Trends in endometrial cancer incidence rates in the United States, 1999-2006
Duong LM , Wilson RJ , Ajani UA , Singh SD , Eheman CR . J Womens Health (Larchmt) 2011 20 (8) 1157-63 BACKGROUND: Risk factors for endometrial cancer, such as hormone replacement therapy (HRT) and obesity, have changed significantly in the last decade. We investigated trends in endometrial cancer histologic subtypes on a national level during 1999-2006. METHODS: Data covering 88% of the U.S. population were from central cancer registries in the National Program of Cancer Registries (NPCR) and Surveillance, Epidemiology, and End Results (SEER) programs that met high-quality United States Cancer Statistics (USCS) criteria. Our analyses included females with microscopically confirmed invasive uterine cancer (n=257,039). Age-adjusted incidence rates and trends for all invasive uterine cancers and by endometrial cancer histologic subtypes (type I and II) were assessed. RSEULTS: There were 145,922 cases of type I endometrial cancers and 15,591 cases of type II for 1999-2006. We found that type I endometrial cancers have been increasing, whereas type II endometrial cancers and all invasive uterine cancers have been relatively stable throughout the 1999-2006 period. CONCLUSIONS: During the past decade, the overall burden of uterine cancer has been stable, although there have been changes in underlying histologies (e.g., endometrial). Changes in trends for underlying histologies may be masked when reviewing trends irrespective of histologic subtypes. Our findings suggest the need to examine trends of uterine cancer by histologic subtype in order to better understand the burden of endometrial cancer in relation to these subtypes to help women at increased risk for developing more aggressive types of endometrial cancer (e.g., type II). |
Liquid-based cytology test use by office-based physicians: United States, 2006-2007
Hing E , Saraiya M , Roland KB . Natl Health Stat Report 2011 (40) 1-6 BACKGROUND: In the United States, liquid-based cytology (LBC) has become a common screening method for cervical cancer. However, the extent of LBC use, and how it varies by patient and practice characteristics, is unknown. OBJECTIVE: This report describes the ordering and provision of Papanicolaou (Pap) tests, with a major focus on the extent to which LBC has supplanted conventional cytology. The type of Pap test is examined for visits made to primary care physicians in 2006-2007 by females aged 15-64. METHODS: Estimates of Pap test cytology use (both LBC and conventional) are based on combined data from the 2006-2007 National Ambulatory Medical Care Survey (NAMCS), an annual nationally representative survey of visits to nonfederal office-based physicians in the United States, as well as on information reported by sample physicians in Cervical Cancer Screening Supplements fielded as part of NAMCS during the same years. RESULTS: In 2006-2007, LBC was used in approximately 75% of Pap tests for which the type of cytology was known. LBC was less likely to be used for Medicare patients than for privately insured patients, although LBC use did not vary significantly according to the other patient or practice characteristics examined. CONCLUSION: The high percentage of LBC use by office-based physicians in 2006-2007 confirms the widespread use of this screening method among primary care providers, as has been reported in the literature. |
Low-risk human papillomavirus testing and other nonrecommended human papillomavirus testing practices among U.S. health care providers
Lee JW , Berkowitz Z , Saraiya M . Obstet Gynecol 2011 118 (1) 4-13 OBJECTIVE: To assess self-reported human papillomavirus (HPV) DNA testing practices by health care providers and clinics, including nonrecommended practices such as low-risk HPV testing, HPV cotesting in women younger than age 30 years, and HPV reflex testing for high-grade abnormal Pap test results. METHODS: We analyzed responses to a cross-sectional survey of a nationally representative sample of Papanicolaou test providers administered in conjunction with the 2006 National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey. Data analysis was performed on responses from 376 office-based health care providers and 216 outpatient clinics. RESULTS: Overall, 75.5% (95% confidence interval [CI] 68.7-81.2%) of health care providers and 77.2% (95% CI 60.3-88.3%) of clinics reported ever using the HPV DNA test. Of health care providers who used HPV testing, 28.5% (95% CI 21.6-36.6%) used both high-risk and low-risk HPV tests. Most health care providers (59.6%, 95% CI 48.5-69.7%) and clinics (66.0%, 95% CI 48.0-80.3%) used HPV cotesting in women younger than age 30 years. A high percentage of health care providers and clinics performed reflex HPV testing after Pap test results of atypical squamous cells, cannot exclude high-grade squamous intraepithelial lesions (71.4%, 95% CI 63.5-78.3% and 62.8%, 95% CI 49.0-74.9%, respectively) and high-grade squamous intraepithelial lesions (50.7%, 95% CI 42.4-58.9% and 49.0%, 95% CI 33.1-65.2%, respectively), results for which HPV testing is not recommended. CONCLUSION: Many health care providers reported inappropriate uses of HPV testing, which may lead to unnecessary follow-up and increased medical costs without added benefits. Interventions such as eliminating the low-risk HPV test from the U.S. market and educating health care providers and patients on appropriate indications for HPV testing are needed to discourage health care providers from such practices. LEVEL OF EVIDENCE: III. |
Pandemic (H1N1) 2009 virus revisited: an evolutionary retrospective.
