Real-time analysis of the effects of toxic, therapeutic and sub-therapeutic concentrations of digitoxin on lung cancer cells
Eldawud R , Stueckle TA , Manivannan S , Elbaz H , Chen M , Rojanasakul Y , Dinu CZ . Biosens Bioelectron 2014 59c 192-199 Digitoxin belongs to a naturally occurring class of cardiac glycosides (CG); digitoxin is clinically approved for heart failure and known for its anti-cancer effects against non-small lung cancer cells (NSCLC). However, concerns associated with its narrow therapeutic index and its concentration-dependent mechanism of action are rising. Thus, before digitoxin implementation in designing and developing safer and more effective CG-based anti-cancer therapies, its pharmacological and safety profiles need to be fully elucidated. In this research we used a combinatorial approach to evaluate the anti-cancer mechanisms of digitoxin in real-time. Our approach employed a non-invasive electric cell impedance sensing technique as a proxy to monitor NSCLC behavior post-exposure to toxic, therapeutic and sub-therapeutic concentrations of the drug. By developing structure-function combinatorial relations we showed that digitoxin targets cancer cells in a time and dose-dependant manner by activating pro-apoptotic and anti-proliferative signaling cascades that results in strengthening cellular adhesion and sequestration of key regulatory proliferation protein from the nucleus. |
Trends in cardiovascular disease risk factors by obesity level in adults in the United States, NHANES 1999-2010
Saydah S , Bullard KM , Cheng Y , Ali MK , Gregg EW , Geiss L , Imperatore G . Obesity (Silver Spring) 2014 22 (8) 1888-95 OBJECTIVE: To assess whether trends in cardiovascular disease (CVD) risk factors by among overweight and obese US adults have improved. METHODS: The study included 10,568 adults 18 years and older who participated in National Health and Nutrition Examination Survey 1999-2010. CVD risk factors included diabetes (self-reported diagnosis, glycated hemoglobin ≥6.5%, or fasting plasma glucose ≥126mg/dl), hypertension (treatment or blood pressure ≥140/90 mmHg), dyslipidemia (treatment or non-HDL cholesterol ≥160 mg/dl), and smoking (self-report or cotinine levels ≥10 ng/ml). The prevalence and temporal trends of CVD risk factors for each BMI group were estimated. RESULTS: In 2007-2010, the prevalence of diabetes, hypertension, and dyslipidemia was highest among obese (18.5%, 35.7%, 49.7%, respectively) followed by overweight (8.2%, 26.4%, 44.2%, respectively) and normal weight adults (5.4%, 19.8%, 28.6%, respectively). Smoking exposure was highest among normal weight (29.8%) followed by overweight (24.8%) and obese adults (24.6%). From 1999-2002 to 2007-2010, untreated hypertension decreased among obese and overweight adults and untreated dyslipidemia decreased for all weight groups. There were no significant temporal changes in smoking across BMI groups. CONCLUSIONS: Despite decreases in untreated risk factors, it is important to improve the CVD risk profile of overweight and obese US adults. |
Multiple chronic conditions among US adults: a 2012 update
Ward BW , Schiller JS , Goodman RA . Prev Chronic Dis 2014 11 E62 The objective of this research was to update earlier estimates of prevalence rates of single chronic conditions and multiple (>2) chronic conditions (MCC) among the noninstitutionalized, civilian US adult population. Data from the 2012 National Health Interview Survey (NHIS) were used to generate estimates of MCC for US adults and by select demographic characteristics. Approximately half (117 million) of US adults have at least one of the 10 chronic conditions examined (ie, hypertension, coronary heart disease, stroke, diabetes, cancer, arthritis, hepatitis, weak or failing kidneys, current asthma, or chronic obstructive pulmonary disease [COPD]). Furthermore, 1 in 4 adults has MCC. |
Having their say: patients' perspectives and the clinical management of diabetes
Jack L Jr , Liburd LC , Tucker P , Cockrell T . Clin Ther 2014 36 (4) 469-76 Using an illness narratives framework, we provide 1 method that health care providers can use to obtain insight into the perceptions and experiences of their patients living with diabetes. We propose that understanding patients' cultural perspectives help explains their health behavior and can lead to more productive partnering between provider, patient, and community health resources that support adherence and improved health outcomes. We conclude with resources available to assist health care providers in their efforts to deliver culturally appropriate diabetes care and examples of culturally tailored community-based public health initiatives that have been effective in improving diabetes outcomes among African-American patients. |
Indicators of asthma control among students in a rural, school-based asthma management program
Rasberry CN , Cheung K , Buckley R , Dunville R , Daniels B , Cook D , Robin L , Dean B . J Asthma 2014 51 (8) 876-85 OBJECTIVE: The evaluation sought to determine if a comprehensive, school-based asthma management program in a small, rural school district helped students improve asthma control. METHODS: To determine if students in the asthma program demonstrated better asthma control than students in a comparison school district, the evaluation team used a quasi-experimental, cross-sectional design and administered questionnaires assessing asthma control (which included FEV1 measurement) to 456 students with asthma in the intervention and comparison districts. Data were analyzed for differences in asthma control between students in the two districts. To determine if students in the intervention experienced increased asthma control between baseline and follow-up, the evaluation team used a one-group retrospective design. Program records for 323 students were analyzed for differences in percent of predicted forced expiratory volume in one second (FEV1) between baseline and follow-up. RESULTS: Students with asthma in the intervention district exhibited significantly better asthma control than students with asthma in the comparison district. Percent of predicted FEV1 did not change significantly between baseline and follow-up for the intervention participants; however, post hoc analyses revealed students with poorly-controlled asthma at baseline had significantly higher FEV1 scores at follow-up, and students with well-controlled asthma at baseline had significantly lower FEV1 scores at follow-up. CONCLUSIONS: Findings suggest the comprehensive school-based program led to improvements in asthma control for students with poorly controlled asthma at baseline, and school-based programs need mechanisms for tracking students with initially well-controlled asthma in order to ensure they maintain control. |
Awareness of kidney disease among US adults: findings from the 2011 Behavioral Risk Factor Surveillance System
Li C , Wen XJ , Pavkov ME , Zhao G , Balluz LS , Ford ES , Williams D , Gotway CA . Am J Nephrol 2014 39 (4) 306-313 BACKGROUND: The prevalence of chronic kidney disease as measured by biomarkers is increasing, but the recognition for this condition remains low in the USA. Little is known about the awareness of kidney disease at the state level. METHODS: Data from 490,302 adults aged 18 years or older in all 50 states as well as the District of Columbia who participated in the 2011 Behavioral Risk Factor Surveillance System were analyzed. Kidney disease diagnosis, a measure of individual awareness, was ascertained by participants' self-report in the telephone survey. Prevalence ratios of self-reported kidney disease in subpopulations were estimated and tested using log-linear regression analyses with a robust variance estimator. RESULTS: The unadjusted prevalence of self-reported kidney disease was estimated to be 2.5%. After adjustment for age and all other selected covariates, Hispanics had a higher prevalence than non-Hispanic whites (adjusted prevalence ratio 1.2, 95% CI 1.0-1.4). Persons who were unemployed (adjusted prevalence ratio 1.4, 95% CI 1.2-1.5) had a higher prevalence than those who were employed. Persons who had hypertension (adjusted prevalence ratio 1.9, 95% CI 1.7-2.1), diabetes (adjusted prevalence ratio 1.7, 95% CI 1.5-1.8), cardiovascular disease (coronary heart disease, myocardial infarction or stroke; adjusted prevalence ratio 1.5, 95% CI 1.4-1.6) or cancer (adjusted prevalence ratio 1.5, 95% CI 1.3-1.6) had a higher prevalence of self-reported kidney disease than those without these conditions. CONCLUSION: The overall awareness of kidney disease was low in the general population. Efforts are needed to promote the awareness and early detection of kidney disease in public health services and clinical practice. |
Cardiovascular mortality, all-cause mortality, and diabetes incidence after lifestyle intervention for people with impaired glucose tolerance in the Da Qing Diabetes Prevention Study: a 23-year follow-up study
Li G , Zhang P , Wang J , An Y , Gong Q , Gregg EW , Yang W , Zhang B , Shuai Y , Hong J , Engelgau MM , Li H , Roglic G , Hu Y , Bennett PH . Lancet Diabetes Endocrinol 2014 2 (6) 474-80 BACKGROUND: Lifestyle interventions among people with impaired glucose tolerance reduce the incidence of diabetes, but their effect on all-cause and cardiovascular disease mortality is unclear. We assessed the long-term effect of lifestyle intervention on long-term outcomes among adults with impaired glucose tolerance who participated in the Da Qing Diabetes Prevention Study. METHODS: The study was a cluster randomised trial in which 33 clinics in Da Qing, China-serving 577 adults with impaired glucose tolerance-were randomised (1:1:1:1) to a control group or lifestyle intervention groups (diet or exercise or both). Patients were enrolled in 1986 and the intervention phase lasted for 6 years. In 2009, we followed up participants to assess the primary outcomes of cardiovascular mortality, all-cause mortality, and incidence of diabetes in the intention-to-treat population. FINDINGS: Of the 577 patients, 439 were assigned to the intervention group and 138 were assigned to the control group (one refused baseline examination). 542 (94%) of 576 participants had complete data for mortality and 568 (99%) contributed data to the analysis. 174 participants died during the 23 years of follow-up (121 in the intervention group vs 53 in the control group). Cumulative incidence of cardiovascular disease mortality was 11.9% (95% CI 8.8-15.0) in the intervention group versus 19.6% (12.9-26.3) in the control group (hazard ratio [HR] 0.59, 95% CI 0.36-0.96; p=0.033). All-cause mortality was 28.1% (95% CI 23.9-32.4) versus 38.4% (30.3-46.5; HR 0.71, 95% CI 0.51-0.99; p=0.049). Incidence of diabetes was 72.6% (68.4-76.8) versus 89.9% (84.9-94.9; HR 0.55, 95% CI 0.40-0.76; p=0.001). INTERPRETATION: A 6-year lifestyle intervention programme for Chinese people with impaired glucose tolerance can reduce incidence of cardiovascular and all-cause mortality and diabetes. These findings emphasise the long-term clinical benefits of lifestyle intervention for patients with impaired glucose tolerance and provide further justification for adoption of lifestyle interventions as public health measures to control the consequences of diabetes. FUNDING: Centers for Disease Control and Prevention, WHO, the China-Japan Friendship Hospital, Da Qing First Hospital. |
Changes in diabetes-related complications in the United States, 1990-2010
Gregg EW , Li Y , Wang J , Burrows NR , Ali MK , Rolka D , Williams DE , Geiss L . N Engl J Med 2014 370 (16) 1514-23 BACKGROUND: Preventive care for adults with diabetes has improved substantially in recent decades. We examined trends in the incidence of diabetes-related complications in the United States from 1990 through 2010. METHODS: We used data from the National Health Interview Survey, the National Hospital Discharge Survey, the U.S. Renal Data System, and the U.S. National Vital Statistics System to compare the incidences of lower-extremity amputation, end-stage renal disease, acute myocardial infarction, stroke, and death from hyperglycemic crisis between 1990 and 2010, with age standardized to the U.S. population in the year 2000. RESULTS: Rates of all five complications declined between 1990 and 2010, with the largest relative declines in acute myocardial infarction (-67.8%; 95% confidence interval [CI], -76.2 to -59.3) and death from hyperglycemic crisis (-64.4%; 95% CI, -68.0 to -60.9), followed by stroke and amputations, which each declined by approximately half (-52.7% and -51.4%, respectively); the smallest decline was in end-stage renal disease (-28.3%; 95% CI, -34.6 to -21.6). The greatest absolute decline was in the number of cases of acute myocardial infarction (95.6 fewer cases per 10,000 persons; 95% CI, 76.6 to 114.6), and the smallest absolute decline was in the number of deaths from hyperglycemic crisis (-2.7; 95% CI, -2.4 to -3.0). Rate reductions were larger among adults with diabetes than among adults without diabetes, leading to a reduction in the relative risk of complications associated with diabetes. When expressed as rates for the overall population, in which a change in prevalence also affects complication rates, there was a decline in rates of acute myocardial infarction and death from hyperglycemic crisis (2.7 and 0.1 fewer cases per 10,000, respectively) but not in rates of amputation, stroke, or end-stage renal disease. CONCLUSIONS: Rates of diabetes-related complications have declined substantially in the past two decades, but a large burden of disease persists because of the continued increase in the prevalence of diabetes. (Funded by the Centers for Disease Control and Prevention.). |
Costs and benefits of an organized fecal immunochemical test-based colorectal cancer screening program in the United States
Guy GP Jr , Richardson LC , Pignone MP , Plescia M . Cancer 2014 120 (15) 2308-15 BACKGROUND: Despite clear recommendations and evidence linking colorectal cancer screening to lower incidence and mortality, > 40% of adults are not up to date with screening. Existing domestic and international models of organized cancer screening programs have been effective in increasing screening rates. Implementing an organized, evidence-based, national screening program may be an effective approach to increasing screening rates. METHODS: In the current study, the authors estimated the initial investment required and the cost per person screened of a nationwide fecal immunochemical test (FIT)-based colorectal cancer screening program among adults aged 50 years to 75 years. RESULTS: The initial additional investment required was estimated at $277.9 to $318.2 million annually, with an estimated 8.7 to 9.4 million individuals screened at a cost of $32 to $39 per person screened. The program was estimated to prevent 2900 to 3100 deaths annually. CONCLUSIONS: The results of the current study indicate that implementing a national screening program would make a substantial public health impact at a moderate cost per person screened. Results from this analysis may provide useful information for understanding the public health benefit of an organized screening delivery system and the potential resources required to implement a nationwide colorectal cancer screening program, and help guide decisions about program planning, design, and implementation. |
Molecular epidemiology of contemporary G2P[4] human rotaviruses cocirculating in a single U.S. community: footprints of a globally transitioning genotype.
