Quality of care for the screening, diagnosis, and management of lupus nephritis across multiple healthcare settings
Aggarwal I , Li J , Trupin L , Gaynon L , Katz PP , Lanata C , Criswell L , Murphy LB , Dall'Era M , Yazdany J . Arthritis Care Res (Hoboken) 2019 72 (7) 888-896 OBJECTIVE: We examined quality measures for screening, diagnosis and treatment of lupus nephritis (LN) among participants of the California Lupus Epidemiology Study (CLUES) across 25 different clinical sites to identify gaps in quality of care. METHODS: Data from 250 lupus participants was analyzed across three sources (medical records, physician examination, and patient interviews). Overall performance on eight quality measures was calculated separately for participants with and without LN. We used generalized estimating equations in which the outcome was performance on measures, adjusting for participant demographics, lupus disease severity and practice characteristics. RESULTS: Of 148 patients without LN, 42% had screening labs for nephritis, 38% had lupus activity serologies and 81% had blood pressure checked every 6 months. Of 102 LN patients, 67% had a timely kidney biopsy, at least 81% had appropriate treatment and 78% achieved target blood pressure within 1 year of diagnosis. Overall performance in participants across quality measures was 54% (no LN) and 80% (LN). Significantly higher overall performance for screening measures for LN was seen at academic (63.4-73%) versus community clinics (37.9-38.4%). Similarly, among those with LN, higher performance in academic (84.1-85.2%) versus community clinics (54.8-60.2%) was observed for treatment measures. CONCLUSION: In this quality of care analysis across 25 diverse clinical settings, we found relatively high performance on measures for management of LN. However, future work should focus on bridging the gaps in lupus quality of care for patients without nephritis, particularly in community settings. This article is protected by copyright. All rights reserved. |
Relationships between adverse childhood experiences and health status in systemic lupus erythematosus
DeQuattro K , Trupin L , Li J , Katz PP , Murphy LB , Yelin EH , Rush S , Lanata C , Criswell LA , Dall'Era M , Yazdany J . Arthritis Care Res (Hoboken) 2019 72 (4) 525-533 PURPOSE: Adverse childhood experiences (ACEs) are associated with poor adult health and immune dysregulation. The impact of ACEs on patients with autoimmune disease is unknown. We compared the prevalence of ACEs in Systemic Lupus Erythematosus (SLE) patients to population-based survey estimate and investigated relationships between ACEs and SLE outcomes. METHODS: Data derive from the California Lupus Epidemiology Study (CLUES), a sample of adult SLE patients. Participants completed a 10-item ACE questionnaire covering 3 domains (abuse, neglect, household challenges). We estimated ACEs prevalence in 269 CLUES participants compared to 2015 California Behavioral Risk Factor Surveillance System (BRFSS) geographically matched respondents, standardized (age, sex, race/ethnicity) to CLUES participant characteristics. We examined associations for patient-reported and physician-assessed health status measures with overall ACE levels and domains using multivariable linear regression, controlling for socio-demographics, nephritis, and childhood onset SLE. RESULTS: Though specific domains varied, overall ACE levels were similar for CLUES and BRFSS respondents. Among SLE patients, 63.2% had >/=1 ACE and 19.3% had >/=4. ACEs were more prevalent in those who were older, women, Latino or African American, without college degrees, and with lupus nephritis. In adjusted models, higher ACE levels and ACE domains were associated with worse patient-reported SLE activity, depression, and health status, but were not significantly associated with physician-assessed SLE activity, damage, or severity. CONCLUSIONS: Given the association between ACE levels and important patient-reported outcomes in SLE, our study reinforces the need for prevention of ACEs in childhood and for clinical interventions to promote resilience among adults who have experienced ACEs. This article is protected by copyright. All rights reserved. |
State-specific severe joint pain and physical inactivity among adults with arthritis - United States, 2017
Guglielmo D , Murphy LB , Boring MA , Theis KA , Helmick CG , Hootman JM , Odom EL , Carlson SA , Liu Y , Lu H , Croft JB . MMWR Morb Mortal Wkly Rep 2019 68 (17) 381-387 An estimated 54.4 million (approximately one in four) U.S. adults have doctor-diagnosed arthritis (arthritis) (1). Severe joint pain and physical inactivity are common among adults with arthritis and are linked to adverse mental and physical health effects and limitations (2,3). CDC analyzed 2017 Behavioral Risk Factor Surveillance System (BRFSS) data to estimate current state-specific prevalence of arthritis and, among adults with arthritis, the prevalences of severe joint pain and physical inactivity. In 2017, the median age-standardized state prevalence of arthritis among adults aged >/=18 years was 22.8% (range = 15.7% [District of Columbia] to 34.6% [West Virginia]) and was generally highest in Appalachia and Lower Mississippi Valley regions.* Among adults with arthritis, age-standardized, state-specific prevalences of both severe joint pain (median = 30.3%; range = 20.8% [Colorado] to 45.2% [Mississippi]) and physical inactivity (median = 33.7%; range = 23.2% [Colorado] to 44.4% [Kentucky]) were highest in southeastern states. Physical inactivity prevalence among those with severe joint pain (47.0%) was higher than that among those with moderate (31.8%) or no/mild joint pain (22.6%). Self-management strategies such as maintaining a healthy weight or being physically active can reduce arthritis pain and prevent or delay arthritis-related disability. Evidence-based physical activity and self-management education programs are available that can improve quality of life among adults with arthritis. |
Developing a web-based cost assessment tool for colorectal cancer screening programs
Hoover S , Subramanian S , Tangka F . Prev Chronic Dis 2019 16 E54 INTRODUCTION: We developed a web-based cost assessment tool (CAT) to collect cost data as an improvement from a desktop instrument to perform economic evaluations of the Centers for Disease Control and Prevention's (CDC's) Colorectal Cancer Control Program (CRCCP) grantees. We describe the development of the web-based CAT, evaluate the quality of the data obtained, and discuss lessons learned. METHODS: We developed and refined a web-based CAT to collect 5 years (2009-2014) of cost data from 29 CRCCP grantees. We analyzed funding distribution; costs by budget categories; distribution of costs related to screening promotion, screening provision, and overarching activities; and reporting of screenings for grantees that received funding from non-CDC sources compared with those grantees that did not. RESULTS: CDC provided 85.6% of the resources for the CRCCP, with smaller amounts from in-kind contributions (7.8%), and funding from other sources (6.6%) (eg, state funding). Grantees allocated, on average, 95% of their expenditures to specific program activities and 5% to other activities. Some non-CDC funds were used to provide screening tests to additional people, and these additional screens were captured in the CAT. CONCLUSION: A web-based tool can be successfully used to collect cost data on expenditures associated with CRCCP activities. Areas for future refinement include how to collect and allocate dollars from other sources in addition to CDC dollars. |
Association of glucose levels in pregnancy with use of health care services
Vesco KK , Sharma AJ , Bulkley J , Terry Kimes M , Callaghan WM , England FLJ , Hornbrook MC . Diabetes Res Clin Pract 2019 152 146-155 AIMS: To determine whether women with abnormal gestational diabetes (GDM) screening test results short of frank GDM have increased health-services utilization compared to women with normal results. METHODS: We conducted a retrospective-cohort study among 29,999 women enrolled in Kaiser Permanente Northwest who completed GDM screening (two-step method:1-hour, 50-gram glucose-challenge test (GCT); 3-hour, 100-gram oral-glucose-tolerance test (OGTT)). Test results were categorized as normal GCT (referent, n=25,535), normal OGTT (n=2,246), abnormal OGTT but not GDM (n=1477), and GDM (n=741). Rate ratios (RRs) were calculated for utilization measures and analyses were age- and BMI-adjusted. RESULTS: Compared to women with normal GCT, rates for obstetrical ultrasound, noninvasive and invasive antenatal testing, and ambulatory visits to the obstetrics department were significantly greater among women with abnormal OGTT (RRs 1.2 [95%CI 1.1, 1.4], 1.3 [1.1, 1.4], 1.7 [1.3, 2.3], and 1.1 [1.1, 1.1], respectively) and GDM (RRs 1.8, 1.8, 2.0, and 1.3, respectively). Women with abnormal OGTT results were more likely to visit a dietician than women with normal GCT; RRs ranged from 4.0 [3.3, 4.9] for women with abnormal GCT but normal OGTT to 72.1 [64, 81] for women with GDM. CONCLUSIONS: Health-services utilization increased with severity of glucose result, even among women without GDM. |
Notes from the Field: Outbreak of Multidrug-Resistant Shigella sonnei Infections in a Retirement Community - Vermont, October-November 2018.
