Birth defects were rare in all exposure groups, occurring in about 1% of live births with available infant data. CONCLUSIONS AND RELEVANCE: This study found that 9vHPV vaccine exposures during or around the time of pregnancy were uncommon and not associated with SABs or selected adverse birth outcomes. These findings can inform counseling for inadvertent 9vHPV vaccine exposures. |
Iterative guided machine learning-assisted systematic literature reviews: a diabetes case study.
Zimmerman J , Soler RE , Lavinder J , Murphy S , Atkins C , Hulbert L , Lusk R , Ng BP . Syst Rev 2021 10 (1) 97 BACKGROUND: Systematic Reviews (SR), studies of studies, use a formal process to evaluate the quality of scientific literature and determine ensuing effectiveness from qualifying articles to establish consensus findings around a hypothesis. Their value is increasing as the conduct and publication of research and evaluation has expanded and the process of identifying key insights becomes more time consuming. Text analytics and machine learning (ML) techniques may help overcome this problem of scale while still maintaining the level of rigor expected of SRs. METHODS: In this article, we discuss an approach that uses existing examples of SRs to build and test a method for assisting the SR title and abstract pre-screening by reducing the initial pool of potential articles down to articles that meet inclusion criteria. Our approach differs from previous approaches to using ML as a SR tool in that it incorporates ML configurations guided by previously conducted SRs, and human confirmation on ML predictions of relevant articles during multiple iterative reviews on smaller tranches of citations. We applied the tailored method to a new SR review effort to validate performance. RESULTS: The case study test of the approach proved a sensitivity (recall) in finding relevant articles during down selection that may rival many traditional processes and show ability to overcome most type II errors. The study achieved a sensitivity of 99.5% (213 out of 214) of total relevant articles while only conducting a human review of 31% of total articles available for review. CONCLUSIONS: We believe this iterative method can help overcome bias in initial ML model training by having humans reinforce ML models with new and relevant information, and is an applied step towards transfer learning for ML in SR. |
Trojan Horse: An Analysis of Targeted Advertising to Reduce Sexually Transmitted Diseases Among YMSM.
Tolosa-Kline A , Yom-Tov E , Hoffman C , Walker-Baban C , Lewis FMT . Health Educ Behav 2021 48 (5) 637-650 BACKGROUND: Men who have sex with men (MSM) increasingly use internet-based websites and geospatial apps to seek sex. Though these platforms may be useful for public health intervention, evaluations of such interventions are rare. We sought to evaluate the online behavior of young MSM of color in Philadelphia and the effectiveness of using ads to link them to DoYouPhilly.org, where users can order free condoms, lubricant, and sexually transmitted infection test kits delivered via the U.S. postal service. METHOD: Data collection and analyses were conducted in two phases. First, we performed keyword research and analyzed web browser logs using a proprietary data set owned by Microsoft. Subsequently, we ran a Google Ads campaign using the keywords identified in the preliminary phase, and directed targeted users to the DoYouPhilly.org condom or test kit ordering pages. Results were analyzed using MATLAB 2018. RESULTS: Test kit advertisements received 5,628 impressions, 157 clicks, and 18 unique conversions. The condom advertisements received 128,007 impressions, 2,583 clicks, and 303 unique conversions. Correlation between the click-through rate and the conversion rate per keyword was ρ = -.35 (P = .0096) and per advertisement was ρ = .40 (P = .14). Keywords that directly related to condoms were most effective for condom ordering (42% conversion rate vs. ≤2% for other classes), while keywords emphasizing the adverse effects of unprotected sex were most effective in test kit ordering (91% conversion rate vs. 13% and 12% for other classes). CONCLUSIONS: Online advertisements seemed to affect real-world sexual health behavior, as measured by orders of condoms and test kits, among a group of young MSM living in the same community. |
Engaging Parents in Zimbabwe to Prevent and Respond to Child Sexual Abuse: A Pilot Evaluation
Shaw S , Cham HJ , Galloway E , Winskell K , Mupambireyi Z , Kasese C , Bangani Z , Miller K . J Child Fam Stud 2021 30 (5) 1314-1326 Data from the Violence Against Children Surveys reveal alarming rates of child sexual abuse (CSA) in sub-Saharan Africa, highlighting the critical need for public health programming to prevent and respond to this issue. This paper describes the results of the Families Matter! Program (FMP) pilot evaluation study conducted in two urban suburbs of Harare, Zimbabwe to measure the effect of a new FMP session about preventing and responding to CSA. FMP is an evidence-based intervention for parents of adolescents designed to promote positive parenting practices and effective parent–child communication about sexual risk reduction and HIV prevention. We applied a pre/post-prospective study design to assess changes in CSA-related indicators such as parental monitoring, parent–child communication about CSA, and ability to respond to instances of CSA. Parents and their children (ages 9–12) enrolled in the study as dyads and participated in two assessments administered via ACASI prior to and three months following the intervention, with 248 dyads completing both assessments. Parents and children reported significantly higher levels of parental monitoring (p < 1.001) and communication about CSA after the intervention (p < 0.001). Significantly more parents also reported conversations with people in their community about CSA (p < 0.001) and knowledge of where to access services if their child was abused (p < 0.001). The pilot evaluation suggests that FMP equipped parents with skills and knowledge to prevent and respond to CSA, and increased communication regarding CSA within communities, further normalizing the need to address and talk about child abuse, CSA in particular. © 2021, The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature. |
Chimeric Zika viruses containing structural protein genes of insect-specific flaviviruses cannot replicate in vertebrate cells due to entry and post-translational restrictions.
Tangudu CS , Charles J , Nunez-Avellaneda D , Hargett AM , Brault AC , Blitvich BJ . Virology 2021 559 30-39 Long Pine Key virus (LPKV) and Lammi virus are insect-specific flaviviruses that phylogenetically affiliate with dual-host flaviviruses. The goal of this study was to provide insight into the genetic determinants that condition this host range restriction. Chimeras were initially created by replacing select regions of the Zika virus genome, including the premembrane and envelope protein (prM-E) genes, with the corresponding regions of the LPKV genome. Of the four chimeras produced, one (the prM-E swap) yielded virus that replicated in mosquito cells. Another chimeric virus with a mosquito replication-competent phenotype was created by inserting the prM-E genes of Lammi virus into a Zika virus genetic background. Vertebrate cells did not support the replication of either chimeric virus although trace to modest amounts of viral antigen were produced, consistent with suboptimal viral entry. These data suggest that dual-host affiliated insect-specific flaviviruses cannot replicate in vertebrate cells due to entry and post-translational restrictions. |
Evolution of the complex transcription network controlling biofilm formation in Candida species
Mancera E , Nocedal I , Hammel S , Gulati M , Mitchell KF , Andes DR , Nobile CJ , Butler G , Johnson AD . Elife 2021 10 We examine how a complex transcription network composed of seven 'master' regulators and hundreds of target genes evolved over a span of approximately 70 million years. The network controls biofilm formation in several Candida species, a group of fungi that are present in humans both as constituents of the microbiota and as opportunistic pathogens. Using a variety of approaches, we observed two major types of changes that have occurred in the biofilm network since the four extant species we examined last shared a common ancestor. Master regulator 'substitutions' occurred over relatively long evolutionary times, resulting in different species having overlapping, but different sets of master regulators of biofilm formation. Second, massive changes in the connections between the master regulators and their target genes occurred over much shorter timescales. We believe this analysis is the first detailed, empirical description of how a complex transcription network has evolved. |
Use of Real-Time PCR for Chlamydia psittaci Detection in Human Specimens During an Outbreak of Psittacosis - Georgia and Virginia, 2018.