Dennis AF , McDonald SM , Payne DC , Mijatovic-Rustempasic S , Esona MD , Edwards KM , Chappell JD , Patton JT . J Virol 2014 88 (7) 3789-801 Group A rotaviruses (RVs) remain a leading cause of childhood gastroenteritis worldwide. Although the G/P types of locally circulating RVs can vary from year to year and differ depending upon geographical location, those with G1P[8], G2P[4], G3P[8], G4P[8], G9P[8], and G12P[8] specificities typically dominate. Little is known about the evolution and diversity of G2P[4] RVs and the possible role that widespread vaccine use has had on their increased frequency of detection. To address these issues, we analyzed the 12 G2P[4] RV isolates associated with a rise in RV gastroenteritis cases at Vanderbilt University Medical Center (VUMC) during the 2010-2011 winter season. Full-genome sequencing revealed that the isolates had genotype 2 constellations typical of DS-1-like viruses (G2P[4]-I2-R2-C2-M2-A2-N2-T2-E2-H2). Phylogenetic analyses showed that the genome segments of the isolates were comprised of two or three different subgenotype alleles; this enabled recognition of three distinct clades of G2P[4] viruses that caused disease at VUMC in the 2010-2011 season. Although the three clades cocirculated in the same community, there was no evidence of interclade reassortment. Bayesian analysis of 328 VP7 genes of G2 viruses isolated in the last 39 years indicate that existing G2 VP7 gene lineages continue to evolve and that novel lineages, as represented by the VUMC isolates, are constantly being formed. Moreover, G2 lineages are characteristically shaped by lineage turnover events that introduce new globally dominant strains every 7 years, on average. The ongoing evolution of G2 VP7 lineages may give rise to antigenic changes that undermine vaccine effectiveness in the long term. IMPORTANCE: Little is known about the diversity of cocirculating G2 rotaviruses and how their evolution may undermine the effectiveness of rotavirus vaccines. To expand our understanding of the potential genetic range exhibited by rotaviruses circulating in postvaccine communities, we analyzed part of a collection of rotaviruses recovered from pediatric patients in the United States from 2010 to 2011. Examining the genetic makeup of these viruses revealed they represented three segregated groups that did not exchange genetic material. The distinction between these three groups may be explained by three separate introductions. By comparing a specific gene, namely, VP7, of the recent rotavirus isolates to those from a collection recovered from U.S. children between 1974 and 1991 and other globally circulating rotaviruses, we were able to reconstruct the timing of events that shaped their ancestry. This analysis indicates that G2 rotaviruses are continuously evolving, accumulating changes in their genetic material as they infect new patients. |
The status of HIV testing and counseling in Kenya: results from a nationally representative population-based survey
Ng'ang'a A , Waruiru W , Ngare C , Ssempijja V , Gachuki T , Njoroge I , Oluoch P , Kimanga DO , Maina WK , Mpazanje R , Kim AA . J Acquir Immune Defic Syndr 2014 66 Suppl 1 S27-36 BACKGROUND: HIV testing and counseling (HTC) is essential for successful HIV prevention and treatment programs. The national target for HTC is 80% of the adult population in Kenya. Population-based data to measure progress towards this HTC target are needed to assess the country's changing needs for HIV prevention and treatment. METHODS: In 2012-2013, we conducted a national HIV survey among Kenyans aged 18 months to 64 years. Respondents aged 15-64 years were administered a questionnaire that collected information on demographics, HIV testing behavior, and self-reported HIV status. Blood samples were collected for HIV testing in a central laboratory. Participants were offered home-based testing and counseling to learn their HIV status in the home and point-of-care CD4 testing if they tested HIV-positive. RESULTS: Of 13,720 adults who were interviewed, 71.6% [95% confidence interval (CI): 70.2 to 73.1] had been tested for HIV. Among those, 56.1% (95% CI: 52.8 to 59.4) had been tested in the past year, 69.4% (95% CI: 68.0 to 70.8) had been tested more than once, and 37.2% (95% CI: 35.7 to 38.8) had been tested with a partner. Fifty-three percent (95% CI: 47.6 to 58.7) of HIV-infected persons were unaware of their infection. Overall 9874 (72.0%) of participants accepted home-based HIV testing and counseling; 4.1% (95% CI: 3.3 to 4.9) tested HIV-positive, and of those, 42.5% (95% CI 31.4 to 53.6) were in need of immediate treatment for their HIV infection but not receiving it. CONCLUSIONS: HIV testing rates have nearly reached the national target for HTC in Kenya. However, knowledge of HIV status among HIV-infected persons remains low. HTC needs to be expanded to reach more men and couples, and strategies are needed to increase repeat testing for persons at risk for HIV infection. |
Status of voluntary medical male circumcision in Kenya: findings from 2 nationally representative surveys in Kenya, 2007 and 2012
Galbraith JS , Ochieng A , Mwalili S , Emusu D , Mwandi Z , Kim AA , Rutherford G , Maina WK , Kimanga DO , Chesang K , Cherutich P . J Acquir Immune Defic Syndr 2014 66 Suppl 1 S37-45 BACKGROUND: The Kenyan Ministry of Health initiated a voluntary medical male circumcision (VMMC) program in 2008. We used data from 2 nationally representative surveys to estimate trends in the number, demographic characteristics, and sexual behaviors of recently circumcised and uncircumcised HIV-uninfected men in Kenya. METHODS: We compared the proportion of circumcised men between the first and second Kenya AIDS Indicator Survey (KAIS 2007 and KAIS 2012) to assess the progress of Kenya's VMMC program. We calculated the number of uncircumcised HIV-uninfected men. We conducted descriptive analyses and used multivariable methods to identify the variables independently associated with HIV-uninfected uncircumcised men aged 15-64 years in the VMMC priority region of Nyanza. RESULTS: The proportion of men who reported being circumcised increased significantly from 85.0% in 2007 to 91.2% in 2012. The proportions of circumcised men increased in all regions, with the highest increases of 18.1 and 9.0 percentage points in the VMMC priority regions of Nyanza and Nairobi, respectively. Half (52.5%) of HIV-uninfected and uncircumcised men had never been married, and 84.6% were not using condoms at all times with their last sexual partner. CONCLUSIONS: VMMC prevalence has increased across Kenya demonstrating the success of the national program. Despite this accomplishment, the Nyanza region remains below the target to circumcise 80% of all eligible men aged 15-49 years between 2009 and 2013. As new cohorts of young men enter into adolescence, consistent focus is needed. To ensure sustainability of the VMMC program, financial resources and coordinated planning must continue. |
Treatment practices, outcomes, and costs of multidrug-resistant and extensively drug-resistant tuberculosis, United States, 2005-2007
Marks SM , Flood J , Seaworth B , Hirsch-Moverman Y , Armstrong L , Mase S , Salcedo K , Oh P , Graviss EA , Colson PW , Armitige L , Revuelta M , Sheeran K . Emerg Infect Dis 2014 20 (5) 812-21 To describe factors associated with multidrug-resistant (MDR), including extensively-drug-resistant (XDR), tuberculosis (TB) in the United States, we abstracted inpatient, laboratory, and public health clinic records of a sample of MDR TB patients reported to the Centers for Disease Control and Prevention from California, New York City, and Texas during 2005-2007. At initial diagnosis, MDR TB was detected in 94% of 130 MDR TB patients and XDR TB in 80% of 5 XDR TB patients. Mutually exclusive resistance was 4% XDR, 17% pre-XDR, 24% total first-line resistance, 43% isoniazid/rifampin/rifabutin-plus-other resistance, and 13% isoniazid/rifampin/rifabutin-only resistance. Nearly three-quarters of patients were hospitalized, 78% completed treatment, and 9% died during treatment. Direct costs, mostly covered by the public sector, averaged $134,000 per MDR TB and $430,000 per XDR TB patient; in comparison, estimated cost per non-MDR TB patient is $17,000. Drug resistance was extensive, care was complex, treatment completion rates were high, and treatment was expensive. |
Tuberculosis and HIV at the national level in Kenya: results from the second Kenya AIDS Indicator Survey
Mbithi A , Gichangi A , Kim AA , Katana A , Weyenga H , Williamson J , Robinson K , Oluoch T , Maina WK , Kellogg TA , De Cock KM . J Acquir Immune Defic Syndr 2014 66 Suppl 1 S106-15 BACKGROUND: Co-morbidity with tuberculosis and HIV is a common cause of mortality in sub-Saharan Africa. In the second Kenya AIDS Indicator Survey, we collected data on knowledge and experience of HIV and tuberculosis, as well as on access to and coverage of relevant treatment services and antiretroviral therapy (ART) in Kenya. METHODS: A national, population-based household survey was conducted from October 2012 to February 2013. Information was collected through household questionnaires, and blood samples were taken for HIV, CD4 cell counts, and HIV viral load testing at a central laboratory. RESULTS: Overall, 13,720 persons aged 15-64 years participated; 96.7% [95% confidence interval (CI): 96.3 to 97.1] had heard of tuberculosis, of whom 2.0% (95% CI: 1.7 to 2.2) reported having prior tuberculosis. Among those with laboratory-confirmed HIV infection, 11.6% (95% CI: 8.9 to 14.3) reported prior tuberculosis. The prevalence of laboratory-confirmed HIV infection in persons reporting prior tuberculosis was 33.2% (95% CI: 26.2 to 40.2) compared to 5.1% (95% CI: 4.5 to 5.8) in persons without prior tuberculosis. Among those in care, coverage of ART for treatment-eligible persons was 100% for those with prior tuberculosis and 88.6% (95% CI: 81.6 to 95.7) for those without. Among all HIV-infected persons, ART coverage among treatment-eligible persons was 86.9% (95% CI: 74.2 to 99.5) for persons with prior tuberculosis and 58.3% (95% CI: 47.6 to 69.0) for those without. CONCLUSIONS: Morbidity from tuberculosis and HIV remain major health challenges in Kenya. Tuberculosis is an important entry point for HIV diagnosis and treatment. Lack of knowledge of HIV serostatus is an obstacle to access to HIV services and timely ART for prevention of HIV transmission and HIV-associated disease, including tuberculosis. |
A missed tuberculosis diagnosis resulting in hospital transmission
Medrano BA , Salinas G , Sanchez C , Miramontes R , Restrepo BI , Haddad MB , Lambert LA . Infect Control Hosp Epidemiol 2014 35 (5) 534-7 OBJECTIVE: To find the source of tuberculin skin test conversions among 38 hospital employees on 1 floor during routine testing January-February 2010. METHODS: Record review of patients at a private hospital during September-December 2009 and interviews with hospital employees. Names of patients from the state tuberculosis (TB) registry were cross-referenced with hospital records for admissions. Mycobacterium tuberculosis genotype results in the county and adjacent counties were examined, and contacts were evaluated for TB infection and disease. RESULTS: One of the 38 employees, a nurse, was diagnosed with pulmonary TB with a matching M. tuberculosis genotype and drug resistance pattern (isoniazid monoresistant) to those of a county jail inmate also recently diagnosed with pulmonary TB. The nurse had no known contact with that inmate; however, another inmate in his 20's from the same jail had been hospitalized under that nurse's care in October 2009. That young man died, and a postmortem examination result subsequently confirmed TB, which had not been suspected. Exposure to this man with undiagnosed TB could explain the transmission: 87 (27%) of the 318 hospital-based contacts without previous positive tuberculin skin test results were infected, and 9 contacts had active TB. CONCLUSIONS: This investigation demonstrated M. tuberculosis transmission in a hospital due to a missed diagnosis and nonadherence to national TB infection control guidelines. Routine TB screening of employees allowed early detection of this missed TB diagnosis, facilitating prompt evaluation of contacts. Healthcare providers should suspect TB in symptomatic persons and adhere to TB control policies. |
Mother-to-child transmission of HIV in Kenya: results from a nationally representative study
Sirengo M , Muthoni L , Kellogg TA , Kim AA , Katana A , Mwanyumba S , Kimanga DO , Maina WK , Muraguri N , Elly B , Rutherford GW . J Acquir Immune Defic Syndr 2014 66 Suppl 1 S66-74 BACKGROUND: Kenya has an estimated 13,000 new infant HIV infections that occur annually. We measured the burden of HIV infection among women of childbearing age and assessed access to and coverage of key prevention of mother-to-child transmission interventions. METHODS: The second Kenya AIDS Indicator Survey was a nationally representative 2-stage cluster sample of households. We analyzed data from women aged 15-54 years who had delivered a newborn within the preceding 5 years and from whom we obtained samples for HIV testing. RESULTS: Of 3310 women who had ≥1 live birth in the preceding 5 years, 2862 (86.5%) consented to HIV testing in the survey, and 171 (6.1%) were found to be infected. Ninety-five percent received prenatal care, 93.1% were screened for HIV during prenatal care, and of those screened, 97.8% received their test results. Seventy-six women were known to be infected in their last pregnancy. Of these, 54 (72.3%) received antepartum antiretroviral prophylaxis, and 51 (69.1%) received intrapartum prophylaxis; 56 (75.3%) reported their newborns received postpartum prophylaxis. Of the 76 children born to these mothers, 63 (82.5%) were tested for HIV at the first immunization visit or thereafter, and 8 (15.1%) were HIV infected. CONCLUSIONS: We found a substantial burden of HIV in Kenyan women of childbearing age and a cumulative 5-year mother-to-child transmission rate of 15%. Although screening has improved over the past 5 years, fewer than three-quarters of infected pregnant women are receiving antiretroviral prophylaxis. Universal antiretroviral therapy for HIV-infected pregnant women will be essential in achieving Kenyan's target to eliminate mother-to-child transmission to <5% by 2015. |
Outcomes in a cohort of women who discontinued maternal triple-antiretroviral regimens initially used to prevent mother-to-child transmission during pregnancy and breastfeeding-Kenya, 2003-2009
Minniear TD , Girde S , Angira F , Mills LA , Zeh C , Peters PJ , Masaba R , Lando R , Thomas TK , Taylor AW . PLoS One 2014 9 (4) e93556 BACKGROUND: In 2012, the World Health Organization (WHO) amended their 2010 guidelines for women receiving limited duration, triple-antiretroviral drug regimens during pregnancy and breastfeeding for prevention of mother-to-child transmission of HIV (tARV-PMTCT) (Option B) to include the option to continue lifelong combination antiretroviral therapy (cART) (Option B+). We evaluated clinical and CD4 outcomes in women who had received antiretrovirals for prevention of mother-to-child transmission and then discontinued antiretrovirals 6-months postpartum. METHODS AND FINDINGS: The Kisumu Breastfeeding Study, 2003-2009, was a prospective, non-randomized, open-label clinical trial of tARV-PMTCT in ARV-naive, Kenyan women. Women received tARV-PMTCT from 34 weeks' gestation until 6-months postpartum when women were instructed to discontinue breastfeeding. Women with CD4 count (CD4) <250cells/mm3 or WHO stage III/IV prior to 6-months postpartum continued cART indefinitely. We estimated the change in CD4 after discontinuing tARV-PMTCT and the adjusted relative risk [aRR] for factors associated with declines in maternal CD4. We compared maternal and infant outcomes following weaning-when tARV-PMTCT discontinued-by maternal ARV status through 24-months postpartum. Compared with women who continued cART, discontinuing antiretrovirals was associated with infant HIV transmission and death (10.1% vs. 2.4%; P = 0.03). Among women who discontinued antiretrovirals, CD4<500 cells/mm3 at either initiation (21.8% vs. 1.5%; P = 0.002; aRR: 9.8; 95%-confidence interval [CI]: 2.4-40.6) or discontinuation (36.9% vs. 8.3%; P<0.0001; aRR: 4.4; 95%-CI: 1.9-5.0) were each associated with increased risk of women requiring cART for their own health within 6 months after discontinuing. CONCLUSIONS: Considering the serious health risks to the woman's infant and the brief reprieve from cART gained by stopping, every country should evaluate the need for and feasibility to implement WHO Option B+ for PMTCT. Evaluating CD4 at antiretroviral initiation or 6-months postpartum can identify pregnant women who would most benefit from continuing cART in settings unable to implement WHO Option B+. |
Populations at increased Risk for HIV infection in Kenya: results from a national population-based household survey, 2012
Githuka G , Hladik W , Mwalili S , Cherutich P , Muthui M , Gitonga J , Maina WK , Kim AA . J Acquir Immune Defic Syndr 2014 66 Suppl 1 S46-56 BACKGROUND: Populations with higher risks for HIV exposure contribute to the HIV epidemic in Kenya. We present data from the second Kenya AIDS Indicator Survey to estimate the size and HIV prevalence of populations with high-risk characteristics. METHODS: The Kenya AIDS Indicator Survey 2012 was a national survey of Kenyans aged 18 months to 64 years which linked demographic and behavioral information with HIV results. Data were weighted to account for sampling probability. This analysis was restricted to adults aged 18 years and older. RESULTS: Of 5088 men and 6745 women, 0.1% [95% confidence interval (CI): 0.03 to 0.14] were persons who inject drugs (PWID). Among men, 0.6% (CI: 0.3 to 0.8) had ever had sex with other men, and 3.1% (CI: 2.4 to 3.7) were males who had ever engaged in transactional sex work (MTSW). Among women, 1.9% (CI: 1.3 to 2.5) had ever had anal sex, and 4.1% (CI: 3.5 to 4.8) were women who had ever engaged in transactional sex work (FTSW). Among men, 17.6% (CI: 15.7 to 19.6) had been male clients of transactional sex workers (TSW). HIV prevalence was 0% among men who have sex with men, 6.3% (CI: 0 to 18.1) among persons who injected drugs, 7.1% (CI: 4.8 to 9.4) among male clients of TSW, 7.6% (CI: 1.8 to 13.4) among MTSW, 12.1% (CI: 7.1 to 17.1) among FTSW, and 12.1% (CI: 5.0 to 19.2) among females who ever had engaged in anal sex. CONCLUSIONS: Population-based data on high-risk populations can be used to set realistic targets for HIV prevention, care, and treatment for these groups. These data should inform priorities for high-risk populations in the upcoming Kenyan strategic plan on HIV/AIDS. |
Engagement in HIV care among Kenyan adults and adolescents: results from a national population-based survey