Strysko J , Fialkowski V , Marsh Z , Wadhwa A , Collins J , Gharpure R , Kelso P , Friedman CR , Fullerton KE . MMWR Morb Mortal Wkly Rep 2019 68 (17) 405-406 On October 22, 2018, the Vermont Department of Health (VDH) notified CDC’s Waterborne Disease Prevention Branch of an outbreak of diarrhea caused by Shigella sonnei among residents, visitors, and staff members of a retirement community in Chittenden County, the state’s most populous county. High-quality single nucleotide polymorphism (SNP) analysis predicted initial isolates were multidrug resistant (MDR), and were closely related to a concurrent multistate cluster (differing by 0–11 SNPs). In the United States, rates of MDR shigellosis are increasing (1); outbreaks of MDR shigellosis are more common among men who have sex with men and are rare in retirement community settings (2). CDC collaborated with VDH to identify additional cases, determine transmission routes, and recommend prevention and control measures. |
Mental health, social support, and HIV-related sexual risk behaviors among HIV-negative adolescent sexual minority males: three U.S. cities, 2015
Agnew-Brune CB , Balaji AB , Mustanski B , Newcomb ME , Prachand N , Braunstein SL , Brady KA , Hoots BE , Smith JS , Paz-Bailey G , Broz D . AIDS Behav 2019 23 (12) 3419-3426 We examined the association between mental health issues, social support, and HIV among adolescent sexual minority males (SMM), who are disproportionally affected by HIV. National HIV Behavioral Surveillance among Young Men Who Have Sex with Men (NHBS-YMSM) data among SMM aged 13-18 years were collected in three cities (Chicago, New York City, and Philadelphia). Separate log-linked Poisson regression models were used to estimate associations between mental health issues and social support (general and family), and 3 HIV-related sexual risk behavior outcomes: past-year condomless anal intercourse (CAI) with a male partner, past-year sex with >/= 4 partners, and first vaginal or anal sex before age 13. Of 547 adolescent SMM, 22% reported ever attempting suicide and 10% reported past-month suicidal ideation. The majority (52%) reported depression and anxiety. Thirty-nine percent reported CAI, 29% reported >/= 4 sex partners and 22% reported first sex before age 13. Ever attempting suicide, suicidal ideation, and depression and anxiety were associated with CAI. Separately, ever attempting suicide and lack of family support were associated with >/= 4 sex partners. None of the mental health or support measures were associated with having sex before age 13. General social support was not associated with any sexual risk behaviors. Mental health issues are common among adolescent SMM and associated with sexual risk behaviors. Including mental health support in comprehensive HIV prevention for adolescent SMM could potentially reduce HIV risk in this population. |
Case-case analyses of cryptosporidiosis and giardiasis using routine national surveillance data in the United States - 2005-2015
Benedict KM , Collier SA , Marder EP , Hlavsa MC , Fullerton KE , Yoder JS . Epidemiol Infect 2019 147 e178 Understanding endemic infectious disease risk factors through traditional epidemiological tools is challenging. Population-based case-control studies are costly and time-consuming. A case-case analyses using surveillance data addresses these limitations by using resources more efficiently. We conducted a case-case analyses using routine surveillance data reported by 16 U.S. states (2005-2015), wherein reported cases of salmonellosis were used as a comparison group to identify exposure associations with reported cases of cryptosporidiosis and giardiasis. Odds ratios adjusted for age and reporting state (aOR) and 95% confidence intervals (95% CI) were calculated. A total of 10 704 cryptosporidiosis cases, 17 544 giardiasis cases, and 106 351 salmonellosis cases were included in this analyses. When compared with cases of salmonellosis, exposure to treated recreational water (aOR 4.7, 95% CI 4.3-5.0) and livestock (aOR: 3.2; 95% CI: 2.9-3.5) were significantly associated with cryptosporidiosis and exposure to untreated drinking (aOR 4.1, 95% CI 3.6-4.7) and recreational water (aOR 4.1, 95% CI 3.7-4.5) were associated with giardiasis. Our analyses shows that routine surveillance data with standardised exposure information can be used to identify associations of interest for cryptosporidiosis and giardiasis. |
Psychological and social determinants of health, antiretroviral therapy (ART) adherence, and viral suppression among HIV-positive black women in care
Bradley ELP , Frazier EL , Carree T , Hubbard McCree D , Sutton MY . AIDS Care 2019 31 (8) 1-10 Black women are disproportionately affected by HIV, accounting for 61% of women diagnosed in 2016. Black women with HIV are less likely to be adherent to antiretroviral therapy (ART) and virally suppressed compared to women of other racial/ethnic groups. We analyzed 2013-2014 data from 1703 black women patients in the Centers for Disease Control and Prevention's Medical Monitoring Project to examine whether select psychological and social determinants of health (SDH) factors were associated with ART adherence and viral suppression. We calculated weighted estimates and used multivariable logistic regression with adjusted prevalence ratios (aPR) and 95% confidence intervals (CI) to examine correlates of ART adherence and viral suppression. Women who had not been incarcerated in the past 12 months (aPR = 1.24; CI: 1.04-1.48) and had not experienced discrimination in a health care setting since their HIV diagnosis (aPR = 1.06; 1.00-1.11) were slightly more likely to be adherent to ART. Women who lived above the federal poverty level were more likely to be virally suppressed during the past 12 months (aPR = 1.09; CI: 1.01-1.18). More research is warranted to identify the best strategies to create health care settings that encourage black women's HIV care engagement, and to address other key SDH and/or psychological factors. |
Disparities in incidence of human immunodeficiency virus infection among black and white women - United States, 2010-2016
Bradley ELP , Williams AM , Green S , Lima AC , Geter A , Chesson HW , McCree DH . MMWR Morb Mortal Wkly Rep 2019 68 (18) 416-418 Incident human immunodeficiency virus (HIV) infections among adolescent females and women declined during 2010-2016, with the largest decrease (21%) occurring among black women (1). However, in 2016, although black women accounted for 13% of the U.S. female population, 60% of new HIV infections among women were in black women, indicating persisting disparities (1). CDC used the population attributable proportion (PAP) disparity measure to describe the proportional decrease in HIV infection among black and white women combined that would be realized if the group with the higher rate (blacks) had the same rate as did the group with the lower rate (whites) (2). Analyses indicated that an estimated 3,900 of 4,200 (93%) incident HIV infections among black women in 2016 would not have occurred if rates were the same for black and white women. The PAP disparity measure decreased from 0.75 in 2010 to 0.70 in 2016, suggesting that if incidence rates for black women were the same as those for white women, the annual number of incident HIV infections among black and white women would have been 75% lower in 2010 and 70% lower in 2016. Continued efforts are needed to identify and address social and structural determinants associated with HIV-related disparities to eliminate these disparities and decrease HIV incidence among black women. |
Birth cohort effects in influenza surveillance data: Evidence that first influenza infection affects later influenza-associated illness
Budd AP , Beacham L , Smith CB , Garten RJ , Reed C , Kniss K , Mustaquim D , Ahmad FB , Cummings CN , Garg S , Levine MZ , Fry AM , Brammer L . J Infect Dis 2019 220 (5) 820-829 BACKGROUND: The evolution of influenza A viruses results in birth cohorts that have different initial influenza virus exposures. Historically, A/H3 predominant seasons have been associated with more severe influenza-associated disease; however, since the 2009 pandemic there are suggestions that some birth cohorts experience more severe illness in A/H1 predominant seasons. METHODS: U.S. influenza virologic, hospitalization and mortality surveillance data during 2000-2017 were analyzed for cohorts born between 1918 and 1989 that likely had different initial influenza virus exposures based on viruses circulating during early childhood. Relative risk/rate during H3 compared to H1 predominant seasons during pre-pandemic versus pandemic and later periods were calculated for each cohort. RESULTS: During the pre-pandemic period, all cohorts had more influenza-associated disease during H3 predominant seasons than H1 predominant seasons. During the pandemic and later period, four cohorts had higher hospitalization and mortality rates during H1 predominant seasons than H3 predominant seasons. DISCUSSION: Birth cohort differences in risk of influenza-associated disease by influenza A virus subtype can be seen in U.S. influenza surveillance data and differ between pre-pandemic and pandemic and later periods. As the population ages, the amount of influenza-associated disease may be greater in future H1 predominant seasons than H3 predominant seasons. |
Increase in hepatitis A virus infections - United States, 2013-2018
Foster MA , Hofmeister MG , Kupronis BA , Lin Y , Xia GL , Yin S , Teshale E . MMWR Morb Mortal Wkly Rep 2019 68 (18) 413-415 Hepatitis A virus (HAV) is primarily transmitted fecal-orally after close contact with an infected person (1); it is the most common cause of viral hepatitis worldwide, typically causing acute and self-limited symptoms, although rarely liver failure and death can occur (1). Rates of hepatitis A had declined by approximately 95% during 1996-2011; however, during 2016-2018, CDC received approximately 15,000 reports of HAV infections from U.S. states and territories, indicating a recent increase in transmission (2,3). Since 2017, the vast majority of these reports were related to multiple outbreaks of infections among persons reporting drug use or homelessness (4). In addition, increases of HAV infections have also occurred among men who have sex with men (MSM) and, to a much lesser degree, in association with consumption of imported HAV-contaminated food (5,6). Overall, reports of hepatitis A cases increased 294% during 2016-2018 compared with 2013-2015. During 2016-2018, CDC tested 4,282 specimens, of which 3,877 (91%) had detectable HAV RNA; 565 (15%), 3,255 (84%), and 57 (<1%) of these specimens were genotype IA, IB, or IIIA, respectively. Adherence to the Advisory Committee on Immunization Practices (ACIP) recommendations to vaccinate populations at risk can help control the current increases and prevent future outbreaks of hepatitis A in the United States (7). |