McGovern OL , Kobayashi M , Shaw KA , Szablewski C , Gabel J , Holsinger C , Drenzek C , Brennan S , Milucky J , Farrar JL , Wolff BJ , Benitez AJ , Thurman KA , Diaz MH , Winchell JM , Schrag S . MMWR Morb Mortal Wkly Rep 2021 70 (14) 505-509 Psittacosis is typically a mild febrile respiratory illness caused by infection with the bacterium Chlamydia psittaci and usually transmitted to humans by infected birds (1). On average, 11 psittacosis cases per year were reported in the United States during 2000-2017. During August-October 2018, the largest U.S. psittacosis outbreak in 30 years (82 cases identified*) occurred in two poultry slaughter plants, one each in Virginia and Georgia, that shared source farms (2). CDC used C. psittaci real-time polymerase chain reaction (PCR) to test 54 human specimens from this outbreak. This was the largest number of human specimens from a single outbreak ever tested for C. psittaci using real-time PCR, which is faster and more sensitive than commercially available serologic tests. This represented a rare opportunity to assess the utility of multiple specimen types for real-time PCR detection of C. psittaci. C. psittaci was detected more frequently in lower respiratory specimens (59% [10 of 17]) and stool (four of five) than in upper respiratory specimens (7% [two of 28]). Among six patients with sputum and nasopharyngeal swabs tested, C. psittaci was detected only in sputum in five patients. Cycle threshold (Ct) values suggested bacterial load was higher in lower respiratory specimens than in nasopharyngeal swabs. These findings support prioritizing lower respiratory specimens for real-time PCR detection of C. psittaci. Stool specimens might also have utility for diagnosis of psittacosis. |
Difficulties in Differentiating Coronaviruses from Subcellular Structures in Human Tissues by Electron Microscopy.
Bullock HA , Goldsmith CS , Zaki SR , Martines RB , Miller SE . Emerg Infect Dis 2021 27 (4) 1023-1031 Efforts to combat the coronavirus disease (COVID-19) pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) have placed a renewed focus on the use of transmission electron microscopy for identifying coronavirus in tissues. In attempts to attribute pathology of COVID-19 patients directly to tissue damage caused by SARS-CoV-2, investigators have inaccurately reported subcellular structures, including coated vesicles, multivesicular bodies, and vesiculating rough endoplasmic reticulum, as coronavirus particles. We describe morphologic features of coronavirus that distinguish it from subcellular structures, including particle size range (60-140 nm), intracellular particle location within membrane-bound vacuoles, and a nucleocapsid appearing in cross section as dense dots (6-12 nm) within the particles. In addition, although the characteristic spikes of coronaviruses may be visible on the virus surface, especially on extracellular particles, they are less evident in thin sections than in negative stain preparations. |
Use of a human indirect immunoflorescence antibody assay for Balamuthia mandrillaris in a group of captive northwest Bornean orangutans (Pongo pygmaeus pygmaeus)
Ferris RL , Ali IK , West G . J Zoo Wildl Med 2021 52 (1) 310-314 Granulomatous amoebic encephalitis caused by the free-living amoeba Balamuthia mandrillaris is a highly fatal disease that was first isolated from a mandrill (Mandrillus sphinx), and has since been diagnosed in several nonhuman primates including orangutans. Indirect immunofluorescence antibody (IFA) techniques for Balamuthia have been used in the fields of human medicine and epidemiology both for exposure assessment and screening of clinical patients for antemortem diagnosis. Stored serum samples from five captive Northwest Bornean orangutans (Pongo pygmaeus pygmaeus), including one who had died from B. mandrillaris infection, housed at a single facility were screened with a human IFA assay for B. mandrillaris. Only the single, clinically affected individual was seropositive, and the results suggest that the use of the available human B. mandrillaris IFA assay is a novel diagnostic option for detection of Balamuthia antibodies in this species. A validated screening serological test could be used in individuals exhibiting signs consistent with granulomatous amoebic encephalitis to facilitate earlier antemortem diagnosis of Balamuthia infection, which is critical if treatment is to be pursued. This pilot study presents the use of serological detection methods for B. mandrillaris screening in a nonhuman primate. Subsequent use of the B. mandrillaris IFA assay in the larger captive population should be pursued for validation of the test and to provide further information on seroprevalence and evaluation of risk factors for exposure to Balamuthia and subsequent development of disease. |
Malignant pleural mesothelioma interactome with 364 novel proteinprotein interactions
Karunakaran KB , Yanamala N , Boyce G , Becich MJ , Ganapathiraju MK . Cancers (Basel) 2021 13 (7) Malignant pleural mesothelioma (MPM) is an aggressive cancer affecting the outer lining of the lung, with a median survival of less than one year. We constructed an ‘MPM interactome’ with over 300 computationally predicted protein‐protein interactions (PPIs) and over 2400 known PPIs of 62 literature‐curated genes whose activity affects MPM. Known PPIs of the 62 MPM associated genes were derived from Biological General Repository for Interaction Datasets (BioGRID) and Human Protein Reference Database (HPRD). Novel PPIs were predicted by applying the HiPPIP algorithm, which computes features of protein pairs such as cellular localization, molecular func-tion, biological process membership, genomic location of the gene, and gene expression in microar-ray experiments, and classifies the pairwise features as interacting or non‐interacting based on a random forest model. We validated five novel predicted PPIs experimentally. The interactome is significantly enriched with genes differentially ex‐pressed in MPM tumors compared with normal pleura and with other thoracic tumors, genes whose high expression has been correlated with un-favorable prognosis in lung cancer, genes differentially expressed on crocidolite exposure, and ex-osome‐derived proteins identified from malignant mesothelioma cell lines. 28 of the interactors of MPM proteins are targets of 147 U.S. Food and Drug Administration (FDA)‐approved drugs. By comparing disease‐associated versus drug‐induced differential expression profiles, we identified five potentially repurposable drugs, namely cabazitaxel, primaquine, pyrimethamine, trime-thoprim and gliclazide. Preclinical studies may be con‐ducted in vitro to validate these computa-tional results. Interactome analysis of disease‐associated genes is a powerful approach with high translational impact. It shows how MPM‐associated genes identified by various high throughput studies are functionally linked, leading to clinically translatable results such as repurposed drugs. The PPIs are made available on a webserver with interactive user interface, visualization and advanced search capabilities. |
Standardizing clinical culture specimen collection in Ethiopia: a training-of-trainers