Wafula R , Masyuko S , Ng'ang'a L , Kim AA , Gichangi A , Mukui I , Batuka J , Ngugi EW , Maina WK , Schwarcz S . J Acquir Immune Defic Syndr 2014 66 Suppl 1 S98-s105 BACKGROUND: Increasing access to care and treatment for HIV-infected persons is a goal in Kenya's response to the HIV epidemic. Using data from the second Kenya AIDS Indicator Survey (KAIS 2012), we describe coverage of services received among adults and adolescents who were enrolled in HIV care. METHODS: KAIS 2012 was a population-based survey that collected information from persons aged 15-64 years that included self-reported HIV status, and for persons reporting HIV infection, use of HIV care and antiretroviral therapy (ART). Blood specimens were collected and tested for HIV. HIV-positive specimens were tested for CD4 counts and viral load. RESULTS: Among 363 persons who reported HIV infection, 93.4% [95% confidence interval (CI): 87.2 to 99.6] had ever received HIV care. Among those receiving HIV care, 96.3% (95% CI: 94.1 to 98.4) were using cotrimoxazole prophylaxis, and 74.6% (95% CI: 69.0 to 80.2) were receiving ART. A lower proportion of persons in care and not on ART reported using cotrimoxazole (89.5%, 95% CI: 82.5 to 96.5 compared with 98.6%, 95% CI: 97.1 to 100) and had a CD4 count measurement done (72.9%, 95% CI: 64.0 to 81.9 compared with 90.0%, 95% CI: 82.8 to 97.3) than persons in care and on ART, respectively. Among persons in care and not on ART, 23.2% (95% CI: 6.8 to 39.7) had CD4 counts ≤350 cells per microliter. Viral suppression was observed in 75.3% (95% CI: 68.7 to 81.9) of persons on ART. CONCLUSIONS: Linkage and retention in care are high among persons with known HIV infection. However, improvements in care for the pre-ART population are needed. Viral suppression rates were comparable to developed settings. |
Examining strain diversity and phylogeography in relation to an unusual epidemic pattern of respiratory syncytial virus (RSV) in a long-term refugee camp in Kenya
Agoti CN , Mayieka LM , Otieno JR , Ahmed JA , Fields BS , Waiboci LW , Nyoka R , Eidex RB , Marano N , Burton W , Montgomery JM , Breiman RF , Nokes DJ . BMC Infect Dis 2014 14 (1) 178 BACKGROUND: A recent longitudinal study in the Dadaab refugee camp near the Kenya-Somalia border identified unusual biannual respiratory syncytial virus (RSV) epidemics. We characterized the genetic variability of the associated RSV strains to determine if viral diversity contributed to this unusual epidemic pattern. METHODS: For 336 RSV positive specimens identified from 2007 through 2011 through facility-based surveillance of respiratory illnesses in the camp, 324 (96.4%) were sub-typed by PCR methods, into 201 (62.0%) group A, 118 (36.4%) group B and 5 (1.5%) group A-B co-infections. Partial sequencing of the G gene (coding for the attachment protein) was completed for 290 (89.5%) specimens. These specimens were phylogenetically analyzed together with 1154 contemporaneous strains from 22 countries. RESULTS: Of the 6 epidemic peaks recorded in the camp over the period, the first and last were predominantly made up of group B strains, while the 4 in between were largely composed of group A strains in a consecutive series of minor followed by major epidemics. The Dadaab group A strains belonged to either genotype GA2 (180, 98.9%) or GA5 (2, < 1%) while all group B strains (108, 100%) belonged to BA genotype. In sequential epidemics, strains within these genotypes appeared to be of two types: those continuing from the preceding epidemics and those newly introduced. Genotype diversity was similar in minor and major epidemics. CONCLUSION: RSV strain diversity in Dadaab was similar to contemporaneous diversity worldwide, suggested both between-epidemic persistence and new introductions, and was unrelated to the unusual epidemic pattern. |
Hepatitis B virus and hepatitis C virus infections in United States-bound refugees from Asia and Africa
Mixson-Hayden T , Lee D , Ganova-Raeva L , Drobeniuc J , Stauffer WM , Teshale E , Kamili S . Am J Trop Med Hyg 2014 90 (6) 1014-20 The aim of this study was to determine the prevalence of active hepatitis B and C virus infections among refugees from various countries in Africa and Asia. Pre-admission serum samples collected during 2002-2007 from refugees originating from Bhutan (N = 755), Myanmar (N = 1076), Iraq (N = 1137), Laos (N = 593), Thailand (N = 622), and Somalia (N = 707) were tested for hepatitis B virus (HBV) DNA and hepatitis C virus (HCV) RNA. The HBV DNA (genotypes A, B, C, and G) was detected in 12.1% of samples negative for anti-HBs. Highest HBV prevalence was found among Hmong; lowest among Bhutanese. The HCV RNA (genotypes 1a, 1b, 1c, 3b, 6n, and 6m) was detected in 1.3% of the samples. Highest HCV prevalence was found among Hmong from Thailand; lowest among Iraqis. Screening specific refugee groups at high risk for viral hepatitis infections will identify infected individuals who could benefit from referral to care and treatment and prevent further transmissions. |
Impact of parent-child communication interventions on sex behaviors and cognitive outcomes for black/African-American and Hispanic/Latino youth: a systematic review, 1988-2012
Sutton MY , Lasswell SM , Lanier Y , Miller KS . J Adolesc Health 2014 54 (4) 369-384 PURPOSE: We reviewed human immunodeficiency virus (HIV) and sexually transmitted infection (STI)- behavioral interventions implemented with disproportionately affected black/African-American and Hispanic/Latino youth and designed to improve parent-child communications about sex. We compared their effectiveness in improving sex-related behavior or cognitive outcomes. METHODS: A search of electronic databases identified peer-reviewed studies published between 1988 and 2012. Eligible studies were U.S.-based parent-child communication interventions with active parent components, experimental and quasiexperimental designs, measurement of youth sexual health outcomes, and enrollment of ≥50% black/African-American or Hispanic/Latino youth. We conducted systematic, primary reviews of eligible papers to abstract data on study characteristics and youth outcomes. RESULTS: Fifteen studies evaluating 14 interventions were eligible. Although youth outcome measures and follow-up times varied, 13 of 15 studies (87%) showed at least one significantly improved youth sexual health outcome compared with controls (p < .05). Common components of effective interventions included joint parent and child session attendance, promotion of parent/family involvement, sexuality education for parents, developmental and/or cultural tailoring, and opportunities for parents to practice new communication skills with their youth. CONCLUSIONS: Parent-child communication interventions that include parents of youth disproportionately affected by HIV/STIs can effectively reduce sexual risk for youth. These interventions may help reduce HIV/STI-related health disparities and improve sexual health outcomes. |
The Kenya AIDS indicator survey 2012: rationale, methods, description of participants, and response rates
Waruiru W , Kim AA , Kimanga DO , Ng'ang'a J , Schwarcz S , Kimondo L , Ng'ang'a A , Umuro M , Mwangi M , Ojwang JK , Maina WK . J Acquir Immune Defic Syndr 2014 66 Suppl 1 S3-s12 BACKGROUND: Cross-sectional population-based surveys are essential surveillance tools for tracking changes in HIV epidemics. In 2007, Kenya implemented the first AIDS Indicator Survey [Kenya AIDS Indicator Survey (KAIS) 2007], a nationally representative, population-based survey that collected demographic and behavioral data and blood specimens from individuals aged 15-64 years. Kenya's second AIDS Indicator Survey (KAIS 2012) was conducted to monitor changes in the epidemic, evaluate HIV prevention, care, and treatment initiatives, and plan for an efficient and effective response to the HIV epidemic. METHODS: KAIS 2012 was a cross-sectional 2-stage cluster sampling design, household-based HIV serologic survey that collected information on households as well as demographic and behavioral data from Kenyans aged 18 months to 64 years. Participants also provided blood samples for HIV serology and other related tests at the National HIV Reference Laboratory. RESULTS: Among 9300 households sampled, 9189 (98.8%) were eligible for the survey. Of the eligible households, 8035 (87.4%) completed household-level questionnaires. Of 16,383 eligible individuals aged 15-64 years and emancipated minors aged less than 15 years in these households, 13,720 (83.7%) completed interviews; 11,626 (84.7%) of the interviewees provided a blood specimen. Of 6302 eligible children aged 18 months to 14 years, 4340 (68.9%) provided a blood specimen. Of the 2094 eligible children aged 10-14 years, 1661 (79.3%) completed interviews. CONCLUSIONS: KAIS 2012 provided representative data to inform a strategic response to the HIV epidemic in the country. |
Kenya AIDS Indicator Surveys 2007 and 2012: implications for public health policies for HIV prevention and treatment
Maina WK , Kim AA , Rutherford GW , Harper M , K'Oyugi B O , Sharif S , Kichamu G , Muraguri NM , Akhwale W , De Cock KM . J Acquir Immune Defic Syndr 2014 66 Suppl 1 S130-7 AIDS Indicator Surveys are standardized surveillance tools used by countries with generalized HIV epidemics to provide, in a timely fashion, indicators for effective monitoring of HIV. Such data should guide responses to the HIV epidemic, meet program reporting requirements, and ensure comparability of findings across countries and over time. Kenya has conducted 2 AIDS Indicator Surveys, in 2007 (KAIS 2007) and 2012-2013 (KAIS 2012). These nationally representative surveys have provided essential epidemiologic, sociodemographic, behavioral, and biologic data on HIV and related indicators to evaluate the national HIV response and inform policies for prevention and treatment of the disease. We present a summary of findings from KAIS 2007 and KAIS 2012 and the impact that these data have had on changing HIV policies and practice. |
Adapting the VOICES HIV behavioral intervention for Latino men who have sex with men
O'Donnell L , Stueve A , Joseph HA , Flores S . AIDS Behav 2014 18 (4) 767-75 Latino men who have sex with men (MSM) are disproportionately impacted by HIV/AIDS, but few behavioral interventions address their prevention needs. Adaptation of evidence-based interventions is a pragmatic strategy that builds upon lessons learned and has the potential to fill gaps in prevention programming. Yet there are few reports of how transfers are executed and whether effectiveness is achieved. This research reports on the adaptation of VOICES/VOICES, a single-session intervention designed for heterosexual adults, into No Excuses/Sin buscar excuses for Latino MSM. To test the adapted intervention, 370 at-risk Latino MSM were enrolled in a randomized trial. At a three-month follow-up, there was a sharper decrease in unprotected intercourse in the intervention group compared to controls (59 % vs. 39 %, ANOVA p < 0.05, F = 4.10). Intervention participants also reported more condom use at last intercourse (AOR = 1.69; 95 % CI 1.02-2.81, p < 02). Findings support use of adapted models for meeting prevention needs of high-priority populations. |
Antiretroviral treatment scale-up among persons living with HIV in Kenya: results from a nationally representative survey
Odhiambo JO , Kellogg TA , Kim AA , Ng'ang'a L , Mukui I , Umuro M , Mohammed I , De Cock KM , Kimanga DO , Schwarcz S . J Acquir Immune Defic Syndr 2014 66 Suppl 1 S116-22 BACKGROUND: In 2007, 29% of HIV-infected Kenyans in need of antiretroviral therapy (ART), based on an immunologic criterion of CD4 ≤350 cells per microliter, were receiving ART. Since then, substantial treatment scale-up has occurred in the country. We analyzed data from the second Kenya AIDS Indicator Survey (KAIS 2012) to assess progress of treatment scale-up in Kenya. METHODS: KAIS 2012 was a nationally representative survey of persons aged 18 months to 64 years that collected information on HIV status, care, and treatment. ART eligibility was defined based on 2 standards: (1) 2011 Kenya eligibility criteria for ART initiation: CD4 ≤350 cells per microliter or co-infection with active tuberculosis and (2) 2013 World Health Organization (WHO) eligibility criteria for ART initiation: CD4 ≤500 cells per microliter, co-infection with active tuberculosis, currently pregnant or breastfeeding, and infected partners in serodiscordant relationships. Blood specimens were tested for HIV antibodies and HIV-positive specimens tested for CD4 cell counts. RESULTS: Among 13,720 adults and adolescents aged 15-64 years, 11,626 provided a blood sample, and 648 were HIV infected. Overall, 58.8% [95% confidence interval (CI): 52.0 to 65.5) were eligible for treatment using the 2011 Kenya eligibility criteria and 77.4% (95% CI: 72.4 to 82.4) using the 2013 WHO eligibility criteria. Coverage of ART was 60.5% (95% CI: 50.8 to 70.2) using the 2011 Kenya eligibility criteria and 45.9% (95% CI: 37.7 to 54.2) using the 2013 WHO eligibility criteria. CONCLUSIONS: ART coverage has increased from 29% in 2007 to 61% in 2012. If Kenya adopts the 2013 WHO guidelines for ART initiation, need for ART increases by an additional 19 percentage points and current coverage decreases by an additional 15 percentage points, representing an additional 214,000 persons who will need to be reached. |
Associations between presence of handwashing stations and soap in the home and diarrhoea and respiratory illness, in children less than five years old in rural western Kenya
Kamm KB , Feikin DR , Bigogo GM , Aol G , Audi A , Cohen AL , Shah MM , Yu J , Breiman RF , Ram PK . Trop Med Int Health 2014 19 (4) 398-406 OBJECTIVE: We tested whether soap presence in the home or a designated handwashing station was associated with diarrhoea and respiratory illness in Kenya. METHODS: In April 2009, we observed presence of a handwashing station and soap in households participating in a longitudinal health surveillance system in rural Kenya. Diarrhoea and acute respiratory illness (ARI) in children < 5 years old were identified using parent-reported syndromic surveillance collected January-April 2009. We used multivariate generalised linear regression to estimate differences in prevalence of illness between households with and without the presence of soap in the home and a handwashing station. RESULTS: Among 2547 children, prevalence of diarrhoea and ARI was 2.3 and 11.4 days per 100 child-days, respectively. Soap was observed in 97% of households. Children in households with soap had 1.3 fewer days of diarrhoea/100 child-days (95% CI -2.6, -0.1) than children in households without soap. ARI prevalence was not associated with presence of soap. A handwashing station was identified in 1.4% of households and was not associated with a difference in diarrhoea or ARI prevalence. CONCLUSIONS: Soap presence in the home was significantly associated with reduced diarrhoea, but not ARI, in children in rural western Kenya. Whereas most households had soap in the home, almost none had a designated handwashing station, which may prevent handwashing at key times of hand contamination. |
Burden of HIV infection among children aged 18 months to 14 years in Kenya: results from a nationally representative population-based cross-sectional survey
Ng'eno B , Mwangi A , Ng'ang'a L , Kim AA , Waruru A , Mukui I , Ngugi EW , Rutherford GW . J Acquir Immune Defic Syndr 2014 66 Suppl 1 S82-8 BACKGROUND: In Kenya, mathematical models estimate that there are approximately 220,000 children aged less than 15 years infected with HIV. We analyzed data from the second Kenya AIDS Indicator Survey (KAIS 2012) to estimate the prevalence of HIV infection among children aged 18 months to 14 years. METHODS: KAIS 2012 was a nationally representative 2-stage cluster sample household survey. We studied children aged 18 months to 14 years whose parents or guardians answered questions pertaining to their children by interview. Blood specimens were collected for HIV serology and viral load measurement. RESULTS: We identified 5162 children who were eligible for the study. Blood was obtained for 3681 (71.3%) children. Among child participants, 16.4% had been tested for HIV infection in the past, and among children with parents or guardians who self-reported HIV-positive status, 52.9% had been tested for HIV infection. Twenty-eight (0.9%) children tested HIV-positive in the survey. Of these, 11 had been previously diagnosed with HIV infection before the survey. All 11 children were in HIV care and receiving cotrimoxazole; 8 were on antiretorivral therapy (ART). Among those on ART, 4 were virologically suppressed. CONCLUSIONS: HIV causes a substantial burden of disease in the Kenyan pediatric population. Although most children who had been diagnosed with HIV before the survey were engaged in care and treatment, they represented less than half of HIV-infected children identified in the survey. Future efforts should focus on identifying infected children and getting them into care and on suppressive ART as early as possible. |
The centrality of laboratory services in the HIV treatment and prevention cascade: the need for effective linkages and referrals in resource-limited settings
Alemnji G , Fonjungo P , Van Der Pol B , Peter T , Kantor R , Nkengasong J . AIDS Patient Care STDS 2014 28 (5) 268-73 Strong laboratory services and systems are critical for delivering timely and quality health services that are vital to reduce patient attrition in the HIV treatment and prevention cascade. However, challenges exist in ensuring effective laboratory health systems strengthening and linkages. In particular, linkages and referrals between laboratory testing and other services need to be considered in the context of an integrated health system that includes prevention, treatment, and strategic information. Key components of laboratory health systems that are essential for effective linkages include an adequate workforce, appropriate point-of-care (POC) technology, available financing, supply chain management systems, and quality systems improvement, including accreditation. In this review, we highlight weaknesses of and gaps between laboratory testing and other program services. We propose a model for strengthening these systems to ensure effective linkages of laboratory services for improved access and retention in care of HIV/AIDS patients, particularly in low- and middle-income countries. |
Comparison of laboratory-confirmed influenza and noninfluenza acute respiratory illness in healthcare personnel during the 2010-2011 influenza season