Differences by sex in cardiovascular comorbid conditions among older adults (aged 50-64 or 65 years) receiving care for human immunodeficiency virus
Frazier EL , Sutton MY , Tie Y , Fagan J , Fanfair RN . Clin Infect Dis 2019 69 (12) 2091-2100 BACKGROUND: Differences by sex in cardiovascular comorbid conditions among human immunodeficiency virus (HIV)-infected persons aged 50-64 years have been understudied; even fewer data are available for persons aged >/=65 years. METHODS: We used matched interview and medical record abstraction data from the 2009-2012 data cycles of the Medical Monitoring Project, a nationally representative sample of HIV-infected adults in care. We included men and women aged 50-64 and >/=65 years at time of interview. We calculated weighted prevalence estimates and used logistic regression to compute adjusted prevalence differences and 95% confidence intervals (CIs) assessing sex differences in various characteristics and cardiovascular comorbid conditions. Comorbid conditions included overweight/obesity (body mass index >/=25), abnormal total cholesterol level (defined as >/=200 mg/dL), diagnosed diabetes mellitus, or diagnosed hypertension. RESULTS: Of 7436 participants, 89.5% were aged 50-64 years and 10.4% aged >/=65 years, 75.1% were men, 40.4% (95% CI, 33.5%-47.2%) were non-Hispanic black, 72.0% (70.4%-73.6%) had HIV infection diagnosed >/=10 years earlier. After adjustment for sociodemographic and behavioral factors, women aged 50-64 years were more likely than men to be obese (adjusted prevalence difference, 8.4; 95% CI, 4.4-12.3), have hypertension (3.9; .1-7.6), or have high total cholesterol levels (9.9; 6.2-13.6). Women aged >/=65 years had higher prevalences of diabetes mellitus and high total cholesterol levels than men. CONCLUSIONS: Cardiovascular comorbid conditions were prevalent among older HIV-infected persons in care; disparities existed by sex. Closer monitoring and risk-reduction strategies for cardiovascular comorbid conditions are warranted for older HIV-infected persons, especially older women. |
Epidemiologic patterns of human Salmonella serotype diversity in the USA, 1996-2016
Judd MC , Hoekstra RM , Mahon BE , Fields PI , Wong KK . Epidemiol Infect 2019 147 e187 Although researchers have described numerous risk factors for salmonellosis and for infection with specific common serotypes, the drivers of Salmonella serotype diversity among human populations remain poorly understood. In this retrospective observational study, we partition records of serotyped non-typhoidal Salmonella isolates from human clinical specimens reported to CDC national surveillance by demographic, geographic and seasonal characteristics and adapt sample-based rarefaction methods from the field of community ecology to study how Salmonella serotype diversity varied within and among these populations in the USA during 1996-2016. We observed substantially higher serotype richness in children <2 years old than in older children and adults and steadily increasing richness with age among older adults. Whereas seasonal and regional variation in serotype diversity was highest among infants and young children, variation by specimen source was highest in adults. Our findings suggest that the risk for infection from uncommon serotypes is associated with host and environmental factors, particularly among infants, young children and older adults. These populations may have a higher proportion of illness acquired through environmental transmission pathways than published source attribution models estimate. |
Gentamicin as an alternative treatment for gonorrhoea
Kirkcaldy RD , Workowski KA . Lancet 2019 393 (10190) 2474-2475 A high gonorrhoea disease burden, increasing rates, and growing antimicrobial resistance portend a developing global public health crisis.1 Gonorrhoea can cause reproductive complications such as pelvic inflammatory disease and infertility, blindness in infants born to infected mothers, and can facilitate HIV acquisition and transmission. Effective treatment prevents sequelae and transmission. Yet Neisseria gonorrhoeae has developed resistance to each antimicrobial used for treatment.2 Development of new antimicrobials has not kept pace. |
Pilot study of markers for high-grade anal dysplasia in a southern cohort from the Women's Interagency HIV Study (WIHS)
Lahiri CD , Nguyen ML , Mehta CC , Mosunjac M , Tadros T , Unger ER , Rajeevan MS , Richards J , Ofotokun I , Flowers L . Clin Infect Dis 2019 70 (6) 1121-1128 BACKGROUND: Anal cancer rates have increased, particularly in HIV-positive (HIV+) women. We assessed factors associated with anal precancer in HIV+ and at-risk HIV-negative (ARHIVN) women from the Atlanta Women's Interagency HIV Study Cohort. METHODS: All participants underwent high resolution anoscopy, anal cytology (AC) and had anal (AS) and cervical (CS) samples collected. Specimens were tested for 37 HPV types and for FAM19A4 and microRNA124-2 promoter methylation. Binary logistic regression and multivariate analysis were conducted with histologic anal high grade squamous intraepithelial lesion (A-HSIL) as the dependent variable. RESULTS: Seventy-five women enrolled: 52(69%) were HIV+ with three-fourths having undetectable viral load, 64(86%) were black, with mean age 49+/-8 years. Forty-nine (65%) AC samples were abnormal, and 38(51%) of AS were positive for at least one of 13 high-risk HPV (hrHPV) types. Thirteen (18%) anal biopsies identified A-HSIL. Hypermethylation of FAM19A4 and/or microRNA124-2 was found in 69 (95%) AS and 19(26%) CS. In multivariate analyses, the odds of having A-HSIL were over 6 times higher in women with anal hrHPV (aOR 6.08, 95% CI 1.27-29.18, p=0.02) and with positive cervical methylation (aOR 6.49, 95% CI 1.66-25.35, p=0.007), but not significantly higher in women with positive anal methylation. CONCLUSIONS: Anal hrHPV and promoter hypermethylation in the cervix show promise as biomarkers for anal cancer screening in HIV+ and ARHIVN women. Greater understanding of gene silencing by promoter hypermethylation in anal carcinogenesis is needed. |
Varicella in Tshuapa Province, Democratic Republic of Congo, 2009-2014
Leung J , McCollum AM , Radford K , Hughes C , Lopez AS , Guagliardo SAJ , Nguete B , Likafi T , Kabamba J , Malekani J , Lushima RS , Pukuta E , Karhemere S , Tamfum JJM , Reynolds MG , Okitolonda EW , Schmid DS , Marin M . Trop Med Int Health 2019 24 (7) 839-848 OBJECTIVE: To describe varicella cases in Tshuapa Province of the Democratic Republic of the Congo identified during monkeypox surveillance. METHODS: Demographic, clinical, and epidemiological data were collected from each suspected monkeypox case 2009-2014. Samples were tested by PCR for both Orthopoxviruses and varicella-zoster virus (VZV); a subset of VZV positive samples were genotyped. We defined a varicella case as a rash illness with laboratory-confirmed VZV. RESULTS: 366 varicella cases were identified; 66% were </=19 years old. Most patients had non-typical varicella rash with lesions reported as the same size and stage of evolution (86%), deep and profound (91%), on palms of hands and/or soles of feet (86%), and not itchy (49%). Many had non-typical signs and symptoms, such as lymphadenopathy (70%) and sensitivity to light (23%). A higher proportion of persons aged >/=20 years than persons aged </=19 years had >/=50 lesions (79% versus 65%, p = 0.007) and were bedridden (15% versus 9%, p = 0.056). All VZV isolates genotyped from 79 varicella cases were clade 5. During the surveillance period, one possible VZV-related death occurred in a 7 year-old child. CONCLUSIONS: A large proportion of patients presented with nontypical varicella rash and clinical signs and symptoms, highlighting challenges identifying varicella in an area with endemic monkeypox. Continued surveillance and laboratory diagnosis will help in rapid identification and control of both monkeypox and varicella and improve our understanding of varicella epidemiology in Africa. This article is protected by copyright. All rights reserved. |
Evaluation of Vietnam's post-exposure prophylaxis delivery system, 2017
Nguyen HT , Le ND , Pham TN , Urabe MI , Afriyie DO , Otsu S , Tran DN , Tran HG , Nguyen HV , Le HT , Tran CH . Vaccine 2019 37 Suppl 1 A20-A27 Background: Canine-mediated human rabies deaths typically occur in poor and rural populations with limited access to rabies biologics: vaccine and immunoglobulin. A critical aspect of reducing rabies deaths is understanding how these countries procure, deliver, and forecast rabies biologics. Vietnam is one of the few endemic countries where biologics is widely available. However, a formal evaluation of its current rabies biologics distribution system has not been conducted. Methods: In 2017, we conducted a formal evaluation of Vietnam's rabies biologics distribution system. Our goals were (1)to identify centers providing rabies biologics (2)identify costs to the patient and centers and (3)assess the rabies biologic procurement and delivery system at eligible district and provincial centers (provides and orders biologics for itself and other centers directly from the manufacture). To conduct the formal evaluation, we developed a standardized survey that was distributed to centers. Results: Of the 780 designated rabies biologics centers in Vietnam, 659 (84%)of them provide rabies immunoglobulin (eRIG), vaccine, or both. Of the 177 eligible centers, 90% (160)responded to the survey. The average costs to patients were $8.45 (range: 5.43–12.77)for one dose of IM injection, $13.90 (range: 11.86–16.71)for domestic eRIG, and $23 (21.11–27.11)for imported eRIG. Respondents reported experiencing delays in receiving vaccine in 50 centers and eRIG in 14 centers within the past year. Respondents stated their top three challenges in providing biologics were: delays or shortages from manufactures, lack of funds to pay for biologics, and the high cost of biologics. Conclusions and relevance: Despite the wide availability of biologics in Vietnam, more work is needed to provide affordable and reliable supply of biologics to patients. This includes the expansion of ID injection use throughout the country to lower vaccine demand, and decrease the costs to centers and patients. Furthermore, a more coordinated effort to share biologics among centers, possibly through a more centralized system at the provincial level may alleviate delays and shortages. © 2019 The Author(s) |
