Racial disparities in prostate cancer incidence rates by census division in the United States, 1999-2008
Cook MB , Rosenberg PS , McCarty FA , Wu M , King J , Eheman C , Anderson WF . Prostate 2015 75 (7) 758-63 BACKGROUND: Black men have a higher incidence of prostate cancer than white men in the U.S., but little is known whether incidence or racial differences vary geographically. Understanding these differences may assist future studies on causes of prostate cancer. To address such, we leverage the unique resource of the National Program of Cancer Registries (NPCR) combined with Surveillance, Epidemiology and End Results (SEER). METHODS: Prostate cancer counts and population denominators by race (black, white), age, calendar year, and U.S. census division, for the period 1999-2008, were extracted from NPCR and SEER. We calculated age-standardized incidence rates (ASR) and estimated annual percent changes (EAPC) by race and census division. We assessed black-to-white incidence rate ratios (BWIRR) by census division and by calendar period. RESULTS: This analysis included 1,713,471 prostate cancer cases and 1,217 million person-years. Black ASRs ranged from 176 per 100,000 person-years in Mountain division to 259 in Middle Atlantic. BWIRRs ranged from 1.20 in Western divisions to 1.72 in Southeastern divisions. EAPCs indicated that prostate cancer incidence is not decreasing in East South Central, unlike all other divisions. White EAPCs displayed similar variations by census division, resulting in modest temporal changes in BWIRRs. CONCLUSIONS: Within the U.S., there exists significant geographic variability in prostate cancer incidence rates. Although there are large geographic differences in BWIRRs, temporal trends are fairly stable. This may indicate that primary factors affecting prostate cancer incidence rates vary geographically but affect both black and white men to a similar degree. Prostate 75: 758-763, 2015. Published 2015. This article is a U.S. Government work and is in the public domain in the USA. |
South African National Cancer Registry: effect of withheld data from private health systems on cancer incidence estimates
Singh E , Underwood JM , Nattey C , Babb C , Sengayi M , Kellett P . S Afr Med J 2015 105 (2) 107-109 BACKGROUND: The National Cancer Registry (NCR) was established as a pathology-based cancer reporting system. From 2005 to 2007, private health laboratories withheld cancer reports owing to concerns regarding voluntary sharing of patient data. OBJECTIVES: To estimate the impact of under-reported cancer data from private health laboratories. METHODS: A linear regression analysis was conducted to project expected cancer cases for 2005 - 2007. Differences between actual and projected figures were calculated to estimate percentage under-reporting. RESULTS: The projected NCR case total varied from 53 407 (3.8% net increase from actual cases reported) in 2005 to 54 823 (3.7% net increase) in 2007. The projected number of reported cases from private laboratories in 2005 was 26 359 (19.7% net increase from actual cases reported), 27 012 (18.8% net increase) in 2006 and 27 666 (28.4% net increase) in 2007. CONCLUSION: While private healthcare reporting decreased by 28% from 2005 to 2007, this represented a minimal impact on overall cancer reporting (net decrease of <4%). |
Metabolic risk factors in U.S. youth with low relative muscle mass
Kim S , Valdez R . Obes Res Clin Pract 2015 9 (2) 125-32 AIMS: To examine the association between relative muscle mass (RMM) and nine risk factors for cardiovascular disease and diabetes (CVD/DM) in U.S. youth. METHODS: We used a sample representative of the U.S. population of youth, aged 8-20 years (NHANES 1999-2004). We compared the prevalence of adverse levels of nine CVD/DM risk factors between youths in the lowest quartile of RMM and their peers in the remaining quartiles, controlling for age, sex, and race/ethnicity. We also examined variations in the adjusted prevalence of these risk factors along the entire range of RMM. RESULTS: The adjusted prevalence of adverse levels of risk factors among youths in the lowest quartile of RMM was significantly higher for seven of the nine risk factors examined compared with their peers in the other quartiles. Over the entire range of RMM, the adjusted prevalence of adverse levels of each of these seven risk factors decreased gradually with increasing RMM values (all p for trend <0.001). CONCLUSIONS: RMM and prevalence of adverse risk factors for CVD/DM are highly and inversely associated in U.S. youth. Among youth with low RMM, the risk of these chronic diseases could be significantly high later in life. |
Cancer screening test use - United States, 2013
Sabatino SA , White MC , Thompson TD , Klabunde CN . MMWR Morb Mortal Wkly Rep 2015 64 (17) 464-8 Regular breast, cervical, and colorectal cancer (CRC) screening with timely and appropriate follow-up and treatment reduces deaths from these cancers. Healthy People 2020 targets for cancer screening test use have been established, based on the most recent U.S. Preventive Services Task Force (USPSTF) guidelines. National Health Interview Survey (NHIS) data are used to monitor progress toward the targets. CDC used the 2013 NHIS, the most recent data available, to examine breast, cervical, and CRC screening use. Although some demographic subgroups attained targets, screening use overall was below the targets with no improvements from 2010 to 2013 in breast, cervical, or CRC screening use. Cervical cancer screening declined from 2010 to 2013. Increased efforts are needed to achieve targets and reduce screening disparities. |
Cervical cancer screening among adult women in China, 2010
Wang B , He M , Chao A , Engelgau MM , Saraiya M , Wang L , Wang L . Oncologist 2015 20 (6) 627-34 INTRODUCTION: Cervical cancer is one of the most commonly diagnosed cancers among women in China. The World Health Organization (WHO) recommends routine screening for cervical cancer, and the WHO Global Monitoring Framework suggests that every nation monitors cervical cancer screening. However, little information is available on cervical cancer screening behavior among women in China. METHODS: We used data from the 2010 China Chronic Disease and Risk Factor Surveillance System that included 51,989 women aged 18 years and older. We report the proportion of women who reported ever having had a Papanicolaou (Pap) test, stratified by sociodemographic characteristics and geographic region. Multivariable logistic regression modeling was performed to adjust for potential confounders. RESULTS: Overall, 21% of 51,989 women reported having ever had a Pap test. The highest proportion was reported among women aged 30-39 years (30.1%, 95% confidence interval, 26.8%-33.4%). In all geographic regions, women in rural areas were consistently less likely than women in urban areas to report having had a Pap test. Among women who reported ever having a Pap test, 82% reported having the most recent test in the past 3 years. Factors associated with reporting ever having a test were being aged 30-49 years, higher education, being married, and having urban health insurance. CONCLUSION: Our results indicate that screening programs need to be strengthened along with a more intense focus on specific demographic groups. National cervical cancer screening guidelines and comprehensive implementation strategies are needed to make screening services available and accessible to all women. |
Cluster of inhibitors among adult inpatients with haemophilia in a single institution
Ishaku NG , Key NS , Miller CH , Nielsen B , Buckner T , Chen SL , Hooper WC , Soucie JM . Haemophilia 2015 21 (4) e325-8 In June 2012, an academic haematologist in a tertiary health facility notified the Centers for Disease Control and Prevention (CDC) of new onset inhibitors during hospitalization in four previously treated people with haemophilia (PWH). The four patients were considered at low risk for this complication. Inhibitor onset occurred among patients hospitalized during a 14-month period, whereas no inhibitor cases had occurred among inpatients during the previous 12-month period. All four cases had received a recombinant clotting factor concentrate (CFC) from a single manufacturer, raising concern about a possible product-related issue. The situation was reported to the North Carolina Department of Health and Human Services who advised that an investigation be carried out and requested assistance from CDC. | This report summarizes the results of the investigation conducted with the following specific aims: (i) to determine whether the cases represented an increase in the baseline inhibitor incidence among inpatients with haemophilia at the index facility; (ii) to assess whether the cases were at greater risk for an inhibitor than other inpatients with haemophilia as a result of personal, clinical or treatment factors; and (iii) to evaluate the possible influence of changes in hospital practices related to CFC use during the period. |
Antigenic cooperation among intrahost HCV variants organized into a complex network of cross-immunoreactivity.
Skums P , Bunimovich L , Khudyakov Y . Proc Natl Acad Sci U S A 2015 112 (21) 6653-8 Hepatitis C virus (HCV) has the propensity to cause chronic infection. Continuous immune escape has been proposed as a mechanism of intrahost viral evolution contributing to HCV persistence. Although the pronounced genetic diversity of intrahost HCV populations supports this hypothesis, recent observations of long-term persistence of individual HCV variants, negative selection increase, and complex dynamics of viral subpopulations during infection as well as broad cross-immunoreactivity (CR) among variants are inconsistent with the immune-escape hypothesis. Here, we present a mathematical model of intrahost viral population dynamics under the condition of a complex CR network (CRN) of viral variants and examine the contribution of CR to establishing persistent HCV infection. The model suggests a mechanism of viral adaptation by antigenic cooperation (AC), with immune responses against one variant protecting other variants. AC reduces the capacity of the host's immune system to neutralize certain viral variants. CRN structure determines specific roles for each viral variant in host adaptation, with variants eliciting broad-CR antibodies facilitating persistence of other variants immunoreacting with these antibodies. The proposed mechanism is supported by empirical observations of intrahost HCV evolution. Interference with AC is a potential strategy for interruption and prevention of chronic HCV infection. |
Relationship Between Ebola Virus Real-Time Quantitative Polymerase Chain Reaction-Based Threshold Cycle Value and Virus Isolation From Human Plasma.
Spengler JR , McElroy AK , Harmon JR , Stroher U , Nichol ST , Spiropoulou CF . J Infect Dis 2015 212 Suppl 2 S346-9 We performed a longitudinal analysis of plasma samples obtained from 4 patients with Ebola virus (EBOV) disease (EVD) to determine the relationship between the real-time quantitative reverse transcriptase polymerase chain reaction (qRT-PCR)-based threshold cycle (Ct) value and the presence of infectious EBOV. EBOV was not isolated from plasma samples with a Ct value of >35.5 or >12 days after onset of symptoms. EBOV was not isolated from plasma samples in which anti-EBOV nucleoprotein immunoglobulin G was detected. These data demonstrate the utility of interpreting qRT-PCR results in the context of the course of EBOV infection and associated serological responses for patient-management decisions. |
Race and the Public Health Impact Potential of Pre-Exposure Prophylaxis in the United States
Schneider JA , Bouris A , Smith DK . J Acquir Immune Defic Syndr 2015 70 (1) e30-2 We read with great interest the report on baseline data from the US pre-exposure prophylaxis (PrEP) Demonstration Project,1 the first study to assess the feasibility and acceptability of delivering PrEP to men who have sex with men (MSM) in the United States. The data describe the cohort participating in a prospective, open-label study assessing PrEP delivery through STD clinics in San Francisco and Miami, as well as a community health center in Washington DC. This is an important work given the potential for PrEP (emtricitabine/tenofovir) to have a significant impact in limiting HIV acquisition with >90% efficacy among those with high adherence, as evidenced by detectable drug levels.2 Moreover, identifying clients who are at increased risk for HIV, such as those who seek services at STD clinics, will have the greatest public health impact for every dollar spent.3 The authors make an important distinction between clients enrolled in the study who were self-referred and those who were referred by clinic staff and conclude that interest in PrEP is high among a diverse population of MSM in these settings. Although the overall results suggest that there is high interest among MSM, a few aspects of the study require further clarification for readers to fully understand the public health impact potential and real-world implications. These areas include explicating the classification of race/ethnicity, clinic referral processes, and the rationale for choosing a measure of risk. In addition, we discuss concerns that require additional attention as PrEP is implemented with the goal of HIV elimination. |
Remembering mumps
Latner DR , Hickman CJ . PLoS Pathog 2015 11 (5) e1004791 The mumps virus belongs to the family of paramyxoviruses. It has a single-strand, nonsegmented, negative-sense RNA genome and is spread by the respiratory route. Following a 12–25-day incubation period, infection frequently causes the classic symptom of mumps: painfully swollen parotid salivary glands (parotitis). Some complications of infection include hearing loss, orchitis, oophoritis, mastitis, and pancreatitis. Mumps may also result in aseptic meningitis and, infrequently, encephalitis (5%–10% and <0.5% of unvaccinated cases, respectively) [6]. Importantly it has been estimated that as many as 30% of infections in unvaccinated individuals may be asymptomatic [7]. |
Socio-demographic, behavioral and health characteristics of underage female sex workers in Mozambique: the need to protect a generation from HIV risk
Inguane C , Horth RZ , Miranda AE , Young PW , Sathane I , Cummings BE , Augusto A , Raymond HF , McFarland W . AIDS Behav 2015 19 (12) 2184-93 Characteristics, HIV risk, and program coverage for underage female sex workers (FSW) are rarely systematically described worldwide. We compared characteristics of underage (15-17 years old) and adult (≥18 years old) FSW in three main urban areas of Mozambique (Maputo, Beira and Nampula) using data from three respondent-driven sampling surveys implemented in 2011-2012. Among survey participants, 9.8 % (39/400) in Maputo, 17.0 % (70/411) in Beira and 25.6 % (110/429) in Nampula were underage. Over half reported performing sex work to afford daily living, and 29.7-50.0 % had unprotected sex with their last client. The proportion of underage FSW having accessed care and prevention services was lower compared to adult FSW. While HIV prevalence among underage FSW was lower than in adults, it increased markedly with age. Our results point to the urgency of expanding prevention and care programs geared towards underage FSW. |
Temporal trends in patient characteristics and outcomes among children enrolled in Mozambique's national antiretroviral therapy program
Auld AF , Alfredo C , Macassa E , Jobarteh K , Shiraishi RW , Rivadeneira ED , Houston J , Spira TJ , Ellerbrock TV , Vaz P . Pediatr Infect Dis J 2015 34 (8) e191-9 BACKGROUND: During 2004-2009, >12,000 children (<15 years old) initiated antiretroviral therapy (ART) in Mozambique. Nationally representative outcomes and temporal trends in outcomes were investigated. METHODS: Rates of death, loss to follow-up (LTFU), and attrition (death or LTFU) were evaluated in a nationally representative sample of 1,054 children, who initiated ART during 2004-2009 at 25 facilities randomly selected using probability-proportional-to-size sampling. RESULTS: At ART initiation during 2004-2009, 50% were male, median age was 3.3 years, median CD4% was 13%, median CD4 count was 375 cells/microL, and median weight-for-age z-score was -2.1. During 2004-2009, median time from HIV diagnosis to care initiation declined from 33 to 0 days (p=0.001), median time from care to ART declined from 93 to 62 days (p=0.004), the percentage aged <2 at ART initiation increased from 16% to 48% (p=0.021), the percentage of patients with prior tuberculosis declined from 50% to 10% (p=0.009), and the percentage with prior lymphocytic interstitial pneumonia declined from 16% to 1% (p<0.001). Over 2,652 person-years of ART, 183 children became LTFU and 26 died. Twelve-month attrition was 11% overall, but increased from 3% to 22% during 2004-2009, due mainly to increases in 12-month LTFU (from 3% to 18%). CONCLUSION: Declines in the prevalence of markers of advanced HIV disease at ART initiation probably reflect increasing ART access. However, 12-month LTFU increased during program expansion, and this negated any program improvements in outcomes that might have resulted from earlier ART initiation. |
Towards early inclusion of children in tuberculosis drugs trials: a consensus statement
Nachman S , Ahmed A , Amanullah F , Becerra MC , Botgros R , Brigden G , Browning R , Gardiner E , Hafner R , Hesseling A , How C , Jean-Philippe P , Lessem E , Makhene M , Mbelle N , Marais B , McIlleron H , McNeeley DF , Mendel C , Murray S , Navarro E , Anyalechi EG , Porcalla AR , Powell C , Powell M , Rigaud M , Rouzier V , Samson P , Schaaf HS , Shah S , Starke J , Swaminathan S , Wobudeya E , Worrell C . Lancet Infect Dis 2015 15 (6) 711-20 Children younger than 18 years account for a substantial proportion of patients with tuberculosis worldwide. Available treatments for paediatric drug-susceptible and drug-resistant tuberculosis, albeit generally effective, are hampered by high pill burden, long duration of treatment, coexistent toxic effects, and an overall scarcity of suitable child-friendly formulations. Several new drugs and regimens with promising activity against both drug-susceptible and drug-resistant strains have entered clinical development and are either in various phases of clinical investigation or have received marketing authorisation for adults; however, none have data on their use in children. This consensus statement, generated from an international panel of opinion leaders on childhood tuberculosis and incorporating reviews of published literature from January, 2004, to May, 2014, addressed four key questions: what drugs or regimens should be prioritised for clinical trials in children? Which populations of children are high priorities for study? When can phase 1 or 2 studies be initiated in children? What are the relevant elements of clinical trial design? The consensus panel found that children can be included in studies at the early phases of drug development and should be an integral part of the clinical development plan, rather than studied after regulatory approval in adults is obtained. |
What is the added benefit of oropharyngeal swabs compared to nasal swabs alone for respiratory virus detection in hospitalized children aged <10 years?