Kue J , Bersani A , Stevenson K , Yimer G , Wang SH , Gebreyes W , Hazim C , Westercamp M , Omondi M , Amare B , Alebachew G , Abubeker R , Fentaw S , Tigabu E , Kirley D , Vanderende D , Bancroft E , Gallagher KM , Kanter T , Balada-Llasat JM . BMC Med Educ 2021 21 (1) 195 BACKGROUND: Proper specimen collection is central to improving patient care by ensuring optimal yield of diagnostic tests, guiding appropriate management, and targeting treatment. The purpose of this article is to describe the development and implementation of a training-of-trainers educational program designed to improve clinical culture specimen collection among healthcare personnel (HCP) in Ethiopia. METHODS: A Clinical Specimen Collection training package was created consisting of a Trainer's Manual, Reference Manual, Assessment Tools, Step-by-Step Instruction Guides (i.e., job aides), and Core Module PowerPoint Slides. RESULTS: A two-day course was used in training 16 master trainers and 47 facility-based trainers responsible for cascading trainings on clinical specimen collection to HCP at the pre-service, in-service, or national-levels. The Clinical Specimen Collection Package is offered online via The Ohio State University's CANVAS online platform. CONCLUSIONS: The training-of-trainers approach may be an effective model for development of enhanced specimen collection practices in low-resource countries. |
Editorial: Immune Mechanisms in the Pathologic Response to Particles, Fibers, and Nanomaterials
Ma Q , Pollard KM , Brown JM , Italiani P , Moghimi SM . Front Immunol 2021 12 665810 It may come as a surprise that a Research Topic in Frontiers in Immunology is devoted to “Immune mechanisms” in the pathologic response to “particles, fibers, and nanomaterials,” a large group of natural and man-made particulates with dimensions in micro and nano ranges. Unlike pathogens, many particulate materials do not possess apparent antigenic structures and are assumed to be non-immunogenic. But because of their small size and airborne propensity, inhaled particulates can penetrate deep into the lung and pleura to cause inflammation, fibrosis, and cancer, exemplified by silicosis, asbestosis, and mesothelioma that are progressive and have high mortality rates (1, 2). Notwithstanding, the role of immune responses in the pathogenesis of particulate-induced diseases has gained increasing attention. A plethora of studies have shown that particulates activate various immune cells to promote physiological responses to particulate deposition and, under pathological conditions, development of fibrosis, malignancy, and autoimmunity (3, 4). The past two decades have also witnessed rapid advancement of nanotechnology and commercialization of nanomaterials, raising concerns on their possible adverse immune effects in exposed individuals (5–7). Understanding the interactions between particulates and immune functions has emerged as a new frontier for researchers in immunology, toxicology, and nanoscience. This Research Topic discusses recent trends in particle immunotoxicology with focus on pathologic immune effects of particulates and mechanisms mediating particle-immune interactions. |
Evaluation of natural killer cell assay performance on shipped blood specimens
Querec TD , Abrams J , Stewart JJ , Barnes Z , Balbin E , Klimas N , Fletcher MA , Brown L , Bertolli J , Unger ER . J Immunol Methods 2021 495 113049 Documenting the importance of NK cell function as a biomarker for diseases and physiologic conditions including myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), will require assays amenable to clinical implementation and standardization. Research studies typically perform NK functional assays on the day of sample collection. This pilot study was conducted to compare assay formats and specimen processing to identify those that are most tolerant of conditions required for shipping and amenable to standardization as shown by inter-assay and inter-laboratory correlation of results. We compared performance within and between assays that measure NK cell function using direct cytotoxicity [chromium-51 release (CRCA) or fluorescence (Flow Cytometry Cytotoxicity Assay, FCCA)] or an indirect surrogate marker (CD107a surface expression)]. Additional variables for within/between assay comparisons included time of testing (same day as specimen collection or next day within 24 h), specimen types [whole blood or isolated peripheral blood mononuclear cells (PBMCs)], and processing method (fresh or cryopreserved). Statistical measures included number of samples tested in assay conditions (n), medians (x͂), interquartile range (IQR), Pearson correlation coefficient (R(2)), and correlation p-value (p). Samples came from 3 clinics and included 31 participants. Same day testing was only available for the subset of participants enrolled from the site of the laboratory performing CRCA. Results from same day CRCA testing of whole blood were considered the gold standard [n = 10, x͂=10.0%, IQR = 7.2%], and correlated well with PBMCs isolated next day [n = 26, x͂= 15.6%, IQR = 13.1%] [R(2) = 0.59, p = 0.03]. Next day CRCA results were compromised using whole blood or frozen PBMCs. Next day FCCA cytotoxicity in PBMC [n = 30, x͂=34.1%, IQR = 15.5%] correlated with same day CRCA PMBC [R(2) = 0.8, p = 0.001] and next day CRCA PMBC [R(2) = 0.5, p < 0.0001]. CD107a expression after induction by PMA and ionomycin did not correlate with other cytotoxicity measures. NK function can be measured in PBMCs isolated after overnight shipping/storage at ambient temperature and CRCA and FCCA results on this sample type are well correlated. |
Evaluation of classification methods for identifying multiwalled carbon nanotubes collected on mixed cellulose ester filter media
Smith D , Neu-Baker NM , Eastlake AC , Zurbenko IG , Brenner SA . J Microsc 2021 283 (2) 102-116 Enhanced darkfield microscopy (EDFM) and hyperspectral imaging (HSI) are being evaluated as a potential rapid screening modality to reduce the time-to-knowledge for direct visualization and analysis of filter media used to sample nanoparticulate from work environments, as compared to the current analytical gold standard of transmission electron microscopy (TEM). Here, we compare accuracy, specificity, and sensitivity of several hyperspectral classification models and data pre-processing techniques to determine how to most effectively identify multi-walled carbon nanotubes (MWCNTs) in hyperspectral images. Several classification schemes were identified that are capable of classifying pixels as MWCNT(+) or MWCNT(-) in hyperspectral images with specificity and sensitivity over 99% on the test dataset. Functional principal component analysis (FPCA) was identified as an appropriate data pre-processing technique, testing optimally when coupled with a quadratic discriminant analysis (QDA) model with forward stepwise variable selection and with a support vector machines (SVM) model. The success of these methods suggests that EDFM-HSI may be reliably employed to assess filter media exposed to MWCNTs. Future work will evaluate the ability of EDFM-HSI to quantify MWCNTs collected on filter media using this classification algorithm framework using the best-performing model identified here - quadratic discriminant analysis with forward stepwise selection on functional principal component data - on an expanded sample set. This article is protected by copyright. All rights reserved. |
Multi-walled carbon nanotubes elicit concordant changes in DNA methylation and gene expression following long-term pulmonary exposure in mice
Scala G , Delaval MN , Mukherjee SP , Federico A , Khaliullin TO , Yanamala N , Fatkhutdinova LM , Kisin ER , Greco D , Fadeel B , Shvedova AA . Carbon N Y 2021 178 563-572 Pulmonary exposure to multi-walled carbon nanotubes (MWCNTs) causes inflammation and fibrosis. Our previous work has shown that industrially produced MWCNTs trigger specific changes in gene expression in the lungs of exposed animals. To elucidate whether epigenetic effects play a role for these gene expression changes, we performed whole genome bisulphite sequencing to assess DNA methylation patterns in the lungs 56 days after exposure to MWCNTs. Lung tissues were also evaluated with respect to histopathological changes and cytokine profiling of bronchoalveolar lavage (BAL) fluid was conducted using a multi-plex array. Integrated analysis of transcriptomics data and DNA methylation data revealed concordant changes in gene expression. Functional analysis showed that the muscle contraction, immune system/inflammation, and extracellular matrix pathways were the most affected pathways. Taken together, the present study revealed that MWCNTs exert epigenetic effects in the lungs of exposed animals, potentially driving the subsequent gene expression changes. © 2021 The Authors |