Multidrug-resistant tuberculosis outbreak associated with poor treatment adherence and delayed treatment: Arua District, Uganda, 2013-2017
Okethwangu D , Birungi D , Biribawa C , Kwesiga B , Turyahabwe S , Ario AR , Zhu BP . BMC Infect Dis 2019 19 (1) 387 BACKGROUND: In August 2017, the Uganda Ministry of Health was notified of increased cases of multidrug-resistant tuberculosis (MDR-TB) in Arua District, Uganda during 2017. We investigated to identify the scope of the increase and risk factors for infection, evaluate health facilities' capacity to manage MDR-TB, and recommend evidence-based control measures. METHODS: We defined an MDR-TB case-patient as a TB patient attending Arua Regional Referral Hospital (ARRH) during 2013-2017 with a sputum sample yielding Mycobacterium tuberculosis resistant to at least rifampicin and isoniazid, confirmed by an approved drug susceptibility test. We reviewed clinical records from ARRH and compared the number of MDR-TB cases during January-August 2017 with the same months in 2013-2016. To identify risk factors specific for MDR-TB among cases with secondary infection, we conducted a case-control study using persons with drug-susceptible TB matched by sub-county of residence as controls. We observed infection prevention and control practices in health facilities and community, and assessed health facilities' capacity to manage TB. RESULTS: We identified 33 patients with MDR-TB, of whom 30 were secondary TB infection cases. The number of cases during January-August 2017 was 10, compared with 3-4 cases in January-August from 2013 to 2016 (p = 0.02). Men were more affected than women (6.5 vs 1.6/100,000, p < 0.01), as were cases >/=18 years old compared to those < 18 years (8.7 vs 0.21/100,000, p < 0.01). In the case-control study, poor adherence to first-line anti-TB treatment (aOR = 9.2, 95% CI: 2.3-37) and initiating treatment > 15 months from symptom onset (aOR = 11, 95% CI: 1.5-87) were associated with MDR-TB. All ten facilities assessed reported stockouts of TB commodities. All 15 ambulatory MDR-TB patients we observed were not wearing masks given to them to minimize community infection. The MDR-TB ward at ARRH capacity was 4 patients but there were 11 patients. CONCLUSION: The number of cases during January-August in 2017 was significantly higher than during the same months in 2013-2016. Poor adherence to TB drugs and delayed treatment initiation were associated with MDR-TB infection. We recommended strengthening directly-observed treatment strategy, increasing access to treatment services, and increasing the number of beds in the MDR-TB ward at ARRH. |
Increase in measles cases - United States, January 1-April 26, 2019
Patel M , Lee AD , Redd SB , Clemmons NS , McNall RJ , Cohn AC , Gastanaduy PA . MMWR Morb Mortal Wkly Rep 2019 68 (17) 402-404 As of April 26, 2019, CDC had reported 704 cases of measles in the United States since the beginning of 2019, representing the largest number of cases reported in the country in a single year since 1994, when 963 cases occurred, and since measles was declared eliminated* in 2000 (1,2). Measles is a highly contagious, acute viral illness characterized by fever and a maculopapular rash; complications include pneumonia, encephalitis, and death. Among the 704 cases, 503 (71%) were in unvaccinated persons and 689 (98%) occurred in U.S. residents. Overall, 66 (9%) patients were hospitalized. Thirteen outbreaks have been reported in 2019, accounting for 663 cases, 94% of all reported cases. Six of the 13 outbreaks were associated with underimmunized close-knit communities and accounted for 88% of all cases. High 2-dose measles vaccination coverage in the United States has been critical to limiting transmission (3). However, increased global measles activity poses a risk to U.S. elimination, particularly when unvaccinated travelers acquire measles abroad and return to communities with low vaccination rates (4). Health care providers should ensure persons are up to date with measles, mumps, rubella (MMR) vaccine, including before international travel, and rapidly report all suspected cases of measles to public health authorities. |
Factors associated with recruitment, surveillance participation, and retention in an observational study of pregnant women and influenza
Thompson MG , Li DK , Naleway AL , Ferber JR , Henninger ML , Shifflett P , Sokolow LZ , Odouli R , Kauffman TL , Fink RV , Bulkley J , Cragan JD , Bozeman S . BMC Pregnancy Childbirth 2019 19 (1) 161 BACKGROUND: This report describes the results of recruitment efforts and the subsequent participation of pregnant women in study activities in a 2010-2012 observational study focused on influenza illness and vaccination in California and Oregon, USA. METHODS: Socio-demographic and health characteristics extracted from electronic medical records were compared among pregnant women who enrolled in the study, refused to participate, or were never reached for study invitation. These characteristics plus additional self-reported information were compared between women who enrolled in two study tracks: a prospective cohort vs. women enrolled following an acute respiratory illness (ARI) medical encounter. The characteristics of women who participated in weekly ARI surveillance (cohort enrollees, year one) and a 6-month follow-up interview (all enrollees) were also examined. RESULTS: In year one, we reached 51% (6938/13,655) of the potential participants we tried to contact by telephone, and 20% (1374/6938) of the women we invited agreed to join the prospective cohort. Women with chronic medical conditions, pregnancy complications, and medical encounters for ARI (prior to pregnancy or during the study period) were more likely to be reached for recruitment and more likely to enroll in the cohort. Twenty percent of cohort enrollees never started weekly surveillance reports; among those who did, reports were completed for 55% of the surveillance weeks. Receipt of the influenza vaccine was higher among women who joined the cohort (76%) than those who refused (56%) or were never reached (54%). In contrast, vaccine uptake among medical enrollees in year one (54%; 53/98) and two (52%; 79/151) was similar to other pregnant women in those years. Study site, white race, non-Hispanic ethnicity, and not having a child aged < 13 years at home were most consistently associated with joining as a cohort or medical enrollee and completing study activities after joining. CONCLUSIONS: We observed systematic differences in socio-demographic and health characteristics across different levels of participant engagement and between cohort and medical enrollees. More methodological research and innovation in conducting prospective observational studies in this population are needed, especially when extended participant engagement and ongoing surveillance are required. |
Factors associated with fatal cases of acute respiratory infection (ARI) among hospitalized patients in Guatemala
Tomczyk S , McCracken JP , Contreras CL , Lopez MR , Bernart C , Moir JC , Escobar K , Reyes L , Arvelo W , Lindblade K , Peruski L , Bryan JP , Verani JR . BMC Public Health 2019 19 (1) 499 BACKGROUND: Acute respiratory infection (ARI) is an important cause of mortality in children and adults. However, studies assessing risk factors for ARI-related deaths in low- and middle-income settings are limited. We describe ARI-related death and associated factors among children aged < 2 years and adults aged >/=18 years hospitalized with ARI in Guatemala. METHODS: We used respiratory illness surveillance data in Guatemala from 2007 to 2013. ARI was defined as evidence of acute infection and >/= 1 sign/symptom of respiratory disease in hospitalized patients. Clinical, sociodemographic, and follow-up data were gathered. Nasopharyngeal/oropharyngeal swabs were collected from patients with ARI and tested for 6 respiratory viruses; urine was collected only from adults with ARI and tested for pneumococcal antigen. Blood cultures and chest radiographs were performed at the physician's discretion. Radiographs were interpreted per World Health Organization guidelines to classify endpoint pneumonia (i.e. suggestive of bacterial pneumonia). Multivariable logistic regression was used to compare characteristics of patients with fatal cases, including those who died in-hospital or were discharged in a moribund state, with those of patients with non-fatal cases. RESULTS: Among 4109 ARI cases identified in hospitalized children < 2 years old, 174 (4%) were fatal. Median age at admission was 4 and 6 months for children with fatal and non-fatal cases, respectively. Factors associated with fatality included low weight-for-age, low family income, heart disease, and endpoint pneumonia; breastfeeding and respiratory syncytial virus (RSV) detection were negatively associated with fatality. Among 1517 ARI cases identified in hospitalized adults >/=18 years, 181 (12%) episodes were fatal. Median age at admission was 57 years for adults with fatal and non-fatal cases. Low body mass index, male sex, kidney disease, and endpoint pneumonia were significantly more common among patients with fatal versus non-fatal cases. CONCLUSIONS: Our findings highlight some of the factors that must be addressed in order to reduce ARI-related mortality, including promotion of good nutrition, breastfeeding, management and prevention of chronic comorbidities, and poverty reduction. Although no specific pathogen increased risk for death, endpoint pneumonia was significantly associated with fatality, suggesting that the pneumococcal conjugate vaccine could contribute to future reductions in ARI-related mortality. |
Risk factors for community-associated Clostridioides difficile infection in young children
Weng MK , Adkins SH , Bamberg W , Farley MM , Espinosa CC , Wilson L , Perlmutter R , Holzbauer S , Whitten T , Phipps EC , Hancock EB , Dumyati G , Nelson DS , Beldavs ZG , Ocampo V , Davis CM , Rue B , Korhonen L , McDonald LC , Guh AY . Epidemiol Infect 2019 147 e172 The majority of paediatric Clostridioides difficile infections (CDI) are community-associated (CA), but few data exist regarding associated risk factors. We conducted a case-control study to evaluate CA-CDI risk factors in young children. Participants were enrolled from eight US sites during October 2014-February 2016. Case-patients were defined as children aged 1-5 years with a positive C. difficile specimen collected as an outpatient or 3 days of hospital admission, who had no healthcare facility admission in the prior 12 weeks and no history of CDI. Each case-patient was matched to one control. Caregivers were interviewed regarding relevant exposures. Multivariable conditional logistic regression was performed. Of 68 pairs, 44.1% were female. More case-patients than controls had a comorbidity (33.3% vs. 12.1%; P = 0.01); recent higher-risk outpatient exposures (34.9% vs. 17.7%; P = 0.03); recent antibiotic use (54.4% vs. 19.4%; P < 0.0001); or recent exposure to a household member with diarrhoea (41.3% vs. 21.5%; P = 0.04). In multivariable analysis, antibiotic exposure in the preceding 12 weeks was significantly associated with CA-CDI (adjusted matched odds ratio, 6.25; 95% CI 2.18-17.96). Improved antibiotic prescribing might reduce CA-CDI in this population. Further evaluation of the potential role of outpatient healthcare and household exposures in C. difficile transmission is needed. |