Dawood FS , Jara J , Estripeaut D , Vergara O , Luciani K , Corro M , de Leon T , Saldana R , Castillo Baires JM , Rauda Flores R , Cazares RA , Brizuela de Fuentes YS , Franco D , Gaitan M , Schneider E , Berman L , Azziz-Baumgartner E , Widdowson MA . J Infect Dis 2015 212 (10) 1600-3 We evaluated the added value of collecting both nasal and oropharyngeal swabs compared to nasal swabs alone for detection of common respiratory viruses by reverse-transcription polymerase chain reaction in hospitalized children aged <10 years. Nasal swabs had equal or greater sensitivity than oropharyngeal swabs for detection of respiratory syncytial virus, adenovirus, human metapneumoviruses, rhinovirus, and influenza viruses, but not parainfluenza viruses. The addition of an oropharyngeal swab compared to nasal swab alone increased detection of each respiratory virus by <10% in children aged <10 years. |
Mediation of an efficacious HIV risk reduction intervention for South African men
O'Leary A , Jemmott JB 3rd , Jemmott LS , Bellamy S , Icard LD , Ngwane Z . AIDS Behav 2015 19 (10) 1842-9 Men, Together Making a Difference! is an HIV/STD risk-reduction intervention that significantly increased self-reported consistent condom use during vaginal intercourse compared with a health-promotion attention-control intervention among men (N = 1181) in Eastern Cape Province, South Africa. The present analyses were designed to identify mediators of the intervention's efficacy. The potential mediators were Social Cognitive Theory (SCT) constructs that the intervention targeted, including several aspects of condom-use self-efficacy, outcome expectancies, and knowledge. Mediation was assessed using a product-of-coefficients approach where an alpha path (the intervention's effect on the potential mediator) and a beta path (the potential mediator's effect on the outcome of interest, adjusting for intervention) were estimated independently in a generalized estimating equations framework. Condom-use negotiation self-efficacy, technical-skill self-efficacy, and impulse-control self-efficacy were significant mediators. Although not mediators, descriptive norm and expected friends' approval of condom use predicted subsequent self-reported condom use, whereas the expected approval of sexual partner did not. The present results suggest that HIV/STD risk-reduction interventions that draw upon SCT and that address self-efficacy to negotiate condom use, to apply condoms correctly, and to exercise sufficient control when sexually aroused to use condoms may contribute to efforts to reduce sexual risk behavior among South African men. Future research must examine whether approaches that build normative support for condom use among men's friends are also efficacious. |
Norovirus outbreak associated with a natural lake used for recreation - Oregon, 2014
Zlot A , Simckes M , Vines J , Reynolds L , Sullivan A , Scott AK , McLuckie JM , Kromer D , Hill VR , Yoder JS , Hlavsa MC . MMWR Morb Mortal Wkly Rep 2015 64 (18) 485-90 In July 2014, Multnomah County public health officials investigated a norovirus outbreak among persons visiting Blue Lake Regional Park in Oregon. During the weekend of the reported illnesses (Friday, July 11-Sunday, July 13) approximately 15,400 persons visited the park. The investigation identified 65 probable and five laboratory-confirmed cases of norovirus infection (70 total cases). No hospitalizations or deaths were reported. Analyses from a retrospective cohort study revealed that swimming at Blue Lake during July 12-13 was significantly associated with illness during July 13-14 (adjusted relative risk = 2.3; 95% confidence interval [CI] = 1.1-64.9). Persons who swam were more than twice as likely to become ill compared with those who did not swim in the lake. To control the outbreak, Blue Lake was closed for 10 days to prevent further illness. This investigation underscores the need for guidance for determining when to reopen untreated recreational water venues (e.g., lakes) associated with outbreaks, and communication tools to inform the public about the risks associated with swimming in untreated recreational water venues and measures that can prevent illness. |
Persistence of Ebola virus in ocular fluid during convalescence
Varkey JB , Shantha JG , Crozier I , Kraft CS , Lyon GM , Mehta AK , Kumar G , Smith JR , Kainulainen MH , Whitmer S , Stroher U , Uyeki TM , Ribner BS , Yeh S . N Engl J Med 2015 372 (25) 2423-7 Among the survivors of Ebola virus disease (EVD), complications that include uveitis can develop during convalescence, although the incidence and pathogenesis of EVD-associated uveitis are unknown. We describe a patient who recovered from EVD and was subsequently found to have severe unilateral uveitis during convalescence. Viable Zaire ebolavirus (EBOV) was detected in aqueous humor 14 weeks after the onset of EVD and 9 weeks after the clearance of viremia. |
Possible sexual transmission of Ebola virus - Liberia, 2015
Christie A , Davies-Wayne GJ , Cordier-Lasalle T , Blackley DJ , Laney AS , Williams DE , Shinde SA , Badio M , Lo T , Mate SE , Ladner JT , Wiley MR , Kugelman JR , Palacios G , Holbrook MR , Janosko KB , Wit Ed , Doremalen Nv , Munster VJ , Pettitt J , Schoepp RJ , Verhenne L , Evlampidou I , Kollie KK , Sieh SB , Gasasira A , Bolay F , Kateh FN , Nyenswah TG , De Cock KM . MMWR Morb Mortal Wkly Rep 2015 64 (17) 479-81 On March 20, 2015, 30 days after the most recent confirmed Ebola Virus Disease (Ebola) patient in Liberia was isolated, Ebola was laboratory confirmed in a woman in Monrovia. The investigation identified only one epidemiologic link to Ebola: unprotected vaginal intercourse with a survivor. Published reports from previous outbreaks have demonstrated Ebola survivors can continue to harbor virus in immunologically privileged sites for a period of time after convalescence. Ebola virus has been isolated from semen as long as 82 days after symptom onset and viral RNA has been detected in semen up to 101 days after symptom onset. One instance of possible sexual transmission of Ebola has been reported, although the accompanying evidence was inconclusive. In addition, possible sexual transmission of Marburg virus, a filovirus related to Ebola, was documented in 1968. This report describes the investigation by the Government of Liberia and international response partners of the source of Liberia's latest Ebola case and discusses the public health implications of possible sexual transmission of Ebola virus. Based on information gathered in this investigation, CDC now recommends that contact with semen from male Ebola survivors be avoided until more information regarding the duration and infectiousness of viral shedding in body fluids is known. If male survivors have sex (oral, vaginal, or anal), a condom should be used correctly and consistently every time. |
Postexposure prophylaxis against human immunodeficiency virus (HIV): new guidelines from the WHO: a perspective
Kaplan JE , Dominguez K , Jobarteh K , Spira TJ . Clin Infect Dis 2015 60 Suppl 3 S196-9 Guidelines for antiretroviral (ARV) prophylaxis following high-risk exposure (postexposure prophylaxis—PEP) to human immunodeficiency virus (HIV) date to 1990, when the US Centers for Disease Control and Prevention (CDC) first considered such recommendations for persons with occupational exposures to HIV [1]. The US Public Health Service also issued recommendations focused on occupational exposures in 1996 [2]; these recommendations have been updated 5 times [3–7]. Prophylaxis after non-occupational exposures to HIV (via sexual contact and sharing of drug-using paraphernalia) was first addressed by the CDC in 1998 [8] and updated in 2005 [9]. The World Health Organization (WHO) first considered PEP in 2007 and included PEP recommendations in the 2013 consolidated guidelines; both documents focused on occupational exposures [10, 11]. The most recently published WHO guidelines on PEP recommend that a PEP regimen be administered as soon as possible within the 72-hour window period after an HIV-related exposure and that whereas a 2-drug antiretroviral regimen is acceptable, a 3-drug regimen is preferred [12]. |
Effect of cytomegalovirus infection on breastfeeding transmission of HIV and on the health of infants born to HIV-infected mothers
Chang TS , Wiener J , Dollard SC , Amin MM , Ellington S , Chasela C , Kayira D , Tegha G , Kamwendo D , Jamieson DJ , Van Der Horst C , Kourtis AP . AIDS 2015 29 (7) 831-836 BACKGROUND: Cytomegalovirus (CMV) infection can be acquired in utero or postnatally through horizontal transmission and breastfeeding. The effect of postnatal CMV infection on postnatal HIV transmission is unknown. METHODS: The Breastfeeding, Antiretrovirals and Nutrition study, conducted in Malawi, randomized 2369 mothers and their infants to three antiretroviral prophylaxis arms - mother (triple regimen), infant (nevirapine), or neither - for 28 weeks of breastfeeding, followed by weaning. Stored plasma and peripheral blood mononuclear cell specimens were available for 492 infants at 24 weeks and were tested with CMV PCR. Available samples from infants who were CMV PCR-positive at 24 weeks were also tested at birth (N = 242), and from infants PCR-negative at 24 weeks were tested at 48 weeks (N = 96). Cox proportional-hazards models were used to determine if CMV infection was associated with infant morbidity, mortality, or postnatal HIV acquisition. RESULTS: At 24 weeks of age, CMV DNA was detected in 345/492 infants (70.1%); the estimated congenital CMV infection rate was 2.3%, and the estimated rate of CMV infection at 48 weeks was 78.5%. CMV infection at 24 weeks was associated with subsequent HIV acquisition through breastfeeding or infant death between 24 and 48 weeks of age (hazard ratio 4.27, P = 0.05). CONCLUSION: Most breastfed infants of HIV-infected mothers in this resource-limited setting are infected with CMV by 24 weeks of age. Early CMV infection may be a risk factor for subsequent infant HIV infection through breastfeeding, pointing to the need for comprehensive approaches in order to achieve elimination of breastfeeding transmission of HIV. |
Effects of Antenatal Care and HIV Treatment Integration on Elements of the PMTCT Cascade: Results From the SHAIP Cluster-Randomized Controlled Trial in Kenya
Turan JM , Onono M , Steinfeld RL , Shade SB , Owuor K , Washington S , Bukusi EA , Ackers ML , Kioko J , Interis EC , Cohen CR . J Acquir Immune Defic Syndr 2015 69 (5) e172-81 BACKGROUND: Integrating antenatal care (ANC) and HIV care may improve uptake and retention in services along the prevention of mother-to-child transmission (PMTCT) cascade. The current study aimed to determine if integration of HIV services into ANC settings improves PMTCT service utilization outcomes. METHODS: ANC clinics in rural Kenya were randomized to integrated (6 clinics, 569 women) or non-integrated (6 clinics, 603 women) services. Intervention clinics provided all HIV services, including highly active antiretroviral therapy (HAART), while control clinics provided PMTCT services but referred women to HIV care clinics within the same facility. PMTCT utilization outcomes among HIV-infected women (maternal HIV care enrollment, HAART initiation, and 3-month infant HIV testing uptake) were compared using generalized estimating equations and Cox regression. RESULTS: HIV care enrollment was higher in intervention compared to control clinics (69% versus 36%, Odds Ratio (OR)=3.94, 95% Confidence Interval (CI): 1.14-13.63). Median time to enrollment was significantly shorter among intervention arm women (0 versus 8 days, Hazard Ratio (HR)=2.20, 95% CI: 1.62-3.01). Eligible women in the intervention arm were more likely to initiate HAART (40% versus 17%, OR=3.22, 95% CI: 1.81-5.72). Infant testing was more common in the intervention arm (25% versus 18%), however not statistically different. No significant differences were detected in postnatal service uptake or maternal retention. CONCLUSIONS: Service integration increased maternal HIV care enrollment and HAART uptake. However, PMTCT utilization outcomes were still suboptimal, and postnatal service utilization remained poor in both study arms. Further improvements in the PMTCT cascade will require additional research and interventions. |
Emergence of multidrug resistant influenza A(H1N1)pdm09 virus variants in an immunocompromised child treated with oseltamivir and zanamivir
Tamura D , DeBiasi RL , Okomo-Adhiambo M , Mishin VP , Campbell AP , Loechelt B , Wiedermann BL , Fry AM , Gubareva LV . J Infect Dis 2015 212 (8) 1209-13 Prolonged treatment of an immunocompromised child with oseltamivir and zanamivir for A(H1N1)pdm09 virus infection led to the emergence of viruses carrying H275Y and/or E119G in the neuraminidase. When phenotypically evaluated by neuraminidase inhibition, the dual H275Y-E119G substitution caused highly reduced inhibition by four neuraminidase inhibitors including oseltamivir, zanamivir, peramivir and laninamivir. |
Epidemiology of drug-resistant tuberculosis among children and adolescents in South Africa, 2005-2010
Moore BK , Anyalechi E , van der Walt M , Smith S , Erasmus L , Lancaster J , Morris S , Ndjeka N , Ershova J , Ismail N , Burton D , Menzies H . Int J Tuberc Lung Dis 2015 19 (6) 663-9 OBJECTIVE: To describe the demographic and clinical characteristics of children and adolescents diagnosed with resistance to any anti-tuberculosis drug (drug-resistant tuberculosis; DR-TB) in South Africa. DESIGN: We retrospectively reviewed medical records of all children (<13 years) and adolescents (13 to <18 years) with DR-TB at specialty hospitals in four South African provinces from 2005 to 2010. RESULTS: During the review period, 774 children and adolescents (median age 11.3 years) were diagnosed with DR-TB at selected facilities. A high proportion of patients had a history of previous TB treatment (285/631; 45.2%), human immunodeficiency virus (HIV) infection (375/685; 54.7%), contact with a TB case (347/454; 76.4%), and smear-positive (443/729; 60.8%), cavitary (253/680, 38.7%) disease. Eighty-two per cent of patients with HIV infection received antiretroviral therapy. Of 626 patients diagnosed with multidrug-resistant TB (MDR-TB), 561 (89.6%) received a regimen consistent with national guidelines; the median length of treatment was 22 months (IQR 16-25). Among 400 patients with any DR-TB and a known outcome, 20.3% died during treatment. CONCLUSION: Pediatric DR-TB in these provinces is characterized by complex clinical features at diagnosis, with one in five children dying during treatment. History of previous treatment and contact with a TB patient indicate opportunities for earlier diagnosis and treatment to improve outcomes. |
Estimating the number of patients infected with chronic HCV in the United States who meet highest or high-priority treatment criteria
Xu F , Leidner AJ , Tong X , Holmberg SD . Am J Public Health 2015 105 (7) e1-e5 We estimated the number of people infected with HCV in the United States who would qualify for immediate treatment according to the 2014 guidance. We based fibrosis stage on biopsy results, when available, or on FIB-4 scores. We used laboratory tests and International Classification of Diseases, Ninth Revision, Clinical Modification codes to determine if patients had any qualifying comorbidities. Of the 2.7 million people with HCV infection, we assumed that 1.35 million (50%) had been diagnosed. We estimated 457 000 met the highest and 356 000 the high-priority criteria for treatment, indicating that as many as 813 000 people could be treated immediately with new therapies. These estimates can inform planning efforts to address clinical capacity constraints and treatment costs. |
Identification and linkage to care of HCV-infected persons in five health centers - Philadelphia, Pennsylvania, 2012-2014
Coyle C , Viner K , Hughes E , Kwakwa H , Zibbell JE , Vellozzi C , Holtzman D . MMWR Morb Mortal Wkly Rep 2015 64 (17) 459-63 Approximately three million persons in the United States are infected with hepatitis C virus (HCV), a blood-borne pathogen that is an increasing cause of liver disease and mortality in the United States. Treatments for HCV are curative, of short duration, and have few associated side effects, increasing the importance of identifying HCV-infected persons. Many persons with HCV infection were infected decades ago, before implementation of prevention measures and most are unaware of their infection, regardless of when it occurred. Most newly diagnosed cases are associated with injection drug use. Persons born during 1945-1965 have a fivefold higher risk of HCV infection than other adults and the highest risk for HCV-related morbidity and mortality. CDC recommends testing for this group, for persons who inject drugs, and others at risk for HCV infection. From October 2012 through July 2014, the National Nursing Centers Consortium (NNCC) carried out a project to integrate routine HCV testing and linkage-to-care in five federally qualified health centers in Philadelphia, PA, that primarily serve homeless persons and public housing residents. During the project period, 4,514 patients across the five centers were tested for HCV. Of these, 595 (13.2%) were HCV-antibody positive and 550 (92.4%) had a confirmatory HCV-RNA test performed. Of those who had a confirmatory HCV-RNA test performed, 390 (70.9%) were identified as having current (i.e., chronic) HCV infection (overall prevalence = 8.6%). Of those currently infected with HCV, 90% were informed of their status, 78% were referred to an HCV care specialist, and 62% went to the referred specialist for care. Replicable system modifications that improved HCV testing and care included enhancements to electronic medical records (EMRs), simplification of HCV testing protocols, and addition of a linkage-to-care coordinator. Findings from this project highlight the need for innovative strategies for HCV testing, care, and treatment, as well as the important role of community health centers in expanding access for patient populations disproportionately affected by HCV infection. |
The impact of adherence to preexposure prophylaxis on the risk of HIV infection among people who inject drugs
Martin M , Vanichseni S , Suntharasamai P , Sangkum U , Mock PA , Leethochawalit M , Chiamwongpaet S , Curlin ME , Na-Pompet S , Warapronmongkholkul A , Kittimunkong S , Gvetadze RJ , McNicholl JM , Paxton LA , Choopanya K , Na Ayudhya SS , Kaewnil K , Kitisin P , Kukavejworakit M , Natrujirote P , Simakajorn S , Subhachaturas W . AIDS 2015 29 (7) 819-824 OBJECTIVE: To describe participant adherence to daily oral tenofovir in an HIV preexposure prophylaxis (PrEP) trial, examine factors associated with adherence, and assess the impact of adherence on the risk of HIV infection. DESIGN: The Bangkok Tenofovir Study was a randomized, double-blind, placebo-controlled trial conducted among people who inject drugs, 2005-2012. METHODS: Participants chose daily visits or monthly visits. Study nurses observed participants swallow study drug and both initialed a diary. We assessed adherence using the diary. We examined adherence by age group and sex and used logistic regression to evaluate demographics and risk behaviors as predictors of adherence and Cox regression to assess the impact of adherence on the risk of HIV infection. RESULTS: A total of 2413 people enrolled and contributed 9665 person-years of follow-up (mean 4.0 years, maximum 6.9 years). The risk of HIV infection decreased as adherence improved, from 48.9% overall to 83.5% for those with at least 97.5% adherence. In multivariable analysis, men were less adherent than women (P = 0.006) and participants 20-29 years old (P < 0.001) and 30-39 years old (P = 0.01) were less adherent than older participants. Other factors associated with poor adherence included incarceration (P = 0.02) and injecting methamphetamine (P = 0.04). CONCLUSION: In this HIV PrEP trial among people who inject drugs, improved adherence to daily tenofovir was associated with a lower risk of HIV infection. This is consistent with trials among MSM and HIV-discordant heterosexual couples and suggests that HIV PrEP can provide a high level of protection from HIV infection. |
Impact of maternal HIV seroconversion during pregnancy on early mother to child transmission of HIV (MTCT) measured at 4-8 weeks postpartum in South Africa 2011-2012: a national population-based evaluation
Dinh TH , Delaney KP , Goga A , Jackson D , Lombard C , Woldesenbet S , Mogashoa M , Pillay Y , Shaffer N . PLoS One 2015 10 (5) e0125525 BACKGROUND: Mother-to-child transmission of HIV (MTCT) depends on the timing of HIV infection. We estimated HIV-seroconversion during pregnancy (HSP) after having a HIV-negative result antenatally, and its contribution to early MTCT in South Africa (SA). METHODS AND FINDINGS: Between August 2011 and March 2012, we recruited a nationally representative sample of mother-infant pairs with infants aged 4-to-8 weeks from 578 health facilities. Data collection included mother interviews, child health-card reviews, and infant dried-blood-spots sample (iDBS). iDBS were tested for HIV antibodies and HIV-deoxyribonucleic-acid (HIV-DNA). HSP was defined as maternal self-report of an HIV-negative test during this pregnancy, no documented use of antiretroviral drugs and a matched HIV sero-positive iDBS. We used 20 imputations from a uniform distribution for time from reported antenatal HIV-negative result to delivery to estimate time of HSP. Early MTCT was defined based on detection of HIV-DNA in iDBS. Estimates were adjusted for clustering, nonresponse, and weighted by SA's 2011 live-births. RESULTS: Of 9802 mother-infant pairs, 2738 iDBS were HIV sero-positive, including 212 HSP, resulting in a nationally weighted estimate of 3.3% HSP (95% Confidence Interval: 2.8%-3.8%). Median time of HIV-seroconversion was 32.8weeks gestation;28.3% (19.7%- 36.9%) estimated to be >36 weeks. Early MTCT was 10.7% for HSP (6.2%-16.8%) vs. 2.2% (1.7%-2.8%) for mothers with known HIV-positive status. Although they represent 2.2% of all mothers and 6.7% of HIV-infected mothers, HSP accounted for 26% of early MTCT. Multivariable analysis indicated the highest risk for HSP was among women who knew the baby's father was HIV-infected (adjusted-hazard ratio (aHR) 4.71; 1.49-14.99), or who had been screened for tuberculosis (aHR 1.82; 1.43-2.32). CONCLUSIONS: HSP risk is high and contributes significantly to early MTCT. Identification of HSP by repeat-testing at 32 weeks gestation, during labor, 6 weeks postpartum, in tuberculosis-exposed women, and in discordant couples might reduce MTCT. |
Implementation and operational research: evaluation of Swaziland's hub-and-spoke model for decentralizing access to antiretroviral therapy services
Auld AF , Kamiru H , Azih C , Baughman AL , Nuwagaba-Biribonwoha H , Ehrenkranz P , Agolory S , Sahabo R , Ellerbrock TV , Okello V , Bicego G . J Acquir Immune Defic Syndr 2015 69 (1) e1-e12 BACKGROUND: In 2007, Swaziland initiated a hub-and-spoke model for decentralizing antiretroviral therapy (ART) access. Decentralization was facilitated through (1) down-referral of stable ART patients from overburdened central facilities (hubs) to primary health care clinics (spokes) and (2) ART initiation at spokes (spoke initiation). METHODS: We conducted a nationally representative retrospective cohort study among adult ART enrollees during 2004-2010 to assess the effect of down-referral and spoke-initiation on rates of loss to follow-up (LTFU), death, and attrition (death or LTFU). Sixteen of 31 hubs were randomly selected using probability-proportional-to-size sampling. Seven selected facilities had initiated the hub-and-spoke model by study start. At these facilities, 1149 of 24,782 hub-initiated and maintained and 878 of 7722 down-referred or spoke-initiated patient records were randomly selected and analyzed. At the 9 hub-only facilities, 483 of 6638 records were randomly selected and analyzed. Multivariable proportional hazards regression was used to assess effect of down-referral (a time-varying covariate) and spoke-initiation on outcomes. RESULTS: At ART initiation, median age was 35, 65% were female, and median CD4 count was 147 cells per microliter. Controlling for known confounders, down-referral was strongly protective against LTFU [adjusted hazard ratio (AHR) 0.38; 95% confidence interval (CI): 0.29 to 0.50] and attrition (AHR = 0.50; 95% CI: 0.34 to 0.76) but not mortality. Compared with hub-initiated and maintained patients, spoke-initiated patients had lower LTFU (AHR 0.59; 95% CI: 0.45 to 0.77) and attrition rates (AHR 0.60; 95% CI: 0.47 to 0.77), but not mortality. CONCLUSIONS: Down-referral and spoke-initiation within a hub-and-spoke ART decentralization model were protective against LTFU and overall attrition and could facilitate future ART program expansion. |
Increased incidence of cancer and cancer-related mortality among persons with chronic hepatitis C infection, 2006-2010
Allison RD , Tong X , Moorman AC , Ly KN , Rupp L , Xu F , Gordon SC , Holmberg SD . J Hepatol 2015 63 (4) 822-8 BACKGROUND: Persons chronically infected with the hepatitis C virus (HCV) may be at higher risk for developing and dying from non-liver cancers than the general population. METHODS: 12,126 chronic HCV-infected persons in the Chronic Hepatitis Cohort Study (CHeCS) contributed 39,984 person-years of follow-up from 2006 to 2010 and were compared to 133,795,010 records from 13 Surveillance, Epidemiology and End Results Program (SEER) cancer registries, and approximately 12 million U.S. death certificates from Multiple Cause of Death (MCOD) data. Measurements included standardized rate ratios (SRR) and relative risk (RR). RESULTS: The incidence of the following cancers was significantly higher among patients with chronic HCV infection: liver (SRR, 48.6 [95% CI, 44.4-52.7]), pancreas (2.5 [1.7-3.2]), rectum (2.1 [1.3-2.8]), kidney (1.7 [1.1-2.2]), non-Hodgkin lymphoma (NHL) (1.6 [1.2-2.1]), and lung (1.6 [1.3-1.9]). Age-adjusted mortality was significantly higher among patients with: liver (RR, 29.6 [95% CI, 29.1-30.1]), oral (5.2 [5.1-5.4]), rectum (2.6 [2.5-2.7]), NHL (2.3 [2.2-2.31]), and pancreatic (1.63 [1.6-1.7]) cancers. The mean ages of cancer diagnosis and cancer-related death were significantly younger among CHeCS HCV cohort patients compared to the general population for many cancers. CONCLUSIONS: Incidence and mortality of many types of non-liver cancers were higher, and age at diagnosis and death younger, in patients with chronic HCV infection compared to the general population. |
Increases in hepatitis C virus infection related to injection drug use among persons aged ≤30 years - Kentucky, Tennessee, Virginia, and West Virginia, 2006-2012