Christman MC , Kedwaii A , Xu J , Donis RO , Lu G . Infect Genet Evol 2011 11 (5) 803-11 The pandemic (H1N1) 2009 virus is unique in many aspects, especially in its genetics and evolution. In this paper, we examine the molecular mechanisms underlying the evolution of this novel virus through a comprehensive bioinformatics analysis, and present results in the context of a review of the literature. The pandemic virus was found to arise from a reassortment of two swine viruses, each of which ultimately arose from interspecies transmission. It experienced fast evolutionary rates and strong selection pressures, diverging into two different clusters at the early pandemic stage. Cluster I became extinct at the end of 2009 whereas Cluster II continued to circulate at much lower rates in 2010. Therefore, on August 10 of 2010 the WHO declared the end of the pandemic. Important mutations associated with host specificity, virulence, and drug resistance were detected in the pandemic virus, indicating effective transmission and increased severity in humans. Much has been learned about the evolutionary dynamics of this pandemic virus; however, it is still impossible to predict when the next pandemic will occur and which virus will be responsible. Improved surveillance at different levels (both national and international) and in different hosts (especially in swine) appears to be crucial for early detection and prevention of future influenza pandemics. |
Reduction in the incidence of influenza A but not influenza B associated with use of hand sanitizer and cough hygiene in schools: a randomized controlled trial
Stebbins S , Cummings DA , Stark JH , Vukotich C , Mitruka K , Thompson W , Rinaldo C , Roth L , Wagner M , Wisniewski SR , Dato V , Eng H , Burke DS . Pediatr Infect Dis J 2011 30 (11) 921-6 BACKGROUND: Laboratory-based evidence is lacking regarding the efficacy of nonpharmaceutical interventions (NPIs) such as alcohol-based hand sanitizer and respiratory hygiene to reduce the spread of influenza. METHODS: The Pittsburgh Influenza Prevention Project was a cluster-randomized trial conducted in 10 elementary schools in Pittsburgh, PA, during the 2007 to 2008 influenza season. Children in 5 intervention schools received training in hand and respiratory hygiene, and were provided and encouraged to use hand sanitizer regularly. Children in 5 schools acted as controls. Children with influenza-like illness were tested for influenza A and B by reverse-transcriptase polymerase chain reaction. RESULTS: A total of 3360 children participated in this study. Using reverse-transcriptase polymerase chain reaction, 54 cases of influenza A and 50 cases of influenza B were detected. We found no significant effect of the intervention on the primary study outcome of all laboratory-confirmed influenza cases (incidence rate ratio [IRR]: 0.81; 95% confidence interval [CI]: 0.54, 1.23). However, we did find statistically significant differences in protocol-specified ancillary outcomes. Children in intervention schools had significantly fewer laboratory-confirmed influenza A infections than children in control schools, with an adjusted IRR of 0.48 (95% CI: 0.26, 0.87). Total absent episodes were also significantly lower among the intervention group than among the control group; adjusted IRR 0.74 (95% CI: 0.56, 0.97). CONCLUSIONS: NPIs (respiratory hygiene education and the regular use of hand sanitizer) did not reduce total laboratory-confirmed influenza. However, the interventions did reduce school total absence episodes by 26% and laboratory-confirmed influenza A infections by 52%. Our results suggest that NPIs can be an important adjunct to influenza vaccination programs to reduce the number of influenza A infections among children. |
Risk factors for hospitalized seasonal influenza in rural Western Kenya
Ope MO , Katz MA , Aura B , Gikunju S , Njenga MK , Ng'ang'a Z , Vulule J , Breiman RF , Feikin DR . PLoS One 2011 6 (5) e20111 BACKGROUND: Risk factors for influenza hospitalization in Africa are unknown, including the role of HIV. METHODS: We conducted a case-control study of risk factors for hospitalized seasonal influenza among persons in rural western Kenya, a high HIV prevalence area, from March 2006- August 2008. Eligible cases were ≥five years old, admitted to health facilities with respiratory symptoms, and had nasopharyngeal/oropharyngeal swab specimens that tested positive for influenza A or B by real-time reverse transcription-PCR. Three randomly selected age-, sex- and neighborhood-matched controls were enrolled per case. A structured questionnaire was administered and home-based HIV testing was performed. Risk factors were evaluated using conditional logistic regression. RESULTS: A total of 64 cases (38 with influenza A and 26 with influenza B) and 190 controls were enrolled. The median age was 16 years (range 5-69 years). Among cases, 24.5% were HIV-infected versus 12.5% of controls (p = 0.004). Among persons ≥18 years old, 13 (59%) of 22 tested cases were HIV-positive compared with 15 (24%) of 62 tested controls (p = 0.005). In multivariable analysis, HIV-infection was associated with hospitalization due to influenza [adjusted Odds Ratio (aOR) 3.56, 95% CI 1.25-10.1]. The mean CD4 count among HIV-infected cases and controls was similar (399 vs. 387, respectively, p = 0.89). Chronic lung disease (aOR 6.83, 95% CI 1.37-34.0) was also associated with influenza hospitalization in multivariable analysis. Active pulmonary tuberculosis was associated with influenza hospitalization in bivariate, but not multivariable, analysis. CONCLUSIONS: People with HIV infection and chronic lung disease were at increased risk of hospitalized influenza in rural Kenya. HIV infection is common in many parts of sub-Saharan Africa. Influenza vaccine might prevent severe influenza in these risk groups. |
You have to find TB to treat TB
Cain KP , Varma JK . Int J Tuberc Lung Dis 2011 15 (7) 854 IN 2011, tuberculosis (TB) will continue to kill nearly | 2 million people and will cause at least 25% of all | deaths in people living with HIV (PLHIV).1 Some | patients die from TB before they ever present to the | health care system; many more will die because a clinician did not suspect TB, tests failed to diagnose TB | or the patient did not receive correct treatment. | In 2007, the World Health Organization (WHO) | released new guidelines to improve the diagnosis of | smear-negative and extra-pulmonary TB in high HIV | prevalence settings.2 In this month’s issue of the Journal, Wilson et al. report an evaluation of these guidelines in South Africa.3 The likelihood ratios from | their analysis indicate that the WHO guidelines perform only moderately well at ruling out TB and not | so well at ruling in TB. The study’s use of highly sensitive diagnostic tests on multiple specimens strengthens its validity. In accordance with the 2007 WHO | guidelines, the study defi ned a TB suspect as a person with chronic cough. This defi nition has now been | shown to have low sensitivity for TB in PLHIV, leading the WHO to revise its guidelines.4,5 The overall | sensitivity of the 2007 algorithm, therefore, is likely | even lower than the 80% reported in this study. |
Baseline estimates of diarrhea-associated mortality among United States children before rotavirus vaccine introduction