Incarceration, HIV risk-related behaviors, and partner characteristics among heterosexual men at increased risk of HIV infection, 20 US cities
Wise A , Finlayson T , Sionean C , Paz-Bailey G . Public Health Rep 2019 134 63s-70s OBJECTIVES: The effect of incarceration on HIV risk-related behaviors among at-risk heterosexual men is understudied. The objective of our study was to examine the association between incarceration and HIV risk-related behaviors among a sample of predominantly non-Hispanic black and Hispanic heterosexual men residing in urban areas in the United States with a high prevalence of AIDS. METHODS: We analyzed data from the 2013 National HIV Behavioral Surveillance system on 5321 at-risk heterosexual men using log-linked Poisson regression models, adjusted for demographic characteristics and clustered on city. RESULTS: Of 5321 men, 1417 (26.6%) had recently been incarcerated (in the past 12 months), 2781 (52.3%) had ever been incarcerated but not in the past 12 months, and 1123 (21.1%) had never been incarcerated. Recent incarceration was associated with multiple casual female sexual partners (adjusted prevalence ratio [aPR] = 1.23; 95% confidence interval [CI], 1.05-1.44), condomless sex with multiple female sexual partners (aPR = 1.32; 95% CI, 1.06-1.66), injection drug use (aPR = 3.75; 95% CI, 2.64-5.32), and having sexual partners who were more likely to have ever injected drugs (aPR = 1.84; 95% CI, 1.48-2.28), been incarcerated (aPR = 2.28; 95% CI, 2.01-2.59), or had a concurrent sexual partner (aPR = 1.08; 95% CI, 1.05-1.11), as compared with never-incarcerated men. CONCLUSIONS: Incarceration history was associated with HIV risk-related behaviors among heterosexual men from urban areas in the United States. Correctional rehabilitation initiatives are needed to promote strategies that mitigate HIV risk-related behaviors and promote healthy reentry into communities among heterosexual men at high risk for HIV. |
Good pool chemistry keeps swimming healthy and safe
Hlavsa MC , Laco JP , Hill VR . J Environ Health 2019 81 (9) 32-34 Many pool chemicals are used to protect the health and safety of swimmers and aquatics staff. For example, to help prevent outbreaks of infectious diseases, chlorine or bromine is added as a barrier to pathogen transmission. Muriatic (hydrochloric) acid is added to maintain pH at 7.2–7.8. Clarifiers are added to maximize water clarity, which enable lifeguards and others to identify distressed swimmers underwater and help prevent drownings. | | Maximizing the positive public health impact of pool chemicals calls for minimizing the risk of pool chemical injuries. State and local environmental health practitioners are on the frontline of prevention through educating pool operators about pool chemical safety, inspecting on pool code elements that minimize the risk of pool chemical injuries, investigating pool chemical injuries to identify their root cause(s), and informing the development of optimized measures to prevent future events. This month's column looks at pool chemical injuries and how they can be prevented. |
Childhood polybrominated diphenyl ether (PBDE) serum concentration and reading ability at ages 5 and 8 years: The HOME Study
Liang H , Vuong AM , Xie C , Webster GM , Sjodin A , Yuan W , Miao M , Braun JM , Dietrich KN , Yolton K , Lanphear BP , Chen A . Environ Int 2019 122 330-339 BACKGROUND: Polybrominated diphenyl ethers (PBDEs) exist extensively in the environment and human beings. PBDE concentrations are higher in children than adults. A previous study found that prenatal PBDE exposure was associated with decreased reading skills in children; however, evidence is limited on the potential impact of childhood exposure to PBDEs. The study examined the association between childhood PBDE exposures and reading ability in children at ages 5 and 8years. METHODS: The study included 230 children from an ongoing prospective pregnancy and birth cohort study, the Health Outcomes and Measures of Environment (HOME) Study, conducted in Cincinnati, Ohio. Children's serum concentrations of eleven PBDE congeners were measured at 1, 2, 3, 5, and 8years. The Woodcock-Johnson Tests of Achievement - III and the Wide Range Achievement Test - 4 were administered to assess children's reading skills at ages 5 and 8years, respectively. We used multiple informant models to examine the associations between repeated measures of PBDEs and reading scores at ages 5 and 8years. We also estimated the betas and 95% CIs of the association of PBDE measure at each age by including interaction terms between PBDE concentrations and child age in the models. RESULTS: All childhood BDE-153 concentrations were inversely associated with reading scores at 5 and 8years, but associations were not statistically significant after covariate adjustment. For example, a 10-fold increase in BDE-153 concentrations at ages 3 and 5years was associated with a -5.0 (95% confidence interval (CI): -11.0, 1.0) and -5.5 (95% CI: -12.5, 1.4) point change in Basic Reading score at age 5years, respectively. Similarly, the estimates for Brief Reading score at age 5years were -4.5 (95% CI: -10.5, 1.5) and -5.2 (95% CI: -12.2, 1.7) point changes, respectively. Serum concentration of BDE-47, -99, -100, and Sum4PBDEs (sum of BDE-47, 99, 100, and 153) at every age were inversely associated with reading scores at ages 5 and 8years in unadjusted analyses. While the adjusted estimates were much attenuated and became non-significant, the direction of most of the associations was not altered. CONCLUSION: Our study has shown a suggestive but non-significant trend of inverse associations between childhood PBDE serum concentrations, particularly BDE-153, and children's reading skills. Future studies with a larger sample size are needed to examine these associations. |
Obesity in relation to serum persistent organic pollutant concentrations in CHAMACOS women
Warner M , Rauch S , Coker ES , Harley K , Kogut K , Sjodin A , Eskenazi B . Environ Epidemiol 2018 2 (4) e032 Background: Environmental exposure to endocrine-disrupting chemicals (EDCs), including persistent organic pollutants (POPs), has been hypothesized to increase risk of obesity. Using data from the Center for Health Assessment of Mothers and Children of Salinas (CHAMACOS) study, we examined the longitudinal relationship between serum concentrations of a POPs mixture and several obesity measures. Method(s): Concentrations of 17 POPs were measured in serum collected in 2009-2011 from 468 CHAMACOS women. Anthropometry measurements and personal interviews were completed at up to three study visits between 2009 and 2014. We assessed the relationship of serum POPs concentrations with adiposity measures longitudinally using generalized estimation equation (GEE) models. We implemented Bayesian Kernel Machine Regression (BKMR) to elucidate the effects of joint exposure to the POPs mixture. Result(s): In GEE models, positive associations with body mass index were found for dichlorodiphenyltrichloroethane (Q4 vs. Q1: adjusted beta = 3.2kg/m2; 95% CI = 1.5, 4.9), beta-hexachlorocyclohexane (Q4 vs. Q1: adjusted beta = 3.6kg/m2; 95% CI = 2.0, 5.2), and polybrominated diphenyl ether (PBDE)-47 (Q4 vs. Q1: adjusted beta = 1.9kg/m2; 95% CI = 0.3, 3.5), while PBDE-153 was inversely associated (Q4 vs. Q1: adjusted beta = -2.8kg/m2; 95% CI = -4.4, -1.2). BKMR results, while largely consistent with single pollutant models, revealed the shape and direction of the exposure-response relationships, as well as interactions among pollutants within the mixture, that could not be discovered by single-pollutant models. Conclusion(s): In summary, we found significant associations of serum POPs with several adiposity measures using both conventional regressions and BKMR. Our results provide support for the chemical obesogen hypothesis, that exposure to EDCs may alter risk for later obesity. |
An Overview of PulseNet USA Databases.
Tolar B , Joseph LA , Schroeder MN , Stroika S , Ribot EM , Hise KB , Gerner-Smidt P . Foodborne Pathog Dis 2019 16 (7) 457-462 PulseNet USA is the molecular surveillance network for foodborne disease in the United States. The network consists of state and local public health laboratories, as well as food regulatory agencies, that follow PulseNet's standardized protocols to perform pulsed-field gel electrophoresis (PFGE) and whole genome sequencing (WGS) and analyze the results using standardized software. The raw sequences are uploaded to the GenomeTrakr or PulseNet bioprojects at the National Center for Biotechnology Information. The PFGE patterns and analyzed sequence data are uploaded in real time with associated demographic data to the PulseNet national databases managed at the Centers for Disease Control and Prevention. The PulseNet databases are organism specific and provide a central storage location for molecular and demographic data related to an isolate. Sequences are compared in the databases, thereby facilitating the rapid detection of clusters of foodborne diseases that may represent widespread outbreaks. WGS genotyping data, for example, antibiotic resistance and virulence profiles, are also uploaded in real time to the PulseNet databases to improve food safety surveillance activities. |
Factors associated with increased dissemination of positive mental health messaging on social media