Zibbell JE , Iqbal K , Patel RC , Suryaprasad A , Sanders KJ , Moore-Moravian L , Serrecchia J , Blankenship S , Ward JW , Holtzman D . MMWR Morb Mortal Wkly Rep 2015 64 (17) 453-8 Hepatitis C virus (HCV) infection is the most common blood-borne infection in the United States, with approximately three million persons living with current infection. Percutaneous exposure to contaminated blood is the most efficient mode of transmission, and in the United States, injection drug use (IDU) is the primary risk factor for infection. State surveillance reports from the period 2006-2012 reveal a nationwide increase in reported cases of acute HCV infection, with the largest increases occurring east of the Mississippi River, particularly among states in central Appalachia. Demographic and behavioral data accompanying these reports show young persons (aged ≤30 years) from nonurban areas contributed to the majority of cases, with about 73% citing IDU as a principal risk factor. To better understand the increase in acute cases of HCV infection and its correlation to IDU, CDC examined surveillance data for acute case reports in conjunction with analyzing drug treatment admissions data from the Treatment Episode Data Set-Admissions (TEDS-A) among persons aged ≤30 years in four states (Kentucky, Tennessee, Virginia, and West Virginia) for the period 2006-2012. During this period, significant increases in cases of acute HCV infection were found among persons in both urban and nonurban areas, with a substantially higher incidence observed each year among persons residing in nonurban areas. During the same period, the proportion of treatment admissions for opioid dependency increased 21.1% in the four states, with a significant increase in the proportion of persons admitted who identified injecting as their main route of drug administration (an increase of 12.6%). Taken together, these increases indicate a geographic intersection among opioid abuse, drug injecting, and HCV infection in central Appalachia and underscore the need for integrated health services in substance abuse treatment settings to prevent HCV infection and ensure that those who are infected receive medical care. |
Initiation of a ring approach to infection prevention and control at non-Ebola health care facilities - Liberia, January-February 2015
Nyenswah T , Massaquoi M , Gbanya MZ , Fallah M , Amegashie F , Kenta A , Johnson KL , Yahya D , Badini M , Soro L , Pessoa-Silva CL , Roger I , Selvey L , VanderEnde K , Murphy M , Cooley LA , Olsen SJ , Christie A , Vertefeuille J , Navin T , McElroy P , Park BJ , Esswein E , Fagan R , Mahoney F . MMWR Morb Mortal Wkly Rep 2015 64 (18) 505-8 From mid-January to mid-February 2015, all confirmed Ebola virus disease (Ebola) cases that occurred in Liberia were epidemiologically linked to a single index patient from the St. Paul Bridge area of Montserrado County. Of the 22 confirmed patients in this cluster, eight (36%) sought and received care from at least one of 10 non-Ebola health care facilities (HCFs), including clinics and hospitals in Montserrado and Margibi counties, before admission to an Ebola treatment unit. After recognition that three patients in this emerging cluster had received care from a non-Ebola treatment unit, and in response to the risk for Ebola transmission in non-Ebola treatment unit health care settings, a focused infection prevention and control (IPC) rapid response effort for the immediate area was developed to target facilities at increased risk for exposure to a person with Ebola (Ring IPC). The Ring IPC approach, which provided rapid, intensive, and short-term IPC support to HCFs in areas of active Ebola transmission, was an addition to Liberia's proposed longer term national IPC strategy, which focused on providing a comprehensive package of IPC training and support to all HCFs in the country. This report describes possible health care worker exposures to the cluster's eight patients who sought care from an HCF and implementation of the Ring IPC approach. On May 9, 2015, the World Health Organization (WHO) declared the end of the Ebola outbreak in Liberia. |
Investigation of an outbreak of variant influenza A (H3N2) virus associated with an agricultural fair - Ohio, August 2012
Greenbaum A , Quinn C , Bailer J , Su S , Havers F , Durand LO , Jiang V , Page S , Budd J , Shaw M , Biggerstaff M , de Fijter S , Smith K , Reed C , Epperson S , Brammer L , Feltz D , Sohner K , Ford J , Jain S , Gargiullo P , Weiss E , Burg P , DiOrio M , Fowler B , Finelli L , Jhung MA . J Infect Dis 2015 212 (10) 1592-9 BACKGROUND: In 2012, one third of cases in a multi-state outbreak of variant influenza A(H3N2) virus [(H3N2)v] occurred in Ohio. We conducted an investigation of (H3N2)v cases associated with agricultural Fair A in Ohio. METHODS: We surveyed Fair A swine exhibitors and their household members. Confirmed cases had influenza-like illness (ILI) and a positive laboratory test for (H3N2)v virus and probable cases had ILI. We calculated attack rates. We determined risk factors for infection using multivariable log-binomial regression. RESULTS: We identified a total of 20 confirmed and 94 probable cases associated with Fair A. Among 114 cases, the median age was 10 years, there were no hospitalizations or deaths, and 85% had swine exposure. In the exhibitor household cohort of 359 persons (83 households), we identified 6 confirmed (2%) and 40 probable (11%) cases. Age <10 years was a significant risk factor (p<0.01) for illness. One instance of likely human-to-human transmission was identified. CONCLUSIONS: In this (H3N2)v outbreak, no evidence of sustained human-to-human (H3N2)v transmission was found. Our risk factor analysis contributed to the development of recommendations that those at increased risk of influenza complications, including children aged <5 years, avoid swine barns at fairs during the 2012 fair season. |
It's all about the return on investment: the Model Aquatic Health Code
Hlavsa MC , Kunz JM , Beach MJ . J Environ Health 2015 77 (9) 34-35 In 2005, local, state, and federal public health officials and representatives from the aquatic sector met in Atlanta to discuss and develop a strategy to tackle the increasing incidence of recreational water-associated outbreaks, particularly cryptosporidiosis outbreaks associated with public pools. Public health and the aquatics sector quickly reached consensus. They identified the lack of uniform national standards for the design, construction, operation, and maintenance of public pools as the key barrier to preventing outbreaks and called on the Centers for Disease Control and Prevention (CDC) to lead development of national guidance. For the next seven years, CDC and New York State Department of Health spearheaded a national, multi-partner effort to create the Model Aquatic Health Code (MAHC; www. cdc.gov/healthywater/swimming/pools/mahc/ index.html). In August 2014, the first edition of the MAHC was released. This 316page resource is based on the latest science and best practices to maximize prevention of recreational water-associated outbreaks, pool chemical-associated health events, and drowning. The accompanying 371-page annex provides the rationale behind the guidance. The MAHC and its annex represent the culmination of the hard work of more than 150 public health, aquatic sector, and academic volunteers and their response to 4,407 public comments, of which 72% were accepted. So where do we go from here? Together, we need to set up systems to assess the MAHC's ROI and use system data to maximize the MAHC's ability to provide long-term public health dividends. |
A brief screening tool to assess the risk of contracting HIV infection among active injection drug users
Smith DK , Pan Y , Rose CE , Pals SL , Mehta SH , Kirk GD , Herbst JH . J Addict Med 2015 9 (3) 226-32 OBJECTIVE: To incorporate preexposure prophylaxis and other biomedical or intensive behavioral interventions into the care of injection drug users (IDUs), health care providers need validated, rapid, risk screening tools for identifying persons at highest risk of incident HIV infection. METHODS: To develop and validate a brief screening tool for assessing the risk of contracting HIV (ARCH), we included behavioral and HIV test data from 1904 initially HIV-uninfected men and women enrolled and followed in the AIDS Linked to the Intravenous Experience prospective cohort study between 1988 and 2008. Using logistic regression analyses with generalized estimating equations, we identified significant predictors of incident HIV infection, then rescaled and summed their regression coefficients to create a risk score. RESULTS: The final logistic regression model included age, engagement in a methadone maintenance program, and a composite injection risk score obtained by counting the number of the following 5 behaviors reported during the past 6 months: injection of heroin, injection of cocaine, sharing a cooker, sharing needles, or visiting a shooting gallery. The area under the receiver operating characteristic curve was 0.720; possible scores on the index ranged from 0 to 100 and a score 46 or greater had a sensitivity of 86.2% and a specificity of 42.5%, appropriate for a screening tool. DISCUSSION: We developed an easy to administer 7-question screening tool with a cutoff that is predictive of incident HIV infection in a large prospective cohort of IDUs in Baltimore. The ARCH-IDUs screening tool can be used to prioritize persons who are injecting illicit drugs for consideration of preexposure prophylaxis and other intensive HIV prevention efforts. |
Choice of antiretroviral drugs for postexposure prophylaxis for children: a systematic review
Penazzato M , Dominguez K , Cotton M , Barlow-Mosha L , Ford N . Clin Infect Dis 2015 60 Suppl 3 S177-81 BACKGROUND: This systematic review aimed to assess the safety and efficacy of antiretroviral options for postexposure prophylaxis (PEP). Recognizing the limited data on the safety and efficacy of antiretroviral drugs for PEP in children, this review was extended to include consideration of data on the use of antiretroviral drugs for treatment of infants and children living with human immunodeficiency virus. METHODS: The PEP literature was assessed to identify studies reporting safety and completion rates for children given PEP, and this information was complemented by safety and efficacy data for drugs used in antiretroviral therapy. The proportion of patients experiencing each outcome was calculated and data were pooled using random-effects meta-analysis. RESULTS: Three prospective cohort studies reported outcomes of children given zidovudine (ZDV) plus lamivudine (3TC) as a 2-drug PEP regimen. The proportion of children completing the full 28-day course of PEP was 64.0% (95% confidence interval [CI], 41.2%-86.8%), whereas the proportion discontinuing due to adverse events was 4.5% (95% CI, .4%-8.6%). One randomized trial compared abacavir (ABC) plus lamivudine (3TC) and ZDV+3TC as part of a dual or triple first-line antiretroviral therapy regimen; this study showed better efficacy in the ABC-containing combinations and no difference in the time to first serious adverse event. Three randomized trials compared lopinavir/ritonavir (LPV/r) to nevirapine (NVP) for antiretroviral therapy and showed a lower risk of treatment discontinuations associated with LPV/r vs NVP (hazard ratio, 0.56 [95% CI, .41-.75]) but no difference in drug-related adverse events. The overall quality of the evidence was rated as very low. CONCLUSIONS: This review supports ZDV+3TC+LPV/r as the preferred 3-drug regimen for PEP in children. |
Controlling the last known cluster of Ebola virus disease - Liberia, January-February 2015
Nyenswah T , Fallah M , Sieh S , Kollie K , Badio M , Gray A , Dilah P , Shannon M , Duwor S , Ihekweazu C , Cordier-Lasalle T , Shinde SA , Hamblion E , Davies-Wayne G , Ratnesh M , Dye C , Yoder JS , McElroy P , Hoots B , Christie A , Vertefeuille J , Olsen SJ , Laney AS , Neal JJ , Navin TR , Coulter S , Pordell P , Lo T , Kinkade C , Mahoney F . MMWR Morb Mortal Wkly Rep 2015 64 (18) 500-4 As one of the three West African countries highly affected by the 2014-2015 Ebola virus disease (Ebola) epidemic, Liberia reported approximately 10,000 cases. The Ebola epidemic in Liberia was marked by intense urban transmission, multiple community outbreaks with source cases occurring in patients coming from the urban areas, and outbreaks in health care facilities (HCFs). This report, based on data from routine case investigations and contact tracing, describes efforts to stop the last known chain of Ebola transmission in Liberia. The index patient became ill on December 29, 2014, and the last of 21 associated cases was in a patient admitted into an Ebola treatment unit (ETU) on February 18, 2015. The chain of transmission was stopped because of early detection of new cases; identification, monitoring, and support of contacts in acceptable settings; effective triage within the health care system; and rapid isolation of symptomatic contacts. In addition, a "sector" approach, which divided Montserrado County into geographic units, facilitated the ability of response teams to rapidly respond to community needs. In the final stages of the outbreak, intensive coordination among partners and engagement of community leaders were needed to stop transmission in densely populated Montserrado County. A companion report describes the efforts to enhance infection prevention and control efforts in HCFs. After February 19, no additional clusters of Ebola cases have been detected in Liberia. On May 9, the World Health Organization declared the end of the Ebola outbreak in Liberia. |
Differences in treatment of Chlamydia trachomatis by ambulatory care setting
Pearson WS , Gift TL , Leichliter JS , Jenkins WD . J Community Health 2015 40 (6) 1115-21 Chlamydia trachomatis (CT) is the most commonly reported sexually transmitted infection (STI) in the US and timely, correct treatment can reduce CT transmission and sequelae. Emergency departments (ED) are an important location for diagnosing STIs. This study compared recommended treatment of CT in EDs to treatment in physician offices. Five years of data (2006-2010) were analyzed from the National Ambulatory Medical Care Survey, and the National Hospital Ambulatory Medical Care Surveys (NHAMCS), including the Outpatient survey (NHAMCS-OPD) and Emergency Department survey (NHAMCS-ED). All visits with a CT diagnosis and those with a diagnosis of unspecified venereal disease were selected for analysis. Differences in receipt of recommended treatments were compared between visits to physician offices and emergency departments using Chi square tests and logistic regression models. During the 5 year period, approximately 3.2 million ambulatory care visits had diagnosed CT or an unspecified venereal disease. A greater proportion of visits to EDs received the recommended treatment for CT compared to visits to physician offices (66.1 vs. 44.9 %, p < .01). When controlling for patients' age, sex and race/ethnicity, those presenting to the ED with CT were more likely to receive the recommended antibiotic treatment than patients presenting to a physician's office (OR 2.16; 95 % CI 1.04-4.48). This effect was attenuated when further controlling for patients' expected source of payment. These analyses demonstrate differences in the treatment of CT by ambulatory care setting as well as opportunities for increasing use of recommended treatments for diagnosed cases of this important STI. |
Dynamics of influenza seasonality at sub-regional levels in India and implications for vaccination timing
Chadha MS , Potdar VA , Saha S , Koul PA , Broor S , Dar L , Chawla-Sarkar M , Biswas D , Gunasekaran P , Abraham AM , Shrikhande S , Jain A , Anukumar B , Lal RB , Mishra AC . PLoS One 2015 10 (5) e0124122 BACKGROUND: Influenza surveillance is an important tool to identify emerging/reemerging strains, and defining seasonality. We describe the distinct patterns of circulating strains of the virus in different areas in India from 2009 to 2013. METHODS: Patients in ten cities presenting with influenza like illness in out-patient departments of dispensaries/hospitals and hospitalized patients with severe acute respiratory infections were enrolled. Nasopharangeal swabs were tested for influenza viruses by real-time RT-PCR, and subtyping; antigenic and genetic analysis were carried out using standard assays. RESULTS: Of the 44,127 ILI/SARI cases, 6,193 (14.0%) were positive for influenza virus. Peaks of influenza were observed during July-September coinciding with monsoon in cities Delhi and Lucknow (north), Pune (west), Allaphuza (southwest), Nagpur (central), Kolkata (east) and Dibrugarh (northeast), whereas Chennai and Vellore (southeast) revealed peaks in October-November, coinciding with the monsoon months in these cities. In Srinagar (Northern most city at 34 degrees N latitude) influenza circulation peaked in January-March in winter months. The patterns of circulating strains varied over the years: whereas A/H1N1pdm09 and type B co-circulated in 2009 and 2010, H3N2 was the predominant circulating strain in 2011, followed by circulation of A/H1N1pdm09 and influenza B in 2012 and return of A/H3N2 in 2013. Antigenic analysis revealed that most circulating viruses were close to vaccine selected viral strains. CONCLUSIONS: Our data shows that India, though physically located in northern hemisphere, has distinct seasonality that might be related to latitude and environmental factors. While cities with temperate seasonality will benefit from vaccination in September-October, cities with peaks in the monsoon season in July-September will benefit from vaccination in April-May. Continued surveillance is critical to understand regional differences in influenza seasonality at regional and sub-regional level, especially in countries with large latitude span. |
Transcriptome Profiling of the Virus-Induced Innate Immune Response in Pteropus vampyrus and Its Attenuation by Nipah Virus Interferon Antagonist Functions.
Glennon NB , Jabado O , Lo MK , Shaw ML . J Virol 2015 89 (15) 7550-66 Bats are important reservoirs for several viruses, many of which cause lethal infections in humans but have reduced pathogenicity in bats. As the innate immune response is critical for controlling viruses, the nature of this response in bats, and how it may differ from other mammals, is of great interest. Using next generation mRNAseq, we profiled the transcriptional response of Pteropus vampyrus bat kidney (PVK) cells to Newcastle disease virus (NDV), an avian paramyxovirus known to elicit a strong innate immune response in mammalian cells. This bat species is a known reservoir of Nipah virus (NiV) and Hendra virus (HeV). Analysis of the 200-300 regulated genes showed that interferon (IFN) and antiviral pathways are highly upregulated in NDV infected PVK cells, including genes such as IFN beta, RIGI, MDA5, ISG15, and IRF1. NDV infected cells also upregulated several genes not previously characterized as antiviral such as RND1, SERTAD1, CHAC1, and MORC3. In fact, we show that MORC3 is induced by both IFN and NDV infection in PVK cells, but by neither stimulus in human A549 cells. In contrast to NDV, HeV and NiV infection of PVK cells failed to induce these innate immune genes. Likewise, an attenuated response was observed in PVK cells infected with recombinant NDVs expressing the NiV IFN antagonist proteins V and W. This study provides the first global profile of a robust virus-induced innate immune response in bats and indicates that henipavirus IFN antagonist mechanisms are likely active in bat cells. IMPORTANCE: Bats are the reservoir host for many highly pathogenic human viruses, including henipaviruses, lyssaviruses, SARS coronavirus, and filoviruses, and many other viruses have also been isolated from bats. Viral infections are reportedly asymptomatic or heavily attenuated in bat populations. Despite their ecological importance to viral maintenance, research into their immune system and mechanisms for viral control has only recently begun. Nipah virus and Hendra virus are two paramyxoviruses associated with high mortality rates in humans and whose reservoir is the Pteropus genus of bats. Greater knowledge of the innate immune response of P. vampyrus to viral infection may elucidate how bats serve as a reservoir for so many viruses. |
Relative abundance and Plasmodium infection rates of malaria vectors in and around Jabalpur, a malaria endemic region in Madhya Pradesh State, Central India
Singh N , Mishra AK , Chand SK , Bharti PK , Singh MP , Nanda N , Singh OP , Sodagiri K , Udhyakumar V . PLoS One 2015 10 (5) e0126932 BACKGROUND: This study was undertaken in two Primary Health Centers (PHCs) of malaria endemic district Jabalpur in Madhya Pradesh (Central India). METHODS: In this study we had investigated the relative frequencies of the different anopheline species collected within the study areas by using indoor resting catches, CDC light trap and human landing methods. Sibling species of malaria vectors were identified by cytogenetic and molecular techniques. The role of each vector and its sibling species in the transmission of the different Plasmodium species was ascertained by using sporozoite ELISA. RESULTS: A total of 52,857 specimens comprising of 17 anopheline species were collected by three different methods (39,964 by indoor resting collections, 1059 by human landing and 11,834 by CDC light trap). Anopheles culicifacies was most predominant species in all collections (55, 71 and 32% in indoor resting, human landing and light trap collections respectively) followed by An. subpictus and An. annularis. All five sibling species of An. culicifacies viz. species A, B, C, D and E were found while only species T and S of An. fluviatilis were collected. The overall sporozoite rate in An. culicifacies and An. fluviatilis were 0.42% (0.25% for P. falciparum and 0.17% for P. vivax) and 0.90% (0.45% for P. falciparum and 0.45% for P. vivax) respectively. An. culicifacies and An. fluviatilis were found harbouring both P. vivax variants VK-210 and VK-247, and P. falciparum. An. culicifacies sibling species C and D were incriminated as vectors during most part of the year while sibling species T of An. fluviatilis was identified as potential vector in monsoon and post monsoon season. CONCLUSIONS: An. culicifacies species C (59%) was the most abundant species followed by An. culicifacies D (24%), B (8.7%), E (6.7%) and A (1.5%). Among An. fluviatilis sibling species, species T was common (99%) and only few specimens of S were found. Our study provides crucial information on the prevalence of An. culicifacies and An. fluviatilis sibling species and their potential in malaria transmission which will assist in developing strategic control measures against these vectors. |
Fate and transport of enteric microbes from septic systems in a coastal watershed
Schneeberger CL , O'Driscoll M , Humphrey C , Henry K , Deal N , Seiber K , Hill VR , Zarate-Bermudez M . J Environ Health 2015 77 (9) 22-30 Onsite wastewater treatment systems (OWTS) are commonly used in coastal areas to treat household wastewater. These systems represent potential sources of fecal pollution of groundwater and nearby surface water. OWTS are expected to reduce microbial concentrations in wastewater; however, system and environmental factors can affect treatment efficiency and impacts on ground and surface water. In the study of OWTS described in this article, the authors sampled septic tanks and groundwater at two households in coastal North Carolina between October 2009 and October 2011. Samples were tested for the fecal indicator microbes E. coli, enterococci, and Clostridium perfringens. Microbial source tracking was also performed in year two. Results showed that enteric microbe concentrations in groundwater significantly decreased with distance from the OWTS. Human markers of fecal contamination were also detected in the OWTS and downgradient groundwater, indicating that OWTS can impact the microbial quality of shallow groundwater. |
Biomonitoring and environmental public health tracking
Namulanda G . J Environ Health 2015 77 (9) 36-38 As part of our continuing effort to highlight innovative approaches and tools to improve the health and environment of communities, the Journal is pleased to publish a bimonthly column from the Centers for Disease Control and Prevention's (CDC's) Environmental Public Health Tracking Network (Tracking Network). The Tracking Network is a system of integrated health, exposure, and hazard information and data from a variety of national, state, and city sources. The Tracking Network brings together data concerning health and environmental problems with the goal of providing information to help improve where we live, work, and play. Environmental causes of chronic diseases are hard to identify. Measuring amounts of hazardous substances in our environment in a standard way, tracing the spread of these over time and area, seeing how they show up in human tissues, and understanding how they may cause illness is critical. The Tracking Network is a tool that can help connect these efforts. Through these columns, readers will learn about the program and the resources, tools, and information available from CDC's Tracking Network. The conclusions of this article are those of the author(s) and do not necessarily represent the views of CDC. Gonza Namulanda is a health scientist with the Environmental Health Tracking Branch. She works primarily on the biomonitoring and childhood blood lead content areas and electronic health records and metadata for environmental public health tracking. |
Preliminary incidence and trends of infection with pathogens transmitted commonly through food - Foodborne Diseases Active Surveillance Network, 10 U.S. Sites, 2006-2014
Crim SM , Griffin PM , Tauxe R , Marder EP , Gilliss D , Cronquist AB , Cartter M , Tobin-D'Angelo M , Blythe D , Smith K , Lathrop S , Zansky S , Cieslak PR , Dunn J , Holt KG , Wolpert B , Henao OL . MMWR Morb Mortal Wkly Rep 2015 64 (18) 495-9 Foodborne illnesses represent a substantial, yet largely preventable, health burden in the United States. In 10 U.S. geographic areas, the Foodborne Diseases Active Surveillance Network* (FoodNet) monitors the incidence of laboratory-confirmed infections caused by nine pathogens transmitted commonly through food. This report summarizes preliminary 2014 data and describes changes in incidence compared with 2006-2008 and 2011-2013. In 2014, FoodNet reported 19,542 infections, 4,445 hospitalizations, and 71 deaths. The incidence of Shiga toxin-producing Escherichia coli (STEC) O157 and Salmonella enterica serotype Typhimurium infections declined in 2014 compared with 2006-2008, and the incidence of infection with Campylobacter, Vibrio, and Salmonella serotypes Infantis and Javiana was higher. Compared with 2011-2013, the incidence of STEC O157 and Salmonella Typhimurium infections was lower, and the incidence of STEC non-O157 and Salmonella serotype Infantis infections was higher in 2014. Despite ongoing food safety efforts, the incidence of many infections remains high, indicating that further prevention measures are needed to make food safer and achieve national health objectives. |
Phylogeographical analysis of the dominant multidrug-resistant H58 clade of Salmonella Typhi identifies inter- and intracontinental transmission events.