Esposito DH , Holman RC , Haberling DL , Tate JE , Podewils LJ , Glass RI , Parashar U . Pediatr Infect Dis J 2011 30 (11) 942-7 OBJECTIVES: Deaths due to diarrhea among US children declined substantially from the 1960s through the 1980s, but have not been recently assessed. We examined diarrhea-associated mortality among young US children from 1992 to 2006 to establish baseline estimates through which the effect of rotavirus vaccines, introduced in 2006, can be assessed. METHODS: National Center for Health Statistics multiple cause-of-death mortality data were used to examine diarrhea-associated deaths and death rates among US children 1 to 59 months of age during 1992-2006. The winter residual method was used to indirectly estimate the annual number of diarrhea-associated deaths attributable to rotavirus. RESULTS: An average of 369 diarrhea-associated deaths/year (3320 total deaths) occurred among US children 1 to 59 months of age during 1992-1998 and 2005-2006. The diarrhea-associated death rate increased 40% between the first 3 and last 2 years of the study period, from an average of 1.6 deaths per 100,000 to 2.3 deaths per 100,000. Black children died at almost 4 times the rate of white children. Diarrhea-associated deaths showed a winter seasonal pattern similar to that of rotavirus, particularly among children 4 to 23 months of age. Using indirect methods, we estimated 25 yearly rotavirus-associated deaths during the study period. Rotavirus vaccination could potentially prevent 21 of these deaths annually. CONCLUSIONS: Diarrhea-associated mortality among US children stabilized but appears to be increasing in recent years. Rotavirus was associated with a small but significant number of preventable deaths. The national multiple cause-of-death data should prove useful for assessing mortality impact of rotavirus vaccination in the United States. |
Establishing a baseline measure of school wellness-related policies implemented in a nationally representative sample of school districts
Brener ND , Chriqui JF , O'Toole TP , Schwartz MB , McManus T . J Am Diet Assoc 2011 111 (6) 894-901 The Child Nutrition and WIC Reauthorization Act of 2004 required school districts to establish a local school wellness policy by the first day of the 2006-2007 school year. To provide a baseline measure of the extent to which wellness-related policies were implemented in school districts nationwide in 2006, this study analyzed data from the 2006 School Health Policies and Programs Study (SHPPS). SHPPS used a cross-sectional design to measure policies and practices among a nationally representative sample of 538 public school districts. The authors applied a standardized wellness policy coding system to the data by matching each element to relevant questions from SHPPS and calculated the percentage of school districts meeting each element in the coding system. Statistical analyses included calculation of 95% confidence intervals for percentages and mean number of elements met in each area. In 2006, none of the districts met all elements included in the coding system for local wellness policies. In addition, the percentage of districts meeting each element varied widely. On average, districts met the greatest number of elements in the area of nutrition education and the least number of elements in the area of physical activity. By applying a coding system for district policies to an existing dataset, this study used a novel approach to determine areas of strength and weakness in the implementation of local school wellness-related policies in 2006. |
A community demand-driven approach toward sustainable water and sanitation infrastructure development
Hubbard B , Sarisky J , Gelting R , Baffigo V , Seminario R , Centurion C . Int J Hyg Environ Health 2011 214 (4) 326-34 In September 2001, Cooperative Assistance and Relief Everywhere, Peru Country Office (CARE Peru), obtained funding from the United States Agency for International Development (USAID) to implement community-supported, condominial water and sanitation interventions in Manuel Cardozo Davila, a settlement in Iquitos, Peru. With technical support from the Centers for Disease Control and Prevention (CDC), CARE Peru's Urban Environmental Health Models (Modelos Urbanos de Salud Ambiental [MUSA]) project built on previous work from implementing the Protocol for Assessing Community Excellence in Environmental Health in this same community. The project led to the municipal water supply distribution system being extended 1.3 kilometers into the Southern zone of Iquitos, where it connected to the condominial water system. Altogether, 1030 households were connected to the water supply system after the installation of a condominial water and sewerage system in Cardozo. Diarrheal disease decreased by 37% for children less than 5 years of age from 2003 to 2004. This paper illustrates the strategy used by CARE Peru in conjunction with the Cardozo community to assure that the local demand for improved water and sanitation was met. |
Early diagnoses of autism spectrum disorders in Massachusetts birth cohorts, 2001-2005
Manning SE , Davin CA , Barfield WD , Kotelchuck M , Clements K , Diop H , Osbahr T , Smith LA . Pediatrics 2011 127 (6) 1043-51 OBJECTIVE: We examined trends in autism spectrum disorder diagnoses by age 36 months (early diagnoses) and identified characteristics associated with early diagnoses. METHODS: Massachusetts birth certificate and early-intervention program data were linked to identify infants born between 2001 and 2005 who were enrolled in early intervention and receiving autism-related services before age 36 months (through December 31, 2008). Trends in early autism spectrum disorders were examined using Cochran-Armitage trend tests. chi(2) Statistics were used to compare distributions of selected characteristics for children with and without autism spectrum disorders. Multivariate logistic regression analyses were conducted to identify independent predictors of early diagnoses. RESULTS: A total of 3013 children (77.5 per 10 000 study population births) were enrolled in early intervention for autism spectrum disorder by age 36 months. Autism spectrum disorder incidence increased from 56 per 10 000 infants among the 2001 birth cohort to 93 per 10 000 infants in 2005. Infants of mothers younger than 24 years of age, whose primary language was not English or who were foreign-born had lower odds of an early autism spectrum disorder diagnosis. Maternal age older than 30 years was associated with increased odds of an early autism spectrum disorder diagnosis. Odds of early autism spectrum disorders were 4.5 (95% confidence interval: 4.1-5.0) times higher for boys than girls. CONCLUSIONS: Early autism spectrum disorder diagnoses are increasing in Massachusetts, reflecting the national trend observed among older children. Linkage of early-intervention program data with population-based vital statistics is valuable for monitoring autism spectrum disorder trends and planning developmental and educational service needs. |
Effect of misclassified underlying cause of death on survival estimates of colon and rectal cancer
Yin D , Morris CR , Bates JH , German RR . J Natl Cancer Inst 2011 103 (14) 1130-3 Inaccurate coding of patients' Underlying Cause of Death (UCOD) has constrained cause-specific survival estimates for colon and rectal cancers. Using California data from the Accuracy of Cancer Mortality study, we compared the cancer site data from the California Cancer Registry (CCR) with UCODs reported on death certificates and reclassified the UCODs based on cancer registry data when they disagreed. We then calculated 1-, 3-, 5-, and 10-year cause-specific survival for colon and rectal cancers separately, before and after the reclassification. Records from 26 312 colon and 10 687 rectal cancer patients were examined. UCOD records disagreed with CCR records for 700 (6%) of 11 404 colon cancer deaths and with 1958 (39%) of 5011 rectal cancer deaths, and 82% of the misclassified rectal cancer deaths were coded as colon cancer deaths in the UCOD. Reclassification decreased cause-specific survival for both colon and rectal cancers, but the impact was more pronounced for rectal cancer (eg, 5-year cause-specific survival of colon cancer decreased by 2.8% and of rectal cancer decreased by 20.0% relative to previous estimates; absolute rates changed from 65.4% to 63.6%, and 81.2% to 64.9%, respectively, after reclassification). Interchangeable use of the terms colon cancer and colorectal cancer is likely to be one of the reasons for UCOD misclassification. Educational measures could improve the accuracy of UCOD for colon and rectal cancer deaths. |
Geographic variation in invasive pneumococcal disease following pneumococcal conjugate vaccine introduction in the United States