Sumner SA , Bowen DA , Bartholow B . Crisis 2019 41 (2) 1-5 Background: The dissemination of positive messages about mental health is a key goal of organizations and individuals. Aims: Our aim was to examine factors that predict increased dissemination of such messages. Method: We analyzed 10,998 positive messages authored on Twitter and studied factors associated with messages that are shared (re-tweeted) using logistic regression. Characteristics of the account, message, linguistic style, sentiment, and topic were examined. Results: Less than one third of positive messages (31.7%) were shared at least once. In adjusted models, accounts that posted a greater number of messages were less likely to have any single message shared. Messages about military-related topics were 60% more likely to be shared (adjusted odds ratio [AOR] = 1.6, 95% CI [1.1, 2.1]) as well as messages containing achievement-related keywords (AOR = 1.6, 95% CI [1.3, 1.9]). Conversely, positive messages explicitly addressing eating/food, appearance, and sad affective states were less likely to be shared. Multiple other message characteristics influenced sharing. Limitations: Only messages on a single platform and over a focused period of time were analyzed. Conclusion: A knowledge of factors affecting dissemination of positive mental health messages may aid organizations and individuals seeking to promote such messages online. |
Identification of a carbapenemase-producing hypervirulent Klebsiella pneumoniae isolate, United States
Karlsson M , Stanton RA , Ansari U , McAllister G , Chan MY , Sula E , Grass JE , Duffy N , Anacker ML , Witwer ML , Rasheed JK , Elkins CA , Halpin AL . Antimicrob Agents Chemother 2019 63 (7) We report on a carbapenemase-producing hypervirulent Klebsiella pneumoniae (CP-hvKP) collected from a U.S. patient at an outpatient clinic. The isolate was identified as K. pneumoniae serotype K1, sequence type 23 and included both a hypervirulence (with rmpA, rmpA2 iroBCDN, peg-344 and iucABCD-iutA genes) and a carbapenemase-encoding (bla KPC-2) plasmid. The emergence of CP-hvKP underscores the importance of clinical awareness of this pathotype and the need for continued monitoring of CP-hvKP in the United States. |
Outbreak investigation of Pseudomonas aeruginosa infections in a neonatal intensive care unit
Weng MK , Brooks RB , Glowicz J , Keckler MS , Christensen BE , Tsai V , Mitchell CS , Wilson LE , Laxton R , Moulton-Meissner H , Fagan R . Am J Infect Control 2019 47 (9) 1148-1150 A Pseudomonas aeruginosa outbreak was investigated in a neonatal intensive care unit that had experienced a prior similar outbreak. The 8 cases identified included 2 deaths. An investigation found the cause of the outbreak: tap water from contaminated hospital plumbing which was used for humidifier reservoirs, neonatal bathing, and nutritional preparation. Our findings reinforce a recent Centers for Medicare & Medicaid Services memo recommending increased attention to water management to improve awareness, identification, mitigation, and prevention of water-associated, health care-associated infections. |
Applying sequential surveillance methods that use regression adjustment or weighting to control confounding in a multi-site, rare event, distributed setting: Part 2 In-Depth Example of a re-analysis of the measles-mumps-rubella-varicella combination vaccine and seizure risk
Cook AJ , Wellman RD , Marsh T , Shoaibi A , Tiwari R , Nguyen M , Boudreau D , Weintraub ES , Jackson L , Nelson JC . J Clin Epidemiol 2019 113 114-122 OBJECTIVE: In-depth example of two new group sequential methods for postmarket safety monitoring of new medical products. STUDY DESIGN AND SETTING: Existing trial-based group sequential approaches have been extended to adjust for confounders, accommodate rare events, and address privacy-related constraints on data sharing. Most adaptations have involved design-based confounder strategies, for example, self-controlled or exposure matching, while analysis-based approaches like regression and weighting have received less attention. We describe the methodology of two new group sequential approaches that use analysis-based confounder adjustment (GS GEE) and weighting (GS IPTW). Using data from the Food and Drug Administration's Sentinel network, we apply both methods in the context of a known positive association: the measles-mumps-rubella-varicella vaccine and seizure risk in infants. RESULTS: Estimates from both new approaches were similar and comparable to prior studies using design-based methods to address confounding. The time to detection of a safety signal was considerably shorter for GS IPTW, which estimates a risk difference, compared to GS GEE, which provides relative estimates of excess risk. CONCLUSION: Future group sequential safety surveillance efforts should consider analysis-based confounder adjustment techniques that evaluate safety signals on the risk difference scale to achieve greater statistical power and more timely results. |
Vaccine safety in HIV-infected adults within the Vaccine Safety Datalink Project
Hechter RC , Qian L , Tartof SY , Sy LS , Klein NP , Weintraub E , Mercado C , Naleway A , McLean HQ , Jacobsen SJ . Vaccine 2019 37 (25) 3296-3302 OBJECTIVES: We evaluate safety of routine vaccination among adults infected with human immunodeficiency virus (HIV) in five healthcare organizations in the United States. METHODS: We conducted a retrospective cohort study of HIV-infected adults who received inactivated influenza vaccines, hepatitis B vaccines, pneumococcal vaccines, or tetanus, diphtheria, and acellular pertussis vaccines between 2002 and 2013. We conducted self-controlled case series analysis to estimate the relative risk (RR) for 11 pre-specified adverse events (AEs) requiring medical attention. RESULTS: Among 20,417 HIV-infected adults (90.2% male), a total of 137,674 vaccine doses were administered. Based on ICD-9 codes, we detected an increased risk of cellulitis and infection (RR: 1.18, 95% CI: 1.03-1.35) among all patients, and an increased risk of stroke/cerebrovascular diseases among patients with an HIV viral load >10,000 copies/ml (adjusted RR: 3.94, 95% CI: 1.32-11.72). Further analyses on chart confirmed cases of stroke/cerebrovascular diseases indicated no statistically significant increased risk (adjusted RR: 1.72, 95% CI: 0.41-7.24). There was no evidence of increased risk for other AEs following routine vaccination in HIV-infected adults. CONCLUSIONS: Routinely administered vaccines are generally safe for HIV-infected adults. |
Progress toward measles elimination - European Region, 2009-2018
Zimmerman LA , Muscat M , Singh S , Ben Mamou M , Jankovic D , Datta S , Alexander JP , Goodson JL , O'Connor P . MMWR Morb Mortal Wkly Rep 2019 68 (17) 396-401 In 2010, all 53 countries* in the World Health Organization (WHO) European Region (EUR) reconfirmed their commitment to eliminating measles and rubella and congenital rubella syndrome (1); this goal was included as a priority in the European Vaccine Action Plan 2015-2020 (2). The WHO-recommended elimination strategies in EUR include 1) achieving and maintaining >/=95% coverage with 2 doses of measles-containing vaccine (MCV) through routine immunization services; 2) providing measles and rubella vaccination opportunities, including supplementary immunization activities (SIAs), to populations susceptible to measles or rubella; 3) strengthening surveillance by conducting case investigations and confirming suspected cases and outbreaks with laboratory results; and 4) improving the availability and use of evidence for the benefits and risks associated with vaccination (3). This report updates a previous report (4) and describes progress toward measles elimination in EUR during 2009-2018. During 2009-2017, estimated regional coverage with the first MCV dose (MCV1) was 93%-95%, and coverage with the second dose (MCV2) increased from 73% to 90%. In 2017, 30 (57%) countries achieved >/=95% MCV1 coverage, and 15 (28%) achieved >/=95% coverage with both doses. During 2009-2018, >16 million persons were vaccinated during SIAs in 13 (24%) countries. Measles incidence declined to 5.8 per 1 million population in 2016, but increased to 89.5 in 2018, because of large outbreaks in several EUR countries. To achieve measles elimination in EUR, measures are needed to strengthen immunization programs by ensuring >/=95% 2-dose MCV coverage in every district of each country, offering supplemental measles vaccination to susceptible adults, maintaining high-quality surveillance for rapid case detection and confirmation, and ensuring effective outbreak preparedness and response. |
Evaluation of a hospital-based injury surveillance system for monitoring road traffic deaths in Phuket, Thailand
Nittayasoot N , Peterson AB , Thammawijaya P , Parker EM , Sathawornwiwat A , Boonthanapat N , Chantian T , Voradetwitaya L , Jiraphongsa C , Sagarasaeranee O , Sansilapin C , Rattanathamsakul T , Ketgudee L , Tantiworrawit P . Traffic Inj Prev 2019 20 (4) 1-7 OBJECTIVES: The objective of this study was to evaluate and injury surveillance (IS) system's ability to monitor road traffic deaths and the coverage of road traffic injury and death surveillance in Phuket, Thailand. METHODS: U.S. Centers for Disease Control and Prevention guidelines on surveillance system evaluation were used to qualitatively and quantitatively evaluate IS. Interviews with key stakeholders focused on IS's usefulness, simplicity, flexibility, acceptability, and stability. Active case finding of 2014 road traffic deaths in all paper and electronic hospital record systems was used to assess system sensitivity, positive predictive value, and data quality. Electronic data matching software was used to determine the implications of combining IS data with other provincial-level data sources (e.g., death certificates, electronic vehicle insurance claim system). RESULTS: Evaluation results indicated that IS was useful, flexible, acceptable, and stable, with a high positive predictive value (99%). Simplicity was limited due to the burden of collecting data on all injuries and use of paper-based data collection forms. Sensitivity was low, with IS only identifying 55% of hospital road traffic death cases identified during active case finding; however, IS cases were representative of cases identified. Data accuracy and completeness varied across data fields. Combining IS with active case finding, death certificates, and the electronic vehicle insurance claim system more than doubled the number of road traffic death cases identified in Phuket. CONCLUSION: An efficient and comprehensive road traffic injury and death surveillance system is critical for monitoring Phuket's road traffic burden. The hospital-based IS system is a useful system for monitoring road traffic deaths and assessing risk behaviors. However, the complexity of data collection and limited coverage hinders the ability of IS to fully represent road traffic deaths in Phuket Province. Combining data sources could improve coverage and should be considered. |
Taxonomy of the order Bunyavirales: update 2019.