Aerosol agitation: Quantifying the hydrodynamic stressors on particulates encapsulated in small droplets
McRae O , Mead KR , Bird JC . Phys Rev Fluids 2021 6 (3) Lower respiratory tract infections originate from multiple aerosol sources, varying from droplets erupting from bursting bubbles in a toilet or those produced by human speech. A key component of the aerosol-based infection pathway-from source to potential host-is the survival of the pathogen during aerosolization. Due to their finite-time instability, pinch-off processes occurring during aerosolization have the potential to rapidly accelerate the fluid into focused regions of these droplets, stress objects therein, and if powerful enough, disrupt biological life. However, the extent that a pathogen will be exposed to damaging hydrodynamic stressors during the aerosolization process is unknown. Here we compute the probability that particulates will be exposed to a hydrodynamic stressor during the generation of droplets that range in size from one to 100 microns. For example, particulates in water droplets less than 5 μm have a 50% chance of being subjected to an energy dissipation rate in excess of 1011 W/m3, hydrodynamic stresses in excess of 104 Pa, and strain rates in excess of 107 s-1, values known to damage certain biological cells. Using a combination of numerical simulations and self-similar dynamics, we show how the exposure within a droplet can be generally predicted from its size, surface tension, and density, even across different aerosolization mechanisms. Collectively, these results introduce aerosol agitation as a potential factor in pathogen transmission and implicate the pinch-off singularity flow as setting the distribution of hydrodynamic stressors experienced within the droplet. © 2021 American Physical Society. |
Assessing Gas Leakage Potential into Coal Mines from Shale Gas Well Failures: Inference from Field Determination of Strata Permeability Responses to Longwall-Induced Deformations
Watkins E , Karacan CÖ , Gangrade V , Schatzel S . Nat Resour Res 2021 30 (3) 2347-2360 This paper summarizes the changes in permeability at three boreholes located above an abutment pillar at a longwall coal mine in southwestern Pennsylvania. The motivation of this study was to better characterize the potential interaction between shale gas wells and the mine environment, through measurement of permeability changes in the coal mine overburden caused by mining-induced deformations. Measuring permeability changes around boreholes affected by longwall mining is an effective method to indicate changes in the fracture network above longwall abutment pillars and estimate the capacity for gas flow from shale gas wells to the mine environment. This study measured permeability through falling-head slug tests at different longwall face positions during the mining of two longwall panels on either side of the test abutment pillar where the test boreholes were located. Three test boreholes were drilled to different depths above the active mining level, and they had screened intervals to evaluate the response of different stratigraphic zones to mining-induced stresses. The results showed that the permeability around the slotted intervals of each borehole increased pre-mining to post-mining, and the permeability increased from mining of the first longwall panel to mining of the second one, adjacent to the pillar. © 2021, This is a U.S. government work and not under copyright protection in the U.S.; foreign copyright protection may apply. |
Differential DNA Methylation by Hispanic Ethnicity Among Firefighters in the United States.
Goodrich JM , Furlong MA , Caban-Martinez AJ , Jung AM , Batai K , Jenkins T , Beitel S , Littau S , Gulotta J , Wallentine D , Hughes J , Popp C , Calkins MM , Burgess JL . Epigenet Insights 2021 14 25168657211006159 Firefighters are exposed to a variety of environmental hazards and are at increased risk for multiple cancers. There is evidence that risks differ by ethnicity, yet the biological or environmental differences underlying these differences are not known. DNA methylation is one type of epigenetic regulation that is altered in cancers. In this pilot study, we profiled DNA methylation with the Infinium MethylationEPIC in blood leukocytes from 31 Hispanic white and 163 non-Hispanic white firefighters. We compared DNA methylation (1) at 12 xenobiotic metabolizing genes and (2) at all loci on the array (>740 000), adjusting for confounders. Five of the xenobiotic metabolizing genes were differentially methylated at a raw P-value <.05 when comparing the 2 ethnic groups, yet were not statistically significant at a 5% false discovery rate (q-value <.05). In the epigenome-wide analysis, 76 loci exhibited DNA methylation differences at q <.05. Among these, 3 CpG sites in the promoter region of the biotransformation gene SULT1C2 had lower methylation in Hispanic compared to non-Hispanic firefighters. Other differentially methylated loci included genes that have been implicated in carcinogenesis in published studies (FOXK2, GYLTL1B, ZBTB16, ARHGEF10, and more). In this pilot study, we report differential DNA methylation between Hispanic and non-Hispanic firefighters in xenobiotic metabolism genes and other genes with functions related to cancer. Epigenetic susceptibility by ethnicity merits further study as this may alter risk for cancers linked to toxic exposures. |
Probability of hyperthermia in a hot environment while wearing a liquid cooling garment underneath firefighters' protective clothing
Aljaroudi AM , Bhattacharya A , Yorio P , Strauch AL , Quinn TD , Williams WJ . J Occup Environ Hyg 2021 18 1-13 Firefighters' protective clothing (FPC) can limit human thermoregulation due to limited water vapor permeability and insulation. This study investigated the effect of cooling on the physiological responses and probability of hyperthermia in subjects wearing FPC during exercise in a hot environment. Twelve males participated in this study. A maximal graded treadmill exercise test was performed to measure maximal oxygen uptake (V̇O(2max)) and to assess subjects' capacity to perform the assigned exercise. Exercise included treadmill walking at 40% V̇O(2max) in warm (30 °C) and humid (70% RH) conditions for 40 min while wearing FPC. Subjects participated in two randomly counterbalanced assigned experimental protocols: control (no cooling) and intervention (cooling). The experimental intervention consisted of a cooling garment infused with cooled water (18 °C) through silastic tubing sewn into the fabric and worn underneath FPC. Each subject served as their own control and, therefore, completed both the control and intervention of the protocol. A logistic regression model was used to analyze the interaction effect of cooling on the probability of progression to hyperthermia (T(c) ≥ 38 °C). Subjects' physiological responses increased during exercise in a warm and humid environment. Active cooling decreased (p < 0.05) the thermal stress thereby reducing the probability of hyperthermia while exercising in hot and humid conditions. The results indicate that when cooling was used each subject, on average, was 91% less likely to reach the lower threshold limit of hyperthermia. Exercise in hot environments while wearing FPC results in significant physiological strain, which may lead to hyperthermia. Utilization of a cooling garment reduced physiological strain and the probability of hyperthermia. |
Nonparametric Binary Classification to Distinguish Closely Related versus Unrelated P. Falciparum Parasites.