Wong VK , Baker S , Pickard DJ , Parkhill J , Page AJ , Feasey NA , Kingsley RA , Thomson NR , Keane JA , Weill FX , Edwards DJ , Hawkey J , Harris SR , Mather AE , Cain AK , Hadfield J , Hart PJ , Thieu NT , Klemm EJ , Glinos DA , Breiman RF , Watson CH , Kariuki S , Gordon MA , Heyderman RS , Okoro C , Jacobs J , Lunguya O , Edmunds WJ , Msefula C , Chabalgoity JA , Kama M , Jenkins K , Dutta S , Marks F , Campos J , Thompson C , Obaro S , MacLennan CA , Dolecek C , Keddy KH , Smith AM , Parry CM , Karkey A , Mulholland EK , Campbell JI , Dongol S , Basnyat B , Dufour M , Bandaranayake D , Naseri TT , Singh SP , Hatta M , Newton P , Onsare RS , Isaia L , Dance D , Davong V , Thwaites G , Wijedoru L , Crump JA , De Pinna E , Nair S , Nilles EJ , Thanh DP , Turner P , Soeng S , Valcanis M , Powling J , Dimovski K , Hogg G , Farrar J , Holt KE , Dougan G . Nat Genet 2015 47 (6) 632-9 The emergence of multidrug-resistant (MDR) typhoid is a major global health threat affecting many countries where the disease is endemic. Here whole-genome sequence analysis of 1,832 Salmonella enterica serovar Typhi (S. Typhi) identifies a single dominant MDR lineage, H58, that has emerged and spread throughout Asia and Africa over the last 30 years. Our analysis identifies numerous transmissions of H58, including multiple transfers from Asia to Africa and an ongoing, unrecognized MDR epidemic within Africa itself. Notably, our analysis indicates that H58 lineages are displacing antibiotic-sensitive isolates, transforming the global population structure of this pathogen. H58 isolates can harbor a complex MDR element residing either on transmissible IncHI1 plasmids or within multiple chromosomal integration sites. We also identify new mutations that define the H58 lineage. This phylogeographical analysis provides a framework to facilitate global management of MDR typhoid and is applicable to similar MDR lineages emerging in other bacterial species. |
Nomenclature updates resulting from the evolution of avian influenza A(H5) virus clades 2.1.3.2a, 2.2.1, and 2.3.4 during 2013-2014.
Donis RO , Smith GJ . Influenza Other Respir Viruses 2015 9 (5) 271-6 The divergence of the A(H5) hemagglutinin (HA) gene of highly pathogenic avian influenza (HPAI) viruses (A/goose/Guangdong/96 lineage) was analyzed by phylogenetic and average pairwise distance methods to identify new clades that merit nomenclature changes. Three new clade designations were recommended based on division of clade 2.1.3.2a (Indonesia), 2.2.1 (Egypt) and 2.3.4 (widespread detection in Asia, Europe and North America) that includes newly emergent HPAI virus subtypes H5N2, H5N3, H5N5, H5N6 and H5N8. |
Rotavirus Group A Genotypes Detected Through Diarrheal Disease Surveillance in Haiti, 2012.
Esona MD , Buteau J , Lucien MA , Joseph GA , Leshem E , Boncy J , Katz MA , Bowen MD , Balajee SA . Am J Trop Med Hyg 2015 93 (1) 54-6 Samples collected in 2012 through diarrheal disease surveillance in Haiti were tested for rotavirus by enzyme immunoassay and real time RT-PCR and positive samples were genotyped. The predominant genotypes were G1P[8] (29% prevalence) and G9P[8] (21%). The observed genotype prevalence is similar to that reported previously for other Caribbean countries. |
Full genomic characterization and phylogenetic analysis of a zoonotic human G8P[14] rotavirus strain detected in a sample from Guatemala.
Gautam R , Mijatovic-Rustempasic S , Roy S , Esona MD , Lopez B , Mencos Y , Rey-Benito G , Bowen MD . Infect Genet Evol 2015 33 206-11 We report the genomic characterization of a rare human G8P[14] rotavirus strain, identified in a stool sample from Guatemala (GTM) during routine rotavirus surveillance. This strain was designated as RVA/Human-wt/GTM/2009726790/2009/G8P[14], with a genomic constellation of G8-P[14]-I2-R2-C2-M2-A13-N2-T6-E2-H3. The VP4 gene occupied lineage VII within the P[14] genotype. Phylogenetic analysis of each genome segment revealed close relatedness to several zoonotic simian, guanaco and bovine strains. Our findings suggest that strain RVA/Human-wt/GTM/2009726790/2009/G8P[14] is an example of a direct zoonotic transmission event. The results of this study reinforce the potential role of interspecies transmission and reassortment in generating novel and rare rotavirus strains which infect humans. |
Genome wide identification of new genes and pathways in patients with both autoimmune thyroiditis and type 1 diabetes.
Tomer Y , Dolan LM , Kahaly G , Divers J , D'Agostino RB Jr , Imperatore G , Dabelea D , Marcovina S , Black MH , Pihoker C , Hasham A , Hammerstad SS , Greenberg DA , Lotay V , Zhang W , Monti MC , Matheis N . J Autoimmun 2015 60 32-9 Autoimmune thyroid diseases (AITD) and Type 1 diabetes (T1D) frequently occur in the same individual pointing to a strong shared genetic susceptibility. Indeed, the co-occurrence of T1D and AITD in the same individual is classified as a variant of the autoimmune polyglandular syndrome type 3 (designated APS3v). Our aim was to identify new genes and mechanisms causing the co-occurrence of T1D + AITD (APS3v) in the same individual using a genome-wide approach. For our discovery set we analyzed 346 Caucasian APS3v patients and 727 gender and ethnicity matched healthy controls. Genotyping was performed using the Illumina Human660W-Quad.v1. The replication set included 185 APS3v patients and 340 controls. Association analyses were performed using the PLINK program, and pathway analyses were performed using the MAGENTA software. We identified multiple signals within the HLA region and conditioning studies suggested that a few of them contributed independently to the strong association of the HLA locus with APS3v. Outside the HLA region, variants in GPR103, a gene not suggested by previous studies of APS3v, T1D, or AITD, showed genome-wide significance (p < 5 x 10-8). In addition, a locus on 1p13 containing the PTPN22 gene showed genome-wide significant associations. Pathway analysis demonstrated that cell cycle, B-cell development, CD40, and CTLA-4 signaling were the major pathways contributing to the pathogenesis of APS3v. These findings suggest that complex mechanisms involving T-cell and B-cell pathways are involved in the strong genetic association between AITD and T1D. |
Dominance of Giardia duodenalis assemblage A and Enterocytozoon bieneusi genotype BEB6 in sheep in Inner Mongolia, China.
Ye J , Xiao L , Wang Y , Guo Y , Roellig DM , Feng Y . Vet Parasitol 2015 210 235-9 To examine the occurrence and genotype distribution of Giardia duodenalis and Enterocytozoon bieneusi in sheep, fecal specimens were collected from 162 lambs and 213 ewes on seven farms in the Hulunbeier Prairie in Inner Mongolia, China. By PCR analysis of the triose-phosphate isomerase gene, 16 of the 375 (4.3%) specimens were positive for G. duodenalis, with 13 sequenced successfully belonging to assemblage A. Lambs had a significantly higher infection rate than ewes (8.6% versus 0.9%, respectively). The dominance of assemblage A in sheep was supported by PCR analysis of the beta-giardin and glutamate dehydrogenase genes; 4 of 7 beta-giardin-positive specimens and 3 of 5 glutamate dehydrogenase-positive specimens were identified as assemblage A. A much higher occurrence of E. bieneusi was detected by PCR analysis of the ribosomal internal transcribed spacer; 77.8% of lambs and 62.9% of ewes were positive for the pathogen. Two genotypes of E. bieneusi were found: BEB6 and CM7. Genotype BEB6 was seen in 237 animals and on all seven farms, whereas genotype CM7 was detected in 23 animals from six farms. These data indicate that sheep in Inner Mongolia are commonly infected with G. duodenalis assemblage A and E. bieneusi genotype BEB6, two zoonotic pathogens in China. |
Transmission of Hepatitis C Virus From Organ Donors Despite Nucleic Acid Test Screening.
Suryaprasad A , Basavaraju SV , Hocevar SN , Theodoropoulos N , Zuckerman RA , Hayden T , Forbi J , Pegues D , Levine M , Martin SI , Kuehnert MJ , Blumberg EA . Am J Transplant 2015 15 (7) 1827-35 Nucleic acid testing (NAT) for hepatitis C virus (HCV) is recommended for screening of organ donors, yet not all donor infections may be detected. We describe three US clusters of HCV transmission from donors at increased risk for HCV infection. Donor's and recipients' medical records were reviewed. Newly infected recipients were interviewed. Donor-derived HCV infection was considered when infection was newly detected after transplantation in recipients of organs from increased risk donors. Stored donor sera and tissue samples were tested for HCV RNA with high-sensitivity quantitative PCR. Posttransplant and pretransplant recipient sera were tested for HCV RNA. Quasispecies analysis of hypervariable region-1 was used to establish genetic relatedness of recipient HCV variants. Each donor had evidence of injection drug use preceding death. Of 12 recipients, 8 were HCV-infected-6 were newly diagnosed posttransplant. HCV RNA was retrospectively detected in stored samples from donor immunologic tissue collected at organ procurement. Phylogenetic analysis showed two clusters of closely related HCV variants from recipients. These investigations identified the first known HCV transmissions from increased risk organ donors with negative NAT screening, indicating very recent donor infection. Recipient informed consent and posttransplant screening for blood-borne pathogens are essential when considering increased risk donors. |
Incident hepatitis among repeat blood donors: a sentinel event signaling possible health care-associated infection and need for reporting to public health authorities
Moorman AC , Stramer SL , Schaefer MK , Collier MG , Suryaprasad A , Kuehnert MJ , Moore Z , Rowan E , Habicht K , Bradley K , Fucci MC , Hopkins C , Xu F . Transfusion 2015 55 (10) 2531-3 Identification of a recently acquired viral hepatitis infection among repeat blood donors can be a sentinel event signaling a possible healthcare-associated infection (HAI) in the donor, especially in individuals who did not disclose self-reported behavioral risk factors and were test-negative at prior successful donations. With the 2012 update to the Council of State and Territorial Epidemiologists (CSTE) acute hepatitis B and hepatitis C surveillance case definitions, asymptomatic individuals who meet the laboratory criteria for these case definitions should be included among the cases reportable to public health authorities (1,2). This report serves as a reminder of the importance of recognizing incident hepatitis infections in blood donors as a possible sentinel event to uncover previous healthcare-associated transmission clusters, and that identification of a hepatitis B virus (HBV) or hepatitis C virus (HCV) nucleic acid test (NAT) confirmed positive result within six months of a NAT negative result (as may be identified in a repeat blood donor) is reportable to public health authorities. Recent data suggest consideration that this six month period be extended to within one year. |
Acceptability and use of portable drinking water and hand washing stations in health care facilities and their impact on patient hygiene practices, Western Kenya
Bennett SD , Otieno R , Ayers TL , Odhiambo A , Faith SH , Quick R . PLoS One 2015 10 (5) e0126916 Many health care facilities (HCF) in developing countries lack access to reliable hand washing stations and safe drinking water. To address this problem, we installed portable, low-cost hand washing stations (HWS) and drinking water stations (DWS), and trained healthcare workers (HCW) on hand hygiene, safe drinking water, and patient education techniques at 200 rural HCFs lacking a reliable water supply in western Kenya. We performed a survey at baseline and a follow-up evaluation at 15 months to assess the impact of the intervention at a random sample of 40 HCFs and 391 households nearest to these HCFs. From baseline to follow-up, there was a statistically significant increase in the percentage of dispensaries with access to HWSs with soap (42% vs. 77%, p<0.01) and access to safe drinking water (6% vs. 55%, p<0.01). Female heads of household in the HCF catchment area exhibited statistically significant increases from baseline to follow-up in the ability to state target times for hand washing (10% vs. 35%, p<0.01), perform all four hand washing steps correctly (32% vs. 43%, p = 0.01), and report treatment of stored drinking water using any method (73% vs. 92%, p<0.01); the percentage of households with detectable free residual chlorine in stored drinking water did not change (6%, vs. 8%, p = 0.14). The installation of low-cost, low-maintenance, locally-available, portable hand washing and drinking water stations in rural HCFs without access to 24-hour piped water helped assure that health workers had a place to wash their hands and provide safe drinking water. This HCF intervention may have also contributed to the improvement of hand hygiene and reported safe drinking water behaviors among households nearest to HCFs. |
Challenges in assessing transmission of Mycobacterium tuberculosis in long-term-care facilities
Jackson DA , Mailer K , Porter KA , Niemeier RT , Fearey DA , Pope L , Lambert LA , Mitruka K , de Perio MA . Am J Infect Control 2015 43 (9) 992-6 In 2012, the Centers for Disease Control and Prevention (CDC) reported 3.2 cases of tuberculosis (TB) per 100,000 persons in the United States.1 Although TB incidence has declined during the past several decades, the 2010 goal of < 1 case per 1,000,000 persons—as established in the national strategic plan for TB elimination—has yet to be achieved.2 Although persons aged ≥ 65 years accounted for only 14% of the population in 2012, this group represented 22% of reported cases of TB.3,4 An analysis of 1993–2008 cases reported in the United States showed that the rate of TB among elderly adults was as much as 30% higher than among younger adults.5 Even more striking are the disproportionate rates documented among those living in long-term-care facilities (LTCFs). Previous reports have estimated that adults aged ≥ 65 years residing in LTCFs may have between 4 and 50 times the risk of developing TB disease than elderly persons living in the community.5–7 | As of April 2014, approximately 3.2 million workers were employed in LTCFs.8 The size of this occupational group will grow significantly in the coming years if LTCF resident populations increase as expected. Past estimates suggest the TB case rates are 3 times higher among LTCF workers compared with those working in any other job.9 Therefore, prevention and control of TB in LTCFs are essential to protect both the residents and employees in these settings. The goal of this article is to summarize findings of an LTCF TB outbreak investigation to highlight the unique challenges posed by Mycobacterium tuberculosis transmission in these settings. |
Tdap vaccine effectiveness in adolescents during the 2012 Washington State pertussis epidemic
Acosta AM , DeBolt C , Tasslimi A , Lewis M , Stewart LK , Misegades LK , Messonnier NE , Clark TA , Martin SW , Patel M . Pediatrics 2015 135 (6) 981-9 BACKGROUND: Acellular pertussis vaccines replaced whole-cell vaccines for the 5-dose childhood vaccination series in 1997. A sixth dose of pertussis-containing vaccine, tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis, adsorbed (Tdap), was recommended in 2005 for adolescents and adults. Studies examining Tdap vaccine effectiveness (VE) among adolescents who have received all acellular vaccines are limited. METHODS: To assess Tdap VE and duration of protection, we conducted a matched case-control study during the 2012 pertussis epidemic in Washington among adolescents born during 1993-2000. All pertussis cases reported from January 1 through June 30, 2012, in 7 counties were included; 3 controls were matched by primary provider clinic and birth year to each case. Vaccination histories were obtained through medical records, the state immunization registry, and parent interviews. Participants were classified by type of pertussis vaccine received on the basis of birth year: a mix of whole-cell and acellular vaccines (1993-1997) or all acellular vaccines (1998-2000). We used conditional logistic regression to calculate odds ratios comparing Tdap receipt between cases and controls. RESULTS: Among adolescents who received all acellular vaccines (450 cases, 1246 controls), overall Tdap VE was 63.9% (95% confidence interval [CI]: 50% to 74%). VE within 1 year of vaccination was 73% (95% CI: 60% to 82%). At 2 to 4 years postvaccination, VE declined to 34% (95% CI: -0.03% to 58%). CONCLUSIONS: Tdap protection wanes within 2 to 4 years. Lack of long-term protection after vaccination is likely contributing to increases in pertussis among adolescents. |
Urban and rural differences in parental attitudes about influenza vaccination and vaccine delivery models
O'Leary ST , Barnard J , Lockhart S , Kolasa M , Shmueli D , Dickinson LM , Kile D , Dibert E , Kempe A . J Rural Health 2015 31 (4) 421-30 OBJECTIVES: To assess and compare among parents of healthy children in urban and rural areas: (1) reported influenza vaccination status; (2) attitudes regarding influenza vaccination; and (3) attitudes about collaborative models for influenza vaccination delivery involving practices and public health departments. METHODS: A mail survey to random samples of parents from 2 urban and 2 rural private practices in Colorado from April 2012 to June 2012. RESULTS: The response rate was 58% (288/500). In the prior season, 63% of urban and 41% of rural parents reported their child received influenza vaccination (P < .001). No differences in attitudes about influenza infection or vaccination between urban and rural parents were found, with 75% of urban and 73% of rural parents agreeing their child should receive an influenza vaccine every year (P = .71). High proportions reported willingness to participate in a collaborative clinic in a community setting (59% urban, 70% rural, P = .05) or at their child's provider (73% urban, 73% rural, P = .99) with public health department assisting. Fewer (36% urban, 53% rural, P < .01) were likely to go to the public health department if referred by their provider. Rural parents were more willing for their child to receive vaccination outside of their provider's office (70% vs. 55%, P = .01). CONCLUSIONS: While attitudes regarding influenza vaccination were similar, rural children were much less likely to have received vaccination. Most parents were amenable to collaborative models of influenza vaccination delivery, but rural parents were more comfortable with influenza vaccination outside their provider's office, suggesting that other venues for influenza vaccination in rural settings should be promoted. |
Vaccination Week in the Americas, 2011: an opportunity to assess the routine vaccination program in the Bolivarian Republic of Venezuela
Sanchez D , Sodha SV , Kurtis HJ , Ghisays G , Wannemuehler KA , Danovaro-Holliday MC , Ropero-Alvarez AM . BMC Public Health 2015 15 395 BACKGROUND: Vaccination Week in the Americas (VWA) is an annual initiative in countries and territories of the Americas every April to highlight the work of national expanded programs on immunization (EPI) and increase access to vaccination services for high-risk population groups. In 2011, as part of VWA, Venezuela targeted children aged less than 6 years in 25 priority border municipalities using social mobilization to increase institution-based vaccination. Implementation of social communication activities was decentralized to the local level. We conducted a survey in one border municipality of Venezuela to evaluate the outcome of VWA 2011 and provide a snapshot of the overall performance of the routine EPI at that level. METHODS: We conducted a coverage survey, using stratified cluster sampling, in the Venezuelan municipality of Bolivar (bordering Colombia) in August 2011. We collected information for children aged <6 years through caregiver interviews and transcription of vaccination card data. We estimated each child's eligibility to receive a specific vaccine dose during VWA 2011 and whether or not they were actually vaccinated during VWA activities. We also estimated baseline vaccination coverage, timeliness and 95% confidence intervals (CI), and used chi-square tests to compare coverage across age cohorts, taking into account the sampling design. RESULTS: We surveyed 839 children from 698 households; 93% of children had a vaccination card. Among households surveyed, 216 (31%) caregivers reported having heard about a vaccination activity during April or May 2011. Of the 528 children eligible to receive a vaccine during VWA, 24% received at least one dose, while 13% received all doses due. Overall, baseline coverage with routine vaccines, as measured by the survey, was >85%, with a few exceptions. CONCLUSION: Low levels of VWA awareness among caregivers probably contributed to the limited vaccination of eligible children during the VWA activities in Bolivar in 2011. However, vaccine coverage for most EPI vaccines was high. Additionally, high vaccination card availability and high participation in VWA among those caregivers aware of it in 2011 suggest public trust in the EPI program in the municipality. Health authorities have used survey findings to inform changes to the routine EPI and better VWA implementation in subsequent years. |
Present status of human papillomavirus vaccine development and implementation
Herrero R , Gonzalez P , Markowitz LE . Lancet Oncol 2015 16 (5) e206-e216 Oncogenic human papillomavirus (HPV) infection is the cause of nearly all cervical cancers and a proportion of other anogenital and oropharyngeal cancers. A bivalent vaccine containing HPV 16 and 18 and a quadrivalent vaccine containing HPV 6, 11, 16, and 18 antigens are in use in vaccination programmes around the world. In clinical trials, three vaccine doses provided 90-100% protection against cervical infection and pre-cancer related to HPV 16 and 18 in women aged 15-26 years who were not infected at vaccination. Partial cross-protection against other HPV types has been reported but its duration is unknown. The vaccines were also efficacious at the prevention of HPV 16 and 18 infections at other anatomical sites in both sexes. Immunobridging studies allowed licensing of the vaccines for use starting at age 9 years for both sexes. Two-dose schedules elicit high antibody concentrations, leading to the recommendation of two-dose schedules for girls aged 9-14 years. Pre-licensure and post-licensure studies have provided data supporting vaccine safety. In 2014, a nonavalent vaccine containing HPV 6, 11, 16, 18, 31, 33, 45, 52, and 58 antigens was licensed by the US Food and Drug Administration. HPV vaccination was first introduced in high-income countries owing to vaccine cost, logistic challenges, and competing health priorities. Since 2011, vaccine prices have lowered, allowing the introduction of the vaccine in some middle-income countries. Funding of the vaccine by the GAVI Alliance in 2012 led to demonstration projects in some low-income countries. By 2014, more than 57 countries had included the HPV vaccine in their national health programmes. Data from several countries have shown the effect of vaccination on HPV infection and associated disease, and provided evidence of herd immunity. Expansion of programmes to countries with the highest burden of disease is beginning, but further efforts are needed to realise the potential of HPV vaccines. |
Promoting influenza vaccination: insights from a qualitative meta-analysis of 14 years of influenza-related communications research by U.S. Centers for Disease Control and Prevention (CDC)
Nowak GJ , Sheedy K , Bursey K , Smith TM , Basket M . Vaccine 2015 33 (24) 2741-56 INTRODUCTION: A primary mission of the U.S. Centers for Disease Control and Prevention's (CDC) is promoting immunization against seasonal influenza. As with most education efforts, CDC's influenza-related communications are often informed by formative research. METHODS: A qualitative meta-analysis of 29 unpublished, primarily qualitative CDC-sponsored studies related to flu and flu vaccination knowledge, attitudes and beliefs (KABs). The studies, undertaken between 2000 and 2013, involved focus groups, in-depth interviews, message testing and surveys. Some involved health care professionals, while others involved members of the public, including sub-populations at risk for severe illness. FINDINGS: The themes that emerged suggested progress in terms of KABs related to influenza and influenza vaccination, but also the persistence of many barriers to vaccine acceptance. With respect to the public, recurring themes included limited understanding of influenza and immunization recommendations, indications of greater sub-group recognition of the value of flu vaccination, continued resistance to vaccination among many, and overestimation of the effectiveness of non-vaccine measures. Seven cognitive facilitators of vaccination were identified in the studies along with six cognitive barriers. For health care providers, the analysis suggests greater knowledge and more favorable beliefs, but many misperceptions persist and are similar to those held by the public. KABs often differed by type or category of health care provider. CONCLUSIONS: The themes identified in this qualitative analysis illustrate the difficulty in changing KABs related to influenza and influenza vaccine, particularly on the scope and scale needed to greatly improve uptake. Even with an influenza pandemic and more vaccine options available, public and some health care provider perceptions and beliefs are difficult and slow to change. This meta-analysis does, however, provide important insights from previously unpublished information that can help those who are promoting influenza vaccination to health care providers, the general public and specific populations within the general population. |
Evidence-based decision-making for vaccine introductions: overview of the ProVac International Working Group's experience