Abudurexiti A , Adkins S , Alioto D , Alkhovsky SV , Avsic-Zupanc T , Ballinger MJ , Bente DA , Beer M , Bergeron E , Blair CD , Briese T , Buchmeier MJ , Burt FJ , Calisher CH , Chang C , Charrel RN , Choi IR , Clegg JCS , de la Torre JC , de Lamballerie X , Deng F , Di Serio F , Digiaro M , Drebot MA , Duan X , Ebihara H , Elbeaino T , Ergunay K , Fulhorst CF , Garrison AR , Gao GF , Gonzalez JJ , Groschup MH , Gunther S , Haenni AL , Hall RA , Hepojoki J , Hewson R , Hu Z , Hughes HR , Jonson MG , Junglen S , Klempa B , Klingstrom J , Kou C , Laenen L , Lambert AJ , Langevin SA , Liu D , Lukashevich IS , Luo T , Lu C , Maes P , de Souza WM , Marklewitz M , Martelli GP , Matsuno K , Mielke-Ehret N , Minutolo M , Mirazimi A , Moming A , Muhlbach HP , Naidu R , Navarro B , Nunes MRT , Palacios G , Papa A , Pauvolid-Correa A , Paweska JT , Qiao J , Radoshitzky SR , Resende RO , Romanowski V , Sall AA , Salvato MS , Sasaya T , Shen S , Shi X , Shirako Y , Simmonds P , Sironi M , Song JW , Spengler JR , Stenglein MD , Su Z , Sun S , Tang S , Turina M , Wang B , Wang C , Wang H , Wang J , Wei T , Whitfield AE , Zerbini FM , Zhang J , Zhang L , Zhang Y , Zhang YZ , Zhang Y , Zhou X , Zhu L , Kuhn JH . Arch Virol 2019 164 (7) 1949-1965 In February 2019, following the annual taxon ratification vote, the order Bunyavirales was amended by creation of two new families, four new subfamilies, 11 new genera and 77 new species, merging of two species, and deletion of one species. This article presents the updated taxonomy of the order Bunyavirales now accepted by the International Committee on Taxonomy of Viruses (ICTV). |
Maternal occupational oil mist exposure and birth defects, National Birth Defects Prevention Study, 1997(-)2011
Siegel M , Rocheleau CM , Johnson CY , Waters MA , Lawson CC , Riehle-Colarusso T , Reefhuis J . Int J Environ Res Public Health 2019 16 (9) Workers in various industries can be exposed to oil mists when oil-based fluids are aerosolized during work processes. Oil mists can be inhaled or deposited on the skin. Little research exists on the reproductive effects of oil mist exposure in pregnant workers. We aimed to investigate associations between occupational oil mist exposure in early pregnancy and a spectrum of birth defects using data from 22,011 case mothers and 8140 control mothers in the National Birth Defects Prevention Study. In total, 150 mothers were rated as exposed. Manufacturing jobs, particularly apparel manufacturing, comprised the largest groups of exposed mothers. Mothers of infants with septal heart defects (odds ratio (OR): 1.8, 95% confidence interval (CI): 1.0-3.3), and especially perimembranous ventricular septal defects (OR: 2.5, CI: 1.2-5.2), were more likely to be occupationally exposed to oil mists in early pregnancy than control mothers; and their rater-estimated cumulative exposure was more likely to be higher. This was the first U.S. study evaluating associations between oil mist exposure and a broad spectrum of birth defects. Our results are consistent with previous European studies, supporting a potential association between oil-based exposures and congenital heart defects. Further research is needed to evaluate the reproductive effects of occupational oil mist exposure. |
The association between job insecurity and engagement of employees at work
Getahun Asfaw A , Chang CC . J Workplace Behav Health 2019 34 (2) 96-110 This study examined the association between employees’ perceived job insecurity and employee engagement. Using Gallup-Sharecare Well-Being Index (2008–2014) data, we applied logistic regressions to examine the association between job insecurity and engagement, controlling for covariates. The job insecurity variable was also interacted with the supervisor support variable. We found that perceived job insecurity was associated with reduced engagement and that this may be moderated by supervisor support. This is the first study using nationally representative data to examine the role of supervisor support in mitigating the negative impact of job insecurity on engagement. © 2019, © 2019 Taylor & Francis Group, LLC. |
Hypersensitivity pneumonitis mortality by industry and occupation
Hall NB , Wood JM , Laney AS , Blackley DJ . Am J Respir Crit Care Med 2019 200 (4) 518 We read with interest the research letter by Fernández Pérez and colleagues (1) and agree that population-level mortality from hypersensitivity pneumonitis (HP) has not been well characterized in the United States. However, the role of occupation in the development and severity of HP is well established (2–4). Occupational exposures are responsible for a substantial portion of HP cases, and it is important to monitor trends in morbidity and mortality so that prevention activities can be prioritized. To that end, we conducted a similar analysis of HP mortality data from 2003 to 2017 (ICD-10 code J67.x) while also taking available employment history into account. |
Quality of malaria services offered in public health facilities in three provinces of Mozambique: a cross-sectional study
Candrinho B , Plucinski MM , Colborn JM , da Silva M , Mathe G , Dimene M , Chico AR , Castel-Branco AC , Brito F , Andela M , Ponce de Leon G , Saifodine A , Zulliger R . Malar J 2019 18 (1) 162 BACKGROUND: Fever associated with malaria is the leading cause of health care-seeking in Mozambique, yet there is limited evidence on the quality of malaria case management. This study evaluated the quality of malaria service provision offered in public health facilities in Mozambique. METHODS: A cross-sectional assessment was conducted in April-May 2018 in three provinces of Mozambique: Maputo Province (low malaria burden), Cabo Delgado (high), and Zambezia (high). The study included all secondary and tertiary facilities and a random sample of primary facilities in each province. Data collection included exit interviews and re-examinations of 20 randomly selected outpatient service patients, interviews with up to five health care providers and the health facility director, a stockroom inventory and routine data abstraction. RESULTS: A total of 319 health care providers and 1840 patients from 117 health facilities were included. Of these, 1325 patients (72%) had suspected malaria (fever/history of fever) and 550 (30%) had febrile, confirmed malaria with the highest burden in Cabo Delgado (43%), followed by Zambezia (34%) and Maputo Province (2%). Appropriate management of malaria cases, defined as testing malaria suspects and treating confirmed cases with the correct dose of anti-malarial, was highest in Zambezia and Cabo Delgado where 52% (95% CI 42-62) and 49% (42-57) of febrile malaria cases were appropriately managed, respectively. Only 14% (5-34) of febrile cases in Maputo Province were appropriately managed. The biggest gap in the malaria case management pathway was failure to test febrile patients, with only 46% of patients with this indication tested for malaria in Maputo Province. Additionally, anti-malarial treatment of patients with a negative malaria test result was common, ranging from 8% (2-23) in Maputo Province to 22% (14-32) of patients with a negative test in Zambezia. Only 58-62% of patients prescribed an anti-malarial correctly recited dosing instructions. Provider training and malaria knowledge was low outside of Zambezia and supervision rates were low in all provinces. Factors associated with correct case management varied by province and included patient age, facility type, treatment and testing availability, supervision, and training. CONCLUSION: These findings underscore the need to strengthen provider testing of all patients with fever, provider adherence to negative test results, and effective counselling of patients across epidemiological settings in Mozambique. |
Severe maternal morbidity, a tale of 2 states using Data for Action - Ohio and Massachusetts
Conrey EJ , Manning SE , Shellhaas C , Somerville NJ , Stone SL , Diop H , Rankin K , Goodman D . Matern Child Health J 2019 23 (8) 989-995 Purpose Describe how Ohio and Massachusetts explored severe maternal morbidity (SMM) data, and used these data for increasing awareness and driving practice changes to reduce maternal morbidity and mortality. Description For 2008-2013, Ohio used de-identified hospital discharge records and International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) codes to identify delivery hospitalizations. Massachusetts used existing linked data system infrastructure to identify delivery hospitalizations from birth certificates linked to hospital discharge records. To identify delivery hospitalizations complicated by one or more of 25 SMMs, both states applied an algorithm of ICD-9-CM diagnosis and procedure codes. Ohio calculated a 2013 SMM rate of 144 per 10,000 delivery hospitalizations; Massachusetts calculated a rate of 162. Ohio observed no increase in the SMM rate from 2008 to 2013; Massachusetts observed a 33% increase. Both identified disparities in SMM rates by maternal race, age, and insurance type. Assessment Ohio and Massachusetts engaged stakeholders, including perinatal quality collaboratives and maternal mortality review committees, to share results and raise awareness about the SMM rates and identified high-risk populations. Both states are applying findings to inform strategies for improving perinatal outcomes, such as simulation training for obstetrical emergencies, licensure rules for maternity units, and a focus on health equity. Conclusion Despite data access differences, examination of SMM data informed public health practice in both states. Ohio and Massachusetts maximized available state data for SMM investigation, which other states might similarly use to understand trends, identify high risk populations, and suggest clinical or population level interventions to improve maternal morbidity and mortality. |
Health care provider attitudes toward safety of selected hormonal contraceptives in breastfeeding women
Mayhew A , Ermias Y , Zapata LB , Pagano HP , Tepper NK . Matern Child Health J 2019 23 (8) 1079-1086 OBJECTIVES: Little is known about provider attitudes regarding safety of selected hormonal contraceptives among breastfeeding women. METHODS: Using a nationwide survey, associations were analyzed between provider characteristics and perception of safety of combined oral contraceptives (COCs) in breastfeeding women >/= 1 month postpartum without other venous thrombosis risk factors and depot medroxyprogesterone acetate (DMPA) in breastfeeding women < 1 month postpartum and >/= 1 month postpartum. RESULTS: Approximately 68% of public-sector providers considered COCs safe for breastfeeding women >/= 1 month postpartum without other venous thrombosis risk factors, with lower odds among non-physicians versus physicians (adjusted odds ratios [aOR] range 0.34-0.51) and those with a focus on adolescent health/pediatrics versus reproductive health (aOR 0.68, 95% confidence interval [CI] 0.47-0.99). Most public-sector providers considered DMPA safe for breastfeeding women during any time postpartum, with lower odds among non-physicians versus physicians (aOR range 0.20-0.54) and those with primary clinical focus other than reproductive health (aOR range 0.26-0.65). The majority of office-based physicians considered COCs safe for breastfeeding women >/= 1 month postpartum without other venous thrombosis risk factors, with lower odds among those who did not use, versus those who used, CDC's contraceptive guidance (aOR 0.40, 95% CI 0.21-0.77). Most office-based physicians also considered DMPA safe for breastfeeding women during any time postpartum. CONCLUSIONS FOR PRACTICE: A high proportion of providers considered use of selected hormonal contraceptives safe for breastfeeding women, consistent with evidence-based guidelines. However, certain provider groups might benefit from education regarding the safety of these methods for breastfeeding women. |
Vital Signs: Pregnancy-related deaths, United States, 2011-2015, and strategies for prevention, 13 states, 2013-2017