Rosen JB , Thomas AR , Lexau CA , Reingold A , Hadler JL , Harrison LH , Bennett NM , Schaffner W , Farley MM , Beall BW , Moore MR . Clin Infect Dis 2011 53 (2) 137-43 BACKGROUND: Rates of invasive pneumococcal disease (IPD) varied among the United States before pneumococcal conjugate vaccine (PCV7) introduction. We compared trends in IPD rates among diverse US sites over 10 years since PCV7 introduction. METHODS: Patients with IPD of all ages were identified through active population and laboratory-based surveillance in 8 geographic areas under continuous surveillance during 1998-2009. Isolates were serotyped. IPD incidence rates and percent changes were calculated by site, serotype group, age, and year. RESULTS: Reductions in rates of IPD ranged, by site, from 19 to 29.9 cases per 100,000 population during 1998-1999 to 11.2-18.0 cases per 100,000 population during 2009 (rate reduction, 5.1-15.3 cases per 100,000 population). Reductions in IPD rates among children aged <5 years ranged from 35.7 to 117.2 cases per 100,000 population across the sites. Reductions in rates of IPD due to PCV7 serotypes were seen in all age groups at all sites, ranging from 12 to 21.4 cases per 100,000 population during 1998-1999 to <2 cases per 100,000 population during 2009 (92%-98% reductions). Serotype 19A rates ranged from 0.4 to 1.5 cases per 100,000 population during 1998-1999 to 1.3 to 3.4 cases per 100,000 population during 2009 (rate difference, 0.9-2.8 cases per 100,000 population); modest increases were observed for most age groups across the sites. Rates of IPD due to all other serotypes ranged from 6.3 to 10.3 cases per 100,000 population during 1998-1999 to 8.3-13.6 cases per 100,000 population during 2009 (rate difference, -0.4 to 5.7 cases per 100,000 population). Across the sites, the greatest rate increases were seen in the 50-64 and >65 year age groups. CONCLUSIONS: Reductions in IPD due to vaccine serotypes were consistent across sites. Changes in serotype 19A and all other serotypes were variable. Although relative increases in non-vaccine type serotypes were large in some sites, absolute rate increases were small. |
Changes in pregnancy mortality ascertainment: United States, 1999-2005
MacKay AP , Berg CJ , Liu X , Duran C , Hoyert DL . Obstet Gynecol 2011 118 (1) 104-10 OBJECTIVE: To estimate mortality ratios for all reported pregnancy deaths in the United States, 1999-2005, and to estimate the effect of the 1999 implementation of International Classification of Diseases, Tenth Revision (ICD-10) and adoption of the U.S. Standard Certificate of Death, 2003 Revision, on the ascertainment of deaths resulting from pregnancy. METHODS: We combined information on pregnancy deaths from the National Vital Statistics System and the Pregnancy Mortality Surveillance System to estimate maternal (during or within 42 days of pregnancy) and pregnancy-related (during or within 1 year of pregnancy) mortality ratios (deaths per 100,000 live births). Data for 1995-1997, 1999-2002, and 2003-2005 were compared in order to estimate the effects of the change to ICD-10 and the inclusion of a pregnancy checkbox on the death certificate. RESULTS: The maternal mortality ratio increased significantly from 11.6 in 1995-1997 to 13.1 for 1999-2002 and 15.3 in 2003-2005; the pregnancy-related mortality ratio increased significantly from 12.6 to 14.7 and 18.1 during the same periods. Vital statistics identified significantly more indirect maternal deaths in 2002-2005 than in 1999-2002. Between 2002 and 2005, mortality ratios increased significantly among 19 states using the revised death certificate with a pregnancy checkbox; ratios did not increase in states without a checkbox. CONCLUSION: Changes in ICD-10 and the 2003 revision of the death certificate increased ascertainment of pregnancy deaths. The changes may also have contributed to misclassification of some deaths as maternal in the vital statistics system. Combining data from both systems estimates higher pregnancy mortality ratios than from either system individually. LEVEL OF EVIDENCE: II. |
Diabetes and tuberculosis, US National Health Interview Survey, 2000-2005
Marks SM . Int J Tuberc Lung Dis 2011 15 (7) 982-4 Blacks and Hispanics are disproportionately affected by diabetes, which may confound ethnic association with tuberculosis (TB). We analyzed 2000-2005 National Health Interview Survey data. We present adjusted odds ratios (aORs) and 99% confidence intervals (CIs) for the association of diabetes with history of TB disease, controlling for race/ethnicity and age. Diabetics had an aOR of 1.4 (99%CI 1.0-2.0) for history of TB, controlling for being foreign-born non-Hispanic (aOR 2.2, 99%CI 1.6-3.2), US-born Hispanic (aOR 2.1, 99%CI 1.4-3.2), age ≥65 years (aOR 2.0, 99%CI 1.5-2.6), and being Black (aOR 1.6, 99%CI 1.1-2.4). After controlling for race/ethnicity, self-identified diabetics had an increased aOR for history of TB. |
Travel history, hunting, and venison consumption related to prion disease exposure, 2006-2007 FoodNet population survey
Abrams JY , Maddox RA , Harvey AR , Schonberger LB , Belay ED . J Am Diet Assoc 2011 111 (6) 858-63 The transmission of bovine spongiform encephalopathy (BSE) to human beings and the spread of chronic wasting disease (CWD) among cervids have prompted concerns about zoonotic transmission of prion diseases. Travel to the United Kingdom and other European countries, hunting for deer or elk, and venison consumption could result in the exposure of US residents to the agents that cause BSE and CWD. The Foodborne Diseases Active Surveillance Network 2006-2007 population survey was used to assess the prevalence of these behaviors among residents of 10 catchment areas across the United States. Of 17,372 survey respondents, 19.4% reported travel to the United Kingdom since 1980, and 29.5% reported travel to any of the nine European countries considered to be BSE-endemic since 1980. The proportion of respondents who had ever hunted deer or elk was 18.5%, and 1.2% had hunted deer or elk in a CWD-endemic area. More than two thirds (67.4%) reported having ever eaten deer or elk meat. Respondents who traveled spent more time in the United Kingdom (median 14 days) than in any other BSE-endemic country. Of the 11,635 respondents who had consumed venison, 59.8% ate venison at most one to two times during their year of highest consumption, and 88.6% had obtained all of their meat from the wild. The survey results were useful in determining the prevalence and frequency of behaviors that could be important factors for foodborne prion transmission. |
Characterization and allelic polymorphisms of rhesus macaque (Macaca mulatta) IgG Fc receptor genes.
Nguyen DC , Scinicariello F , Attanasio R . Immunogenetics 2011 63 (6) 351-62 Macaque models are invaluable for AIDS research. Indeed, initial development of HIV-1 vaccines relies heavily on simian immunodeficiency virus-infected rhesus macaques. Neutralizing antibodies, a major component of anti-HIV protective responses, ultimately interact with Fc receptors on phagocytic and natural killer cells to eliminate the pathogen. Despite the major role that Fc receptors play in protective responses, there is very limited information available on these molecules in rhesus macaques. Therefore, in this study, rhesus macaque CD32 (FcgammaRII) and CD64 (FcgammaRI) homologues were genetically characterized. In addition, presence of CD16 (FcgammaRIII), CD32, and CD64 allelic polymorphisms were determined in a group of nine animals. Results from this study show that the predicted structures of macaque CD32 and CD64 are highly similar to their human counterparts. Macaque and human CD32 and CD64 extracellular domains are 88-90% and 94-95% homologous, respectively. Although all cysteines are conserved between the two species, macaque CD32 exhibits two additional N-linked glycosylation sites, whereas CD64 lacks three of them when compared to humans. Five CD32, three CD64, and three CD16 distinct allelic sequences were indentified in the nine animals examined, indicating a relatively high level of polymorphism in macaque Fcgamma receptors. Together, these results validate rhesus macaques as models for vaccine development and antibody responses, while at the same time, underscoring the need to take into account the high degree of genetic heterogeneity present in this species when designing experimental protocols. |
Genetic variability, phylogenetic relationships and gene flow in Triatoma infestans dark morphs from the Argentinean Chaco.