Henkle E , Irving SA , Naleway AL , Gaglani MJ , Ball S , Spencer S , Peasah S , Thompson MG . Infect Control Hosp Epidemiol 2014 35 (5) 538-46 OBJECTIVE: Compare the severity of illnesses associated with influenza and noninfluenza acute respiratory illness (ARI) in healthcare personnel (HCP). DESIGN: Prospective observational cohort. PARTICIPANTS: HCP at 2 healthcare organizations with direct patient contact were enrolled prior to the 2010-2011 influenza season. METHODS: HCP who were fewer than 8 days from the start of fever/feverishness/chills and cough were eligible for real-time reverse-transcription polymerase chain reaction influenza virus testing of respiratory specimen. Illness severity was assessed by the sum of self-rated severity (0, absent; 3, severe) of 12 illness symptoms, subjective health (0, best health; 9, worst health), activities of daily living impairment (0, able to perform; 9, unable to perform), missed work, and duration of illness. RESULTS: Of 1,701 HCP enrolled, 267 were tested for influenza, and 58 (22%) of these tested positive. Influenza compared with noninfluenza illnesses was associated with higher summed 12-symptom severity score (mean [standard deviation], 17.9 [5.4] vs 14.6 [4.8]; P < .001), worse subjective health (4.5 [1.8] vs 4.0 [1.8]; P <.05), greater impairment of activities of daily living (4.9 [2.5] vs 3.8 [2.5]; P < .01), and more missed work (12.1 [10.5] vs 7.8 [10.5] hours; P < .01). Differences in symptom severity, activities of daily living, and missed work remained significant after adjusting for illness and participant characteristics. CONCLUSIONS: Influenza had a greater negative impact on HCP than noninfluenza ARIs, indicated by higher symptom severity scores, less ability to perform activities of daily living, and more missed work. These results highlight the importance of efforts to prevent influenza infection in HCP. |
Disparities in the quality of HIV care when using US Department of Health and Human Services indicators
Althoff KN , Rebeiro P , Brooks JT , Buchacz K , Gebo K , Martin J , Hogg R , Thorne JE , Klein M , Gill MJ , Sterling TR , Yehia B , Silverberg MJ , Crane H , Justice AC , Gange SJ , Moore R , Kitahata MM , Horberg MA . Clin Infect Dis 2014 58 (8) 1185-9 We estimated US Department of Health and Human Services (DHHS)-approved human immunodeficiency virus (HIV) indicators. Among patients, 71% were retained in care, 82% were prescribed treatment, and 78% had HIV RNA ≤200 copies/mL; younger adults, women, blacks, and injection drug users had poorer outcomes. Interventions are needed to reduce retention- and treatment-related disparities. |
Roosting behaviour and habitat selection of Pteropus giganteus reveal potential links to Nipah virus epidemiology
Hahn MB , Epstein JH , Gurley ES , Islam MS , Luby SP , Daszak P , Patz JA . J Appl Ecol 2014 51 (2) 376-387 Flying foxes Pteropus spp. play a key role in forest regeneration as seed dispersers and are also the reservoir of many viruses, including Nipah virus in Bangladesh. Little is known about their habitat requirements, particularly in South Asia. Identifying Pteropus habitat preferences could assist in understanding the risk of zoonotic disease transmission broadly and, in Bangladesh, could help explain the spatial distribution of human Nipah virus cases. 2. We analysed characteristics of Pteropus giganteus roosts and constructed an ecological niche model to identify suitable habitat in Bangladesh. We also assessed the distribution of suitable habitat in relation to the location of human Nipah virus cases. 3. Compared to non-roost trees, P.giganteus roost trees are taller with larger diameters and are more frequently canopy trees. Colony size was larger in densely forested regions and smaller in flood-affected areas. Roosts were located in areas with lower annual precipitation and higher human population density than non-roost sites. 4. We predicted that 2-17% of Bangladesh's land area is suitable roosting habitat. Nipah virus outbreak villages were 2.6 times more likely to be located in areas predicted as highly suitable habitat for P. giganteus compared to non-outbreak villages. 5. Synthesis and applications. Habitat suitability modelling may help identify previously undocumented Nipah outbreak locations and improve our understanding of Nipah virus ecology by highlighting regions where there is suitable bat habitat but no reported human Nipah virus. Conservation and public health education is a key component of P.giganteus management in Bangladesh due to the general misunderstanding and fear of bats that are a reservoir of Nipah virus. Affiliation between Old World fruit bats (Pteropodidae) and people is common throughout their range, and in order to conserve these keystone bat species and prevent emergence of zoonotic viruses, it is imperative that we continue to improve our understanding of Pteropus resource requirements and routes of virus transmission from bats to people. Results presented here can be utilized to develop land management strategies and conservation policies that simultaneously protect fruit bats and public health. |
Spatial distribution of counties in the continental United States with records of occurrence of Amblyomma americanum (Ixodida: Ixodidae)
Springer YP , Eisen L , Beati L , James AM , Eisen RJ . J Med Entomol 2014 51 (2) 342-51 In addition to being a major nuisance biter, the lone star tick, Amblyomma americanum (L.), is increasingly recognized as an important vector of pathogens affecting humans, domestic animals, and wildlife. Despite its notoriety, efforts have been lacking to define the spatial occurrence ofA. americanum in the continental United States with precision beyond that conveyed in continental-scale distribution maps. Here we present a county-level distribution map for A. americanum generated by compiling collection records obtained from a search of the published literature and databases managed by the USDA, U.S. National Tick Collection, and Walter Reed Biosystematics Unit. Our decadal and cumulative maps, which visually summarize 18,121 collections made between 1898 and 2012, show that A. americanum is either established (> or = six ticks or -two life stages) or reported (<six ticks of a single life stage or number of ticks not specified) in 1,300 counties distributed among 39 states and the District of Columbia. Our cumulative map depicts a species with a core distributional area in the southern part of the eastern United States, but that also occurs further north, especially along the Atlantic Coast and into the Midwest. Although our decadal maps suggest a northward shift in the tick's distribution in recent decades, the lack of systematic tick surveillance makes this difficult to confirm. The data presented herein should aid in identifying areas posing risk for A. americanum-associated illnesses and environmental correlates that define the tick's distributional limits. |
Outbreak of Serratia marcescens bloodstream infections in patients receiving parenteral nutrition prepared by a compounding pharmacy
Gupta N , Hocevar SN , Moulton-Meissner H , Stevens KM , McIntyre MG , Jensen B , Kuhar DT , Noble-Wang J , Schnatz RG , Becker SC , Kastango ES , Shehab N , Kallen AJ . Clin Infect Dis 2014 59 (1) 1-8 BACKGROUND: Compounding pharmacies often prepare parenteral nutrition (PN) and must adhere to rigorous standards to avoid contamination of the sterile preparation. In March 2011, Serratia marcescens bloodstream infections (BSIs) were identified in five patients receiving PN from a single compounding pharmacy. An investigation was conducted to identify potential sources of contamination and prevent further infections. METHODS: Cases were defined as S. marcescens BSIs in patients receiving PN from the pharmacy between January and March 2011. We reviewed case-patient clinical records, evaluated pharmacy compounding practices, and obtained epidemiologically-directed environmental cultures. Molecular relatedness of available Serratia isolates was determined by pulsed-field gel electrophoresis (PFGE). RESULTS: Nineteen case-patients were identified; nine died. The attack rate for patients receiving PN in March was 35%. No case-patients were younger than 18 years. In October 2010, the pharmacy began compounding and filter-sterilizing amino acid solution for adult PN using non-sterile amino acids due to a national manufacturer shortage. Review of this process identified breaches in mixing, filtration, and sterility testing practices. Serratia marcescens was identified from a pharmacy water faucet, mixing container, and opened amino acid powder. These isolates were indistinguishable from the outbreak strain by PFGE. CONCLUSIONS: Compounding of non-sterile amino acid components of PN was initiated due to a manufacturer shortage. Failure to follow recommended compounding standards contributed to an outbreak of S. marcescens BSIs. Improved adherence to sterile compounding standards, critical examination of standards for sterile compounding from non-sterile ingredients, and more rigorous oversight of compounding pharmacies is needed to prevent future outbreaks. |
Quantitative analysis and stability of the rodenticide TETS (tetramine) in finished tap water
Knaack JS , Hamelin EI , Magnuson M , Silvestri E , Ash D , Johnson RC . Anal Methods 2014 6 (8) 2780-2784 The determination of the rodenticide tetramethylenedisulfotetramine (TETS) in drinking water is reportable through the use of automated sample preparation via solid phase extraction and detection using isotope dilution gas chromatography-mass spectrometry. The method was characterized over twenty-two analytical batches with quality control samples. Accuracies for low and high concentration quality control pools were 100 and 101%, respectively. The minimum reporting level (MRL) for TETS in this method is 0.50 g L-1. Five drinking waters representing a range of water quality parameters and disinfection practices were fortified with TETS at ten times the MRL and analyzed over a 28 day period to determine the stability of TETS in these waters. The amount of TETS measured in these samples averaged 100 +/- 6% of the amount fortified suggesting that tap water samples may be held for up to 28 days prior to analysis. |
Assessment of blood lead levels among children aged ≤ 5 years - Zamfara State, Nigeria, June-July 2012
Bashir M , Umar-Tsafe N , Getso K , Kaita IM , Nasidi A , Sani-Gwarzo N , Nguku P , Davis L , Brown MJ . MMWR Morb Mortal Wkly Rep 2014 63 (15) 325-7 Since 2010, Nigerian state and federal governments and the international community have been responding to an outbreak of lead poisoning caused by the processing of lead-containing gold ore in Zamfara State, Nigeria, that resulted in the deaths of approximately 400 children aged ≤5 years. Widespread education, surveys of high-risk villages, testing of blood lead levels (BLLs), medical treatment, and environmental cleanup all have been implemented. To evaluate the success of these remediation efforts in reducing the prevalence of lead poisoning and dangerous work practices, a population-based assessment of children's BLLs and ore processing techniques was conducted during June-July 2012. The assessment found few children in need of medical treatment, significantly lower BLLs, and substantially less exposure of children to dangerous work practices. Public health strategies designed to identify and treat children with lead poisoning, clean up existing environmental hazards, and prevent children from being exposed to dangerous ore processing techniques can produce a sustained reduction in BLLs. |
Association of blood lead level with neurological features in 972 children affected by an acute severe lead poisoning outbreak in Zamfara State, northern Nigeria
Greig J , Thurtle N , Cooney L , Ariti C , Ahmed AO , Ashagre T , Ayela A , Chukwumalu K , Criado-Perez A , Gomez-Restrepo C , Meredith C , Neri A , Stellmach D , Sani-Gwarzo N , Nasidi A , Shanks L , Dargan PI . PLoS One 2014 9 (4) e93716 BACKGROUND: In 2010, Medecins Sans Frontieres (MSF) investigated reports of high mortality in young children in Zamfara State, Nigeria, leading to confirmation of villages with widespread acute severe lead poisoning. In a retrospective analysis, we aimed to determine venous blood lead level (VBLL) thresholds and risk factors for encephalopathy using MSF programmatic data from the first year of the outbreak response. METHODS AND FINDINGS: We included children aged ≤5 years with VBLL ≥45 microg/dL before any chelation and recorded neurological status. Odds ratios (OR) for neurological features were estimated; the final model was adjusted for age and baseline VBLL, using random effects for village of residence. 972 children met inclusion criteria: 885 (91%) had no neurological features; 34 (4%) had severe features; 47 (5%) had reported recent seizures; and six (1%) had other neurological abnormalities. The geometric mean VBLLs for all groups with neurological features were >100 microg/dL vs 65.9 microg/dL for those without neurological features. The adjusted OR for neurological features increased with increasing VBLL: from 2.75, 95%CI 1.27-5.98 (80-99.9 microg/dL) to 22.95, 95%CI 10.54-49.96 (≥120 microg/dL). Neurological features were associated with younger age (OR 4.77 [95% CI 2.50-9.11] for 1-<2 years and 2.69 [95%CI 1.15-6.26] for 2-<3 years, both vs 3-5 years). Severe neurological features were seen at VBLL <105 microg/dL only in those with malaria. INTERPRETATION: Increasing VBLL (from ≥80 microg/dL) and age 1-<3 years were strongly associated with neurological features; in those tested for malaria, a positive test was also strongly associated. These factors will help clinicians managing children with lead poisoning in prioritising therapy and developing chelation protocols. |
National patterns of Escherichia coli O157 infections, USA, 1996-2011
Sodha SV , Heiman K , Gould LH , Bishop R , Iwamoto M , Swerdlow DL , Griffin PM . Epidemiol Infect 2014 143 (2) 1-7 US public health laboratories began reporting Escherichia coli O157 isolates to CDC in 1996. We describe temporal and geographical patterns of isolates reported from 1996 to 2011 and demographics of persons whose specimens yielded isolates. We calculated annual E. coli O157 isolation rates/100 000 persons by patient's state of residence, county of residence, age, and sex using census data. The average annual isolation rate was 0.84. The average isolation rate in northern states (1.52) was higher than in southern states (0.43). Counties with 76% rural population had a lower isolation rate (0.67) than counties with 25%, 26-50%, and 51-75% rural populations (0.81, 0.92, and 0.81, respectively). The highest isolation rate (3.19) was in children aged 1-4 years. Infections were seasonal with 49% of isolates collected during July to September. Research into reasons for higher incidence in northern states and for seasonality could guide strategies to prevent illnesses. |
Incidence and trends of infection with pathogens transmitted commonly through food - Foodborne Diseases Active Surveillance Network, 10 U.S. sites, 2006-2013
Crim SM , Iwamoto M , Huang JY , Griffin PM , Gilliss D , Cronquist AB , Cartter M , Tobin-D'Angelo M , Blythe D , Smith K , Lathrop S , Zansky S , Cieslak PR , Dunn J , Holt KG , Lance S , Tauxe R , Henao OL . MMWR Morb Mortal Wkly Rep 2014 63 (15) 328-32 Foodborne disease continues to be an important problem in the United States. Most illnesses are preventable. To evaluate progress toward prevention, the Foodborne Diseases Active Surveillance Network (FoodNet) monitors the incidence of laboratory-confirmed infections caused by nine pathogens transmitted commonly through food in 10 U.S. sites, covering approximately 15% of the U.S. population. This report summarizes preliminary 2013 data and describes trends since 2006. In 2013, a total of 19,056 infections, 4,200 hospitalizations, and 80 deaths were reported. For most infections, incidence was well above national Healthy People 2020 incidence targets and highest among children aged <5 years. Compared with 2010-2012, the estimated incidence of infection in 2013 was lower for Salmonella, higher for Vibrio, and unchanged overall.dagger Since 2006-2008, the overall incidence has not changed significantly. More needs to be done. Reducing these infections requires actions targeted to sources and pathogens, such as continued use of Salmonella poultry performance standards and actions mandated by the Food Safety Modernization Act (FSMA). FoodNet provides federal and state public health and regulatory agencies as well as the food industry with important information needed to determine if regulations, guidelines, and safety practices applied across the farm-to-table continuum are working. |
Increase in Vibrio parahaemolyticus infections associated with consumption of Atlantic Coast shellfish - 2013
Newton AE , Garrett N , Stroika SG , Halpin JL , Turnsek M , Mody RK . MMWR Morb Mortal Wkly Rep 2014 63 (15) 335-6 Vibrio parahaemolyticus (Vp) is found naturally in coastal saltwater. In the United States, Vp causes an estimated 35,000 domestically acquired foodborne infections annually, of which most are attributable to consumption of raw or undercooked shellfish. Illness typically consists of mild to moderate gastroenteritis, although severe infection can occur. Demographic, clinical, and exposure information (including traceback information on implicated seafood) for all laboratory-confirmed illnesses are reported by state health departments to CDC through the Cholera and Other Vibrio Surveillance system. Vp isolates are distinguished by serotyping (>90 serotypes have been described) and by pulsed-field gel electrophoresis (PFGE). |
HIV risk perception and behavior among sex workers in three major urban centers of Mozambique
Langa J , Sousa C , Sidat M , Kroeger K , McLellan-Lemal E , Belani H , Patel S , Shodell D , Shodell M , Benech I , Needle R . PLoS One 2014 9 (4) e94838 HIV risk perceptions and behaviors of 236 commercial sex workers from three major Mozambican urban centers were studied using the International Rapid Assessment, Response and Evaluation (I-RARE) methodology. All were offered HIV testing and, in Maputo, syphilis testing was offered as well. Sixty-three of the 236 opted for HIV testing, with 30 (48%) testing positive for HIV. In Maputo, all 30 receiving HIV tests also had syphilis testing, with 6 (20%) found to be positive. Results include interview excerpts and qualitative results using I-RARE methodology and AnSWR-assisted analyses of the interviews and focus group sessions. |
Strategies to prevent catheter-associated urinary tract infections in acute care hospitals: 2014 update
Lo E , Nicolle LE , Coffin SE , Gould C , Maragakis LL , Meddings J , Pegues DA , Pettis AM , Saint S , Yokoe DS . Infect Control Hosp Epidemiol 2014 35 (5) 464-79 Previously published guidelines are available that provide comprehensive recommendations for detecting and preventing healthcare-associated infections (HAIs). The intent of this document is to highlight practical recommendations in a concise format designed to assist acute care hospitals in implementing and prioritizing their catheter-associated urinary tract infection (CAUTI) prevention efforts. This document updates "Strategies to Prevent Catheter-Associated Urinary Tract Infections in Acute Care Hospitals," published in 2008. This expert guidance document is sponsored by the Society for Healthcare Epidemiology of America (SHEA) and is the product of a collaborative effort led by SHEA, the Infectious Diseases Society of America (IDSA), the American Hospital Association (AHA), the Association for Professionals in Infection Control and Epidemiology (APIC), and The Joint Commission, with major contributions from representatives of a number of organizations and societies with content expertise. The list of endorsing and supporting organizations is presented in the introduction to the 2014 updates. |