Petersen EE , Davis NL , Goodman D , Cox S , Mayes N , Johnston E , Syverson C , Seed K , Shapiro-Mendoza CK , Callaghan WM , Barfield W . MMWR Morb Mortal Wkly Rep 2019 68 (18) 423-429 BACKGROUND: Approximately 700 women die from pregnancy-related complications in the United States every year. METHODS: Data from CDC's national Pregnancy Mortality Surveillance System (PMSS) for 2011-2015 were analyzed. Pregnancy-related mortality ratios (pregnancy-related deaths per 100,000 live births; PRMRs) were calculated overall and by sociodemographic characteristics. The distribution of pregnancy-related deaths by timing relative to the end of pregnancy and leading causes of death were calculated. Detailed data on pregnancy-related deaths during 2013-2017 from 13 state maternal mortality review committees (MMRCs) were analyzed for preventability, factors that contributed to pregnancy-related deaths, and MMRC-identified prevention strategies to address contributing factors. RESULTS: For 2011-2015, the national PRMR was 17.2 per 100,000 live births. Non-Hispanic black (black) women and American Indian/Alaska Native women had the highest PRMRs (42.8 and 32.5, respectively), 3.3 and 2.5 times as high, respectively, as the PRMR for non-Hispanic white (white) women (13.0). Timing of death was known for 87.7% (2,990) of pregnancy-related deaths. Among these deaths, 31.3% occurred during pregnancy, 16.9% on the day of delivery, 18.6% 1-6 days postpartum, 21.4% 7-42 days postpartum, and 11.7% 43-365 days postpartum. Leading causes of death included cardiovascular conditions, infection, and hemorrhage, and varied by timing. Approximately sixty percent of pregnancy-related deaths from state MMRCs were determined to be preventable and did not differ significantly by race/ethnicity or timing of death. MMRC data indicated that multiple factors contributed to pregnancy-related deaths. Contributing factors and prevention strategies can be categorized at the community, health facility, patient, provider, and system levels and include improving access to, and coordination and delivery of, quality care. CONCLUSIONS: Pregnancy-related deaths occurred during pregnancy, around the time of delivery, and up to 1 year postpartum; leading causes varied by timing of death. Approximately three in five pregnancy-related deaths were preventable. IMPLICATIONS FOR PUBLIC HEALTH PRACTICE: Strategies to address contributing factors to pregnancy-related deaths can be enacted at the community, health facility, patient, provider, and system levels. |
Drug overdose deaths involving cocaine and psychostimulants with abuse potential - United States, 2003-2017
Kariisa M , Scholl L , Wilson N , Seth P , Hoots B . MMWR Morb Mortal Wkly Rep 2019 68 (17) 388-395 In 2016, a total of 63,632 persons died from drug overdoses in the United States (1). Drug overdose deaths involving cocaine, psychostimulants with abuse potential (psychostimulants), or both substances combined increased 42.4% from 12,122 in 2015 to 17,258 in 2016.* Psychostimulants with abuse potential include drugs such as methamphetamine, 3,4-methylenedioxy-methamphetamine (MDMA), dextroamphetamine, levoamphetamine, methylphenidate (Ritalin), and caffeine. From 2015 to 2016, cocaine-involved and psychostimulant-involved death rates increased 52.4% and 33.3%, respectively (1). A total of 70,237 persons died from drug overdoses in the United States in 2017; approximately two thirds of these deaths involved an opioid (2). CDC analyzed 2016-2017 changes in age-adjusted death rates involving cocaine and psychostimulants by demographic characteristics, urbanization levels, U.S. Census region, 34 states, and the District of Columbia (DC). CDC also examined trends in age-adjusted cocaine-involved and psychostimulant-involved death rates from 2003 to 2017 overall, as well as with and without co-involvement of opioids. Among all 2017 drug overdose deaths, 13,942 (19.8%) involved cocaine, and 10,333 (14.7%) involved psychostimulants. Death rates increased from 2016 to 2017 for both drug categories across demographic characteristics, urbanization levels, Census regions, and states. In 2017, opioids were involved in 72.7% and 50.4% of cocaine-involved and psychostimulant-involved overdoses, respectively, and the data suggest that increases in cocaine-involved overdose deaths from 2012 to 2017 were driven primarily by synthetic opioids. Conversely, increases in psychostimulant-involved deaths from 2010 to 2017 occurred largely independent of opioids, with increased co-involvement of synthetic opioids in recent years. Provisional data from 2018 indicate that deaths involving cocaine and psychostimulants are continuing to increase.(dagger) Increases in stimulant-involved deaths are part of a growing polysubstance landscape. Increased surveillance and evidence-based multisectoral prevention and response strategies are needed to address deaths involving cocaine and psychostimulants and opioids. Enhancing linkage to care, building state and local capacity, and public health/public safety collaborations are critical components of prevention efforts. |
Comparative analysis of diet and tobacco use among households in Bangladesh
Virk-Baker M , Husain MJ , Parascandola M . Tob Prev Cessat 2019 5 12 INTRODUCTION: While studies from developed countries have reported dietary differences between tobacco users and non-users, less is known about the influence of tobacco on diet in developing countries where malnutrition is a major public health challenge. METHODS: In this study we used the nationally representative Household Income Expenditure Survey 2010 from Bangladesh. Detailed household-level food consumption data including both ethnic and region-specific foods were collected over 14 days, consisting of 7 visits each collecting two days of dietary recall information. RESULTS: Out of 12240 households, 2061 consumed smoking tobacco only (16.8%), 3284 consumed smokeless tobacco only (26.8%), and 3348 consumed both (27.4%). Overall, 71% of the households reported expenditure on tobacco (smoking and/or smokeless) and were considered any-tobacco use households. Our results indicate that after controlling for household expenditure, household size, household child to adult ratio, place of residence (urban/rural), and region fixed effects, any-tobacco households consumed significantly lower amounts (g/day) of milk and dairy products (beta = -17.11, p<0.01) and oil/fat (beta = -10.30, p<0.01) compared to tobacco non-use households (beta: adjusted mean difference in food amount g/day/household). Conversely, consumption of cereal grains (beta = 152.46, p<0.0001) and sugar (beta = 8.16, p<0.0001) were significantly higher among any-tobacco households compared to non-tobacco households. We observed similar patterns for smoking-only, smokeless-only, and dual tobacco product households. CONCLUSION: Evidence of dietary differences between tobacco-use and non-use households may play an important role in developing strategies to address poor diet and malnutrition among tobacco-use households in a developing country like Bangladesh. This study provides one of the first reports addressing diet in relation to tobacco use from a developing country, particularly using nationally representative data. The finding that tobacco-use households have poorer dietary consumption than non-use households suggests that it is important to address tobacco use in the context of nutrition and development programs in low-income environments. |
A computational method for the identification of Dengue, Zika and Chikungunya virus species and genotypes.
Fonseca V , Libin PJK , Theys K , Faria NR , Nunes MRT , Restovic MI , Freire M , Giovanetti M , Cuypers L , Nowe A , Abecasis A , Deforche K , Santiago GA , Siqueira IC , San EJ , Machado KCB , Azevedo V , Filippis AMB , Cunha RVD , Pybus OG , Vandamme AM , Alcantara LCJ , de Oliveira T . PLoS Negl Trop Dis 2019 13 (5) e0007231 In recent years, an increasing number of outbreaks of Dengue, Chikungunya and Zika viruses have been reported in Asia and the Americas. Monitoring virus genotype diversity is crucial to understand the emergence and spread of outbreaks, both aspects that are vital to develop effective prevention and treatment strategies. Hence, we developed an efficient method to classify virus sequences with respect to their species and sub-species (i.e. serotype and/or genotype). This ArboTyping tool provides an easy-to-use software implementation of this new method and was validated on a large dataset assessing the classification performance with respect to whole-genome sequences and partial-genome sequences. Available online: http://krisp.ukzn.ac.za/app/. |
Transmission of Nipah virus - 14 years of investigations in Bangladesh
Nikolay B , Salje H , Hossain MJ , Khan Akmd , Sazzad HMS , Rahman M , Daszak P , Stroher U , Pulliam JRC , Kilpatrick AM , Nichol ST , Klena JD , Sultana S , Afroj S , Luby SP , Cauchemez S , Gurley ES . N Engl J Med 2019 380 (19) 1804-1814 BACKGROUND: Nipah virus is a highly virulent zoonotic pathogen that can be transmitted between humans. Understanding the dynamics of person-to-person transmission is key to designing effective interventions. METHODS: We used data from all Nipah virus cases identified during outbreak investigations in Bangladesh from April 2001 through April 2014 to investigate case-patient characteristics associated with onward transmission and factors associated with the risk of infection among patient contacts. RESULTS: Of 248 Nipah virus cases identified, 82 were caused by person-to-person transmission, corresponding to a reproduction number (i.e., the average number of secondary cases per case patient) of 0.33 (95% confidence interval [CI], 0.19 to 0.59). The predicted reproduction number increased with the case patient's age and was highest among patients 45 years of age or older who had difficulty breathing (1.1; 95% CI, 0.4 to 3.2). Case patients who did not have difficulty breathing infected 0.05 times as many contacts (95% CI, 0.01 to 0.3) as other case patients did. Serologic testing of 1863 asymptomatic contacts revealed no infections. Spouses of case patients were more often infected (8 of 56 [14%]) than other close family members (7 of 547 [1.3%]) or other contacts (18 of 1996 [0.9%]). The risk of infection increased with increased duration of exposure of the contacts (adjusted odds ratio for exposure of >48 hours vs. </=1 hour, 13; 95% CI, 2.6 to 62) and with exposure to body fluids (adjusted odds ratio, 4.3; 95% CI, 1.6 to 11). CONCLUSIONS: Increasing age and respiratory symptoms were indicators of infectivity of Nipah virus. Interventions to control person-to-person transmission should aim to reduce exposure to body fluids. (Funded by the National Institutes of Health and others.). |
Assessing health systems in Guinea for prevention and control of priority zoonotic diseases: A One Health approach
Standley CJ , Carlin EP , Sorrell EM , Barry AM , Bile E , Diakite AS , Keita MS , Koivogui L , Mane S , Martel LD , Katz R . One Health 2019 7 100093 To guide One Health capacity building efforts in the Republic of Guinea in the wake of the 2014-2016 Ebola virus disease (EVD) outbreak, we sought to identify and assess the existing systems and structures for zoonotic disease detection and control. We partnered with the government ministries responsible for human, animal, and environmental health to identify a list of zoonotic diseases - rabies, anthrax, brucellosis, viral hemorrhagic fevers, trypanosomiasis and highly pathogenic avian influenza - as the country's top priorities. We used each priority disease as a case study to identify existing processes for prevention, surveillance, diagnosis, laboratory confirmation, reporting and response across the three ministries. Results were used to produce disease-specific systems "maps" emphasizing linkages across the systems, as well as opportunities for improvement. We identified brucellosis as a particularly neglected condition. Past efforts to build avian influenza capabilities, which had degraded substantially in less than a decade, highlighted the challenge of sustainability. We observed a keen interest across sectors to reinvigorate national rabies control, and given the regional and global support for One Health approaches to rabies elimination, rabies could serve as an ideal disease to test incipient One Health coordination mechanisms and procedures. Overall, we identified five major categories of gaps and challenges: (1) Coordination; (2) Training; (3) Infrastructure; (4) Public Awareness; and (5) Research. We developed and prioritized recommendations to address the gaps, estimated the level of resource investment needed, and estimated a timeline for implementation. These prioritized recommendations can be used by the Government of Guinea to plan strategically for future One Health efforts, ideally under the auspices of the national One Health Platform. This work demonstrates an effective methodology for mapping systems and structures for zoonotic diseases, and the benefit of conducting a baseline review of systemic capabilities prior to embarking on capacity building efforts. |
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