Piccinali RV , Marcet PL , Ceballos LA , Kitron U , Gurtler RE , Dotson EM . Infect Genet Evol 2011 11 (5) 895-903 The recent discovery of sylvatic populations of Triatoma infestans outside the Andean Valleys of Bolivia prompted an evolutionary question about the putative ancestral area of origin and dispersal of the species, and an epidemiological question regarding the possible role of these sylvatic populations in the recolonization process of insecticide-treated houses. The finding of a population of sylvatic melanic T. infestans (dark morphs) in the Argentinean dry Chaco at 7km from a peridomestic bug population of typical coloration gave us the opportunity to test both questions simultaneously by employing phylogenetic and population genetic approaches. For this purpose we analyzed sylvatic and peridomestic bugs using sequence-based mitochondrial and nuclear markers (mtCOI and ITS-1) and microsatellites. Sylvatic bugs were confirmed to be T. infestans and not hybrids, and showed high levels of genetic variability and departures from neutral expectations for mtCOI variation. New ITS-1 and mtCOI haplotypes were recorded, as well as haplotypes shared with peridomestic and/or domestic bugs from previous records. The peridomestic population was invariant for ITS-1 and mtCOI, but showed variability for microsatellites and signatures of a population bottleneck, probably due to a limited number of founders. Phylogenetic analyses were consistent with the presence of ancestral haplotypes in sylvatic bugs. According to F-statistics and assignment methods there was a significant differentiation between sylvatic and peridomestic bugs and gene flow was low and asymmetric, with more bugs moving from the peridomicile to the sylvatic environment. These results support the hypothesis of the Chaco region as the area of origin of T. infestans, and a limited role of sylvatic melanic T. infestans in peridomestic infestation in the Argentinean Chaco. |
Novel pandemic A (H1N1) influenza vaccination among pregnant women: motivators and barriers
SteelFisher GK , Blendon RJ , Bekheit MM , Mitchell EW , Williams J , Lubell K , Peugh J , DiSogra CA . Am J Obstet Gynecol 2011 204 S116-23 We sought to examine motivators and barriers related to monovalent 2009 influenza A (H1N1) vaccination among pregnant women. We conducted a national poll of pregnant women using a random online sample (237) and opt-in supplement (277). In all, 42% of pregnant women reported getting the vaccine. Vaccination was positively associated with attitudinal factors including believing the vaccine is very safe or benefits the baby, and with provider recommendations. Women in racial/ethnic minority groups, women with less education, and women <35 years were less likely to get the vaccine and had differing views and experiences. Despite H1N1 vaccination rates that are higher than past seasonal influenza rates, barriers like safety concerns may persist in a pandemic. Messaging from providers that encourages women to believe the vaccine is very safe and benefits their baby may be compelling. Messaging and outreach during future pandemics may require customization to increase vaccination among high-risk groups. |
Poliovirus vaccines: past, present, and future
Nathanson N , Kew OM . Arch Pediatr Adolesc Med 2011 165 (6) 489-90 An important pediatric advance of the 1950s was the introduction of inactivated poliovirus vaccine (IPV), also known as the Salk vaccine.1 Inactivated poliovirus vaccine and its counterpart, oral poliovirus vaccine (OPV), also known as the Sabin vaccine,2 have saved hundreds of thousands of children and adults from contracting paralytic poliomyelitis, a major scourge of the mid-20th century.3 The celebration of the 100th anniversary of the Archives of Pediatrics and Adolescent Medicine provides a fitting opportunity to describe the effect of poliovirus vaccines during the past 50 years. This topic is particularly pertinent now because a major effort is underway to achieve the global eradication of wild poliovirus4-7; however, the merits of this quest are being debated within the international health care community.6,8-10 |
HPV vaccine effect: is the glass half full or half empty?
Saraiya M , Hariri S . Lancet 2011 377 (9783) 2057-8 In The Lancet, Julia Brotherton and colleagues1 report a decrease in precancerous cervical lesions in girls younger than 18 years after population-wide human papillomavirus (HPV) vaccination in Victoria, Australia, in 2007. The study reports a 0·38% absolute decrease in the rates of histologically confirmed high-grade cervical lesions in these girls during the 2 years after HPV vaccine introduction compared with the 3 years before vaccine introduction.1 This ecological finding might be an early sentinel of the potential real-life effect of the vaccine on the main outcome in the clinical trials: cervical intraepithelial neoplasia of grade 2 or worse (CIN2+). However, these results should be viewed with caution, in view of the well-known limitations of ecological studies. For example, guidelines that emphasise less aggressive management of low-grade cytology, which were published 9 months before HPV vaccine introduction, could have contributed to the reported CIN2+ decrease.2 Health-care providers might also have screened and managed vaccinated patients less aggressively, especially girls younger than the recommended screening age of 18 years. With the 47·5% relative decrease in the incidence of high-grade cervical abnormalities recorded in girls younger than 18 years, a similar though smaller decrease would be expected in girls in the next oldest age group (those aged 18–20 years), who were likely to benefit from the vaccine and in whom vaccine coverage was high. However, no decrease was observed in this age group. |
Human papillomavirus vaccine uptake among 9- to 17-year-old girls: National Health Interview Survey, 2008
Wong CA , Berkowitz Z , Dorell CG , Price RA , Lee J , Saraiya M . Cancer 2011 117 (24) 5612-20 BACKGROUND: Since 2006, the human papillomavirus (HPV) vaccine has been routinely recommended for preadolescent and adolescent girls in the United States. Depending on uptake patterns, HPV vaccine could reduce existing disparities in cervical cancer. METHODS: HPV vaccination status and reasons for not vaccinating were assessed using data from the 2008 National Health Interview Survey. Households with a girl aged 9-17 years were included (N = 2205). Sociodemographic factors and health behaviors associated with vaccine uptake were assessed using multivariate logistic regression. RESULTS: Overall, 2.8% of 9- to 10-year-olds, 14.7% of 11- to 12-year-olds, and 25.4% of 13- to 17-year-olds received at least 1 dose of HPV vaccine; 5.5% of 11- to 12-year-olds and 10.7% of 13- to 17-year-olds received all 3 doses. Factors associated with higher uptake in multivariate analysis included less than high school parental education, well-child check and influenza shot in the past year, and parental familiarity with HPV vaccine. Parents' primary reasons for not vaccinating were beliefs that their daughters did not need vaccination, that their daughters were not sexually active, or had insufficient vaccine knowledge. More parents with private insurance (58.0%) than public (39.8%) or no insurance (39.5%) would pay $360-$500 to vaccinate their daughters. CONCLUSIONS: Less than one quarter of girls aged 9-17 years had initiated HPV vaccination by the end of 2008. Efforts to increase HPV uptake should focus on girls in the target age group, encourage providers to educate parents, and promote access to reduced-cost vaccines. Cancer 2011;. (c) 2011 American Cancer Society. |