Jauregui B , Garcia AG , Bess Janusz C , Blau J , Munier A , Atherly D , Mvundura M , Hajjeh R , Lopman B , Clark AD , Baxter L , Hutubessy R , de Quadros C , Andrus JK . Vaccine 2015 33 Suppl 1 A28-33 INTRODUCTION: Pan American Health Organization's (PAHO) ProVac Initiative aims to strengthen countries' technical capacity to make evidence-based immunization policy. With financial support from the Bill and Melinda Gates Foundation, PAHO established the ProVac International Working Group (IWG), a platform created for two years to transfer the ProVac Initiative's tools and methods to support decisions in non-PAHO regions. METHODS: In 2011, WHO Regional Offices and partner agencies established the IWG to transfer the ProVac framework for new vaccine decision support, including tools and trainings to other regions of the world. During the two year period, PAHO served as the coordinating secretariat and partner agencies played implementing or advisory roles. RESULTS: Fifty nine national professionals from 17 countries received training on the use of economic evaluations to aid vaccine policy making through regional workshops. The IWG provided direct technical support to nine countries to develop cost-effectiveness analyses to inform decisions. All nine countries introduced the new vaccine evaluated or their NITAGs have made a recommendation to the Ministry of Health to introduce the new vaccine. DISCUSSION: Developing countries around the world are increasingly interested in weighing the potential health impact due to new vaccine introduction against the investments required. During the two years, the ProVac approach proved valuable and timely to aid the national decision making processes, even despite the different challenges and idiosyncrasies encountered in each region. The results of this work suggest that: (1) there is great need and demand for technical support and for capacity building around economic evaluations; and (2) the ProVac method of supporting country-owned analyses is as effective in other regions as it has been in the PAHO region. CONCLUSION: Decision support for new vaccine introduction in low- and middle-income countries is critical to guiding the efficient use of resources and prioritizing high impact vaccination programs. |
First pertussis vaccine dose and prevention of infant mortality
Tiwari TS , Baughman AL , Clark TA . Pediatrics 2015 135 (6) 990-9 BACKGROUND: American infants are at highest risk of severe pertussis and death. We investigated the role of ≥1 pertussis vaccinations in preventing pertussis-related deaths and risk markers for death among infants aged <42 days. METHODS: We analyzed characteristics of fatal and nonfatal infant pertussis cases reported nationally during 1991-2008. Infants were categorized into 2 age groups on the basis of eligibility to receive a first pertussis vaccine dose at age 6 weeks; dose 1 was considered valid if given ≥14 days before illness onset. Multivariable logistic regression was used to estimate the effect of ≥1 pertussis vaccine doses on outcome and risk markers. RESULTS: Pertussis-related deaths occurred among 258 of 45 404 cases. Fatal and nonfatal cases were confirmed by culture (54% vs 49%) and polymerase chain reaction (31% vs 27%). All deaths occurred before age 34 weeks at illness onset; 64% occurred before age 6 weeks. Among infants aged ≥42 days, receiving ≥1 doses of vaccine protected against death (adjusted odds ratio [aOR]: 0.28; 95% confidence interval [CI]: 0.11-0.74), hospitalization (aOR: 0.69; 95% CI: 0.63-0.77), and pneumonia (aOR: 0.80; 95% CI: 0.68-0.95). Risk was elevated for Hispanic ethnicity (aOR: 2.28; 95% CI: 1.36-3.83) and American Indian/Alaska Native race (aOR: 5.15; 95% CI: 2.37-11.2) and lower for recommended antibiotic treatment (aOR: 0.28; 95% CI: 0.16-0.47). Among infants aged <42 days, risk was elevated for Hispanic ethnicity and lower with recommended antibiotic use. CONCLUSIONS: The first pertussis vaccine dose and antibiotic treatment protect against death, hospitalization, and pneumonia. |
Immunology of protection from Ebola virus infection
Krause PR , Bryant PR , Clark T , Dempsey W , Henchal E , Michael NL , Regules JA , Gruber MF . Sci Transl Med 2015 7 (286) 286ps11 A December 2014 meeting reviewed Ebola virus immunology relevant to vaccine development, including Ebola prevention, immunity, assay standardization, and regulatory considerations. Vaccinated humans appear to achieve immune responses comparable in magnitude with those associated with protection in nonhuman primates, suggesting that immunological data could be used to demonstrate vaccine efficacy. |
Invasive pneumococcal disease following the introduction of 13-valent conjugate vaccine in children in New York City from 2007 to 2012
Farnham AC , Zimmerman CM , Papadouka V , Konty KJ , Zucker JR , Nattanmai GV , Jose S , Rosen JB . JAMA Pediatr 2015 169 (7) 646-52 IMPORTANCE: Invasive pneumococcal disease (IPD) is a leading cause of pneumonia, meningitis, and bacteremia in children. In March 2010, a 13-valent pneumococcal conjugate vaccine (PCV13) was introduced to the routine childhood immunization schedule. The PCV13 contains 6 serotypes not included in the previously recommended 7-valent pneumococcal conjugate vaccine, including serotype 19A, the predominant cause of IPD prior to the introduction of PCV13. OBJECTIVES: To describe changes in the epidemiology and incidence of IPD in children younger than 5 years in New York City (NYC) after the introduction of PCV13 and assess PCV13 coverage in NYC. DESIGN, SETTING, AND PARTICIPANTS: Retrospective analysis of population-based IPD surveillance data of the general population residing in NYC between January 1, 2007, and December 31, 2012. Invasive pneumococcal disease cases were identified by laboratory reporting of positive pneumococcal cultures from a normally sterile body site in NYC residents younger than 5 years. Isolates were serotyped. Participants included 468 cases younger than 5 years with IPD reported through routine surveillance to the NYC Department of Health and Mental Hygiene. MAIN OUTCOMES AND MEASURES: Absolute differences and percentage changes in IPD incidence before and after the introduction of PCV13 by serotype grouping, age, and race/ethnicity. The number of PCV13 doses administered to children younger than 5 years was calculated using the NYC immunization information system. RESULTS: There were 468 IPD cases from 2007 to 2012. The incidence of IPD decreased by 69.6% (95% CI, -79.3% to -55.5%) from 21.0 cases per 100000 (2007-2009 mean) pre-PCV13 to 6.4 cases per 100000 (2011-2012 mean) post-PCV13. Estimates of disease caused by serotypes included in the PCV13 decreased by 82.5% (95% CI, -90.0% to -69.3%), including a 79.7% reduction in serotype 19A (95% CI, -89.0% to -62.4%). Reductions in IPD incidence were seen in all age groups, with the largest reduction in children younger than 12 months (80.4%; P = .005). Incidence decreased significantly in all racial/ethnic groups. The percentage of children younger than 5 years in NYC with 1 or more doses of PCV13 increased from 47.8% in 2010 to 89.8% in 2012. CONCLUSIONS AND RELEVANCE: The incidence of IPD in NYC children younger than 5 years and, particularly, the incidence of IPD caused by serotype 19A decreased dramatically following the introduction of PCV13, with reductions among all age and racial/ethnic groups. This represents a significant achievement for public health immunization programs and underscores the importance of achieving high immunization coverage. |
ACA provisions associated with increase in percentage of young adult women initiating and completing the HPV vaccine
Lipton BJ , Decker SL . Health Aff (Millwood) 2015 34 (5) 757-64 Affordable Care Act provisions implemented in 2010 required insurance plans to offer dependent coverage to people ages 19-25 and to provide targeted preventive services with zero cost sharing. These provisions both increased the percentage of young adults with any source of health insurance coverage and improved the generosity of coverage. We examined how these provisions affected use of the human papillomavirus (HPV) vaccine, which is among the most expensive of recommended vaccines, among young adult women. Using 2008-12 data from the National Health Interview Survey, we estimated that the 2010 policy implementation increased the likelihood of HPV vaccine initiation and completion by 7.7 and 5.8 percentage points, respectively, for women ages 19-25 relative to a control group of women age 18 or 26. These estimates translate to approximately 1.1 million young women initiating and 854,000 young women completing the vaccine series. |
Development of influenza A(H7N9) candidate vaccine viruses with improved hemagglutinin antigen yield in eggs
Ridenour C , Johnson A , Winne E , Hossain J , Mateu-Petit G , Balish A , Santana W , Kim T , Davis C , Cox NJ , Barr JR , Donis RO , Villanueva J , Williams TL , Chen LM . Influenza Other Respir Viruses 2015 9 (5) 263-70 BACKGROUND: The emergence of avian influenza A(H7N9) virus in poultry causing zoonotic human infections was reported on March 31, 2013. Development of A(H7N9) candidate vaccine viruses (CVV) for pandemic preparedness purposes was initiated without delay. Candidate vaccine viruses were derived by reverse genetics using the internal genes of A/Puerto/Rico/8/34 (PR8). The resulting A(H7N9) CVVs needed improvement because they had titers and antigen yields that were suboptimal for vaccine manufacturing in eggs, especially in a pandemic situation. METHODS: Two CVVs derived by reverse genetics were serially passaged in embryonated eggs to improve the hemagglutinin (HA) antigen yield. The total viral protein and HA antigen yields of six egg-passaged CVVs were determined by the BCA assay and isotope dilution mass spectrometry (IDMS) analysis, respectively. CVVs were antigenically characterized by hemagglutination inhibition (HI) assays with ferret antisera. RESULTS: Improvement of total viral protein yield was observed for the six egg-passaged CVVs; HA quantification by IDMS indicated approximately a two-fold increase in yield of several egg-passaged viruses as compared to that of the parental CVV. Several different amino acid substitutions were identified in the HA of all viruses after serial passage; however HI tests indicated that the antigenic properties of two CVVs remained unchanged. CONCLUSIONS: If influenza A(H7N9) viruses were to acquire sustained human to human transmissibility, the improved HA yield of the egg-passaged CVVs generated in this study could expedite vaccine manufacturing for pandemic mitigation. |
Electronic health records to support obesity-related patient care: results from a survey of United States physicians
Bronder KL , Dooyema CA , Onufrak SJ , Foltz JL . Prev Med 2015 77 41-7 OBJECTIVE: Obesity-related electronic health record (EHR) functions increase the rates of measuring BMI, diagnosing obesity, and providing obesity services. This study describes the prevalence of obesity-related EHR functions in clinical practice and analyzes characteristics associated with increased obesity-related EHR sophistication. MATERIALS AND METHODS: Data were analyzed from DocStyles, a web-based panel survey administered to 1507 primary care providers practicing in the United States in June, 2013. Physicians were asked if their EHR has specific obesity-related functions. Logistical regression analyses identified characteristics associated with improved obesity-related EHR sophistication. RESULTS: Of the 88% of providers with an EHR, 83% of EHRs calculate BMI, 52% calculate pediatric BMI percentile, and 32% flag patients with abnormal BMI values. Only 36% provide obesity-related decision support and 17% suggest additional resources for obesity-related care. Characteristics associated with having a more sophisticated EHR include age ≤45years old, being a pediatrician or family practitioner, and practicing in a larger, outpatient practice. DISCUSSION: Few EHRs optimally supported physician's obesity-related clinical care. The low rates of obesity-related EHR functions currently in practice highlight areas to improve the clinical health information technology in primary care practice. CONCLUSIONS: More work can be done to develop, implement, and promote the effective utilization of obesity-related EHR functions to improve obesity treatment and prevention efforts. |
Reach and knowledge change among coaches and other participants of the online course: "Concussion in Sports: What You Need to Know"
Parker EM , Gilchrist J , Schuster D , Lee R , Sarmiento K . J Head Trauma Rehabil 2015 30 (3) 198-206 OBJECTIVES: To describe the reach of the Heads Up "Concussion in Sports: What You Need to Know," online course and to assess knowledge change. SETTING: Online. PARTICIPANTS: Individuals who have taken the free online course since its inception in May 2010 to July 2013. DESIGN: Descriptive, uncontrolled, before and after study design. MAIN MEASURES: Reach is measured by the number of unique participants and the number of times the course was completed by state and sport coached and the rate of participation per 100 000 population by state. Knowledge change is measured by the distribution and mean of pre- and posttest scores by sex, primary role (eg, coach, student, and parent), and sport coached. RESULTS: Between May 2010 and July 2013, the online concussion course was completed 819 223 times, reaching 666 026 unique participants, including residents from all US states and the District of Columbia. The distribution of overall scores improved from pre- to posttests, with 21% answering all questions correctly on the pretest and 60% answering all questions correctly on the posttest. CONCLUSION: Online training can be effective in reaching large audiences and improving knowledge about emerging health and safety issues such as concussion awareness. |
Sleep disruption and the sequelae associated with traumatic brain injury
Lucke-Wold BP , Smith KE , Nguyen L , Turner RC , Logsdon AF , Jackson GJ , Huber JD , Rosen CL , Miller DB . Neurosci Biobehav Rev 2015 55 68-77 Sleep disruption, which includes a loss of sleep as well as poor quality fragmented sleep, frequently follows traumatic brain injury (TBI) impacting a large number of patients each year in the United States. Fragmented and/or disrupted sleep can worsen neuropsychiatric, behavioral, and physical symptoms of TBI. Additionally, sleep disruption impairs recovery and can lead to cognitive decline. The most common sleep disruption following TBI is insomnia. The consequences of disrupted sleep following injury range from deranged metabolomics and blood brain barrier compromise to altered neuroplasticity and degeneration. There are several theories for why sleep is necessary (e.g., glymphatic clearance and metabolic regulation) and these may help explain how sleep disruption contributes to degeneration within the brain. Experimental data indicate disrupted sleep allows hyperphosphorylated tau and amyloid beta plaques to accumulate. As sleep disruption may act as a cellular stressor, target areas warranting further scientific investigation include the increase in endoplasmic reticulum and oxidative stress following acute periods of sleep deprivation. Potential treatment options for restoring the normal sleep cycle include melatonin derivatives and cognitive behavioral therapy. |
Trends in sports- and recreation-related traumatic brain injuries treated in US emergency departments: the National Electronic Injury Surveillance System-All Injury Program (NEISS-AIP) 2001-2012
Coronado VG , Haileyesus T , Cheng TA , Bell JM , Haarbauer-Krupa J , Lionbarger MR , Flores-Herrera J , McGuire LC , Gilchrist J . J Head Trauma Rehabil 2015 30 (3) 185-97 IMPORTANCE: Sports- and recreation-related traumatic brain injuries (SRR-TBIs) are a growing public health problem affecting persons of all ages in the United States. OBJECTIVE: To describe the trends of SRR-TBIs treated in US emergency departments (EDs) from 2001 to 2012 and to identify which sports and recreational activities and demographic groups are at higher risk for these injuries. DESIGN: Data on initial ED visits for an SRR-TBI from the National Electronic Injury Surveillance System-All Injury Program (NEISS-AIP) for 2001-2012 were analyzed. SETTING: NEISS-AIP data are drawn from a nationally representative sample of hospital-based EDs. PARTICIPANTS: Cases of TBI were identified from approximately 500 000 annual initial visits for all causes and types of injuries treated in EDs captured by NEISS-AIP. MAIN OUTCOME MEASURE(S): Numbers and rates by age group, sex, and year were estimated. Aggregated numbers and percentages by discharge disposition were produced. RESULTS: Approximately 3.42 million ED visits for an SRR-TBI occurred during 2001-2012. During this period, the rates of SRR-TBIs treated in US EDs significantly increased in both males and females regardless of age (all Ps < .001). For males, significant increases ranged from a low of 45.8% (ages 5-9) to a high of 139.8 % (ages 10-14), and for females, from 25.1% (ages 0-4) to 211.5% (ages 15-19) (all Ps < .001). Every year males had about twice the rates of SRR-TBIs than females. Approximately 70% of all SRR-TBIs were reported among persons aged 0 to 19 years. The largest number of SRR-TBIs among males occurred during bicycling, football, and basketball. Among females, the largest number of SRR-TBIs occurred during bicycling, playground activities, and horseback riding. Approximately 89% of males and 91% of females with an SRR-TBI were treated and released from EDs. CONCLUSION AND RELEVANCE: The rates of ED-treated SRR-TBIs increased during 2001-2012, affecting mainly persons aged 0 to 19 years and males in all age groups. Increases began to appear in 2004 for females and 2006 for males. Activities associated with the largest number of TBIs varied by sex and age. Reasons for the reported increases in ED visits are unknown but may be associated with increased awareness of TBI through increased media exposure and from campaigns, such as the Centers for Disease Control and Prevention's Heads Up. Prevention efforts should be targeted by sports and recreational activity, age, and sex. |
Unemployment in the United States after traumatic brain injury for working-age individuals: prevalence and associated factors 2 years postinjury
Cuthbert JP , Harrison-Felix C , Corrigan JD , Bell JM , Haarbauer-Krupa JK , Miller AC . J Head Trauma Rehabil 2015 30 (3) 160-74 OBJECTIVE: To estimate the prevalence of unemployment and part-time employment in the United States for working-age individuals completing rehabilitation for a primary diagnosis of traumatic brain injury (TBI) between 2001 and 2010. DESIGN: Secondary data analysis. SETTING: Acute inpatient rehabilitation facilities. PARTICIPANTS: Patients aged 16 to 60 years at injury who completed inpatient rehabilitation for TBI between 2001 and 2010. MAIN OUTCOME MEASURES: Unemployment; Part-time employment. RESULTS: The prevalence of unemployment for persons in the selected cohort was 60.4% at 2-year postinjury. Prevalence of unemployment at 2-year postinjury was significantly associated with the majority of categories of age group, race, gender, marital status, primary inpatient rehabilitation payment source, education, preinjury vocational status, length of stay, and Disability Rating Scale. The direction of association for the majority of these variables complement previous research in this area, with only Hispanic ethnicity and the FIM Cognitive subscale demonstrating disparate findings. For those employed at 2-year postinjury, the prevalence of part-time employment was 35.0%. The model of prevalence for part-time employment at 2-year postinjury was less robust, with significant relationships with some categorical components of age group, gender, marital status, primary payment source, preinjury vocational status, and Disability Rating Scale. CONCLUSIONS: The prevalence of unemployment for patients completing inpatient rehabilitation for TBI was substantial (60.4%). The majority of factors found to associate with 2 years' unemployment were complementary of previously published research; however, these were often smaller in magnitude than previous reports. The prevalence of part-time employment was also an issue for this cohort and included 35.0% of all employed individuals. In regard to the determination of factors associated with part-time employment, additional analyses that include more fine-grained factors associated with employment, including physical and psychosocial functioning, are recommended. |
The public health approach to TBI
Bell JM , Taylor CA , Breiding MJ . J Head Trauma Rehabil 2015 30 (3) 148-9 IN 1996, CONGRESS PASSED PUBLIC LAW 104-166 mandating the Centers for Diseases Control and Prevention (CDC) to engage in work focused on reducing the incidence of traumatic brain injury (TBI) in the United States. The TBI Act, which has been amended and renewed 3 times since then, specifies certain activities around which the TBI work at the CDC should be focused. The CDC's National Center for Injury Prevention and Control has remained responsive to Congress by conducting surveillance to better understand the burden of TBI, conducting research to better explore the full range of TBI outcomes, identifying prevention strategies, implementing education initiatives, and providing technical assistance to states and other key partners. As the field evolved, new priorities emerged and the CDC revised its strategic plan for measuring and reducing the public health burden of TBI in the United States. The articles included in this special issue fit within this newly developed strategic plan. | The public health model emphasizes a framework by which a health condition of interest is defined and systematically studied to describe the overall public health burden, identify modifiable risk and protective factors, implement effective prevention strategies, and carry out widespread dissemination to increase adoption of evidence-based practices. The CDC's strategic plan for TBI aims to anchor work to the public health model with the intent of achieving maximum impact in reducing TBI-related morbidity and mortality. The CDC's strategic plan for TBI is organized into 4 pillars: (1) improving the understanding of the public health burden of TBI; (2) reducing the incidence of TBI through primary prevention; (3) improving the recognition and management of mild TBI; and (4) promoting healthy lifestyles and improving health outcomes for persons living with TBI. |
Experience of forced sex and subsequent sexual, drug, and mental health outcomes: African American and Hispanic women in the southeastern United States
Jones D , Marks G , Villar-Loubet O , Weiss SM , O’Daniels C , Borkowf CB , Simpson C , Adimora AA , McLellan-Lemal E . Int J Sex Health 2015 27 (3) 249-263 OBJECTIVES: This cross-sectional study examined African American and Hispanic women's (N = 1,509) self-reports of unwanted forced sex and its association with behavioral and mental health outcomes after the event. METHODS: Twenty percent of the women had experienced forced sex (1st occurrence at age 15 years or younger for 10%, 1st occurrence at older than 15 years of age for 10%). RESULTS: Regardless of when forced sex 1st occurred, women were more likely to have engaged in unprotected vaginal and anal sex, to have had multiple unprotected sex partners, to have sexually transmitted infections, to have reported binge drinking and illicit drug use, and to exhibit distress and have received mental health counseling. CONCLUSIONS: Forced sex may have wide-ranging behavioral and mental health consequences years later. |
Healthcare providers' perceptions and self-reported fall prevention practices: findings from a large New York health system
Smith ML , Stevens JA , Ehrenreich H , Wilson AD , Schuster RJ , Cherry CO , Ory MG . Front Public Health 2015 3 17 Among older adults, falls are the leading cause of injury-related deaths and emergency department visits, and the incidence of falls in the United States is rising as the number of older Americans increases. Research has shown that falls can be reduced by modifying fall-risk factors using multifactorial interventions implemented in clinical settings. However, the literature indicates that many providers feel that they do not know how to conduct fall-risk assessments or do not have adequate knowledge about fall prevention. To help healthcare providers incorporate older adult fall prevention (i.e., falls risk assessment and treatment) into their clinical practice, the Centers for Disease Control and Prevention's (CDC) Injury Center has developed the Stopping Elderly Accidents, Deaths, and Injuries (STEADI) tool kit. This study was conducted to identify the practice characteristics and providers' beliefs, knowledge, and fall-related activities before they received training on how to use the STEADI tool kit. Data were collected as part of a larger State Fall Prevention Project funded by CDC's Injury Center. Completed questionnaires were returned by 38 medical providers from 11 healthcare practices within a large New York health system. Healthcare providers ranked falls as the lowest priority of five conditions, after diabetes, cardiovascular disease, mental health, and musculoskeletal conditions. Less than 40% of the providers asked most or all of their older patients if they had fallen during the past 12 months. Less than a quarter referred their older patients to physical therapists for balance or gait training, and <20% referred older patients to community-based fall prevention programs. Less than 16% reported they conducted standardized functional assessments with their older patients at least once a year. These results suggest that implementing the STEADI tool kit in clinical settings could address knowledge gaps and provide the necessary tools to help providers incorporate fall-risk assessment and treatment into clinical practice. |
Addressing the Intersection of HIV and intimate partner violence among women with or at risk for HIV in the United States