Introduction to "a compendium of strategies to prevent healthcare-associated infections in acute care hospitals: 2014 updates"
Yokoe DS , Anderson DJ , Berenholtz SM , Calfee DP , Dubberke ER , Ellingson K , Gerding DN , Haas J , Kaye KS , Klompas M , Lo E , Marschall J , Mermel LA , Nicolle L , Salgado C , Bryant K , Classen D , Crist K , Foster N , Humphreys E , Padberg J , Podgorny K , Vanamringe M , Weaver T , Wise R , Maragakis LL . Infect Control Hosp Epidemiol 2014 35 (5) 455-9 Since the publication of "A Compendium of Strategies to Prevent Healthcare-Associated Infections in Acute Care Hospitals" in 2008, prevention of healthcare-associated infections (HAIs) has become a national priority. Despite improvements, preventable HAIs continue to occur. The 2014 updates to the Compendium were created to provide acute care hospitals with up-to-date, practical, expert guidance to assist in prioritizing and implementing their HAI prevention efforts. It is the product of a highly collaborative effort led by the Society for Healthcare Epidemiology of America (SHEA), the Infectious Diseases Society of America (IDSA), the American Hospital Association (AHA), the Association for Professionals in Infection Control and Epidemiology (APIC), and The Joint Commission, with major contributions from representatives of a number of organizations and societies with content expertise, including the Centers for Disease Control and Prevention (CDC), the Institute for Healthcare Improvement (IHI), the Pediatric Infectious Diseases Society (PIDS), the Society for Critical Care Medicine (SCCM), the Society for Hospital Medicine (SHM), and the Surgical Infection Society (SIS). |
Safety of influenza vaccination during pregnancy: a review of subsequent maternal obstetric events and findings from two recent cohort studies
Naleway AL , Irving SA , Henninger ML , Li DK , Shifflett P , Ball S , Williams JL , Cragan J , Gee J , Thompson MG . Vaccine 2014 32 (26) 3122-7 Pregnant women and their infants are vulnerable to severe disease and secondary complications from influenza infection. For this reason, annual influenza vaccination is recommended for all pregnant women in the United States. Women frequently cite concerns about vaccine safety as a barrier to vaccination. This review describes the safety of inactivated influenza vaccination during pregnancy with a focus on maternal obstetric events, including hypertensive disorders, gestational diabetes, and chorioamnionitis. Included in the review are new findings from two studies which examined the safety of seasonal inactivated influenza vaccination during pregnancy. The first study enrolled 641 pregnant women during the 2010-2011 season and prospectively followed them until delivery or pregnancy termination. The second study enrolled 1616 pregnant women during the 2010-2011 influenza season, and followed the women and their infants for six months after delivery. No associations between inactivated influenza vaccination and gestational diabetes, gestational hypertension, preeclampsia/eclampsia, or chorioamnionitis were observed in either cohort. When considered as a whole, these studies should further reassure women and clinicians that influenza vaccination during pregnancy is safe for mothers. |
Vaccine preventable disease incidence as a complement to vaccine efficacy for setting vaccine policy
Gessner BD , Feikin DR . Vaccine 2014 32 (26) 3133-8 Traditionally, vaccines have been evaluated in clinical trials that establish vaccine efficacy (VE) against etiology-confirmed disease outcomes, a measure important for licensure. Yet, VE does not reflect a vaccine's public health impact because it does not account for relative disease incidence. An additional measure that more directly establishes a vaccine's public health value is the vaccine preventable disease incidence (VPDI), which is the incidence of disease preventable by vaccine in a given context. We describe how VE and VPDI can vary, sometimes in inverse directions, across disease outcomes and vaccinated populations. We provide examples of how VPDI can be used to reveal the relative public health impact of vaccines in developing countries, which can be masked by focus on VE alone. We recommend that VPDI be incorporated along with VE into the analytic plans of vaccine trials, as well as decisions by funders, ministries of health, and regulatory authorities. |
National and state-specific estimates of place of influenza vaccination among adult populations - United States, 2011-12 influenza season
Lu PJ , O'Halloran A , Ding H , Williams WW , Bridges CB , Kennedy ED . Vaccine 2014 32 (26) 3198-204 BACKGROUND: Annual influenza vaccination has been recommended for all persons ≥6 months since the 2010-11 season. New partnerships between public health agencies and medical and nonmedical vaccination providers have increased the number of vaccination providers and locations where vaccination services are delivered. METHODS: Data from the 2011-12 Behavioral Risk Factor Surveillance System (BRFSS) were analyzed. Point estimates of place of vaccination and 95% confidence intervals were calculated. Multivariable logistic regression and predictive marginal modeling were conducted to identify factors associated with vaccination settings. RESULTS: Among adults vaccinated during the 2011-12 influenza season, a doctor's office was the most common place (38.4%) for receipt of influenza vaccination, with stores (e.g., supermarkets or drug stores) (20.1%) the next common, and workplaces (17.6%) the third common. Overall, reported vaccination in nonmedical settings by state ranged from 32.2% in California to 60.4% in Nevada, with a median of 45.8%. Characteristics significantly associated with an increased likelihood of receipt of vaccination in nonmedical settings were higher education, not having certain identified high-risk conditions, not having had a routine checkup in the previous 12 months, and not having a primary doctor for health care. Being a member of a racial/ethnic minority group, unemployed or not in the work force were significantly associated with a decreased likelihood of receipt of vaccination in nonmedical settings. CONCLUSION: Doctor's offices were the most common medical setting for adult influenza vaccination; workplaces and stores were important nonmedical settings. Increasing access to vaccination services in medical and nonmedical settings should be considered as important strategies for improving vaccination coverage. These results also can help guide development of strategies for achieving Healthy People 2020 objectives for influenza vaccination of adult populations. |
Pertussis resurgence: perspectives from the Working Group Meeting on Pertussis on the causes, possible paths forward, and gaps in our knowledge
Burns DL , Meade BD , Messionnier NE . J Infect Dis 2014 209 Suppl 1 S32-5 The incidence of reported pertussis has steadily increased in the United States since the 1980s, with a striking increase observed since 2005 [1]. Provisional case counts in the United States for 2012 exceed 41 000, with 14 deaths among infants [2]. This resurgence in pertussis that has been seen in the United States and other countries [3] has caused considerable concern. | On 6 March 2013, 64 experts in the field of pertussis vaccinology, from academia, government agencies, and pharmaceutical companies, met during the Working Group Meeting on Pertussis that was held in Bethesda, Maryland. This workshop offered a unique opportunity for experts to discuss possible causes of the resurgence in pertussis, the possible paths forward, and the remaining gaps in our knowledge. To take advantage of this collection of experts, 3 discussion sessions were held during the workshop to discuss (1) potential root cause(s) of the problem, (2) what interim solutions may exist, and (3) how the problem might be solved in the long term. At the end of the workshop, the experts agreed that use of the currently available vaccines is an important strategy but that longer-term solutions are necessary to more effectively control pertussis. No clear consensus was reached as to a single root cause of the problem nor did a clear long-term solution emerge. However, the group began to define gaps in knowledge, discussed hypotheses that could be tested, and suggested priorities for research and development. |
Effectiveness of ten-valent pneumococcal conjugate vaccine against invasive pneumococcal disease in Brazil: a matched case-control study
Domingues CM , Verani JR , Montenegro Renoiner EI , de Cunto Brandileone MC , Flannery B , de Oliveira LH , Santos JB , de Moraes JC . Lancet Respir Med 2014 2 (6) 464-71 BACKGROUND: In March 2010, Brazil introduced the ten-valent pneumococcal conjugate vaccine (PCV10), which was licensed based on non-inferiority of immunological correlates of protection compared with the seven-valent vaccine. The schedule comprised three primary doses at ages 2 months, 4 months, and 6 months, and a booster dose at age 12 months. A single catch-up dose was offered for children aged 12-23 months at the time of introduction. We assessed PCV10 effectiveness against invasive pneumococcal disease in Brazilian children. METHODS: Invasive pneumococcal disease, defined as isolation of Streptococcus pneumoniae from blood, cerebrospinal fluid, or another normally sterile site, was identified in children age-eligible for at least one PCV10 dose through laboratory-based and hospital-based surveillance in ten states in Brazil from March 1, 2010, until Dec 31, 2012. We aimed to identify four age-matched and neighbourhood-matched controls for each case. We used conditional logistic regression and calculated PCV10 effectiveness as (1-adjusted matched odds ratio) x 100% for vaccine-type and vaccine-related serotypes (ie, in the same serogroup as a vaccine serotype). FINDINGS: In 316 cases (median age 13.2 months, range 2.6-53.1) and 1219 controls (13.3 months, 2.6-53.1), the adjusted effectiveness of an age-appropriate PCV10 schedule was 83.8% (95% CI 65.9-92.3) against vaccine serotypes, and 77.9% (41.0-91.7) against vaccine-related serotypes. Serotype-specific effectiveness was shown for the two most common vaccine serotypes-14 (87.7%, 60.8-96.1) and 6B (82.8%, 23.8-96.1)-and serotype 19A (82.2%, 10.7-96.4), a serotype related to vaccine serotype 19F. A single catch-up dose in children aged 12-23 months was effective against vaccine-type disease (68.0%, 17.6-87.6). No significant effectiveness was shown against non-vaccine serotypes for age-appropriate or catch-up schedules. INTERPRETATION: In the routine immunisation programme in Brazil, PCV10 prevents invasive disease caused by vaccine serotypes. PCV10 might provide cross-protection against some vaccine-related serotypes. FUNDING: Brazilian Ministry of Health, Pan-American Health Organization, and US Centers for Disease Control and Prevention. |
Herpes zoster caused by vaccine-strain varicella zoster virus in an immunocompetent recipient of zoster vaccine
Tseng HF , Schmid DS , Harpaz R , Larussa P , Jensen NJ , Rivailler P , Radford K , Folster J , Jacobsen SJ . Clin Infect Dis 2014 58 (8) 1125-8 We report the first laboratory-documented case of herpes zoster caused by the attenuated varicella zoster virus (VZV) contained in Zostavax in a 68-year-old immunocompetent adult with strong evidence of prior wild-type VZV infection. The complete genome sequence of the isolate revealed that the strain carried 15 of 42 (36%) recognized varicella vaccine-associated single-nucleotide polymorphisms, including all 5 of the fixed vaccine markers present in nearly all of the strains in the vaccine. The case of herpes zoster was relatively mild and resolved without complications. |
Impact of rotavirus vaccination on diarrhea-related hospitalizations in Sao Paulo State, Brazil
Fernandes EG , Sato HK , Leshem E , Flannery B , Konstantyner TC , Veras MA , Patel MM . Vaccine 2014 32 (27) 3402-8 INTRODUCTION: Following introduction of routine infant rotavirus vaccination, severe diarrhea hospitalization rates declined among children aged <5 years throughout Brazil. Ensuring equity of rotavirus vaccine impact is important in countries that self-finance immunization programs. The objective of this study was to examine rotavirus vaccine impact on diarrhea admission rates among children aged <5 years in Brazil's public health system, according to area-based measures of human development in the state of Sao Paulo, Brazil. METHODS: Ecological analysis of public health system hospitalization rates for acute gastroenteritis among children aged <5 years in the state of Sao Paulo, Brazil, according to five categories of municipal development based on a modified Human Development Index for municipalities. Acute gastroenteritis hospitalization rates among children aged <5 years after national rotavirus vaccine introduction (2008-2011) were compared to rates in pre-vaccine years (2000-2005) to calculate percent decline in rates (1-rate ratio) and 95% confidence intervals (CI) for each municipal development category. Direct hospitalization costs during the two periods were compared. RESULTS: Annual rates declined by 40% (95% CI, 39-42%) from 631 diarrhea hospitalizations per 100,000 person years pre-rotavirus vaccination to 377 per 100,000 post-vaccination among children aged <5 years and 50% (95% CI, 48-52%) from 1009 to 505 per 100,000 among infants. Highest rates were observed in least developed municipalities. Significant declines of 26-52% among children <5 years and 41-63% among infants were observed in all categories of municipal development. Lower diarrhea hospitalization rates resulted in annual savings of approximately 2 million USD for the state of Sao Paulo. Savings in direct hospitalization costs benefitted municipalities in all five categories. CONCLUSION: The introduction of rotavirus vaccination was associated with substantial reductions of diarrhea-related admissions at all levels of municipal development in Sao Paulo State, Brazil. |
Influenza epidemiology and vaccine effectiveness among patients with influenza-like illness, viral watch sentinel sites, South Africa, 2005-2009
Ntshoe GM , McAnerney JM , Tempia S , Blumberg L , Moyes J , Buys A , Naidoo D , Venter M , Besselaar T , Schoub BD , Harris BN , Cohen C . PLoS One 2014 9 (4) e94681 BACKGROUND: There is limited data on the epidemiology of influenza and few published estimates of influenza vaccine effectiveness (VE) from Africa. In April 2009, a new influenza virus strain infecting humans was identified and rapidly spread globally. We compared the characteristics of patients ill with influenza A(H1N1)pdm09 virus to those ill with seasonal influenza and estimated influenza vaccine effectiveness during five influenza seasons (2005-2009) in South Africa. METHODS: Epidemiological data and throat and/or nasal swabs were collected from patients with influenza-like illness (ILI) at sentinel sites. Samples were tested for seasonal influenza viruses using culture, haemagglutination inhibition tests and/or polymerase chain reaction (PCR) and for influenza A(H1N1)pdm09 by real-time PCR. For the vaccine effectiveness (VE) analysis we considered patients testing positive for influenza A and/or B as cases and those testing negative for influenza as controls. Age-adjusted VE was calculated as 1-odds ratio for influenza in vaccinated and non-vaccinated individuals. RESULTS: From 2005 through 2009 we identified 3,717 influenza case-patients. The median age was significantly lower among patients infected with influenza A(H1N1)pdm09 virus than those with seasonal influenza, 17 and 27 years respectively (p<0.001). The vaccine coverage during the influenza season ranged from 3.4% in 2009 to 5.1% in 2006 and was higher in the ≥50 years (range 6.9% in 2008 to 13.2% in 2006) than in the <50 years age group (range 2.2% in 2007 to 3.7% in 2006). The age-adjusted VE estimates for seasonal influenza were 48.6% (4.9%, 73.2%); -14.2% (-9.7%, 34.8%); 12.0% (-70.4%, 55.4%); 67.4% (12.4%, 90.3%) and 29.6% (-21.5%, 60.1%) from 2005 to 2009 respectively. For the A(H1N1)pdm09 season, the efficacy of seasonal vaccine was -6.4% (-93.5%, 43.3%). CONCLUSION: Influenza vaccine demonstrated a significant protective effect in two of the five years evaluated. Low vaccine coverage may have reduced power to estimate vaccine effectiveness. |
Using information and communications technology in a national population-based survey: the Kenya AIDS Indicator Survey 2012
Ojwang JK , Lee VC , Waruru A , Ssempijja V , Ng'ang'a JG , Wakhutu BE , Kandege NO , Koske DK , Kamiru SM , Omondi KO , Kakinyi M , Kim AA , Oluoch T . J Acquir Immune Defic Syndr 2014 66 Suppl 1 S123-9 BACKGROUND: With improvements in technology, electronic data capture (EDC) for large surveys is feasible. EDC offers benefits over traditional paper-based data collection, including more accurate data, greater completeness of data, and decreased data cleaning burden. METHODS: The second Kenya AIDS Indicator Survey (KAIS 2012) was a population-based survey of persons aged 18 months to 64 years. A software application was designed to capture the interview, specimen collection, and home-based testing and counseling data. The application included: interview translations for local languages; options for single, multiple, and fill-in responses; and automated participant eligibility determination. Data quality checks were programmed to automate skip patterns and prohibit outlier responses. A data sharing architecture was developed to transmit the data in real-time from the field to a central server over a virtual private network. RESULTS: KAIS 2012 was conducted between October 2012 and February 2013. Overall, 68,202 records for the interviews, specimen collection, and home-based testing and counseling were entered into the application. Challenges arose during implementation, including poor connectivity and a systems malfunction that created duplicate records, which prevented timely data transmission to the central server. Data cleaning was minimal given the data quality control measures. CONCLUSIONS: KAIS 2012 demonstrated the feasibility of using EDC in a population-based survey. The benefits of EDC were apparent in data quality and minimal time needed for data cleaning. Several important lessons were learned, such as the time and monetary investment required before survey implementation, the importance of continuous application testing, and contingency plans for data transmission due to connectivity challenges. |
Three enzymatically active neurotoxins of Clostridium botulinum strain Af84: BoNT/A2, /F4, and /F5