Impact of maternal immunization on influenza hospitalizations in infants
Poehling KA , Szilagyi PG , Staat MA , Snively BM , Payne DC , Bridges CB , Chu SY , Light LS , Prill MM , Finelli L , Griffin MR , Edwards KM . Am J Obstet Gynecol 2011 204 S141-8 We sought to determine whether maternal vaccination during pregnancy was associated with a reduced risk of laboratory-confirmed influenza hospitalizations in infants <6 months old. Active population-based, laboratory-confirmed influenza surveillance was conducted in children hospitalized with fever and/or respiratory symptoms in 3 US counties from November through April during the 2002 through 2009 influenza seasons. The exposure, influenza vaccination during pregnancy, and the outcome, positive/negative influenza testing among their hospitalized infants, were compared using logistic regression analyses. Among 1510 hospitalized infants <6 months old, 151 (10%) had laboratory-confirmed influenza and 294 (19%) mothers reported receiving influenza vaccine during pregnancy. Eighteen (12%) mothers of influenza-positive infants and 276 (20%) mothers of influenza-negative infants were vaccinated (unadjusted odds ratio, 0.53; 95% confidence interval, 0.32-0.88 and adjusted odds ratio, 0.52; 95% confidence interval, 0.30-0.91). Infants of vaccinated mothers were 45-48% less likely to have influenza hospitalizations than infants of unvaccinated mothers. Our results support the current influenza vaccination recommendation for pregnant women. |
Increasing adolescent vaccination coverage: the challenges that remain
Stokley S , Vogt T , Shefer A . Arch Pediatr Adolesc Med 2011 165 (6) 568-70 Between 2005 and 2007, the recommended vaccination schedule for adolescents expanded to include vaccines to protect against pertussis, meningitis (MCV4), and for girls, human papillomavirus (HPV).1-3 The most recent data available from the 2009 National Immunization Survey-Teen show that, while coverage among 13- to 17-year-old adolescents has been increasing for each of these vaccines, it remains suboptimal: 55.6% received pertussis, 53.6% received MCV4, and 26.7% (females only) received all 3 doses of the HPV vaccine series.4 Evidenced-based strategies to increase vaccination coverage among adolescents are needed. | In this issue of the Archives, Szilagyi et al5 describe the results of a primary care, practice-based, randomized clinical trial designed to assess the effectiveness of an intervention to increase coverage of pertussis, MCV4, and HPV vaccinations among urban adolescents. The intervention was carried out by trained immunization navigators who implemented a tiered approach that included tracking immunizations, telephone or mailed patient reminder/recall, and outreach via a home visit. By the end of the study period, 44.7% of adolescents in the intervention group and 32.4% in the control group had received all 3 recommended vaccines, and vaccination coverage levels for each individual vaccine were 12% to 16% higher in the intervention group compared with the control group. An additional intervention benefit was that the rate of preventive health visits also increased. |
Multiplex real-time PCR assay for detection of methicillin-resistant Staphylococcus aureus and associated toxin genes.
Fosheim G , Nicholson A , Albrecht V , Limbago B . J Clin Microbiol 2011 49 (8) 3071-3 We describe a real-time PCR assay for the detection of methicillin-resistant Staphylococcus aureus and genes encoding TSST-1 and PVL. Rapid screening and detection of toxins is a useful tool for surveillance studies and outbreak investigations involving large numbers of isolates. |
Azole resistance in Aspergillus fumigatus isolates from the ARTEMIS global surveillance study is primarily due to the TR/L98H mutation in the cyp51A gene.
Lockhart SR , Frade JP , Etienne KA , Pfaller MA , Diekema DJ , Balajee SA . Antimicrob Agents Chemother 2011 55 (9) 4465-8 We surveyed 497 isolates of Aspergillus fumigatus collected 2008-2009 as part of the ARTEMIS global surveillance study for elevated MIC values to itraconazole, voriconazole and posaconazole. Sequencing of the cyp51A gene revealed that 8/29 isolates with elevated MIC values to one or more triazole, all originating in China, contained the TR/L98H mutation associated with resistant European isolates of A. fumigatus. This is the first time the TR/L98H mutation has been identified outside of Europe. |
Reference ranges for testosterone in men generated using liquid chromatography tandem mass spectrometry in a community-based sample of healthy nonobese young men in the Framingham Heart Study and applied to three geographically distinct cohorts
Bhasin S , Pencina M , Jasuja GK , Travison TG , Coviello A , Orwoll E , Wang PY , Nielson C , Wu F , Tajar A , Labrie F , Vesper H , Zhang A , Ulloor J , Singh R , D'Agostino R , Vasan RS . J Clin Endocrinol Metab 2011 96 (8) 2430-9 CONTEXT: Reference ranges are essential for partitioning testosterone levels into low or normal and making the diagnosis of androgen deficiency. We established reference ranges for total testosterone (TT) and free testosterone (FT) in a community-based sample of men. METHODS: TT was measured using liquid chromatography tandem mass spectrometry in nonobese healthy men, 19-40 yr old, in the Framingham Heart Study Generation 3; FT was calculated. Values below the 2.5th percentile of reference sample were deemed low. We determined the association of low TT and FT with physical dysfunction, sexual symptoms [European Male Aging Study (EMAS) only], and diabetes mellitus in three cohorts: Framingham Heart Study generations 2 and 3, EMAS, and the Osteoporotic Fractures in Men Study. RESULTS: In a reference sample of 456 men, mean (sd), median (quartile), and 2.5th percentile values were 723.8 (221.1), 698.7 (296.5), and 348.3 ng/dl for TT and 141. 8 (45.0), 134.0 (60.0), and 70.0 pg/ml for FT, respectively. In all three samples, men with low TT and FT were more likely to have slow walking speed, difficulty climbing stairs, or frailty and diabetes than those with normal levels. In EMAS, men with low TT and FT were more likely to report sexual symptoms than men with normal levels. Men with low TT and FT were more likely to have at least one of the following: sexual symptoms (EMAS only), physical dysfunction, or diabetes. CONCLUSION: Reference ranges generated in a community-based sample of men provide a rational basis for categorizing testosterone levels as low or normal. Men with low TT or FT by these criteria had higher prevalence of physical dysfunction, sexual dysfunction, and diabetes. These reference limits should be validated prospectively in relation to incident outcomes and in randomized trials. |