McCree DH , Koenig LJ , Basile KC , Fowler D , Green Y . J Womens Health (Larchmt) 2015 24 (5) 331-5 In 2012, the White House established a working group in recognition of the need to understand and address the intersection of human immunodeficiency virus (HIV) infection and violence against women and girls. This report describes the Centers for Disease Control and Prevention (CDC)'s efforts for addressing intimate partner violence and HIV among women and provides suggestions for future prevention efforts. CDC's current efforts are focused on understanding these often co-occurring public health problems, identifying effective interventions, and ensuring that states and communities have the capacity and resources to implement prevention approaches based on the best available evidence. Additional research is needed on effective strategies for integrating violence prevention and HIV programming into health services targeting adolescent girls and women who experience intimate partner violence or are at risk for HIV. |
Comparability of national estimates for traumatic brain injury-related medical encounters
Taylor CA , Greenspan AI , Xu L , Kresnow MJ . J Head Trauma Rehabil 2015 30 (3) 150-9 OBJECTIVE: To describe similarities and differences in the number of civilian traumatic brain injury (TBI)-related hospitalizations and emergency department visits between national databases that capture US hospital data. PARTICIPANTS: TBI-related hospitalizations included in the National Hospital Discharge Survey (NHDS) and Healthcare Cost and Utilization Project Nationwide Inpatient Sample (HCUP-NIS) and emergency department visits in the National Hospital Ambulatory Medical Care Survey (NHAMCS) and HCUP Nationwide Emergency Department Sample (HCUP-NEDS) for 2006-2010. DESIGN: Cross-sectional design. MAIN MEASURES: Nationwide counts of TBI-related medical encounters. RESULTS: Overall, the frequency of TBI is comparable when comparing NHDS with HCUP-NIS and NHAMCS with HCUP-NEDS. However, annual counts in both NHDS and NHAMCS are consistently unstable when examined in smaller subgroups, such as by age group and injury mechanism. Injury mechanism is consistently missing from many more records in NHDS compared with HCUP-NIS. CONCLUSION: Given the large sample size of HCUP-NIS and HCUP-NEDS, these data can offer a valuable resource for examining TBI-related hospitalization and emergency department visits, especially by subgroup. These data hold promise for future examinations of annual TBI counts, but ongoing comparisons with national probability samples will be necessary to ensure that HCUP continues to track with estimates from these data. |
Competency Guidelines for Public Health Laboratory Professionals: CDC and the Association of Public Health Laboratories.
Ned-Sykes R , Johnson C , Ridderhof JC , Perlman E , Pollock A , DeBoy JM . MMWR Suppl 2015 64 (1) 1-81 These competency guidelines outline the knowledge, skills, and abilities necessary for public health laboratory (PHL) professionals to deliver the core services of PHLs efficiently and effectively. As part of a 2-year workforce project sponsored in 2012 by CDC and the Association of Public Health Laboratories (APHL), competencies for 15 domain areas were developed by experts representing state and local PHLs, clinical laboratories, academic institutions, laboratory professional organizations, CDC, and APHL. The competencies were developed and reviewed by approximately 170 subject matter experts with diverse backgrounds and experiences in laboratory science and public health. The guidelines comprise general, cross-cutting, and specialized domain areas and are divided into four levels of proficiency: beginner, competent, proficient, and expert. The 15 domain areas are 1) Quality Management System, 2) Ethics, 3) Management and Leadership, 4) Communication, 5) Security, 6) Emergency Management and Response, 7) Workforce Training, 8) General Laboratory Practice, 9) Safety, 10) Surveillance, 11) Informatics, 12) Microbiology, 13) Chemistry, 14) Bioinformatics, and 15) Research. These competency guidelines are targeted to scientists working in PHLs, defined as governmental public health, environmental, and agricultural laboratories that provide analytic biological and/or chemical testing and testing-related services that protect human populations against infectious diseases, foodborne and waterborne diseases, environmental hazards, treatable hereditary disorders, and natural and human-made public health emergencies. The competencies support certain PHL workforce needs such as identifying job responsibilities, assessing individual performance, and providing a guiding framework for producing education and training programs. Although these competencies were developed specifically for the PHL community, this does not preclude their broader application to other professionals in a variety of different work settings. |
Validation of serological tests for the detection of antibodies against Treponema pallidum in nonhuman primates
Knauf S , Dahlmann F , Batamuzi EK , Frischmann S , Liu H . PLoS Negl Trop Dis 2015 9 (3) e0003637 There is evidence to suggest that the yaws bacterium (Treponema pallidum ssp. pertenue) may exist in non-human primate populations residing in regions where yaws is endemic in humans. Especially in light of the fact that the World Health Organizaiton (WHO) recently launched its second yaws eradication campaign, there is a considerable need for reliable tools to identify treponemal infection in our closest relatives, African monkeys and great apes. It was hypothesized that commercially available serological tests detect simian anti-T. pallidum antibody in serum samples of baboons, with comparable sensitivity and specificity to their results on human sera. Test performances of five different treponemal tests (TTs) and two non-treponemal tests (NTTs) were evaluated using serum samples of 57 naturally T. pallidum-infected olive baboons (Papio anubis) from Lake Manyara National Park in Tanzania. The T. pallidum particle agglutination assay (TP-PA) was used as a gold standard for comparison. In addition, the overall infection status of the animals was used to further validate test performances. For most accurate results, only samples that originated from baboons of known infection status, as verified in a previous study by clinical inspection, PCR and immunohistochemistry, were included. All tests, TTs and NTTs, used in this study were able to reliably detect antibodies against T. pallidum in serum samples of infected baboons. The sensitivity of TTs ranged from 97.7-100%, while specificity was between 88.0-100.0%. The two NTTs detected anti-lipoidal antibodies in serum samples of infected baboons with a sensitivity of 83.3% whereas specificity was 100%. For screening purposes, the TT Espline TP provided the highest sensitivity and specificity and at the same time provided the most suitable format for use in the field. The enzyme immune assay Mastblot TP (IgG), however, could be considered as a confirmatory test. |
Video studies of passage by Anopheles gambiae mosquitoes through holes in a simulated bed net: effects of hole size, hole orientation and net environment
Sutcliffe J , Colborn KL . Malar J 2015 14 (1) 199 BACKGROUND: Holes in netting provide potential routes for mosquitoes to enter ITNs. Despite this, there is little information on how mosquitoes respond to holes in bed nets and how their responses are affected by hole size, shape and orientation or by ambient conditions around the net. METHODS: Female Anopheles gambiae (G3) were recorded in a simulated bed net consisting of two sizes of untreated netting-covered behavioural arenas placed above and beside (to simulate the bed net roof and sides respectively) the experimenter who was a source of host cues from 'inside' the net. A round hole of 9 mm or 13 mm diameter was cut into the centre of the netting of each arena. Videos of unfed female mosquitoes in arenas were analysed for time spent flying, walking and standing still and for exit through the hole. The effects of the experimenter on temperature and relative humidity around the simulated net were also measured. RESULTS: Mosquitoes were significantly more active in overhead arenas than in arenas to the side. Hole passage was significantly more likely in smaller arenas than larger ones and for larger holes than smaller ones. In arenas to the side, hole passage rate through small holes was about 50 % less likely than what could be explained by area alone. Passage rate through holes in overhead arenas was consistent with hole area. Temperature in arenas did not strongly reflect the experimenter's presence in the simulated net. Relative humidity and absolute humidity in overhead arenas, but not in arenas to the side, were immediately affected by experimenter presence. CONCLUSIONS: Higher levels of activity in overhead arenas than in arenas to the side were likely due to the rising heat and humidity plume from the experimenter. Lower than expected passage rates through smaller vertically oriented holes may have been be due to an edge effect that does not apply to horizontally oriented holes. Results suggest that current methods of assessing the importance of physical damage to ITNs may not accurately reflect mosquito entry risk in all cases. |
N-acetyl cysteine and mushroom Agaricus sylvaticus supplementation decreased parasitaemia and pulmonary oxidative stress in a mice model of malaria
Quadros Gomes BA , da Silva LF , Quadros Gomes AR , Moreira DR , Dolabela MF , Santos RS , Green MD , Carvalho EP , Percario S . Malar J 2015 14 (1) 202 BACKGROUND: Malaria infection can cause high oxidative stress, which could lead to the development of severe forms of malaria, such as pulmonary malaria. In recent years, the role of reactive oxygen species in the pathogenesis of the disease has been discussed, as well as the potential benefit of antioxidants supplementation. The aim of this study was to investigate the effects of N-acetyl cysteine (NAC) or mushroom Agaricus sylvaticus supplementation on the pulmonary oxidative changes in an experimental model of malaria caused by Plasmodium berghei strain ANKA. METHODS: Swiss male mice were infected with P. berghei and treated with NAC or AS. Samples of lung tissue and whole blood were collected after one, three, five, seven or ten days of infection for the assessment of thiobarbituric acid reactive substances (TBARS), trolox equivalent antioxidant capacity (TEAC), nitrites and nitrates (NN) and to assess the degree of parasitaemia. RESULTS: Although parasitaemia increased progressively with the evolution of the disease in all infected groups, there was a significant decrease from the seventh to the tenth day of infection in both antioxidant-supplemented groups. Results showed significant higher levels of TEAC in both supplemented groups, the highest occurring in the group supplemented with A. sylvaticus. In parallel, TBARS showed similar levels among all groups, while levels of NN were higher in animals supplemented with NAC in relation to the positive control groups and A. sylvaticus, whose levels were similar to the negative control group. CONCLUSION: Oxidative stress arising from plasmodial infection was attenuated by supplementation of both antioxidants, but A. sylvaticus proved to be more effective and has the potential to become an important tool in the adjuvant therapy of malaria. |
Environmental conditions affect exhalation of H3N2 seasonal and variant influenza viruses and respiratory droplet transmission in Ferrets
Gustin KM , Belser JA , Veguilla V , Zeng H , Katz JM , Tumpey TM , Maines TR . PLoS One 2015 10 (5) e0125874 The seasonality of influenza virus infections in temperate climates and the role of environmental conditions like temperature and humidity in the transmission of influenza virus through the air are not well understood. Using ferrets housed at four different environmental conditions, we evaluated the respiratory droplet transmission of two influenza viruses (a seasonal H3N2 virus and an H3N2 variant virus, the etiologic virus of a swine to human summertime infection) and concurrently characterized the aerosol shedding profiles of infected animals. Comparisons were made among the different temperature and humidity conditions and between the two viruses to determine if the H3N2 variant virus exhibited enhanced capabilities that may have contributed to the infections occurring in the summer. We report here that although increased levels of H3N2 variant virus were found in ferret nasal wash and exhaled aerosol samples compared to the seasonal H3N2 virus, enhanced respiratory droplet transmission was not observed under any of the environmental settings. However, overall environmental conditions were shown to modulate the frequency of influenza virus transmission through the air. Transmission occurred most frequently at 23 degrees C/30%RH, while the levels of infectious virus in aerosols exhaled by infected ferrets agree with these results. Improving our understanding of how environmental conditions affect influenza virus infectivity and transmission may reveal ways to better protect the public against influenza virus infections. |
Experience in implementing a quality management system in a tuberculosis laboratory, Kisumu, Kenya
Musau S , McCarthy K , Okumu A , Shinnick T , Wandiga S , Williamson J , Cain K . Int J Tuberc Lung Dis 2015 19 (6) 693-5 We implemented a quality management system (QMS) and documented our improvements in a tuberculosis (TB) laboratory in Kisumu, Kenya. After implementation of the QMS, a sustained reduction in culture contamination rates for solid (from 15.4% to 5.3%) and liquid media (from 15.2% to 9.3%) was observed, and waste from product expiry was reduced significantly. External quality assurance (EQA) results were satisfactory before and after QMS implementation, and a client survey after implementation revealed 98% satisfaction. The laboratory attained ISO 15189 accreditation in October 2013. The implementation of QMS facilitated the attainment of target quality indicators, reduced waste due to expiry and led to high client satisfaction. |
Inhibition of MAP kinase/NF-kB mediated signaling and attenuation of lipopolysaccharide induced severe sepsis by cerium oxide nanoparticles
Selvaraj V , Nepal N , Rogers S , Manne ND , Arvapalli R , Rice KM , Asano S , Fankhanel E , Ma JJ , Shokuhfar T , Maheshwari M , Blough ER . Biomaterials 2015 59 160-171 Sepsis is a life threatening disease that is associated with high mortality. Existing treatments have failed to improve survivability in septic patients. The purpose of this present study is to evaluate whether cerium oxide nanoparticles (CeO2NPs) can prevent lipopolysaccharide (LPS) induced severe sepsis mortality by preventing hepatic dysfunction in male Sprague Dawley rats. Administration of a single dose (0.5 mg/kg) of CeO2NPs intravenously to septic rats significantly improved survival rates and functioned to restore body temperature, respiratory rate and blood pressure towards baseline. Treatment-induced increases in animal survivability were associated with decreased hepatic damage along with reductions in serum cytokines/chemokines, and diminished inflammatory related signaling. Kupffer cells and macrophage cells exposed to CeO2NPs exhibited decreases in LPS-induced cytokine release (TNF-alpha, IL-1beta, IL-6, HMGB1) which were associated with diminished cellular ROS, reduced levels of nitric oxide synthase (iNOS), cyclooxygenase 2 (COX-2), and decreased nuclear factor-kappa light chain enhancer of activated B cells (NF-kB) transcriptional activity. The findings of this study indicate that CeO2NPs may be useful as a therapeutic agent for sepsis. |
An anti-G protein monoclonal antibody treats RSV disease more effectively than an anti-F monoclonal antibody in BALB/c mice
Boyoglu-Barnum S , Todd SO , Chirkova T , Barnum TR , Gaston KA , Haynes LM , Tripp RA , Moore ML , Anderson LJ . Virology 2015 483 117-125 Respiratory syncytial virus (RSV) belongs to the family Paramyxoviridae and is the single most important cause of serious lower respiratory tract infections in young children, yet no highly effective treatment or vaccine is available. To clarify the potential for an anti-G mAb, 131-2G which has both anti-viral and anti-inflammatory effects, to effectively treat RSV disease, we determined the kinetics of its effect compared to the effect of the anti-F mAb, 143-6C on disease in mice. Treatment administered three days after RSV rA2-line19F (r19F) infection showed 131-2G decreased breathing effort, pulmonary mucin levels, weight loss, and pulmonary inflammation earlier and more effectively than treatment with mAb 143-6C. Both mAbs stopped lung virus replication at day 5 post-infection. These data show that, in mice, anti-G protein mAb is superior to treating disease during RSV infection than an anti-F protein mAb similar to Palivizumab. This combination of anti-viral and anti-inflammatory activity makes 131-2G a promising candidate for treating for active human RSV infection. |
Antivibration gloves: effects on vascular and sensorineural function, an animal model
Krajnak K , Waugh S , Johnson C , Miller RG , Welcome D , Xu X , Warren C , Sarkisian S , Andrew M , Dong RG . J Toxicol Environ Health A 2015 78 (9) 571-82 Anti-vibration gloves have been used to block the transmission of vibration from powered hand tools to the user, and to protect users from the negative health consequences associated with exposure to vibration. However, there are conflicting reports as to the efficacy of gloves in protecting workers. The goal of this study was to use a characterized animal model of vibration-induced peripheral vascular and nerve injury to determine whether antivibration materials reduced or inhibited the effects of vibration on these physiological symptoms. Rats were exposed to 4 h of tail vibration at 125 Hz with an acceleration 49 m/s(2). The platform was either bare or covered with antivibrating glove material. Rats were tested for tactile sensitivity to applied pressure before and after vibration exposure. One day following the exposure, ventral tail arteries were assessed for sensitivity to vasodilating and vasoconstricting factors and nerves were examined histologically for early indicators of edema and inflammation. Ventral tail artery responses to an alpha2C-adrenoreceptor agonist were enhanced in arteries from vibration-exposed rats compared to controls, regardless of whether antivibration materials were used or not. Rats exposed to vibration were also less sensitive to pressure after exposure. These findings are consistent with experimental findings in humans suggesting that antivibration gloves may not provide protection against the adverse health consequences of vibration exposure in all conditions. Additional studies need to be done examining newer antivibration materials. |
A candidate reference measurement procedure for quantifying serum concentrations of 25-hydroxyvitamin D and 25-hydroxyvitamin D using isotope-dilution liquid chromatography-tandem mass spectrometry
Mineva EM , Schleicher RL , Chaudhary-Webb M , Maw KL , Botelho JC , Vesper HW , Pfeiffer CM . Anal Bioanal Chem 2015 407 (19) 5615-24 The inaccuracy of routine serum 25-hydroxyvitamin D measurements hampers the interpretation of data in patient care and public health research. We developed and validated a candidate reference measurement procedure (RMP) for highly accurate quantitation of two clinically important 25-hydroxyvitamin D metabolites in serum, 25-hydroxyvitamin D2 [25(OH)D2] and 25-hydroxyvitamin D3 [25(OH)D3]. The two compounds of interest together with spiked deuterium-labeled internal standards [d 3-25(OH)D2 and d 6-25(OH)D3] were extracted from serum via liquid-liquid extraction. The featured isotope-dilution LC-MS/MS method used reversed-phase chromatography and atmospheric pressure chemical ionization in positive ion mode. A pentafluorophenylpropyl-packed UHPLC column together with isocratic elution allowed for complete baseline resolution of 25(OH)D2 and 25(OH)D3 from their structural C-3 isomers within 12 min. We evaluated method trueness, precision, potential interferences, matrix effects, limits of quantitation, and measurement uncertainty. Calibration materials were, or were traceable to, NIST Standard Reference Materials 2972. Within-day and total imprecision (CV) averaged 1.9 and 2.0 % for 25(OH)D3, respectively, and 2.4 and 3.5 % for 25(OH)D2, respectively. Mean trueness was 100.3 % for 25(OH)D3 and 25(OH)D2. The limits of quantitation/limits of detection were 4.61/1.38 nmol/L for 25(OH)D3 and 1.46/0.13 nmol/L for 25(OH)D2. When we compared our RMP results to an established RMP using 40 serum samples, we found a nonsignificant mean bias of 0.2 % for total 25(OH)D. This candidate RMP for 25(OH)D metabolites meets predefined method performance specifications (≤5 % total CV and ≤1.7 % bias) and provides sufficient sample throughput to meet the needs of the Centers for Disease Control and Prevention Vitamin D Standardization Certification Program. Graphical abstract Bias assessment using NIST standard reference materials. Legend CDC mean mass fractions (ng/g) +/- U 95 (6 replicates per mean). NIST-certified mass fractions (ng/g) +/- U 95 from the Certificates of Analysis. |
Clinical performance and safety of adapters for intradermal delivery with conventional and autodisable syringes
Tsals I , Jarrahian C , Snyder FE , Saganic L , Saxon E , Zehrung D , Zimmerman G , Papania M , Klaff L . Vaccine 2015 33 (37) 4705-11 Although the number of vaccines and diagnostic tests currently delivered intradermally is limited, this route of administration offers potential advantages due to the high concentration of antigen-presenting cells in the skin. One factor which may in part be limiting development and use of intradermal (ID) administration is concern about the ease and reliability of the needle and syringe-based Mantoux technique. A phase I clinical study was conducted to evaluate two ID adapters that have been developed as injection-delivery aids to increase the safety, simplicity, and reliability of ID injection: a prototype autodisable, intradermal (ADID) adapter for autodisable (AD) syringes, and a marketed side-merge adapter (SMA). Thirty healthy adult volunteers each received six injections of 0.1mL of sterile saline solution. Each adapter was used to give injections into the upper deltoid, forearm, and suprascapular regions of each volunteer. The needle-bevel orientation during injection was random. Injection performance was determined by measuring wheal size and fluid leakage. Wheals were similar in size for the ADID adapter (mean 9.9+/-0.17mm) and SMA (mean 9.8+/-0.15mm). In all of the injections completed with the SMA, and 98% of those completed with the ADID, fluid leakage was less than 10% of the intended injection volume. Minor skin abrasions were the only adverse events. Based on self-reporting of pain, injections were well tolerated (mean pain score of 2 on a 0-10 scale). ID delivery using the SMA and ADID adapters appears safe and effective. |
Detection of 5-fluorouracil surface contamination in near real time
Smith JP , Sammons DL , Pretty JR , Kurtz KS , Robertson SA , DeBord DG , Connor TH , Snawder JE . J Oncol Pharm Pract 2015 22 (3) 396-408 OBJECTIVES: Contamination of workplace surfaces by antineoplastic drugs presents an exposure risk for healthcare workers. Traditional instrumental methods to detect contamination such as gas chromatography-mass spectrometry (GC-MS) or liquid chromatography-tandem mass spectrometry (LC-MS/MS) are sensitive and accurate but expensive and incapable of producing results in real time. This limits their utility in preventing worker exposure. We are currently developing monitors based on lateral flow immunoassay that can detect drug contamination in near real time. In this report, we describe the laboratory performance of a 5-fluorouracil (5-FU) monitor. METHODS: The monitor was evaluated by spiking ceramic, vinyl, composite, stainless steel, and glass surfaces of 100 cm2 area with 5-FU masses of 0, 5, 10, 25, 50, and 100 ng. The surface was sampled with a wetted cotton swab, the swab was extracted with buffer, and the resulting solution was applied to a lateral flow monitor. Two ways of evaluating the response of these monitors were used: an electronic method where a lateral flow reader was used for measuring line intensities, and a visual method where the intensity of the test line was visually compared to the control line. RESULTS: The 5-FU monitor is capable of detecting 10 ng/100 cm2 (0.1 ng/cm2) using the electronic reader and 25 ng/100 cm2 (0.25 ng/cm2) using the visual comparison method for the surfaces studied. The response of the monitors was compared to LC-MS/MS results for the same samples for validation and there was good correlation of the two methods but some differences in absolute response, especially at higher spiking levels for the surface samples. |
Detection of antibodies directed to the N-terminal region of GAD is dependent on assay format and contributes to differences in the specificity of GAD autoantibody assays for type 1 diabetes
Williams AJ , Lampasona V , Schlosser M , Mueller PW , Pittman DL , Winter WE , Akolkar B , Wyatt R , Brigatti C , Krause S , Achenbach P . Diabetes 2015 64 (9) 3239-46 Autoantibodies to glutamate decarboxylase (GADA) are sensitive markers of islet autoimmunity and type 1 diabetes. They form the basis of robust prediction models and are widely used for recruitment of subjects at high risk of type 1 diabetes to prevention trials. However GADA are also found in many individuals at low risk of diabetes progression. To identify the sources of diabetes irrelevant GADA reactivity therefore, we analyzed data from the 2009 and 2010 Diabetes Autoantibody Standardization Program GADA workshop and found that binding of healthy control sera varied according to assay type. Characterization of control sera found positive by radiobinding assay, but negative by ELISA showed that many of these sera reacted to epitopes in the N-terminal region of the molecule. This finding prompted development of an N-terminally truncated GAD65 radiolabel, 35S-GAD65(96-585), which improved the performance of most GADA radiobinding assays (RBAs) participating in an Islet Autoantibody Standardization Program GADA substudy. These detailed workshop comparisons have identified a source of disease-irrelevant signals in GADA RBAs and suggest that N-terminally truncated GAD labels will enable more specific measurement of GADA in type 1 diabetes. |
Morbidity associated with cesarean delivery in the United States: is placenta accreta an increasingly important contributor?