Plucinski MM , Barratt JLN . Am J Trop Med Hyg 2021 104 (5) 1830-1835 Assessing genetic relatedness of Plasmodium falciparum genotypes is a key component of antimalarial efficacy trials. Previous methods have focused on determining a priori definitions of the level of genetic similarity sufficient to classify two infections as sharing the same strain. However, factors such as mixed-strain infections, allelic suppression, imprecise typing methods, and heterozygosity complicate comparisons of apicomplexan genotypes. Here, we introduce a novel method for nonparametric statistical testing of relatedness for P. falciparum parasites. First, the background distribution of genetic distance between unrelated strains is computed. Second, a threshold genetic distance is computed from this empiric distribution of distances to demarcate genetic distances that are unlikely to have arisen by chance. Third, the genetic distance between paired samples is computed, and paired samples with genetic distances below the threshold are classified as related. The method is designed to work with any arbitrary genetic distance definition. We validated this procedure using two independent approaches to calculating genetic distance. We assessed the concordance of the novel nonparametric classification with a gold-standard Bayesian approach for 175 pairs of recurrent P. falciparum episodes from previously published malaria efficacy trials with microsatellite data from five studies in Guinea and Angola. The novel nonparametric approach was 98% sensitive and 84-89% specific in correctly identifying related genotypes compared with a gold-standard Bayesian algorithm. The approach provides a unified and systematic method to statistically assess relatedness of P. falciparum parasites using arbitrary genetic distance methodologies. |
Detection of malaria parasites in samples from returning US travelers using the Alethia® Malaria Plus LAMP assay.
Ljolje D , Abdallah R , Lucchi NW . BMC Res Notes 2021 14 (1) 128 OBJECTIVE: In this study, the performance of a commercially available malaria LAMP assay (Alethia® Malaria Plus LAMP) was evaluated using retrospective clinical samples obtained from travelers returning to the United States of America (USA). Recently, several laboratories in non-malaria endemic countries evaluated the use of the loop mediated isothermal amplification (LAMP) assays for the diagnosis of imported malaria cases. These tests are simpler than polymerase-chain reaction (PCR)-based assays and were shown to have high sensitivity. Much of malaria diagnoses in the USA, is undertaken at the state level using mainly microscopy and rapid diagnostic tests (RDTs). However, molecular tools offer greater sensitivity over microscopy and RDTs. A reliable, easy to perform molecular assay can provide a test of choice for the accurate detection of malaria parasites in places where expert microscopy is lacking and/or for the detection of low-parasite density infections. RESULTS: The Alethia® Malaria Plus LAMP assay was easy to use, had similar test performances as the real-time PCR reference test and results were obtained faster (within 1 h) than the reference test. The sensitivity of the assay was 100% with a kappa score of 1 when compared to the reference PET-PCR assay. |
Immunofocusing humoral immunity potentiates the functional efficacy of the AnAPN1 malaria transmission-blocking vaccine antigen
Bender NG , Khare P , Martinez J , Tweedell RE , Nyasembe VO , López-Gutiérrez B , Tripathi A , Miller D , Hamerly T , Vela EM , Davis RR , Howard RF , Nsango S , Cobb RR , Harbers M , Dinglasan RR . NPJ Vaccines 2021 6 (1) 49 Malaria transmission-blocking vaccines (TBVs) prevent the completion of the developmental lifecycle of malarial parasites within the mosquito vector, effectively blocking subsequent infections. The mosquito midgut protein Anopheline alanyl aminopeptidase N (AnAPN1) is the leading, mosquito-based TBV antigen. Structure-function studies identified two Class II epitopes that can induce potent transmission-blocking (T-B) antibodies, informing the design of the next-generation AnAPN1. Here, we functionally screened new immunogens and down-selected to the UF6b construct that has two glycine-linked copies of the T-B epitopes. We then established a process for manufacturing UF6b and evaluated in outbred female CD1 mice the immunogenicity of the preclinical product with the human-safe adjuvant Glucopyranosyl Lipid Adjuvant in a liposomal formulation with saponin QS21 (GLA-LSQ). UF6b:GLA-LSQ effectively immunofocused the humoral response to one of the key T-B epitopes resulting in potent T-B activity, underscoring UF6b as a prime TBV candidate to aid in malaria elimination and eradication efforts. |
Prevalence of Malaria Parasite Infections among U.S.-Bound Congolese Refugees with and without Splenomegaly
Mwesigwa M , Webster JL , Nsobya SL , Rowan A , Basnet MS , Phares CR , Weinberg M , Klosovsky A , Naoum M , Rosenthal PJ , Stauffer W . Am J Trop Med Hyg 2021 104 (3) 996-9 All U.S.-bound refugees from sub-Saharan Africa receive presumptive antimalarial treatment before departing for the United States. Among U.S.-bound Congolese refugees, breakthrough malaria cases and persistent splenomegaly have been reported. In response, an enhanced malaria diagnostic program was instituted. Here, we report the prevalence of plasmodial infection among 803 U.S.-bound Congolese refugees who received enhanced diagnostics. Infections by either rapid diagnostic test (RDT) or PCR were detected in 187 (23%) refugees, with 78 (10%) by RDT only, 35 (4%) by PCR only, and 74 (9%) by both. Infections identified by PCR included 103 monoinfections (87 Plasmodium falciparum, eight Plasmodium ovale, seven Plasmodium vivax, and one Plasmodium malariae) and six mixed infections. Splenomegaly was associated with malaria detectable by RDT (odds ratio: 1.8, 95% CI: 1.0-3.0), but not by PCR. Splenomegaly was not strongly associated with parasitemia, indicating that active malaria parasitemia is not necessary for splenomegaly. |
Rapid Screening for Non-falciparum Malaria in Elimination Settings Using Multiplex Antigen and Antibody Detection: Post Hoc Identification of Plasmodium malariae in an Infant in Haiti