Serologic assays for influenza surveillance, diagnosis and vaccine evaluation
Katz JM , Hancock K , Xu X . Expert Rev Anti Infect Ther 2011 9 (6) 669-83 Serological techniques play a critical role in various aspects of influenza surveillance, vaccine development and evaluation, and sometimes in diagnosis, particularly for novel influenza virus infections of humans. Because individuals are repeatedly exposed to antigenically and genetically diverse influenza viruses over a lifetime, the gold standard for detection of a recent influenza virus infection or response to current vaccination is the demonstration of a seroconversion, a fourfold or greater rise in antibody titer relative to a baseline sample, to a circulating influenza strain or vaccine component. The hemagglutination-inhibition assay remains the most widely used assay to detect strain-specific serum antibodies to influenza. The hemagglutination-inhibition assay is also used to monitor antigenic changes among influenza viruses which are constantly evolving; such antigenic data is essential for consideration of changes in influenza vaccine composition. The use of the hemagglutinin-specific microneutralization assay has increased, in part, owing to its sensitivity for detection of human antibodies to novel influenza viruses of animal origin. Neutralization assays using replication-incompetent pseudotyped particles may be advantageous in some laboratory settings for detection of antibodies to influenza viruses with heightened biocontainment requirements. The use of standardized protocols and antibody standards are important steps to improve reproducibility and interlaboratory comparability of results of serologic assays for influenza viruses. |
Unusual interferon gamma measurements with QuantiFERON-TB Gold and QuantiFERON-TB Gold In-Tube tests
Powell RD 3rd , Whitworth WC , Bernardo J , Moonan PK , Mazurek GH . PLoS One 2011 6 (6) e20061 INTRODUCTION: Interferon gamma (IFN-gamma) release assays, such as QuantiFERON(R)-TB Gold test (QFT-G) and QuantiFERON(R)-TB Gold In-Tube test (QFT-GIT) are designed to detect M. tuberculosis (Mtb) infection. Recognition of unusual IFN-gamma measurements may help indicate inaccurate results. METHODS: We examined QFT-G and QFT-GIT results from subjects who had two or more tests completed. We classified unusual IFN-gamma measurements as: 1) High Nil Concentration (HNC) when IFN-gamma concentration in plasma from unstimulated blood exceeded 0.7 IU/mL; 2) Low Mitogen Response (LMR) when Mitogen Response was <0.5 IU/mL; 3) Very Low Mitogen Response (VLMR) when Mitogen Response was ≤-0.5 IU/mL; and 4) Very Low Antigen Response (VLAR) when the response to a Mtb antigen was ≤-0.35 IU/mL and ≤-0.5 times the IFN-gamma concentration in plasma from unstimulated blood. RESULTS: Among 5,309 results from 1,728 subjects, HNC occurred in 234 (4.4%) tests for 162 subjects, LMR in 108 (2.0%) tests for 85 subjects, VLMR in 22 (0.4%) tests for 21 subjects, and VLAR in 41 (0.8%) tests for 39 subjects. QFT-GIT had fewer HNC, VLMR, and VLAR (p = 0.042, 0.004, and 0.067 respectively); QFT-G had fewer LMR (p = 0.005). Twenty-four (51.6%) of 47 subjects with positive results and HNC were negative or indeterminate by all other tests. Thirteen (61.9%) of 21 subjects with positive results and LMR were negative or indeterminate by all other tests. CONCLUSION: Unusual IFN-gamma measurements including HNC, LMR, VLMR, and VLAR were encountered in small numbers, and in most instances were not seen on simultaneously or subsequently performed tests. To avoid erroneous diagnosis of Mtb infection, IGRAs with unusual IFN-gamma measurements should be repeated with another blood sample and interpreted with caution if they recur. |
Viral shedding in patients infected with pandemic influenza A (H1N1) virus in Kenya, 2009
Waiboci LW , Lebo E , Williamson JM , Mwiti W , Kikwai GK , Njuguna H , Olack B , Breiman RF , Njenga MK , Katz MA . PLoS One 2011 6 (6) e20320 BACKGROUND: Understanding shedding patterns of 2009 pandemic influenza A (H1N1) (pH1N1) can inform recommendations about infection control measures. We evaluated the duration of pH1N1 virus shedding in patients in Nairobi, Kenya. METHODS: Nasopharyngeal (NP) and oropharyngeal (OP) specimens were collected from consenting laboratory-confirmed pH1N1 cases every 2 days during October 14-November 25, 2009, and tested at the Centers for Diseases Control and Prevention-Kenya by real time reverse transcriptase polymerase chain reaction (rRT-PCR). A subset of rRT-PCR-positive samples was cultured. RESULTS: Of 285 NP/OP specimens from patients with acute respiratory illness, 140 (49%) tested positive for pH1N1 by rRT-PCR; 106 (76%) patients consented and were enrolled. The median age was 6 years (Range: 4 months-41 years); only two patients, both asthmatic, received oseltamivir. The median duration of pH1N1 detection after illness onset was 8 days (95% CI: 7-10 days) for rRT-PCR and 3 days (Range: 0-13 days) for viral isolation. Viable pH1N1 virus was isolated from 132/162 (81%) of rRT-PCR-positive specimens, which included 118/125 (94%) rRT-PCR-positive specimens collected on day 0-7 after symptoms onset. Viral RNA was detectable in 18 (17%) and virus isolated in 7/18 (39%) of specimens collected from patients after all their symptoms had resolved. CONCLUSIONS: In this cohort, pH1N1 was detected by rRT-PCR for a median of 8 days. There was a strong correlation between rRT-PCR results and virus isolation in the first week of illness. In some patients, pH1N1 virus was detectable after all their symptoms had resolved. |
Measurement of nicotine, cotinine and trans-3'-hydroxycotinine in meconium by liquid chromatography-tandem mass spectrometry
Xia Y , Xu M , Alexander RR , Bernert JT . J Chromatogr B Analyt Technol Biomed Life Sci 2011 879 (22) 2142-8 Nicotine (NIC), cotinine (COT) and trans-3'-hydroxycotinine (OHCOT) are the most prevalent and abundant tobacco biomarkers in meconium. We have developed and validated an accurate and precise method for the measurement of these analytes in meconium in which potassium hydroxide is used to digest the meconium sample, followed by solid phase extraction from the liquified sample. The precision of OHCOT, COT and NIC measurements (intra-day and inter-day) were 4.8-10.6%, 3.4-11.6% and 9.3-15.8%, respectively. Evaluation of accuracy indicated bias of -4.0, 2.0 and 0.8% for OHCOT at concentrations of 0.5, 2.5 and 7.5ng/g. The accuracy estimates for COT at concentrations of 0.5, 2.5 and 7.5ng/g are 4.0, 4.0 and 5.7%, respectively. For NIC at 2, 10 and 30ng/g the accuracy was calculated to be 3.0, 5.0 and 5.1%, respectively. The linear range of standard solutions was 0.125-37.5ng/mL for OHCOT and COT, and 0.75-150ng/mL for NIC. This method was applied to the analysis of 374 meconium samples from infants of both smoking and nonsmoking mothers. Positive correlations with r(2)≥0.63 were observed between NIC and COT, COT and OHCOT, NIC and OHCOT, and NIC and (OHCOT+COT) in these samples. |