Creanga AA , Bateman BT , Butwick AJ , Raleigh L , Maeda A , Kuklina E , Callaghan WM . Am J Obstet Gynecol 2015 213 (3) 384 e1-11 OBJECTIVE: To examine cesarean morbidity and its predictors in the United States. STUDY DESIGN: We used 2000-2011 Nationwide Inpatient Sample data to identify cesarean deliveries and records with 12 potential cesarean complications, including placenta accreta. We estimated cesarean morbidity rates and rate changes during 2000-2011, and fitted Poisson regression models to assess the relative incidence of morbidity among repeat versus primary cesareans and explore its predictors. RESULTS: During 2000-2011, 76 in 1,000 cesareans (97 in 1,000 primary and 48 in 1,000 repeat cesareans) were accompanied by ≥1 of 12 complications. The unadjusted composite cesarean morbidity rate increased by 3.6% only among women with a primary cesarean (p<0.001), while the unadjusted rate of placenta accreta increased by 30.8% only among women with a repeat cesarean (p=0.025). The adjusted rate of overall composite cesarean morbidity decreased by 1% annually during 2000-2011 (p<0.001). Compared to women with a primary cesarean, those who underwent a repeat cesarean were half as likely (incidence rate ratio=0.50; 95%CI 0.49-0.50) to develop a complication, but 2.13 (95%CI 1.98-2.29) times more likely to have a placenta accreta diagnosis. Both cesarean morbidity and placenta accreta were positively associated with: age >30 years; non-Hispanic black race-ethnicity; presence of a chronic medical condition; and delivery in urban, teaching, or larger hospitals. CONCLUSIONS: Overall, cesarean morbidity declined modestly during 2000-2011, but placenta accreta became an increasingly important contributor to repeat cesarean morbidity. Clinicians should maintain a high index of suspicion for abnormal placentation and make adequate preparations for patients who need cesarean deliveries. |
Elimination of mother-to-child transmission of HIV and syphilis: a dual approach in the African Region to improve quality of antenatal care and integrated disease control
Newman Owiredu M , Newman L , Nzomo T , Conombo Kafando G , Sanni S , Shaffer N , Bucagu M , Peeling R , Mark J , Diop Toure I . Int J Gynaecol Obstet 2015 130 Suppl 1 S27-31 The World Health Organization's (WHO) Strategic Framework for the Elimination of New HIV Infections among Children in Africa by 2015 identifies important synergies for the elimination of mother-to-child transmission of HIV and syphilis in terms of prevention interventions, implementation logistics and service delivery, monitoring and evaluation systems, and need for sustained political commitment. The WHO advocates the use of an integrated, rights-based dual approach with partnerships and collaboration to make the best use of available resources. Through a consultative approach, six countries in the African Region committed to dual elimination and developed and implemented action plans for this purpose. Where interest and commitment are high, this may also be possible and effective in other African countries. |
Estimated number of infants detected and missed by critical congenital heart defect screening
Ailes EC , Gilboa SM , Honein MA , Oster ME . Pediatrics 2015 135 (6) 1000-8 BACKGROUND AND OBJECTIVES: In 2011, the US Secretary of Health and Human Services recommended universal screening of newborns for critical congenital heart defects (CCHDs), yet few estimates of the number of infants with CCHDs likely to be detected through universal screening exist. Our objective was to estimate the number of infants with nonsyndromic CCHDs in the United States likely to be detected (true positives) and missed (false negatives) through universal newborn CCHD screening. METHODS: We developed a simulation model based on estimates of birth prevalence, prenatal diagnosis, late detection, and sensitivity of newborn CCHD screening through pulse oximetry to estimate the number of true-positive and false-negative nonsyndromic cases of the 7 primary and 5 secondary CCHD screening targets identified through screening. RESULTS: We estimated that 875 (95% uncertainty interval [UI]: 705-1060) US infants with nonsyndromic CCHDs, including 470 (95% UI: 360-585) infants with primary CCHD screening targets, will be detected annually through newborn CCHD screening. An additional 880 (UI: 700-1080) false-negative screenings, including 280 (95% UI: 195-385) among primary screening targets, are expected. We estimated that similar numbers of CCHDs would be detected under scenarios comparing "lower" ( approximately 19%) and "higher" ( approximately 41%) than current prenatal detection prevalences. CONCLUSIONS: A substantial number of nonsyndromic CCHD cases are likely to be detected through universal CCHD screening; however, an equal number of false-negative screenings, primarily among secondary targets of screening, are likely to occur. Future efforts should document the true impact of CCHD screening in practice. |
Improving global estimates of syphilis in pregnancy by diagnostic test type: a systematic review and meta-analysis
Ham DC , Lin C , Newman L , Wijesooriya NS , Kamb M . Int J Gynaecol Obstet 2015 130 Suppl 1 S10-4 BACKGROUND: "Probable active syphilis," is defined as seroreactivity in both non-treponemal and treponemal tests. A correction factor of 65%, namely the proportion of pregnant women reactive in one syphilis test type that were likely reactive in the second, was applied to reported syphilis seropositivity data reported to WHO for global estimates of syphilis during pregnancy. OBJECTIVES: To identify more accurate correction factors based on test type reported. SEARCH STRATEGY: Medline search using: "Syphilis [Mesh] and Pregnancy [Mesh]," "Syphilis [Mesh] and Prenatal Diagnosis [Mesh]," and "Syphilis [Mesh] and Antenatal [Keyword]. SELECTION CRITERIA: Eligible studies must have reported results for pregnant or puerperal women for both non-treponemal and treponemal serology. DATA COLLECTION AND ANALYSIS: We manually calculated the crude percent estimates of subjects with both reactive treponemal and reactive non-treponemal tests among subjects with reactive treponemal and among subjects with reactive non-treponemal tests. We summarized the percent estimates using random effects models. MAIN RESULTS: Countries reporting both reactive non-treponemal and reactive treponemal testing required no correction factor. Countries reporting non-treponemal testing or treponemal testing alone required a correction factor of 52.2% and 53.6%, respectively. Countries not reporting test type required a correction factor of 68.6%. CONCLUSIONS: Future estimates should adjust reported maternal syphilis seropositivity by test type to ensure accuracy. |
Assessment of the impact of rapid syphilis tests on syphilis screening and treatment of pregnant women in Zambia
Bonawitz RE , Duncan J , Hammond E , Hamomba L , Nambule J , Sambambi K , Musonda V , Calise A , Knapp A , Mwale J , McCauley J , Thea D , Herlihy JM . Int J Gynaecol Obstet 2015 130 Suppl 1 S58-62 OBJECTIVE: To evaluate the impact of rapid syphilis tests (RSTs) on syphilis testing and treatment in pregnant women in Kalomo District, Zambia. METHODS: In March 2012, health workers at all 35 health facilities in Kalomo Distract were trained in RST use and penicillin treatment. In March 2013, data were retrospectively abstracted from 18 randomly selected health facilities and stratified into three time intervals: baseline (6months prior to RST introduction), midline (0-6 months after RST introduction), and endline (7-12 months after RST introduction). RESULTS: Data collected on 4154 pregnant women showed a syphilis-reactive seroprevalence of 2.7%. The proportion of women screened improved from baseline (140/1365, 10.6%) to midline (976/1446, 67.5%), finally decreasing at endline (752/1337, 56.3%) (P<0.001). There was no significant difference in the proportion of syphilis-seroreactive pregnant women who received 1 dose of penicillin before (1/2, 50%) or after (5/48, 10.4%; P=0.199) RST introduction with low treatment rates throughout. CONCLUSION: With RST scale-up in Zambia and other resource-limited settings, same-day test and treatment with penicillin should be prioritized to achieve the goal of eliminating congenital syphilis. |
Time to clinical stability among children hospitalized with pneumonia
Wolf RB , Edwards K , Grijalva CG , Self WH , Zhu Y , Chappell J , Bramley AM , Jain S , Williams DJ . J Hosp Med 2015 10 (6) 380-3 We evaluated the performance of time to clinical stability (TCS), a longitudinal outcome measure using 4 physiologic parameters (temperature, heart rate, respiratory rate, and use of supplemental oxygen), among children enrolled in a prospective study of pneumonia hospitalizations. We calculated the time from admission to normalization for each of the 4 parameters individually along with various combinations of these parameters (≥2 parameters). We assessed for agreement between the combined TCS measures and both hospital length of stay and an ordinal severity scale (nonsevere, severe, and very severe). Overall, 323 (96.7%) of 334 included children had ≥1 parameter abnormal on admission; 70 (21%) children had ≥1 parameter abnormal at discharge. For the 4 combined measures, median TCS decreased with increasing age. Increasing TCS was associated with both longer length of stay and increasing disease severity. The simplest combined measure incorporating only respiratory rate and need for supplemental oxygen performed similarly to more complex measures including additional parameters. Our study demonstrates that longitudinal TCS measures may be useful in children with pneumonia, both in clinical settings to assess recovery and readiness for discharge, and as an outcome measure in research and quality assessments. Additional study is needed to further validate our findings. |
Use of urine biomarkers to assess sodium intake: challenges and opportunities
Cogswell ME , Maalouf J , Elliott P , Loria CM , Patel S , Bowman BA . Annu Rev Nutr 2015 35 349-87 This article summarizes current data and approaches to assess sodium intake in individuals and populations. A review of the literature on sodium excretion and intake estimation supports the continued use of 24-h urine collections for assessing population and individual sodium intake. Since 2000, 29 studies used urine biomarkers to estimate population sodium intake, primarily among adults. More than half used 24-h urine; the rest used a spot/casual, overnight, or 12-h specimen. Associations between individual sodium intake and health outcomes were investigated in 13 prospective cohort studies published since 2000. Only three included an indicator of long-term individual sodium intake, i.e., multiple 24-h urine specimens collected several days apart. Although not insurmountable, logistic challenges of 24-h urine collection remain a barrier for research on the relationship of sodium intake and chronic disease. Newer approaches, including modeling based on shorter collections, offer promise for estimating population sodium intake in some groups. Expected final online publication date for the Annual Review of Nutrition Volume 35 is July 17, 2015. Please see http://www.annualreviews.org/catalog/pubdates.aspx for revised estimates. |
Genetic variants in TNFa, TGFB1, PTGS1 and PTGS2 genes are associated with diisocyanate-induced asthma.