Kalb SR , Baudys J , Smith TJ , Smith LA , Barr JR . Anal Chem 2014 86 (7) 3254-62 Botulinum neurotoxins (BoNTs) are produced by various species of clostridia and are potent neurotoxins which cause the disease botulism, by cleaving proteins needed for successful nerve transmission. There are currently seven confirmed serotypes of BoNTs, labeled A-G, and toxin-producing clostridia typically only produce one serotype of BoNT. There are a few strains (bivalent strains) which are known to produce more than one serotype of BoNT, producing either both BoNT/A and /B, BoNT/A and /F, or BoNT/B and /F, designated as Ab, Ba, Af, or Bf. Recently, it was reported that Clostridium botulinum strain Af84 has three neurotoxin gene clusters: bont/A2, bont/F4, and bont/F5. This was the first report of a clostridial organism containing more than two neurotoxin gene clusters. Using a mass spectrometry based proteomics approach, we report here that all three neurotoxins, BoNT/A2, /F4, and /F5, are produced by C. botulinum Af84. Label free MS(E) quantification of the three toxins indicated that toxin composition is 88% BoNT/A2, 1% BoNT/F4, and 11% BoNT/F5. The enzymatic activity of all three neurotoxins was assessed by examining the enzymatic activity of the neurotoxins upon peptide substrates, which mimic the toxins' natural targets, and monitoring cleavage of the substrates by mass spectrometry. We determined that all three neurotoxins are enzymatically active. This is the first report of three enzymatically active neurotoxins produced in a single strain of Clostridium botulinum. |
The torque on a dipole in uniform motion
Griffiths DJ , Hnizdo V . Am J Phys 2014 82 (3) 251-254 We calculate the torque on an ideal (point) dipole moving with constant velocity through uniform electric and magnetic fields. |
Tuberculin skin tests versus interferon-gamma release assays in tuberculosis screening among immigrant visa applicants
Chuke SO , Yen NT , Laserson KF , Phuoc NH , Trinh NA , Nhung DT , Mai VT , Qui AD , Hai HH , Loan le TH , Jones WG , Whitworth WC , Shah JJ , Painter JA , Mazurek GH , Maloney SA . Tuberc Res Treat 2014 2014 217969 OBJECTIVE: Use of tuberculin skin tests (TSTs) and interferon gamma release assays (IGRAs) as part of tuberculosis (TB) screening among immigrants from high TB-burden countries has not been fully evaluated. METHODS: Prevalence of Mycobacterium tuberculosis infection (MTBI) based on TST, or the QuantiFERON-TB Gold test (QFT-G), was determined among immigrant applicants in Vietnam bound for the United States (US); factors associated with test results and discordance were assessed; predictive values of TST and QFT-G for identifying chest radiographs (CXRs) consistent with TB were calculated. RESULTS: Of 1,246 immigrant visa applicants studied, 57.9% were TST positive, 28.3% were QFT-G positive, and test agreement was 59.4%. Increasing age was associated with positive TST results, positive QFT-G results, TST-positive but QFT-G-negative discordance, and abnormal CXRs consistent with TB. Positive predictive values of TST and QFT-G for an abnormal CXR were 25.9% and 25.6%, respectively. CONCLUSION: The estimated prevalence of MTBI among US-bound visa applicants in Vietnam based on TST was twice that based on QFT-G, and 14 times higher than a TST-based estimate of MTBI prevalence reported for the general US population in 2000. QFT-G was not better than TST at predicting abnormal CXRs consistent with TB. |
Multilevel regression and poststratification for small-area estimation of population health outcomes: a case study of chronic obstructive pulmonary disease prevalence using the Behavioral Risk Factor Surveillance System
Zhang X , Holt JB , Lu H , Wheaton AG , Ford ES , Greenlund KJ , Croft JB . Am J Epidemiol 2014 179 (8) 1025-33 A variety of small-area statistical models have been developed for health surveys, but none are sufficiently flexible to generate small-area estimates (SAEs) to meet data needs at different geographic levels. We developed a multilevel logistic model with both state- and nested county-level random effects for chronic obstructive pulmonary disease (COPD) using 2011 data from the Behavioral Risk Factor Surveillance System. We applied poststratification with the (decennial) US Census 2010 counts of census-block population to generate census-block-level SAEs of COPD prevalence which could be conveniently aggregated to all other census geographic units, such as census tracts, counties, and congressional districts. The model-based SAEs and direct survey estimates of COPD prevalence were quite consistent at both the county and state levels. The Pearson correlation coefficient was 0.99 at the state level and ranged from 0.88 to 0.95 at the county level. Our extended multilevel regression modeling and poststratification approach could be adapted for other geocoded national health surveys to generate reliable SAEs for population health outcomes at all administrative and legislative geographic levels of interest in a scalable framework. |
Evaluation of a Rapid Analyte Measurement Platform and real-time reverse-transcriptase polymerase chain reaction assay West Nile virus detection system in mosquito pools
Burkhalter KL , Horiuchi K , Biggerstaff BJ , Savage HM , Nasci RS . J Am Mosq Control Assoc 2014 30 (1) 21-30 We evaluated the commercially available Rapid Analyte Measurement Platform (RAMP (R)) West Nile virus (WNV) antigen detection test for sensitivity and consistency with real-time reverse transcriptase polymerase chain reaction (RT-PCR) confirmation testing. Panels of samples consisting of WNV-spiked mosquito pools and negative control pools were sent to 20 mosquito abatement districts (MADs) that processed the pools using the RAMP assay. The samples were then sent to the reference laboratories used by the MADs for confirmation by real-time RT-PCR. Positive pools with virus titers of roughly 1-3 log(10) PFU/ml had RAMP scores above the RAMP test positive cutoff score of 30 RAMP units, but these virus-positive samples could not be reliably confirmed by real-time RT-PCR testing. Pools with virus titers >= 4 log(10) PFU/ml scored >= 50 RAMP units. Real-time RT-PCR results varied among the confirmation laboratories. With few exceptions, pools returning a RAMP score of >= 100 were confirmed with real-time RT-PCR, while pools returning a RAMP score of 50-99 appeared to be at the limit of real-time RT-PCR detection. Therefore, we recommend using a positive cutoff of 50 RAMP units with no real-time RT-PCR confirmation to maximize speed, efficiency, and economy of the RAMP assay. A more conservative approach would be to implement a "gray zone'' range of 50-100 RAMP units. Pools scoring within the gray zone could be submitted for real-time RT-PCR confirmation with the understanding that positive pools may not confirm due to the inhibitory effect of the RAMP buffer on the real-time RT-PCR assay. We also conducted a series of experiments using laboratory-prepared mosquito pools spiked with WNV to compare mosquito homogenization buffers, pool sizes, and grinding methods in order to determine how these variables affect the RAMP and real-time RT-PCR assay results. |
Field evaluation of Abbott Real Time HIV-1 Qualitative Test for early infant diagnosis using dried blood spots samples in comparison to Roche COBAS Ampliprep/COBAS TaqMan HIV-1 Qual Test in Kenya
Chang J , Omuomo K , Anyango E , Kingwara L , Basiye F , Morwabe A , Shanmugam V , Nguyen S , Sabatier J , Zeh C , Ellenberger D . J Virol Methods 2014 204 25-30 Timely diagnosis and treatment of infants infected with HIV are critical for reducing infant mortality. High-throughput automated diagnostic tests like Roche COBAS AmpliPrep/COBAS TaqMan HIV-1 Qual Test (Roche CAPCTM Qual) and the Abbott Real Time HIV-1 Qualitative (Abbott Qualitative) can be used to rapidly expand early infant diagnosis testing services. In this study, the performance characteristics of the Abbott Qualitative were evaluated using two hundred dried blood spots (DBSs) samples (100 HIV-1 positive and 100 HIV-1 negative) collected from infants attending the antenatal facilities in Kisumu, Kenya. The Abbott Qualitative results were compared to the diagnostic testing completed using the Roche CAPCTM Qual in Kenya. The sensitivity and specificity of the Abbott Qualitative were 99.0% (95% CI: 95.0-100.0) and 100.0% (95% CI: 96.0-100.0), respectively, and the overall reproducibility was 98.0% (95% CI: 86.0-100.0). The limits of detection for the Abbott Qualitative and Roche CAPCTM Qual were 56.5 and 6.9copies/mL at 95% CIs (p=0.005), respectively. The study findings demonstrate that the Abbott Qualitative test is a practical option for timely diagnosis of HIV in infants. |
Inconclusive reverse transcription-PCR assay comparison for dengue virus detection and serotyping
Munoz-Jordan JL , Santiago GA . J Clin Microbiol 2014 52 (5) 1800 A recent comparative study by Waggoner et al. (1) claimed their reverse transcription-PCR (RT-PCR) assay was more sensitive than the CDC DENV-1-4 RT-PCR assay. Although a complete evaluation of the CDC assay was published several weeks before this letter to the editor (2), most of the analytic data were available to the authors in the package insert (3). The CDC assay was optimized and extensively evaluated as a diagnostic test for persons with suspected dengue in order to give unequivocal results in its positive range. Its limit of detection was set at a cutoff value (crossing threshold [CT]) of 37.00 to ensure very high confidence in a positive result, with low likelihood of a false-positive result (2). The Waggoner et al. assay employs a CT of 40.00 (4) without publication of data demonstrating the reliability of results obtained at this cutoff and do not represent false-positive results. Most CDC diagnostic PCR assays (FDA approved or not) find CTs above 37.00, but these values are often in the equivocal range of the assay (5,–9). Waggoner's comparison reported several positive samples in their assay, mostly at >5 days of illness, which were considered negative by the CDC assay because they exceeded the 37.00-CT threshold. Surveillance systems usually detect most suspected dengue cases during the first 5 days of illness; however, the authors' study sample included 61 specimens obtained <5 days after the onset of illness and 82 specimens obtained ≥5 days after the onset of illness. Although the authors indicate this was a random sample, this distribution of specimen collection times is skewed toward late dengue case presentations and is not reflective of the situation in most settings or geographic areas where dengue is endemic. In addition, the distribution of DENV serotypes allowed for a comparison of only dengue virus serotype 1 (DENV-1) and DENV-3. Compared to their evaluation of the assay published just 3 months earlier, both the DENV-1 probe (18/37 nucleotide differences) and their thermocycling protocol were significantly altered (1, 4). The authors offer no explanation for these modifications and claim to have unpublished data demonstrating no changes in performance (1). However, in their discussion, they attribute the improved performance of their assay to the changes in the probe for DENV-1, the predominant serotype in their evaluation specimens. It is interesting that in their discussion, the authors criticize FDA-approved assays for requiring later modifications, when they have done this for their own assay prior to comparing it to the CDC assay. It is notable that the authors often indicate “results not shown” for critical elements of their test validations (1, 4, 10), while an FDA-approved test provides these analytic results in the package insert. Finally, it is important to recognize that Waggoner et al. performed the CDC assay essentially “off-label”. They used the Qiagen Rotor-Gene Q, an instrument that was not approved by the FDA for use with the CDC assay; the package insert states that the ABI 7500 FAST Dx is the only equipment approved for the assay (3). The use of less than robust comparison methods calls into question the conclusions of this study. |
Concentrations and stability of methyl methacrylate, glutaraldehyde, formaldehyde and nickel sulfate in commercial patch test allergen preparations
Siegel PD , Fowler JF , Law BF , Warshaw EM , Taylor JS . Contact Dermatitis 2014 70 (5) 309-15 BACKGROUND: Epicutaneous patch tests are used to reproduce allergy and diagnose allergic contact dermatitis. Reliable allergen test preparations are required. OBJECTIVES: The purpose of the present study was to measure the actual concentrations of nickel(II) sulfate hexahydrate (NiSO4 ), methyl methacrylate, formaldehyde, and glutaraldehyde, and to compare them with the labelled concentrations, in commercial patch test allergen preparations found in dermatology clinics where patch testing is routinely performed. MATERIALS AND METHODS: The commercial in-date and out-of-date patch test allergen preparations concentrations of NiSO4 , methyl methacrylate, formaldehyde and glutaraldehyde from one to three participating clinics were analysed with chromatographic or wet chemical techniques. RESULTS: NiSO4 and formaldehyde concentrations were at or above the labelled concentrations; however, formaldehyde loss occurred with storage. NiSO4 particulate was uniformly distributed throughout the petrolatum. 'In-use' methyl methacrylate reagent syringes all contained ≤ 56% of the 2% label concentration, with no observable relationship with expiration date. Lower methyl methacrylate cocentrations were consistently measured at the syringe tip end, suggesting loss resulting from methyl methacrylate's volatility. The concentrations of glutaraldehyde patch test allergen preparations ranged from 27% to 45% of the labelled (1% in pet.) concentration, independently of expiration date. CONCLUSIONS: Some false-negative methyl methacrylate, formaldehyde or glutaraldehyde patch test results may be attributable to instability of the test preparations. |
Concerns regarding a new culture method for Borrelia burgdorferi not approved for the diagnosis of Lyme disease
Nelson C , Hojvat S , Johnson B , Petersen J , Schriefer M , Beard CB , Petersen L , Mead P . MMWR Morb Mortal Wkly Rep 2014 63 (15) 333 In 2005, CDC and the Food and Drug Administration (FDA) issued a warning regarding the use of Lyme disease tests whose accuracy and clinical usefulness have not been adequately established. Often these are laboratory-developed tests (also known as "home brew" tests) that are manufactured and used within a single laboratory and have not been cleared or approved by FDA. Recently, CDC has received inquiries regarding a laboratory-developed test that uses a novel culture method to identify Borrelia burgdorferi, the spirochete that causes Lyme disease. Patient specimens reportedly are incubated using a two-step pre-enrichment process, followed by immunostaining with or without polymerase chain reaction (PCR) analysis. Specimens that test positive by immunostaining or PCR are deemed "culture positive". Published methods and results for this laboratory-developed test have been reviewed by CDC. The review raised serious concerns about false-positive results caused by laboratory contamination and the potential for misdiagnosis. |
Development, evaluation and comparison of two independent sampling and analytical methods for ortho-phthalaldehyde vapors and condensation aerosols in air
Tucker SP . Anal Methods 2014 6 (8) 2592-2607 Two independent sampling and analytical methods for ortho-phthalaldehyde (OPA) in air have been developed, evaluated and compared: (1) a reagent-coated solid sorbent HPLC-UV method and (2) an impinger-fluorescence method. In the first method, air sampling is conducted at 1.0 L min-1 with a sampler containing 350 mg of silica gel coated with 1 mg of acidified 2,4-dinitrophenylhydrazine (DNPH). After sampling, excess DNPH in ethyl acetate is added to the sampler prior to storage for 68 hours. The OPA-DNPH derivative is eluted with 4.0 mL of dimethyl sulfoxide (DMSO) for measurement by HPLC with a UV detector set at 385 nm. The estimated detection limit is 0.016 g per sample or 0.067 g m-3 (0.012 ppb) for a 240 L air sample. Recoveries of vapor spikes at levels of 1.2 to 6.2 g were 96 to 101%. Recoveries of spikes as mixtures of vapor and condensation aerosols were 97 to 100%. In the second method, air sampling is conducted at 1.0 L min-1 with a midget impinger containing 10 mL of DMSO solution containing N-acetyl-l-cysteine and ethylenediamine. The fluorescence reading is taken 80 min after the completion of air sampling. Since the time of taking the fluorescence reading is critical, the reading is taken with a portable fluorometer. The estimated detection limit is 0.024 g per sample or 0.1 g m-3 (0.018 ppb) for a 240 L air sample. Recoveries of OPA vapor spikes at levels of 1.4 to 5.0 g per sample were 97 to 105%. Recoveries of spikes as mixtures of vapors and condensation aerosols were 95 to 99%. The collection efficiency for a mixture of vapor and condensation aerosol was 99.4%. The two methods were compared side-by-side in a generation system constructed for producing controlled atmospheres of OPA vapor in air. Average air concentrations of OPA vapor found by both methods agreed within 10%. 2014 the Partner Organisations. |
Validation of obstetric estimate of gestational age on US birth certificates
Dietz PM , Bombard JM , Hutchings YL , Gauthier JP , Gambatese MA , Ko JY , Martin JA , Callaghan WM . Am J Obstet Gynecol 2014 210 (4) 335.e1-5 OBJECTIVE: The birth certificate variable obstetric estimate of gestational age (GA) has not been previously validated against GA based on estimated date of delivery from medical records. STUDY DESIGN: We estimated sensitivity, specificity, positive predictive value, negative predictive value and the corresponding 95% confidence intervals (CIs) for preterm delivery (<37 weeks' gestation) based on obstetric estimate using estimated date of delivery-based GA as the gold standard. Trained abstractors obtained the estimated date of delivery from the prenatal record (64.8% in New York City, and 94.6% in Vermont), or, when not available, from the hospital delivery record for 2 population-based samples: 586 live births delivered in New York City and 649 live births delivered in Vermont during 2009. Weights were applied to account for nonresponse and sampling design. RESULTS: In New York City, the preterm delivery rate based on estimated date of delivery was 9.7% (95% CI, 7.6-12.4) and 8.2% (95% CI, 6.3-10.6) based on obstetric estimate; in Vermont, it was 6.8% (95% CI, 5.4-8.4) based on estimated date of delivery and 6.3% (95% CI, 5.1-7.8) based on obstetric estimate. In New York City, sensitivity of obstetric estimate-based preterm delivery was 82.5% (95% CI, 69.4-90.8), specificity 98.1% (95% CI, 96.4-99.1), positive predictive value 98.0% (95% CI, 95.2-99.2), and negative predictive value 98.8% (95% CI, 99.6-99.9). In Vermont, sensitivity of obstetric estimate-based preterm delivery was 93.8% (95% CI, 81.8-98.1), specificity 99.6% (95% CI, 98.5-99.9), positive predictive value 100%, and negative predictive value 100%. CONCLUSION: Obstetric estimate-based preterm delivery had excellent specificity, positive predictive value and negative predictive value. Sensitivity was moderate in New York City and excellent in Vermont. These results suggest obstetric estimate-based preterm delivery from the birth certificate is useful for the surveillance of preterm delivery. |