van den Hoogen LL , Herman C , Présumé J , Romilus I , Mondélus G , Elismé T , Existe A , Boncy J , Joseph V , Stresman G , Tetteh KKA , Drakeley C , Chang MA , Lemoine JF , Eisele TP , Rogier E , Ashton RA . Am J Trop Med Hyg 2021 104 (6) 2139-2145 Haiti is targeting malaria elimination by 2025. The Grand'Anse department in southwestern Haiti experiences one-third to half of all nationally reported Plasmodium falciparum cases. Although there are historical reports of Plasmodium vivax and Plasmodium malariae, today, non-falciparum infections would remain undetected because of extensive use of falciparum-specific histidine-rich protein 2 (HRP2) rapid diagnostic tests (RDT) at health facilities. A recent case-control study was conducted in Grand'Anse to identify risk factors for P. falciparum infection using HRP2-based RDTs (n = 1,107). Post hoc multiplex Plasmodium antigenemia and antibody (IgG) detection by multiplex bead assay revealed one blood sample positive for pan-Plasmodium aldolase, negative for P. falciparum HRP2, and positive for IgG antibodies to P. malariae. Based on this finding, we selected 52 samples with possible P. malariae infection using IgG and antigenemia data and confirmed infection status by species-specific PCR. We confirmed one P. malariae infection in a 6-month-old infant without travel history. Congenital P. malariae could not be excluded. However, our finding-in combination with historical reports of P. malariae-warrants further investigation into the presence and possible extent of non-falciparum malaria in Haiti. Furthermore, we showed the use of multiplex Plasmodium antigen and IgG detection in selecting samples of interest for subsequent PCR analysis, thereby reducing costs as opposed to testing all available samples by PCR. This is of specific use in low-transmission or eliminating settings where infections are rare. |
Implementation of Community-Wide Initiatives Designed to Reduce Teen Pregnancy: Measuring Progress in a 5-Year Project in 10 Communities
House LD , Tevendale H , Brittain A , Burley K , Fuller TR , Mueller T , Romero L , Venugopalan B , Koumans EH . Sex Res Social Policy 2021 19 (2) 496-508 Introduction: Community-wide initiatives (CWI) to prevent teen pregnancy were implemented in 10 communities in the USA. The CWI supported the implementation of evidence-based teen pregnancy interventions (EBIs) and implementation of best practices for adolescent reproductive health care. Implementation was supported through mobilizing communities, educating stakeholders, and strategies to promote health equity. Methods: We assessed indicators of progress of the CWI for the following five project components (data collected from 2010 to 2015): community mobilization, stakeholder education, working with diverse communities, evidence-based interventions, and increasing access to clinical services and the potential contributions of training and technical assistance. Results: Communities engaged multiple stakeholder groups to contribute to planning, community outreach and education, and partnership development and used multiple dissemination methods to share information on adolescent reproductive health needs and teen pregnancy prevention strategies. The amount of training and technical assistance from state- and community-based organizations was associated with increased numbers of youth receiving EBIs and increased provision of contraceptives. The number of health centers implementing best practices for adolescent reproductive health services increased; conducting sexual health assessments, offering hormonal contraception or IUD, and offering quick start of IUDs were associated with increases in long-acting reversible contraception utilization. Conclusions: These findings demonstrate that scaled prevention efforts can occur with adequate support including training and technical assistance and community awareness and engagement in the process. Policy Implications: The findings raise important questions for understanding what factors contribute to successful community-wide implementation of EBIs and health center best practices for contraceptive access and whether these lead to reductions in teen pregnancies in highly impacted communities. © 2021, This is a U.S. government work and not under copyright protection in the U.S.; foreign copyright protection may apply. |
Urinary cotinine and cotinine + trans-3'-hydroxycotinine (TNE-2) cut-points for distinguishing tobacco use from non-use in the United States: PATH Study (2013-2014)
Edwards KC , Naz T , Stanton CA , Goniewicz ML , Hatsukami DK , Smith DM , Wang L , Villanti A , Pearson J , Blount BC , Bansal-Travers M , Feng J , Niaura R , Bover Manderski MT , Sosnoff CS , Delnevo CD , Duffy K , Del Valle-Pinero AY , Rostron BL , Everard C , Kimmel HL , van Bemmel DM , Hyland A . Cancer Epidemiol Biomarkers Prev 2021 30 (6) 1175-1184 BACKGROUND: Determine the overall, sex-, and racially/ethnically-appropriate population-level cotinine and total nicotine equivalents (TNE-2, the molar sum of the two major nicotine metabolites) cut-points to distinguish tobacco users from non-users across multiple definitions of use (e.g., exclusive vs. polytobacco, and daily vs. non-daily). METHODS: Using Wave 1 (2013-2014) of the U.S. Population Assessment of Tobacco and Health (PATH) Study, we conducted weighted Receiver Operating Curve (ROC) analysis to determine the optimal urinary cotinine and TNE-2 cut-points, stratified by sex and race/ethnicity. RESULTS: For past 30-day exclusive cigarette users, the cotinine cut-point that distinguished them from non-users was 40.5 ng/mL, with considerable variation by sex (male: 22.2 ng/mL; female: 43.1 ng/mL) and between racial/ethnic groups (non-Hispanic other: 5.2 ng/mL; non-Hispanic black: 297.0 ng/mL). A similar, but attenuated, pattern emerged when assessing polytobacco cigarette users (overall cut-point= 39.1 ng/mL, range= 5.5 ng/mL- 80.4 ng/mL) and any tobacco users (overall cut-point= 39.1 ng/mL, range= 4.8 ng/mL- 40.0 ng/mL). Using TNE-2, which is less impacted by racial differences in nicotine metabolism, produced a comparable pattern of results although reduced the range magnitude. CONCLUSIONS: Due to similar frequency of cigarette use among polytobacco users, overall cut-points for exclusive cigarette use were not substantially different from cut-points that included polytobacco cigarette use or any tobacco use. Results revealed important differences in sex and race/ethnicity appropriate cut-points when evaluating tobacco use status and established novel urinary TNE-2 cut-points. IMPACT: These cut-points may be used for biochemical verification of self-reported tobacco use in epidemiologic studies and clinical trials. |