Yucesoy B , Kashon ML , Johnson VJ , Lummus ZL , Fluharty K , Gautrin D , Cartier A , Boulet LP , Sastre J , Quirce S , Tarlo SM , Cruz MJ , Munoz X , Luster MI , Bernstein DI . J Immunotoxicol 2015 13 (1) 1-8 Diisocyanates are the most common cause of occupational asthma, but risk factors are not well defined. A case-control study was conducted to investigate whether genetic variants in inflammatory response genes (TNFalpha, IL1alpha, IL1beta, IL1RN, IL10, TGFB1, ADAM33, ALOX-5, PTGS1, PTGS2 and NAG-1/GDF15) are associated with increased susceptibility to diisocyanate asthma (DA). These genes were selected based on their role in asthmatic inflammatory processes and previously reported associations with asthma phenotypes. The main study population consisted of 237 Caucasian French Canadians from among a larger sample of 280 diisocyanate-exposed workers in two groups: workers with specific inhalation challenge (SIC) confirmed DA (DA+, n = 95) and asymptomatic exposed workers (AW, n = 142). Genotyping was performed on genomic DNA, using a 5' nuclease PCR assay. After adjusting for potentially confounding variables of age, smoking status and duration of exposure, the PTGS1 rs5788 and TGFB1 rs1800469 single nucleotide polymorphisms (SNP) showed a protective effect under a dominant model (OR = 0.38; 95% CI = 0.17, 0.89 and OR = 0.38; 95% CI = 0.18, 0.74, respectively) while the TNFalpha rs1800629 SNP was associated with an increased risk of DA (OR = 2.08; 95% CI = 1.03, 4.17). Additionally, the PTGS2 rs20417 variant showed an association with increased risk of DA in a recessive genetic model (OR = 6.40; 95% CI = 1.06, 38.75). These results suggest that genetic variations in TNFalpha, TGFB1, PTGS1 and PTGS2 genes contribute to DA susceptibility. |
Recommendations to improve employee thermal comfort when working in 40 degrees F refrigerated cold rooms
Ceballos D , Mead K , Ramsey J . J Occup Environ Hyg 2015 12 (9) 0 Cold rooms are commonly used for food storage and preparation, and are usually kept around 40 degrees F following food safety guidelines. Some food preparation employees may spend 8 or more hours inside cold rooms. These employees may not be aware of the risks associated with mildly cold temperatures, dampness, and limited ventilation. We performed an evaluation of cold rooms at an airline catering facility because of concerns with exposure to cold temperatures. We spoke with and observed employees in two cold rooms, reviewed daily temperature logs, evaluated employee's physical activity, work/rest schedule, and protective clothing. We measured temperature, percent relative humidity, and air velocities at different work stations inside the cold rooms. We concluded that thermal comfort concerns perceived by cold room employees may have been the result of air drafts at their workstations, insufficient use of personal protective equipment due to dexterity concerns, work practices, and lack of knowledge about good health and safety practices in cold rooms. These moderately cold work conditions with low air velocities are not well covered in current occupational health and safety guidelines, and wind chill calculations do not apply. We provide practical recommendations to improve thermal comfort of cold room employees. Engineering control recommendations include the redesigning of air deflectors and installing of suspended baffles. Administrative controls include the changing out of wet clothing, providing hand warmers outside of cold rooms, and educating employees on cold stress. We also recommended providing more options on personal protective equipment. However, there is a need for guidelines and educational materials tailored to employees in moderately cold environments to improve thermal comfort and minimize health and safety problems. |
Risk of cancer among firefighters in California, 1988-2007
Tsai RJ , Luckhaupt SE , Schumacher P , Cress RD , Deapen DM , Calvert GM . Am J Ind Med 2015 58 (7) 715-29 BACKGROUND: Most studies of firefighter cancer risks were conducted prior to 1990 and do not reflect risk from advances in building materials. METHODS: A case-control study using California Cancer Registry data (1988-2007) was conducted to evaluate the risk of cancer among firefighters, stratified by race. RESULTS: This study identified 3,996 male firefighters with cancer. Firefighters were found to have a significantly elevated risk for melanoma (odds ratio [OR] = 1.8; 95% confidence interval [CI] 1.4-2.1), multiple myeloma (OR 1.4; 95%CI 1.0-1.8), acute myeloid leukemia (OR 1.4; 95%CI 1.0-2.0), and cancers of the esophagus (OR 1.6; 95%CI 1.2-2.1), prostate (OR 1.5; 95%CI 1.3-1.7), brain (OR 1.5; 95%CI 1.2-2.0), and kidney (OR 1.3; 95%CI 1.0-1.6). CONCLUSIONS: In addition to observing cancer findings consistent with previous research, this study generated novel findings for firefighters with race/ethnicity other than white. It provides additional evidence to support the association between firefighting and several specific cancers. |
Risks to health care workers from nano-enabled medical products
Murashov V , Howard J . J Occup Environ Hyg 2015 12 (6) D75-85 Nanotechnology is rapidly expanding into the health care industry. However, occupational safety and health risks of nano-enabled medical products have not been thoroughly assessed. This manuscript highlights occupational risk mitigation practices for nano-enabled medical products throughout their life cycle for all major workplace settings including (1) medical research laboratories, (2) pharmaceutical manufacturing facilities, (3) clinical dispensing pharmacies, (4) health care delivery facilities, (5) home health care, (6) health care support, and (7) medical waste management. It further identifies critical research needs for ensuring worker protection in the health care industry. |
Method for analyzing left-censored bioassay data in large cohort studies
Anderson JL , Apostoaei AI . J Expo Sci Environ Epidemiol 2015 27 (1) 1-6 In retrospective epidemiological studies of large cohorts of workers exposed to radioactive materials, it is often necessary to analyze large numbers of bioassay data sets containing censored values, or values recorded as less than a detection limit. Censored bioassay data create problems for all bioassay analysis methods, including analytical techniques based on least-squares regression to estimate intakes. A method is presented here that uses a simple empirically-derived equation for imputing replacement values for urine uranium concentration results reported as zero or less than a detection limit, that produces minimal bias in intakes estimated using least-square regression methods with the assumption of lognormally distributed measurement errors. |
Qualitative evaluation of a role play bullying simulation
Gillespie GL , Brown K , Grubb P , Shay A , Montoya K . J Nurs Educ Pract 2015 5 (6) 73-80 Bullying against nurses is becoming a pervasive problem. In this article, a role play simulation designed for undergraduate nursing students is described. In addition, the evaluation findings from a subsample of students who participated in a role play simulation addressing bullying behaviors are reported. Focus group sessions were completed with a subset of eight students who participated in the intervention. Sessions were audiorecorded, transcribed verbatim, and analyzed using Colaizzi's procedural steps for qualitative analysis. Themes derived from the data were "The Experience of Being Bullied", "Implementation of the Program", "Desired Outcome of the Program", and "Context of Bullying in the Nursing Profession". Role play simulation was an effective and active learning strategy to diffuse education on bullying in nursing practice. Bullying in nursing was identified as a problem worthy of incorporation into the undergraduate nursing curriculum. To further enhance the learning experience with role play simulation, adequate briefing instructions, opportunity to opt out of the role play, and comprehensive debriefing are essential. |
Preventing community-wide transmission of Cryptosporidium: a proactive public health response to a swimming pool-associated outbreak - Auglaize County, Ohio, USA
Cope JR , Prosser A , Nowicki S , Roberts MW , Roberts JM , Scheer D , Anderson C , Longsworth A , Parsons C , Goldschmidt D , Johnston S , Bishop H , Xiao L , Hill V , Beach M , Hlavsa MC . Epidemiol Infect 2015 143 (16) 1-9 The incidence of recreational water-associated outbreaks in the United States has significantly increased, driven, at least in part, by outbreaks both caused by Cryptosporidium and associated with treated recreational water venues. Because of the parasite's extreme chlorine tolerance, transmission can occur even in well-maintained treated recreational water venues (e.g. pools) and a focal cryptosporidiosis outbreak can evolve into a community-wide outbreak associated with multiple recreational water venues and settings (e.g. childcare facilities). In August 2004 in Auglaize County, Ohio, multiple cryptosporidiosis cases were identified and anecdotally linked to pool A. Within 5 days of the first case being reported, pool A was hyperchlorinated to achieve 99.9% Cryptosporidium inactivition. A case-control study was launched to epidemiologically ascertain the outbreak source 11 days later. A total of 150 confirmed and probable cases were identified; the temporal distribution of illness onset was peaked, indicating a point-source exposure. Cryptosporidiosis was significantly associated with swimming in pool A (matched odds ratio 121.7, 95% confidence interval 27.4-infinity) but not with another venue or setting. The findings of this investigation suggest that proactive implementation of control measures, when increased Cryptosporidium transmission is detected but before an outbreak source is epidemiologically ascertained, might prevent a focal cryptosporidiosis outbreak from evolving into a community-wide outbreak. |
In vivo efficacy of sulphadoxine-pyrimethamine for the treatment of asymptomatic parasitaemia in pregnant women in Machinga District, Malawi
Gutman J , Mwandama D , Wiegand RE , Abdallah J , Iriemenam NC , Shi YP , Mathanga DP , Skarbinski J . Malar J 2015 14 (1) 197 BACKGROUND: The effectiveness of sulphadoxine-pyrimethamine (SP) intermittent preventive treatment of malaria in pregnancy (IPTp) might be compromised by high prevalence of resistance-associated Plasmodium falciparum dihydrofolate reductase (dhfr) and dihydropteroate synthase (dhps) mutations. As a proxy for IPTp-SP effectiveness, the in vivo efficacy of SP to clear parasitaemia and prevent reinfection in asymptomatic parasitaemic pregnant women in an area with high SP resistance prevalence was assessed. METHODS: Pregnant women 16-26 weeks' gestation with asymptomatic parasitaemia presenting for antenatal care were given IPTp-SP and followed for 42 days. The primary outcome was polymerase chain reaction (PCR) uncorrected 42-day survival rate; the per cent of patients without recrudescence or reinfection by day 42. PCR was used to distinguish recrudescence from reinfection. DNA was sequenced to detect resistance-associated dhfr and dhps mutations. RESULTS: Of 245 pregnant women included in the intention-to-treat analysis, 93.9% cleared their parasitaemia by day 7. The day 42 PCR-uncorrected survival rate was 58.1% (95% confidence interval (CI) 51.5-65.7) and day 42 PCR-corrected survival was 68.7% (CI 61.4-76.0). Recrudescence was more common among primi- than among multigravid women; recrudescence rate 33.3% (CI 25.1-42.4%) versus 21.4% (CI 15.0-29.0%) (log rank test p-value 0.006). The quintuple mutant was present in nearly all samples (95%), while 2% were sextuple mutants with an additional mutation at dhps A581G. CONCLUSIONS: SP efficacy for acute malaria treatment has been compromised by resistance, but SP retains partial activity among pregnant women with asymptomatic parasitaemia, and thus might be useful for IPTp. Nonetheless, research on non-SP IPTp regimens should continue. TRIAL REGISTRATION: ClinicalTrials.gov NCT01120145 . |
An assessment of the supply, programmatic use, and regulatory issues of single low-dose primaquine as a Plasmodium falciparum gametocytocide for sub-Saharan Africa
Chen I , Poirot E , Newman M , Kandula D , Shah R , Hwang J , Cohen JM , Gosling R , Rooney L . Malar J 2015 14 (1) 204 BACKGROUND: Global ambitions to eliminate malaria are intensifying, underscoring a critical need for transmission blocking tools. In 2012, the WHO recommended the use of 0.25 mg/kg of single low-dose (SLD) primaquine to stop Plasmodium falciparum transmission. To ensure the availability of SLD primaquine to countries in need of this tool, more information on the supply, programmatic, and regulatory barriers to the rollout of SLD primaquine is required. METHODS: Challenges to the rollout of SLD primaquine in sub-Saharan Africa were established through semi-structured qualitative interviews with three primaquine manufacturers, 43 key informants from Ethiopia, Senegal, Swaziland, Zambia, and Tanzania, and 16 malaria research experts. RESULTS: Sanofi and Remedica are the only two sources of SRA-approved primaquine suitable for procurement by international donors, neither manufacturer produces primaquine tablet strengths suitable for the transmission blocking indication. In-country key informants revealed that the WHO weight-based recommendation to use SLD primaquine is challenging to implement in actual field settings. Malaria programmes expressed safety concerns of SLD primaquine use in individuals with glucose-6-phosphate dehydrogenase (G6PD) deficiency, as well as potential interactions between primaquine and co-morbidities, and drug-drug interactions with HIV and/or tuberculosis treatments. Regulatory processes are a major barrier to the rollout of SLD primaquine, requiring multiple steps at both the country and global level. Despite these barriers, demand for SLD primaquine is growing, and malaria researchers are interested in primaquine deployment through mass screen and treat and/or mass drug administration campaigns. CONCLUSION: Demand for primaquine as a transmission blocking agent is growing rapidly yet multiple barriers to SLD primaquine use exist. Research is needed to define the therapeutic dose range, which will guide dosing regimens in the field, inform the development of new, lower strength primaquine tablets and/or formulation(s), and allay programmatic safety concerns in individuals with G6PD deficiency. Potential interactions between primaquine and co-morbidities and treatments should be explored. To minimize regulatory delays, countries need to prepare for product registration at an early stage, WHO prequalification for suitable primaquine tablet strengths and/or new formulations should be sought, and in the meanwhile only Stringent Regulatory Authority (SRA)-approved primaquine should be used. |
Salivary and serum cortisol levels during recovery from intense exercise and prolonged, moderate exercise
Powell J , DiLeo T , Roberge R , Coca A , Kim JH . Biol Sport 2015 32 (2) 91-95 The aim of this study was to compare serum (SERc) and salivary cortisol (SALc) responses during recovery from two different exhaustive exercises to determine peak cortisol sampling time and the agreement between SERc and SALc levels. Twelve healthy men underwent a maximal treadmill graded exercise to exhaustion (MEx) and a prolonged, submaximal cycle exercise in the heat for 90 min (PEx) while SERc and SALc samples were taken in parallel at baseline, end of exercise, and 15 min intervals over one hour of recovery. MEx and PEx significantly increased SERc and SALc levels (p<0.01) while absolute SERc levels were approximately 7-10 folds higher than SALc. SERc and SALc showed highly positive correlation (R=0.667-0.910, p<0.05) at most sampling times and only a few individual values were out of 95% limit of agreement when analyzed by Bland-Altman plots. However, peak SERc levels (MEx: 784.0+/-147, PEx: 705.5+/-212.0 nmol · L-1) occurred at 15 min of recovery, whereas peak SALc levels (MEx: 102.7+/-46.4, PEx: 95.7+/-40.9 nmol· L-1) were achieved at the end of exercise in MEx and PEx. The recovery trend of SERc and SALc also differed following MEx and PEx. Activity of 11beta-hydroxysteroid dehydrogenase type 2 enzymes may be suppressed following MEx compared to PEx. In conclusion, sampling for peak SERc and SALc levels should take into account their evolution and clearance characteristics as well as type of exercise performed, whereas SALc appeared to be a more sensitive marker than SERc for the measurement of cortisol responses during exercise recovery. |
Value of a small control group for estimating intervention effectiveness: results from simulations of immunization effectiveness studies
Hutchins SS , Brown C , Mayberry R , Sollecito W . J Comp Eff Res 2015 4 (3) 1-12 AIM: To improve evidence for public health practice, the conduct of effectiveness studies by practitioners is needed and may be stimulated if knowledge that smaller than usual samples may provide the same reliability of intervention effect size as larger samples. MATERIALS & METHODS: We examined reliability of intervention effect using computerized simulations of 2000 hypothetical immunization effectiveness studies from an actual study population and by small (30 and 60) and larger (100 and 200) control groups compared with an intervention group of 200 participants. RESULTS & CONCLUSION: Across simulated studies, the mean intervention effect (14%) and effect sizes were equivalent regardless of control group size and equal to the actual study effect. These results are relevant for similarly designed and executed studies and indicate that studies with smaller control groups can generate valid and accurate evidence for effective public health practice in communities. |
Heteroscedastic CAR models for areally referenced temporal processes for analyzing California asthma hospitalization data.
Quick H , Carlin BP , Banerjee S . J R Stat Soc Ser C Appl Stat 2015 64 (5) 799-813 Often in regionally aggregated spatiotemporal models, a single variance parameter is used to capture variability in the spatial structure of the model, ignoring the effect that spatially varying factors may have on the variability in the underlying process. We extend existing methodologies to allow for region-specific variance components in our analysis of monthly asthma hospitalization rates in California counties, introducing a heteroscedastic conditional auto-regression model that can greatly improve the fit of our spatiotemporal process. After demonstrating the effectiveness of our new model via simulation, we reanalyse the asthma hospitalization data and note some important findings. |
Trends and characteristics of heroin overdoses in Wisconsin, 2003-2012
Meiman J , Tomasallo C , Paulozzi L . Drug Alcohol Depend 2015 152 177-84 BACKGROUND: Heroin abuse has increased substantially during the past decade in the United States. This study describes trends and demographic shifts of heroin overdoses and heroin-related fatalities in Wisconsin and contrasts these with prescription opioid overdoses. METHODS: This study was cross-sectional using databases of emergency department (ED) visits, hospital admissions, and death certificates in Wisconsin, United States, during 2003-2012. Cases were Wisconsin residents treated for heroin or prescription opioid overdose, and residents who died of heroin-related drug poisoning. Primary measurements were rates over time and by geographic region, and rates and rate ratios for selected demographic characteristics. RESULTS: During 2003-2012, age-adjusted rates of heroin overdoses treated in EDs increased from 1.0 to 7.9/100,000 persons; hospitalized heroin overdoses increased from 0.7 to 3.5/100,000. Whites accounted for 68% of hospitalized heroin overdoses during 2003-2007 but 80% during 2008-2012. Heroin-related deaths were predominantly among urban residents; however, rural fatalities accounted for zero deaths in 2003 but 31 (17%) deaths in 2012. Among patients aged 18-34 years, those hospitalized with heroin overdose were more often men (73.0% versus 54.9%), uninsured (44.2% versus 29.9%), and urban (84.3% versus 73.2%) than those with prescription opioid overdose. Rates of ED visits for heroin overdose in this age group exceeded rates for prescription opioid overdose in 2012 (26.1/100,000 versus 12.6/100,000 persons, respectively). CONCLUSIONS: An epidemic of heroin abuse is characterized by demographic shifts toward whites and rural residents. Rates of heroin overdose in younger persons now exceed rates of prescription opioid overdose. |
Warning about the harms of tobacco use in 22 countries: findings from a cross-sectional household survey
Chiosi JJ , Andes L , Asma S , Palipudi K , McAfee T . Tob Control 2015 25 (4) 393-401 BACKGROUND: Knowledge about the harms of tobacco use deters initiation and is associated with cessation. Most studies on this knowledge in the general population have been in high-income countries, but the tobacco use burden is increasing in low-income and middle-income countries. We sought to estimate levels of knowledge about tobacco-related diseases in 22 countries and determine the factors associated with differences in knowledge. METHODS: We used data from the Global Adult Tobacco Survey (GATS), a nationally representative survey of persons aged ≥15 years. GATSs were conducted from 2008 to 2013 in 22 low-income and middle-income countries. Information was gathered on tobacco-related knowledge and noticing of antismoking mass media messages and health warning labels on cigarette packages. We constructed a four-point knowledge scale and performed multivariate regression analyses. RESULTS: Median country values for the proportion of adults who believed smoking causes a specific illness were 95.9% for lung cancer, 82.5% for heart attack and 74.0% for stroke. Knowledge scores ranged from 2.1 to 3.8. In multivariate regressions, adults scored significantly higher on the knowledge scale if they noticed antismoking media messages (22 countries) or health warning labels (17 countries). Significantly higher knowledge scores occurred in all 9 countries with pictorial health warning labels compared with only 8 out of 13 countries with text-only warning labels. CONCLUSIONS: Antismoking media messages appear effective for warning the public about the harms from tobacco use in all 22 countries, while warning labels are effective in the majority of these countries. Our findings suggest opportunities to motivate smoking cessation globally. |
Law enforcement officers' involvement level in Hurricane Katrina and alcohol use
Heavey SC , Homish GG , Andrew ME , McCanlies E , Mnatsakanova A , Violanti JM , Burchfiel CM . Int J Emerg Mental Health 2015 17 (1) 267-273 The purpose of this work is to examine the relationship between alcohol use and level of involvement during Hurricane Katrina among law enforcement officers, and to investigate whether marital status or previous military training offer resilience against negative outcomes. Officers in the immediate New Orleans geographic area completed surveys that assessed their involvement in Hurricane Katrina and alcohol use (Alcohol Use and Disorders Identification Test (AUDIT) score). Negative binomial regression models were used to analyze level of hazardous alcohol use; interactions were tested to examine protective influences of marriage and prior military training (controlling for age and gender). There was a significant association between heavy involvement in Hurricane Katrina and having a greater AUDIT score (exp(beta)[EB]=1.81; 95% CI: 1.03, 3.17; p<0.05), indicating higher levels of hazardous alcohol use. Contrary to original hypotheses, marital status and military training were not protective against alcohol use (p>0.05). These results illustrate an association between law enforcement officers' heavy involvement during Hurricane Katrina and greater levels of hazardous alcohol use when compared to officers with low or moderate involvement. This has important treatment implications for those with high involvement in disasters as they may require targeted interventions to overcome the stress of such experiences. |
Mixed-methods for comparing tobacco cessation interventions
Momin B , Neri A , Zhang L , Kahende J , Duke J , Green SG , Malarcher A , Stewart SL . J Smok Cessat 2015 12 (1) 15-21 INTRODUCTION: The National Comprehensive Cancer Control Program (NCCCP) and National Tobacco Control Program (NTCP) are both well-positioned to promote the use of population-based tobacco cessation interventions, such as state quitlines and Web-based interventions. AIMS: This paper outlines the methodology used to conduct a comparative effectiveness research (CER) study of traditional and Web-based tobacco cessation and quitline promotion approaches. METHODS: A mixed-methods study with three components was designed to address the effect of promotional activities on service usage and the comparative effectiveness of population-based smoking cessation activities across multiple states. RESULTS/FINDINGS: The cessation intervention component followed 7,902 smokers (4,307 quitline users and 3,595 Web intervention users) to ascertain prevalence of 30-day abstinence rates seven months after registering for smoking cessation services. User characteristics and quit success was compared across the two modalities. In the promotions component, reach and use of traditional and innovative promotion strategies were assessed for 24 states, including online advertising, state Web sites, social media, mobile applications, and their effects on quitline call volume. The partnership intervention component studied the extent of collaboration among six selected NCCCPs and NTCPs. CONCLUSIONS: This study will guide program staff and clinicians with evidence-based recommendations and best practices for implementation of tobacco cessation within their patient and community populations and establish an evidence base that can be used for decision making. |
Decrease in rate of opioid analgesic overdose deaths - Staten Island, New York City, 2011-2013
Paone D , Tuazon E , Kattan J , Nolan ML , O'Brien DB , Dowell D , Farley TA , Kunins HV . MMWR Morb Mortal Wkly Rep 2015 64 (18) 491-4 From 2000 to 2011, the rate of unintentional drug poisoning (overdose) deaths involving opioid analgesics increased 435% in Staten Island, from 2.0 to 10.7 per 100,000 residents. During 2005-2011, disparities widened between Staten Island and the other four New York City (NYC) boroughs (Bronx, Brooklyn, Manhattan, and Queens); in 2011, the rate in Staten Island was 3.0-4.5 times higher than in the other boroughs. In response, the NYC Department of Health and Mental Hygiene (DOHMH) implemented a comprehensive five-part public health strategy, with both citywide and Staten Island-targeted efforts: 1) citywide opioid prescribing guidelines, 2) a data brief for local media highlighting Staten Island mortality and prescribing data, 3) Staten Island town hall meetings convened by the NYC commissioner of health and meetings with Staten Island stakeholders, 4) a Staten Island campaign to promote prescribing guidelines, and 5) citywide airing of public service announcements with additional airing in Staten Island. Concurrently, the New York state legislature enacted the Internet System for Tracking Over-Prescribing (I-STOP), a law requiring prescribers to review the state prescription monitoring system before prescribing controlled substances. This report describes a 29% decline in the opioid analgesic-involved overdose death rate in Staten Island from 2011 to 2013, while the rate did not change in the other four NYC boroughs, and compares opioid analgesic prescribing data for Staten Island with data for the other boroughs. Targeted public health interventions might be effective in lowering opioid analgesic-involved overdose mortality rates. |
Annual summary of vital statistics: 2012-2013
Osterman MJ , Kochanek KD , MacDorman MF , Strobino DM , Guyer B . Pediatrics 2015 135 (6) 1115-25 The number of births in the United States declined by 1% between 2012 and 2013, to a total of 3 932 181. The general fertility rate also declined 1% to 62.5 births per 1000 women, the lowest rate ever reported. The total fertility rate was down by 1% in 2013 (to 1857.5 births per 1000 women). The teenage birth rate fell to another historic low in 2013, 26.5 births per 1000 women. Birth rates also declined for women 20 to 29 years, but the rates rose for women 30 to 39 and were unchanged for women 40 to 44. The percentage of all births that were to unmarried women declined slightly to 40.6% in 2013, from 40.7% in 2012. In 2013, the cesarean delivery rate declined to 32.7% from 32.8% for 2012. The preterm birth rate declined for the seventh straight year in 2013 to 11.39%; the low birth weight (LBW) rate was essentially unchanged at 8.02%. The infant mortality rate was 5.96 infant deaths per 1000 live births in 2013, down 13% from 2005 (6.86). The age-adjusted death rate for 2013 was 7.3 deaths per 1000 population, unchanged from 2012. Crude death rates for children aged 1 to 19 years declined to 24.0 per 100 000 population in 2013, from 24.8 in 2012. Unintentional injuries and suicide were, respectively, the first and second leading causes of death in this age group. These 2 causes of death jointly accounted for 45.7% of all deaths to children and adolescents in 2013. |
Civil registration and vital statistics: progress in the data revolution for counting and accountability
AbouZahr C , de Savigny D , Mikkelsen L , Setel PW , Lozano R , Nichols E , Notzon F , Lopez AD . Lancet 2015 386 (10001) 1373-1385 New momentum for civil registration and vital statistics (CRVS) is building, driven by the confluence of growing demands for accountability and results in health, improved equity, and rights-based approaches to development challenges, and by the immense potential of innovation and new technologies to accelerate CRVS improvement. Examples of country successes in strengthening of hitherto weak systems are emerging. The key to success has been to build collaborative partnerships involving local ownership by several sectors that span registration, justice, health, statistics, and civil society. Regional partners can be important to raise awareness, set regional goals and targets, foster country-to-country exchange and mutual learning, and build high-level political commitment. These regional partners continue to provide a platform through which country stakeholders, development partners, and technical experts can share experiences, develop and document good practices, and propose innovative approaches to tackle CRVS challenges. This country and regional momentum would benefit from global leadership, commitment, and support. |
Content Index (Achived Edition)
- Chronic Diseases and Conditions
- Communicable Diseases
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- Immunity and Immunization
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- Maternal and Child Health
- Medicine
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- Occupational Safety and Health
- Parasitic Diseases
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- Statistics as Topic
- Substance Use and Abuse
- Vital Statistics
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