Maternal exposure to criteria air pollutants and congenital heart defects in offspring: results from the National Birth Defects Prevention Study
Stingone JA , Luben TJ , Daniels JL , Fuentes M , Richardson DB , Aylsworth AS , Herring AH , Anderka M , Botto L , Correa A , Gilboa SM , Langlois PH , Mosley B , Shaw GM , Siffel C , Olshan AF . Environ Health Perspect 2014 122 (8) 863-72 BACKGROUND: Epidemiologic literature suggests exposure to air pollutants is associated with fetal development. OBJECTIVES: To investigate maternal exposures to air pollutants during weeks two through eight of pregnancy and congenital heart defects. METHODS: Mothers from the National Birth Defects Prevention Study, a nine-state case-control study, were assigned one-week and seven-week averages of daily maximum concentrations of carbon monoxide, nitrogen dioxide, ozone, and sulfur dioxide and 24-hour measurements of fine and coarse particulate matter using the closest air monitor within 50 km to their residence during early pregnancy. Depending upon the pollutant, a maximum of 4632 live-birth controls and 3328 live-birth, fetal-death or electively terminated cases had exposure data. Hierarchical regression models, adjusted for maternal demographics, tobacco and alcohol use, were constructed. Principal component analysis was used to assess these relationships in a multipollutant context. RESULTS: Positive associations were observed between exposure to nitrogen dioxide and coarctation of the aorta and pulmonary valve stenosis. Exposure to fine particulate matter was positively associated with hypoplastic left heart syndrome but inversely associated with atrial septal defects. Examining individual exposure-weeks suggested associations between pollutants and defects that were not observed using the seven-week average. Associations between left ventricular outflow tract obstructions and nitrogen dioxide and hypoplastic left heart syndrome and particulate matter were supported by findings from the multipollutant analyses, although estimates were attenuated at the highest exposure levels. CONCLUSIONS: Utilizing daily maximum pollutant levels and exploring individual exposure-weeks revealed some positive associations between certain pollutants and defects and suggested potential windows of susceptibility during pregnancy. |
Maternal intake of vitamin E and birth defects, National Birth Defects Prevention Study, 1997 to 2005
Gilboa SM , Lee KA , Cogswell ME , Traven FK , Botto LD , Riehle-Colarusso T , Correa A , Boyle CA . Birth Defects Res A Clin Mol Teratol 2014 100 (9) 647-57 BACKGROUND: In a recent study, high maternal periconceptional intake of vitamin E was found to be associated with risk of congenital heart defects (CHDs). To explore this association further, we investigated the association between total daily vitamin E intake and selected birth defects. METHODS: We analyzed data from 4525 controls and 8665 cases from the 1997 to 2005 National Birth Defects Prevention Study. We categorized estimated periconceptional energy-adjusted total daily vitamin E intake from diet and supplements into quartiles (referent, lowest quartile). Associations between quartiles of energy-adjusted vitamin E intake and selected birth defects were adjusted for demographic, lifestyle, and nutritional factors. RESULTS: We observed a statistically significant association with the third quartile of vitamin E intake (odds ratio [OR], 1.17; 95% confidence interval [CI], 1.01-1.35) and all CHDs combined. Among CHD sub-types, we observed associations with left ventricular outflow tract obstruction defects, and its sub-type, coarctation of the aorta and the third quartile of vitamin E intake. Among defects other than CHDs, we observed associations between anorectal atresia and the third quartile of vitamin E intake (OR, 1.66; 95% CI, 1.01-2.72) and hypospadias and the fourth quartile of vitamin E intake (OR, 1.42; 95% CI, 1.09-1.87). CONCLUSION: Selected quartiles of energy-adjusted estimated total daily vitamin E intake were associated with selected birth defects. However, because these few associations did not exhibit exposure-response patterns consistent with increasing risk associated with increasing intake of vitamin E, further studies are warranted to corroborate our findings. |
Orphans and vulnerable children in Kenya: results from a nationally representative population-based survey
Lee VC , Muriithi P , Gilbert-Nandra U , Kim AA , Schmitz ME , Odek J , Mokaya R , Galbraith JS . J Acquir Immune Defic Syndr 2014 66 Suppl 1 S89-97 BACKGROUND: In Kenya, it is estimated that there are approximately 3.6 million children aged <18 years who have been orphaned or who are vulnerable. We examined the data from the second Kenya AIDS Indicator Survey (KAIS 2012) to determine the number and profile of orphans and vulnerable children (OVC) in Kenya who were aged <18 years. METHODS: KAIS 2012 was a nationally representative, population-based household survey. We analyzed the data for all the children from birth to age 17 years who resided in an eligible household so as to determine whether their parents were alive or had been very ill to define their OVC status. RESULTS: We estimated that there were 2.6 million OVC in Kenya in 2012, of whom 1.8 million were orphans and 750,000 were vulnerable. Among orphans, 15% were double orphans. Over one-third of all the OVC were aged between 10 and 14 years. Households with ≥1 OVC (12% of all households) were usually in the lowest 2 wealth quintiles, and 22% of OVC households had experienced moderate or severe hunger. Receipt of OVC support services was low for medical (3.7%), psychological (4.1%), social (1.3%), and material support (6.2%); educational support was slightly more common (11.5%). Orphanhood among children aged <15 years increased from 1993 to 2003 (P < 0.01) but declined from 2003 to 2012 (P < 0.01). CONCLUSIONS: The 2.6 million OVC constitute a significant proportion of Kenya's population aged <18 years. Special attention should be paid to OVC to prevent further vulnerability and ensure their well-being and development as they transition into adulthood. |
Iron-containing micronutrient supplementation of Chinese women with no or mild anemia during pregnancy improved iron status but did not affect perinatal anemia
Mei Z , Serdula MK , Liu JM , Flores-Ayala RC , Wang L , Ye R , Grummer-Strawn LM . J Nutr 2014 144 (6) 943-8 Universal prenatal daily iron-folic acid (IFA) and multiple micronutrient (MM) supplements are recommended to reduce the risk of low birth weight, maternal anemia, and iron deficiency (ID) during pregnancy, but the evidence of their effect on iron status among women with mild or no anemia is limited. The aim of this study was to describe the iron status [serum ferritin (SF), serum soluble transferrin receptor (sTfR), and body iron (BI)] before and after micronutrient supplementation during pregnancy. We examined 834 pregnant women with hemoglobin > 100 g/L at enrollment before 20 wk of gestation and with iron measurement data from a subset of a randomized, double-blind trial in China. Women were randomly assigned to take daily 400 mug of folic acid (FA) (control), FA plus 30 mg of iron, or FA, iron, plus 13 additional MMs provided before 20 wk of gestation to delivery. Venous blood was collected in this subset during study enrollment (before 20 wk of gestation) and 28-32 wk of gestation. We found that, at 28-32 wk of gestation, compared with the FA group, both the IFA and MM groups had significantly lower prevalence of ID regardless of which indicator (SF, sTfR, or BI) was used for defining ID. The prevalence of ID at 28-32 wk of gestation for IFA, MM, and FA were 35.3%, 42.7%, and 59.6% by using low SF, 53.6%, 59.9%, and 69.9% by using high sTfR, and 34.5%, 41.2%, and 59.6% by using low BI, respectively. However, there was no difference in anemia prevalence (hemoglobin < 110 g/L) between FA and IFA or MM groups. We concluded that, compared with FA alone, prenatal IFA and MM supplements provided to women with no or mild anemia improved iron status later during pregnancy but did not affect perinatal anemia. This trial was registered at clinicaltrials.gov as NCT00137744. |
Clinical care for opioid-using pregnant and postpartum women: the role of obstetric providers
Jones HE , Deppen K , Hudak ML , Leffert L , McClelland C , Sahin L , Starer J , Terplan M , Thorp JM Jr , Walsh J , Creanga AA . Am J Obstet Gynecol 2014 210 (4) 302-10 We review clinical care issues that are related to illicit and therapeutic opioid use among pregnant women and women in the postpartum period and outline the major responsibilities of obstetrics providers who care for these patients during the antepartum, intrapartum, and postpartum periods. Selected patient treatment issues are highlighted, and case examples are provided. Securing a strong rapport and trust with these patients is crucial for success in delivering high-quality obstetric care and in coordinating services with other specialists as needed. Obstetrics providers have an ethical obligation to screen, assess, and provide brief interventions and referral to specialized treatment for patients with drug use disorders. Opioid-dependent pregnant women often can be treated effectively with methadone or buprenorphine. These medications are classified as pregnancy category C medications by the Food and Drug Administration, and their use in the treatment of opioid-dependent pregnant patients should not be considered "off-label." Except in rare special circumstances, medication-assisted withdrawal during pregnancy should be discouraged because of a high relapse rate. Acute pain management in this population deserves special consideration because patients who use opioids can be hypersensitive to pain and because the use of mixed opioid-agonist/antagonists can precipitate opioid withdrawal. In the absence of other indications, pregnant women who use opioids do not require more intense medical care than other pregnant patients to ensure adequate treatment and the best possible outcomes. Together with specialists in pain and addiction medicine, obstetricians can coordinate comprehensive care for pregnant women who use opioids and women who use opioids in the postpartum period. |
Differences between the fourth and fifth Korotkoff phases among children and adolescents
Freedman DS , Foltz JL , Berenson GS . Am J Hypertens 2014 27 (12) 1495-502 BACKGROUND: The relative importance of the fourth (K4) and fifth (K5) Korotkoff phases as the indicator of diastolic blood pressure (DBP) levels among children remains uncertain. METHODS: In a sample of 11,525 youth aged 5-17, we examined interexaminer differences in these 2 phases and the relation of theses 2 phases to adult blood pressure levels and hypertension. The longitudinal analyses were conducted among 2,156 children who were re-examined after age 25 years. RESULTS: Mean (+/-SD) levels of DBP were 62 (+/-9) mm Hg (K4) and 49 (+/-13) mm Hg (K5). K4 showed less interobserver variability than did K5, and 7% of the children had at least 1 (of 6) K5 value of 0mm Hg. Longitudinal analyses indicated that K4 was more strongly associated with adult blood pressure levels and hypertension. In correlational analyses of subjects who were not using antihypertensive medications in adulthood (n = 1,848), K4 was more strongly associated with the adult DBP level than was K5 (r = 0.22 vs. 0.17; P < 0.01). Analyses of adult hypertension (based on high blood pressure levels or use of antihypertensive medications) indicated that the screening performance of childhood levels of K4 was similar to that of systolic blood pressure and was higher than that of K5, with areas under the receiver operator characteristic curves of 0.63 (systolic blood pressure), 0.63 (K4), and 0.57 (K5). CONCLUSIONS: As compared with K5 levels among children, K4 shows less interobserver variability and is more strongly associated with adult hypertension. |
Measuring the effects of lighting distribution on walking speed and head pitch with wearable inertial measurement units
Patts J , Sammarco JJ , Eiter B . IEEE Trans Ind Appl 2014 50 (2) 1483-1489 A comparative human performance evaluation of a miner's walking speed and head pitch was conducted on miners wearing two types of LED cap lamps. Walking speed and head pitch are indirect indicators of improved lighting. The better that miners can see the floor, the faster they can walk and the less they pitch their heads downward to illuminate the floor with their cap lamps. NIOSH researchers developed a non-contact way to quantify human performance by using two small wireless, wearable inertial measurement units. Data were collected in the field from nine coal miners in an underground coal mine. The field results showed no statistical difference between the two cap lamps for walking speed. However, there was a trend of 2\circ lower head pitch for one of the cap lamps. The field testing procedures were then replicated in a controlled laboratory environment and the results indicated a 5-degree lower head tilt when using the same cap lamp and a corresponding difference in walking speed. A novel application of magnetometers for distance flagging is also presented. Finally, study limitations and a follow-up study are discussed. |
Student-reported school drinking fountain availability by youth characteristics and state plumbing codes
Onufrak SJ , Park S , Wilking C . Prev Chronic Dis 2014 11 E60 INTRODUCTION: Caloric intake among children could be reduced if sugar-sweetened beverages were replaced by plain water. School drinking water infrastructure is dictated in part by state plumbing codes, which generally require a minimum ratio of drinking fountains to students. Actual availability of drinking fountains in schools and how availability differs according to plumbing codes is unknown. METHODS: We abstracted state plumbing code data and used the 2010 YouthStyles survey data from 1,196 youth aged 9 through 18 years from 47 states. We assessed youth-reported school drinking fountain or dispenser availability and differences in availability according to state plumbing codes, sociodemographic characteristics, and area-level characteristics. RESULTS: Overall, 57.3% of youth reported that drinking fountains or dispensers in their schools were widely available, 40.1% reported there were only a few, and 2.6% reported that there were no working fountains. Reported fountain availability differed significantly (P < .01) by race/ethnicity, census region, the fountain to student ratio specified in plumbing codes, and whether plumbing codes allowed substitution of nonplumbed water sources for plumbed fountains. "Widely available" fountain access ranged from 45.7% in the West to 65.4% in the Midwest and was less common where state plumbing codes required 1 fountain per more than 100 students (45.4%) compared with 1 fountain per 100 students (60.1%) or 1 fountain per fewer than 100 students (57.6%). CONCLUSION: Interventions designed to increase consumption of water may want to consider the role of plumbing codes in availability of school drinking fountains. |
Airborne manganese as dust vs. fume determining blood levels in workers at a manganese alloy production plant
Park RM , Baldwin M , Bouchard MF , Mergler D . Neurotoxicology 2014 45 267-75 The appropriate exposure metrics for characterizing manganese (Mn) exposure associated with neurobehavioral effects have not been established. Blood levels of Mn (B-Mn) provide a potentially important intermediate marker of Mn airborne exposures. Using data from a study of a population of silicon- and ferro-manganese alloy production workers employed between 1973 and 1991, B-Mn levels were modeled in relation to prior Mn exposure using detailed work histories and estimated respirable Mn concentrations from air-sampling records. Despite wide variation in exposure levels estimated for individual jobs, duration of employment (exposure) was itself a strong predictor of B-Mn levels and strongest when an 80-day half-life was applied to contributions over time (t=6.95, 7.44, respectively; p<10-5). Partitioning exposure concentrations based on process origin into two categories: (1) "large" respirable particulate (Mn-LRP) derived mainly from mechanically generated dust, and (2) "small" respirable particulate (Mn-SRP) primarily electric furnace condensation fume, revealed that B-Mn levels largely track the small, fume exposures. With a half-life of 65 days applied in a model with cumulative exposure terms for both Mn-LRP (t=-0.16, p=0.87) and Mn-SRP (t=6.45, p<10-5), the contribution of the large-size fraction contribution was negligible. Constructing metrics based on the square root of SRP exposure concentrations produced a better model fit (t=7.87 vs. 7.44, R2=0.2333 vs. 0.2157). In a model containing both duration (t=0.79, p=0.43) and (square root) fume (t=2.47, p=0.01) metrics, the duration term was a weak contributor. Furnace-derived, small respirable Mn particulate appears to be the primary contributor to B-Mn levels, with a dose-rate dependence in a population chronically exposed to Mn, with air-concentrations declining in recent years. These observations may reflect the presence of homeostatic control of Mn levels in the blood and other body tissues and be useful in assessing Mn exposures for evaluating neurotoxic effects. |
Analysis of the effects of surface stiffness on the contact interaction between a finger and a cylindrical handle using a three-dimensional hybrid model
Wu JZ , Dong RG , Warren CM , Welcome DE , McDowell TW . Med Eng Phys 2014 36 (7) 831-41 Contact interactions between the hand and handle, such as the contact surface softness and contact surface curvature, will affect both physical effort and musculoskeletal fatigue, thereby the comfort and safety of power tool operations. Previous models of hand gripping can be categorized into two groups: multi-body dynamic models and finite element (FE) models. The goal of the current study is to develop a hybrid FE hand gripping model, which combines the features of conventional FE models and multi-body dynamic models. The proposed model is applied to simulate hand-gripping on a cylindrical handle with covering materials of different softness levels. The model included three finger segments (distal, middle, and proximal phalanxes), three finger joints (the distal interphalangeal (DIP), proximal interphalangeal (PIP), and metacarpophalangeal (MCP) joint), and major anatomical substructures. The model was driven by joint moments, which are the net effects of all passive and active muscular forces acting about the joints. The finger model was first calibrated by using experimental data of human subject tests, and then applied to investigate the effects of surface softness on contact interactions between a finger and a cylindrical handle. Our results show that the maximal compressive stress and strain in the soft tissues of the fingers can be effectively reduced by reducing the stiffness of the covering material. |