An application of agent-based modeling to explore the impact of decreasing incarceration rates and increasing drug treatment access on sero-discordant partnerships among people who inject drugs
Linton SL , Jarlais DCD , Ornstein JT , Kasman M , Hammond R , Kianian B , Smith JC , Wolfe ME , Ross Z , German D , Flynn C , Raymond HF , Klevens RM , Spencer E , Schacht JM , Finlayson T , Paz-Bailey G , Wejnert C , Cooper HLF . Int J Drug Policy 2021 94 103194 BACKGROUND: People who inject drugs (PWID) lag behind other key populations in HIV care continuum outcomes. The impacts of criminal justice reform and increasing drug treatment access on HIV have been underexplored. METHODS: We developed agent-based models (ABM) of sexual partnerships among PWID and non-PWID, and injection equipment-sharing partnerships among PWID in five US cities (Baltimore, Boston, Miami, New York City, San Francisco) over 3 years. The first set of ABM projected changes in partnership discordance among PWID as a function of decreasing ZIP code-level incarceration rates. The second set projected discordance as a function of increasing ZIP code-level drug treatment access. ABM were parameterized and validated overall, and by city and PWID race/ethnicity (Black, Latino, White) using National HIV Behavioral Surveillance data, administrative ZIP code-level data, surveillance reports and prior literature. Informed by research on prisoner release and community-level HIV prevalence, reductions in incarceration rates were fixed at 5% and 30% and respectively projected to increase ZIP code-level HIV prevalence by 2% and 12%. Increases in drug treatment access were fixed at 30% and 58%. RESULTS: In each city, a 30% reduction in ZIP code-level incarceration rates and 12% increase in ZIP code-level HIV prevalence significantly increased sero-discordance among at least one racial/ethnic group of PWID by 1-3 percentage points. A 5% reduction in incarceration rates, and 30% and 58% increases in drug treatment access, led to isolated significant changes in sero-discordance among Black and White PWID that were less than 1 percentage point. CONCLUSION: Reductions in incarceration rates may lead to short-term increases in sero-discordant partnerships among some PWID by increasing community-level HIV prevalence. Efforts to increase HIV testing, engagement in care and community reintegration post release, should be strengthened in the wake of incarceration reform. Additional research should confirm these findings and explore the lack of widespread impacts of drug treatment in this study. |
State-led opioid overdose prevention efforts: Challenges, solutions and lessons learned from the CDC Prevention for States Program (PfS)
Underwood N , Rooks-Peck C , Ali N , Wisdom A , Costa O , Robinson A , Mells J , Bacon S . Subst Abus 2021 42 (2) 1-22 Background: The Centers for Disease Control and Prevention's Prevention for States (PfS) program funded 29 state health departments to prevent opioid overdose by implementing evidence-based prevention strategies. The objectives of this analysis were to describe the scope of activities implemented across the four PfS strategies and identify implementation challenges. Methods: PfS recipients submitted annual progress reports (APRs) to state support staff at CDC from 2015 to 2017. APR data were used to calculate the number of required and optional activities implemented under each PfS strategy. APR data were qualitatively analyzed using a systematic content analysis approach to identify key implementation challenges. Results: From 2015 to 2017, PfS recipients implemented 177 activities across four strategies from 2015 to 2017. Cross-cutting implementation challenges were (1) multi-sector collaboration, (2) lack of knowledge and misperceptions about opioid used disorder (OUD) among some partners and local communities and; (3) management and access to opioid data among PfS recipients. Conclusions: PfS recipients implemented an array of prevention interventions to address the opioid overdose crisis and encountered several cross-cutting implementation challenges. Challenges and state driven solutions over the course of implementing PfS led to several lessons learned and actions that CDC enacted to continue to support and expand overdose prevention. |
Provisional Mortality Data - United States, 2020.
Ahmad FB , Cisewski JA , Miniño A , Anderson RN . MMWR Morb Mortal Wkly Rep 2021 70 (14) 519-522 CDC's National Vital Statistics System (NVSS) collects and reports annual mortality statistics using data from U.S. death certificates. Because of the time needed to investigate certain causes of death and to process and review data, final annual mortality data for a given year are typically released 11 months after the end of the calendar year. Daily totals reported by CDC COVID-19 case surveillance are timely but can underestimate numbers of deaths because of incomplete or delayed reporting. As a result of improvements in timeliness and the pressing need for updated, quality data during the global COVID-19 pandemic, NVSS expanded provisional data releases to produce near real-time U.S. mortality data.* This report presents an overview of provisional U.S. mortality data for 2020, including the first ranking of leading causes of death. In 2020, approximately 3,358,814 deaths(†) occurred in the United States. From 2019 to 2020, the estimated age-adjusted death rate increased by 15.9%, from 715.2 to 828.7 deaths per 100,000 population. COVID-19 was reported as the underlying cause of death or a contributing cause of death for an estimated 377,883 (11.3%) of those deaths (91.5 deaths per 100,000). The highest age-adjusted death rates by age, race/ethnicity, and sex occurred among adults aged ≥85 years, non-Hispanic Black or African American (Black) and non-Hispanic American Indian or Alaska Native (AI/AN) persons, and males. COVID-19 death rates were highest among adults aged ≥85 years, AI/AN and Hispanic persons, and males. COVID-19 was the third leading cause of death in 2020, after heart disease and cancer. Provisional death estimates provide an early indication of shifts in mortality trends and can guide public health policies and interventions aimed at reducing numbers of deaths that are directly or indirectly associated with the COVID-19 pandemic. |
Limited Genetic Diversity Detected in Middle East Respiratory Syndrome-Related Coronavirus Variants Circulating in Dromedary Camels in Jordan.
Seifert SN , Schulz JE , Ricklefs S , Letko M , Yabba E , Hijazeen ZS , Holloway P , Al-Omari B , Talafha HA , Tibbo M , Adney DR , Guitian J , Amarin N , Richt JA , McDowell C , Steel J , Abu-Basha EA , Al-Majali AM , van Doremalen N , Munster VJ . Viruses 2021 13 (4) Middle East respiratory syndrome-related coronavirus (MERS-CoV) is a persistent zoonotic pathogen with frequent spillover from dromedary camels to humans in the Arabian Peninsula, resulting in limited outbreaks of MERS with a high case-fatality rate. Full genome sequence data from camel-derived MERS-CoV variants show diverse lineages circulating in domestic camels with frequent recombination. More than 90% of the available full MERS-CoV genome sequences derived from camels are from just two countries, the Kingdom of Saudi Arabia (KSA) and United Arab Emirates (UAE). In this study, we employ a novel method to amplify and sequence the partial MERS-CoV genome with high sensitivity from nasal swabs of infected camels. We recovered more than 99% of the MERS-CoV genome from field-collected samples with greater than 500 TCID(50) equivalent per nasal swab from camel herds sampled in Jordan in May 2016. Our subsequent analyses of 14 camel-derived MERS-CoV genomes show a striking lack of genetic diversity circulating in Jordan camels relative to MERS-CoV genome sequences derived from large camel markets in KSA and UAE. The low genetic diversity detected in Jordan camels during our study is consistent with a lack of endemic circulation in these camel herds and reflective of data from MERS outbreaks in humans dominated by nosocomial transmission following a single introduction as reported during the 2015 MERS outbreak in South Korea. Our data suggest transmission of MERS-CoV among two camel herds in Jordan in 2016 following a single introduction event. |
Animal Reservoirs and Hosts for Emerging Alphacoronaviruses and Betacoronaviruses.
Ghai RR , Carpenter A , Liew AY , Martin KB , Herring MK , Gerber SI , Hall AJ , Sleeman JM , VonDobschuetz S , Behravesh CB . Emerg Infect Dis 2021 27 (4) 1015-1022 The ongoing global pandemic caused by coronavirus disease has once again demonstrated the role of the family Coronaviridae in causing human disease outbreaks. Because severe acute respiratory syndrome coronavirus 2 was first detected in December 2019, information on its tropism, host range, and clinical manifestations in animals is limited. Given the limited information, data from other coronaviruses might be useful for informing scientific inquiry, risk assessment, and decision-making. We reviewed endemic and emerging infections of alphacoronaviruses and betacoronaviruses in wildlife, livestock, and companion animals and provide information on the receptor use, known hosts, and clinical signs associated with each host for 15 coronaviruses detected in humans and animals. This information can be used to guide implementation of a One Health approach that involves human health, animal health, environmental, and other relevant partners in developing strategies for preparedness, response, and control to current and future coronavirus disease threats. |
High Case-Fatality Rate for Human Anthrax, Northern Ghana, 2005-2016
Blackburn JK , Kenu E , Asiedu-Bekoe F , Sarkodie B , Kracalik IT , Bower WA , Stoddard RA , Traxler RM . Emerg Infect Dis 2021 27 (4) 1216-1219 The human cutaneous anthrax case-fatality rate is ≈1% when treated, 5%-20% when untreated. We report high case-fatality rates (median 35.0%; 95% CI 21.1%-66.7%) during 2005-2016 linked to livestock handling in northern Ghana, where veterinary resources are limited. Livestock vaccination and access to human treatment should be evaluated. |
Risk estimation of sexual transmission of Zika virus-United States, 2016-2017
Major CG , Paz-Bailey G , Hills SL , Rodriguez DM , Biggerstaff BJ , Johansson M . J Infect Dis 2021 224 (10) 1756-1764 BACKGROUND: Zika virus (ZIKV) can be transmitted sexually, but the risk of sexual transmission remains unknown. Most evidence of sexual transmission is from partners of infected travelers returning from areas with ZIKV circulation. METHODS: We used data from the U.S. national arboviral disease surveillance system (ArboNET) on travel- and sexually-acquired ZIKV disease cases during 2016-2017 to develop individual-level simulations for estimating risk of male-to-female, male-to-male, and female-to-male sexual transmission of ZIKV via vaginal and/or anal intercourse. We specified parametric distributions to characterize individual-level variability of parameters for ZIKV persistence and sexual behaviors. RESULTS: Using ZIKV RNA persistence in semen/vaginal fluids to approximate infectiousness duration, male-to-male transmission had the highest estimated probability [1.3% (95% CI: 0.4-6.0) per anal sex act], followed by male-to-female and female-to-male transmission [0.4% (95% CI: 0.3-0.6) per vaginal/anal sex act and 0.1% (95% CI:0-0.8) per vaginal sex act, respectively]. Models using viral isolation in semen vs. RNA detection to approximate infectiousness duration predicted greater risk of sexual transmission. CONCLUSIONS: While likely insufficient to maintain sustained transmission, the estimated risk of ZIKV transmission through unprotected sex is not trivial and is especially important for pregnant women, as ZIKV infection can cause severe congenital disorders. |
Exposure of Domestic Cats to Three Zoonotic Bartonella Species in the United States
Osikowicz LM , Horiuchi K , Goodrich I , Breitschwerdt EB , Chomel B , Biggerstaff BJ , Kosoy M . Pathogens 2021 10 (3) Cat-associated Bartonella species, which include B. henselae, B. koehlerae, and B. clarridgeiae, can cause mild to severe illness in humans. In the present study, we evaluated 1362 serum samples obtained from domestic cats across the U.S. for seroreactivity against three species and two strain types of Bartonella associated with cats (B. henselae type 1, B. henselae type 2, B. koehlerae, and B. clarridgeiae) using an indirect immunofluorescent assay (IFA). Overall, the seroprevalence at the cutoff titer level of ≥1:64 was 23.1%. Seroreactivity was 11.1% and 3.7% at the titer level cutoff of ≥1:128 and at the cutoff of ≥1:256, respectively. The highest observation of seroreactivity occurred in the East South-Central, South Atlantic, West North-Central, and West South-Central regions. The lowest seroreactivity was detected in the East North-Central, Middle Atlantic, Mountain, New England, and Pacific regions. We observed reactivity against all four Bartonella spp. antigens in samples from eight out of the nine U.S. geographic regions. |
Negligible risk of rabies importation in dogs thirty days after demonstration of adequate serum antibody titer
Smith TG , Fooks AR , Moore SM , Freuling CM , Müller T , Torres G , Wallace RM . Vaccine 2021 39 (18) 2496-2499 Importation of one rabid dog from areas where rabies virus (RABV) is circulating into a country or zone that is declared free of rabies poses a threat of rabies re-introduction into the resident dog population (if “herd” immunity is insufficient) or congeneric species. To prevent rabies importation, the World Organisation for Animal Health (OIE) Terrestrial Code (8.14.7) currently recommends that rabies-vaccinated animals, individually identifiable and not showing any rabies clinical signs, have a minimum waiting period of three months between proof of adequate rabies serum antibody titer (≥ 0.5 IU/mL) and entry into a rabies free country. Alternatively, dogs may undergo a 6 month quarantine prior to import. The waiting period ensures that a dog with RABV neutralizing antibodies (rVNA) detected through OIE recommended methods is not incubating RABV, which can induce rVNA in late stages of disease. We propose reducing the waiting period to 30 days. |
Content Index (Achived Edition)
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- Injury and Violence
- Laboratory Sciences
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