Coccidioidomycosis among cast and crew members at an outdoor television filming event - California, 2012
Wilken JA , Marquez P , Terashita D , McNary J , Windham G , Materna B . MMWR Morb Mortal Wkly Rep 2014 63 (15) 321-4 In March 2013, the California Department of Public Health (CDPH) identified two Doctor's First Reports of Occupational Injury or Illness (DFRs) regarding Los Angeles County residents who had worked at the same jobsite in January 2012 and had been evaluated for possible work-associated coccidioidomycosis (valley fever). Occupational exposure to Coccidioides, the causative fungi, typically is associated with soil-disrupting activities. The physicians noted that both workers were cast or crew members filming a television series episode, and the site of possible exposure was an outdoor set in Ventura County, California. On the basis of their job titles, neither would have been expected to have been engaged in soil-disrupting activities. Los Angeles County Department of Public Health (LACDPH) conducted an outbreak investigation by using CDPH-provided occupational surveillance records, traditional infectious disease surveillance, and social media searches. This report describes the results of that investigation, which identified a total of five laboratory-confirmed and five probable cases linked to this filming event. The employer and site manager were interviewed. The site manager stated that they would no longer allow soil-disruptive work at the site and would incorporate information about the potential risk for Coccidioides exposure onsite into work contracts. Public health professionals, clinicians, and the television and film industry should be aware that employees working outdoors in areas where Coccidioides is endemic (e.g., central and southern California), even those not engaged in soil-disruptive work, might be at risk for coccidioidomycosis. |
Discrimination, harassment, abuse, and bullying in the workplace: contribution of workplace injustice to occupational health disparities
Okechukwu CA , Souza K , Davis KD , de Castro AB . Am J Ind Med 2014 57 (5) 573-86 BACKGROUND: This paper synthesizes research on the contribution of workplace injustices to occupational health disparities. METHODS: We conducted a broad review of research and other reports on the impact of workplace discrimination, harassment, and bullying on workers' health and on family and job outcomes. RESULTS: Members of demographic minority groups are more likely to be victims of workplace injustice and suffer more adverse outcomes when exposed to workplace injustice compared to demographic majority groups. A growing body of research links workplace injustice to poor psychological and physical health, and a smaller body of evidence links workplace injustice to unhealthy behaviors. Although not as well studied, studies show that workplace injustice can influence workers' health through effects on workers' family life and job-related outcomes. CONCLUSION: Injustice is a key contributor to occupational health injustice and prospective studies with oversample of disadvantaged workers and refinement of methods for characterizing workplace injustices are needed. |
Maintenance and repair injuries in US mining
Pollard J , Heberger J , Dempsey PG . J Qual Maint Eng 2014 20 (1) 20-31 PURPOSE: The purpose of this paper is to identify key tasks, tools, and equipment associated with maintenance and repair injuries at US mines and to provide some mitigation strategies to reduce these types of injuries. DESIGN/METHODOLOGY/APPROACH: This study analyzed incidents resulting in injuries reported to the US Mine Safety and Health Administration from 2002 to 2011. Incident reports were limited to those occurring at mining plants, shops, yards, and aboveground locations. Incident reports were analyzed to determine which activities contributed to injuries and were due to machine maintenance and repair, non-powered hand tools, and powered hand tools. An in-depth analysis of the root causes of these injuries was then performed. FINDINGS: Maintenance and repair in mining is associated with a significant number of hand and finger injuries with a range of severities and averaging over 20 amputated fingers, 180 fractured hands and fingers, and 455 hand and finger lacerations per year. Many of these injuries are caused by hands being struck by or caught in tools and equipment. Back and shoulder strains are found to be associated with the most days lost from work and are mostly attributed to materials handling. PRACTICAL IMPLICATIONS: Occupational injuries and fatalities still occur with high incidences in the mining sector. The mission of the Office of Mine Safety and Health Research (OMSHR; part of the National Institute for Occupational Safety and Health, NIOSH) is to "eliminate mining fatalities, injuries, and illnesses through research and prevention." As part of this work, OMSHR acquires surveillance data from MSHA to quantify the types and sources of injuries at US mining facilities. The authors evaluated maintenance- and repair-related injuries at US mining sites (excluding underground coal mines). Results of this study suggest a need for improved design of machine guarding, improved hand protection through gloves and equipment design/redesign, and manual materials handling solutions. ORIGINALITY/VALUE: The findings indicate that maintenance and repair in mining include occupational risks that may be managed through modifications to machines, proper usage of hand tools and hand protection, and improved manual materials handling processes. |
Preliminary molecular characterizations of Sarcoptes scaibiei (Acari: Sarcoptidae) from farm animals in Egypt.
Amer S , Wahab TA , Metwaly Ael N , Ye J , Roellig D , Feng Y , Xiao L . PLoS One 2014 9 (4) e94705 Little is known about the genetic diversity of Sarcoptes scabiei mites in farm animals in Egypt. In this study, we characterized S. scabiei in 25 skin scrapes from water buffalo, cattle, sheep, and rabbits at the nuclear marker ITS2 and mitochondrial markers COX1 and 16S rRNA. Sequences of the ITS2 showed no host segregation or geographical isolation, whereas those of the mitochondrial COX1 and 16S rRNA genes indicated the presence of both host-adapted and geographically segregated populations of S. scabiei. Host adaptation may limit inter-species transmission of. S. scabiei, thus restrict gene flow among S. scabiei from different hosts. This is the first report on the molecular characterization of sarcoptic mites in Egypt. Further genetic studies involving larger numbers of specimens, especially those from humans and companion animals, are needed to understand the molecular epidemiology of sarcoptic mange in Egypt. |
Prevalence of malaria parasitemia and purchase of artemisinin-based combination therapies (ACTs) among drug shop clients in two regions in Tanzania with ACT subsidies
Briggs MA , Kalolella A , Bruxvoort K , Wiegand R , Lopez G , Festo C , Lyaruu P , Kenani M , Abdulla S , Goodman C , Kachur SP . PLoS One 2014 9 (4) e94074 BACKGROUND: Throughout Africa, many people seek care for malaria in private-sector drug shops where diagnostic testing is often unavailable. Recently, subsidized artemisinin-based combination therapies (ACTs), a first-line medication for uncomplicated malaria, were made available in these drug shops in Tanzania. This study assessed the prevalence of malaria among and purchase of ACTs by drug shop clients in the setting of a national ACT subsidy program and sub-national drug shop accreditation program. METHOD AND FINDINGS: A cross-sectional survey of drug shop clients was performed in two regions in Tanzania, one with a government drug shop accreditation program and one without, from March-May, 2012. Drug shops were randomly sampled from non-urban districts. Shop attendants were interviewed about their education, training, and accreditation status. Clients were interviewed about their symptoms and medication purchases, then underwent a limited physical examination and laboratory testing for malaria. Malaria prevalence and predictors of ACT purchase were assessed using univariate analysis and multiple logistic regression. Amongst 777 clients from 73 drug shops, the prevalence of laboratory-confirmed malaria was 12% (95% CI: 6-18%). Less than a third of clients with malaria had purchased ACTs, and less than a quarter of clients who purchased ACTs tested positive for malaria. Clients were more likely to have purchased ACTs if the participant was <5 years old (aOR: 6.6; 95% CI: 3.9-11.0) or the shop attendant had >5 years, experience (aOR: 2.8; 95% CI: 1.2-6.3). Having malaria was only a predictor of ACT purchase in the region with a drug shop accreditation program (aOR: 3.4; 95% CI: 1.5-7.4). CONCLUSION: Malaria is common amongst persons presenting to drug shops with a complaint of fever. The low proportion of persons with malaria purchasing ACTs, and the high proportion of ACTs going to persons without malaria demonstrates a need to better target who receives ACTs in these drug shops. |
Theory-based behavioral intervention increases self-reported physical activity in South African men: a cluster-randomized controlled trial
Jemmott JB 3rd , Jemmott LS , Ngwane Z , Zhang J , Heeren GA , Icard LD , O'Leary A , Mtose X , Teitelman A , Carty C . Prev Med 2014 64 114-20 OBJECTIVE: To determine whether a health-promotion intervention increases South African men's adherence to physical-activity guidelines. METHOD: We utilized a cluster-randomized controlled trial design. Eligible clusters, residential neighborhoods near East London, South Africa, were matched in pairs. Within randomly selected pairs, neighborhoods were randomized to theory-based, culturally congruent health-promotion intervention encouraging physical activity or attention-matched HIV/STI risk-reduction control intervention. Men residing in the neighborhoods and reporting coitus in the previous 3months were eligible. Primary outcome was self-reported individual-level adherence to physical-activity guidelines averaged over 6-month and 12-month post-intervention assessments. Data were collected in 2007-2010. Data collectors, but not facilitators or participants, were blind to group assignment. RESULTS: Primary outcome intention-to-treat analysis included 22 of 22 clusters and 537 of 572 men in the health-promotion intervention and 22 of 22 clusters and 569 of 609 men in the attention-control intervention. Model-estimated probability of meeting physical-activity guidelines was 51.0% in the health-promotion intervention and 44.7% in attention-matched control (OR=1.34; 95% CI, 1.09-1.63), adjusting for baseline prevalence and clustering from 44 neighborhoods. CONCLUSION: A theory-based culturally congruent intervention increased South African men's self-reported physical activity, a key contributor to deaths from non-communicable diseases in South Africa. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT01490359. |
Odds of getting adequate physical activity by dog walking
Soares J , Epping J , Owens C , Brown D , Lankford TJ , Simoes E , Caspersen C . J Phys Act Health 2014 12 Suppl 1 S102-9 BACKGROUND: We aimed to determine the likelihood that adult dog owners who walk their dogs will achieve a healthy level of moderate-intensity (MI) physical activity (PA), defined as at least 150 mins/wk. METHODS: We conducted a systematic search of 6 databases with data from 1990 to 2012 on dog owners' PA, to identify those who achieved MIPA. To compare dog-walkers' performance with non-dog walkers, we used a random effects model to estimate unadjusted odds ratio (OR) and corresponding 95% confidence interval (CI). RESULTS: We retrieved 9 studies that met our inclusion criterion and allowed OR calculations. These yielded data on 6980 dog owners aged 18 to 81 years (41% men). Among them, 4463 (63.9%) walked their dogs. Based on total weekly PA, 2710 (60.7%) dog walkers, and 950 (37.7%) non-dog walkers achieved at least MIPA. The estimated OR was 2.74 (95% CI 2.09-3.60). CONCLUSION: Across 9 published studies, almost 2 in 3 dog owners reported walking their dogs, and the walkers are more than 2 (1/2) times more likely to achieve at least MIPA. These findings suggest that dog walking may be a viable strategy for dog owners to help achieve levels of PA that may enhance their health. |
Development of a set of indicators to evaluate Injury Control Research Centers
Runyan C , Garrettson M , Yee SL . Eval Rev 2014 38 (2) 133-159 BACKGROUND: Few methods have been defined for evaluating the individual and collective impacts of academic research centers. In this project, with input from injury center directors, we systematically defined indicators to assess the progress and contributions of individual Injury Control Research Centers (ICRCs) and, ultimately, to monitor progress of the overall injury center program. METHOD: We used several methods of deriving a list of recommended priority and supplemental indicators. This included published literature review, telephone interviews with selected federal agency staff, an e-mail survey of injury center directors, an e-mail survey of staff at the Centers for Disease Control and Prevention, a two-stage Delphi process (e-mailed), and an in-person focus group with injury center directors. We derived the final indicators from an analysis of ratings of potential indicators by center directors and CDC staff. We also examined qualitative responses to open-ended items that address conceptual and implementation issues. RESULTS: All currently funded ICRCs participated in at least one part of the process, resulting in a list of 27 primary indicators (some with subcomponents), 31 supplemental indicators, and multiple suggestions for using the indicators. CONCLUSION: Our results support an approach that combines standardized definitions and quantifiable indicators with qualitative reporting, which allows consideration of center distinctions and priorities. The center directors urged caution in using the indicators, given funding constraints and recognition of unique institutional environments. While focused on injury research centers, we suggest these indicators also may be useful to academic research centers of other types. |
Strengthening national health laboratories in sub-Saharan Africa: a decade of remarkable progress
Alemnji GA , Zeh C , Yao K , Fonjungo PN . Trop Med Int Health 2014 19 (4) 450-8 OBJECTIVES: Efforts to combat the HIV/AIDS pandemic have underscored the fragile and neglected nature of some national health laboratories in Africa. In response, national and international partners and various governments have worked collaboratively over the last several years to build sustainable laboratory capacities within the continent. Key accomplishments reflecting this successful partnership include the establishment of the African-based World Health Organization Regional Office for Africa (WHO-AFRO) Stepwise Laboratory Quality Improvement Process Towards Accreditation (SLIPTA); development of the Strengthening Laboratory Management Toward Accreditation (SLMTA) training programme; and launching of a Pan African-based institution, the African Society for Laboratory Medicine (ASLM). These platforms continue to serve as the foundations for national health laboratory infrastructure enhancement, capacity development and overall quality system improvement. Further targeted interventions should encourage countries to aim at integrated tiered referral networks, promote quality system improvement and accreditation, develop laboratory policies and strategic plans, enhance training and laboratory workforce development and a retention strategy, create career paths for laboratory professionals and establish public-private partnerships. Maintaining the gains and ensuring sustainability will require concerted action by all stakeholders with strong leadership and funding from African governments and from the African Union. |
Responding to the Syrian crisis: the needs of women and girls
Sami S , Williams HA , Krause S , Onyango MA , Burton A , Tomczyk B . Lancet 2014 383 (9923) 1179-81 Women and girls are disproportionately affected by conflict because of a lack of access to essential services, as learnt from humanitarian crises in recent years.1, 2 Poor access to sexual assault treatment and emergency obstetric care can contribute to negative health outcomes.1 In Syria, women and girls are strongly affected by the recent conflict and, according to the UN Population Fund, about 1·7 million women and girls might need access to reproductive health services.3 Because women often have an essential role in postconflict reconstruction, their basic needs should be met so they can emerge from this ongoing crisis as essential stakeholders in the recovery process. | The Syrian civil war has entered its third year, resulting in 6·8 million people who need humanitarian assistance, with 5·1 million people internally displaced and 79% of refugees living in urban settings (not camps).4, 5 These estimates change daily as the fighting intensifies. Access to internally displaced people for international organisations is becoming more difficult in Syria.6 The poor access to civilians restricts humanitarian assistance and is a violation of international humanitarian law, which could ultimately result in loss of life.7 Numbers of displaced Syrians are expected to continue to rise.8 The Regional Response Plan for Syria,9 released in June, 2013, requests the humanitarian community to respond to this crisis. At present, only 40% of the total funding requested for Syria has been received.4 Inclusion of long-term planning of comprehensive reproductive health services is imperative to reduce risk factors for reproductive-health-associated causes of morbidity and mortality. |
Content Index (Achived Edition)
- Chronic Diseases and Conditions
- Communicable Diseases
- Disease Reservoirs and Vectors
- Drug Safety
- Environmental Health
- Food Safety
- Health Behavior and Risk
- Healthcare Associated Infections
- Immunity and Immunization
- Informatics
- Laboratory Sciences
- Maternal and Child Health
- Mining
- Nutritional Sciences
- Occupational Safety and Health
- Occupational Safety and Health - Mining
- Parasitic Diseases
- Physical Activity
- Program Evaluation
- Public Health Leadership and Management
- Reproductive Health
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CDC Science Clips is an online, continuously updated, searchable database of scientific literature published by CDC authors. Each article features an Altmetric Attention Score to track social and mainstream media mentions. If you are aware of a CDC-authored publication that does not appear in this database, please let us know.
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