Effective antiviral treatment of systemic orthopoxvirus disease: ST-246 treatment of prairie dogs infected with monkeypox
Smith SK , Self J , Weiss S , Carroll D , Braden Z , Regnery RL , Davidson W , Jordan R , Hruby DE , Damon IK . J Virol 2011 85 (17) 9176-87 Smallpox preparedness research has led to development of antiviral therapies for treatment of serious orthopoxvirus infections. Monkeypox virus is an emerging, zoonotic orthopoxvirus which can cause severe and transmissible disease in humans generating concerns for public health. Monkeypox infection results in a systemic, febrile-rash illness closely resembling smallpox. Currently, there are no small-molecule antiviral therapeutics approved to treat orthopoxvirus infections of humans. The prairie dog, using monkeypox virus as a challenge virus, has provided a valuable non-human animal model in which monkeypox infection closely resembles human systemic orthopoxvirus illness. Here, we assess the efficacy of the anti-orthopoxvirus compound ST-246 in prairie dogs against 65 X LD(50) challenge with monkeypox virus. Animals were infected intranasally and administered ST-246 for 14 days, beginning on days 0, 3, or post rash onset. Swab and blood samples were collected every 2 days and analyzed for presence of viral DNA by real-time PCR and viable virus by tissue culture. Seventy-five percent of infected animals that received vehicle alone succumbed to infection. One hundred percent of animals that received ST-246 survived challenge, and animals that received treatment before symptom onset remained largely asymptomatic. Viable virus and viral DNA were undetected or at greatly reduced levels in animals that began treatment on 0 or 3 days post infection, as compared to control animals or animals treated post rash onset. Animals treated after rash onset manifest illness but all recovered. Our results indicate ST-246 can be used therapeutically, following onset of rash illness, to treat systemic orthopoxvirus infections. |
Fine epitope mapping of monoclonal antibodies against hemagglutinin of a highly pathogenic H5N1 influenza virus using yeast surface display
Han T , Sui J , Bennett AS , Liddington RC , Donis RO , Zhu Q , Marasco WA . Biochem Biophys Res Commun 2011 409 (2) 253-9 Highly pathogenic H5N1 avian influenza viruses pose a debilitating pandemic threat. Thus, understanding mechanisms of antibody-mediated viral inhibition and neutralization escape is critical. Here, a robust yeast display system for fine epitope mapping of viral surface hemagglutinin (HA)-specific antibodies is demonstrated. The full-length H5 subtype HA (HA0) was expressed on the yeast surface in a correctly folded conformation, determined by binding of a panel of extensively characterized neutralizing human monoclonal antibodies (mAbs). These mAbs target conformationally-dependent epitopes of influenza A HA, which are highly conserved across H5 clades and group 1 serotypes. By separately displaying HA1 and HA2 subunits on yeast, domain mapping of two anti-H5 mAbs, NR2728 and H5-2A, localized their epitopes to HA1. These anti-H5 mAb epitopes were further fine mapped by using a library of yeast-displayed HA1 mutants and selecting for loss of binding without prior knowledge of potential contact residues. By overlaying key mutant residues that impacted binding onto a crystal structure of HA, the NR2728 mAb was found to interact with a fully surface-exposed contiguous patch of residues at the receptor binding site (RBS), giving insight into the mechanism underlying its potent inhibition of virus binding. The non-neutralizing H5-2A mAb was similarly mapped to a highly conserved H5 strain-specific but poorly accessible location on a loop at the trimer HA interface. These data further augment our toolchest for studying HA antigenicity, epitope diversity and accessibility in response to natural and experimental influenza infection and vaccines. |
Knee joint angular velocities and accelerations during the patellar tendon jerk
Lebiedowska MK , Sikdar S , Eranki A , Garmirian L . J Neurosci Methods 2011 198 (2) 255-9 Tendon jerk (TJ) is one of the most commonly used clinical tests in differential diagnosis of human motor disorders. There remains some ambiguity in the physiological interpretation of the test, especially with respect to its association to the functional status of patients. The TJ test inputs a non-physiological stimuli, but it is unclear to what degree the kinematics generated during the TJ test exceed the ranges that muscles encounter in activities of daily living (ADLs). The aim of our pilot study was to determine the range of angular knee kinematics (angular velocities and accelerations) corresponding to the muscle stretch elicited by TJ. We measured the longitudinal kinematics (velocities and accelerations) of the rectus femoris muscle in vivo using vector tissue Doppler imaging, an ultrasound-based method, and measured the angular kinematics of the knee in response to tendon taps with an electrogoniometer. We concluded that muscle longitudinal elongation accelerations elicited during the standard TJ test exceed angular accelerations (104.40-4534.20rads(-2)) encountered in typical ADLs, but the velocities (0.82-6.21rads(-1)) elicited do not exceed those elicited by ADLs. |
Antimicrobial susceptibility to azithromycin among Salmonella enterica isolated in the United States
Sjolund-Karlsson M , Joyce K , Blickenstaff K , Ball T , Haro J , Medalla FM , Fedorka-Cray P , Zhao S , Crump JA , Whichard JM . Antimicrob Agents Chemother 2011 55 (9) 3985-9 Due to emerging resistance to traditional antimicrobial agents such as ampicillin, trimethoprim-sulfamethoxazole and chloramphenicol, azithromycin is increasingly used for the treatment of invasive Salmonella infections. In the present study, 696 isolates of non-Typhi Salmonella collected from humans, food animals and retail meats in the United States were investigated for antimicrobial susceptibility to azithromycin. Seventy two Salmonella enterica serotype Typhi isolated from humans were also tested. For each isolate, minimum inhibitory concentrations (MICs) to azithromycin and 15 other antimicrobial agents were determined by broth microdilution. Among the non-Typhi Salmonella isolates, azithromycin MICs among human isolates ranged from 1-32 mcg/mL whereas the MICs among the animal and retail meat isolates ranged from 2-16 mcg/mL and 4-16 mcg/mL, respectively. Among Salmonella ser. Typhi isolates the azithromycin MICs ranged from 4-16 mcg/mL. The highest MIC observed in the present study was 32 mug/mL and was detected in three isolates from humans belonging to serotypes Kentucky, Montevideo and Paratyphi A. Based on our findings, we propose an epidemiological cut-off value (ECOFF) of wild type ≤ 16 mcg/mL for azithromycin and Salmonella. The susceptibility data provided could be used in combination with clinical outcome data to determine tentative clinical breakpoints for azithromycin and Salmonella enterica. |
Detection of TPN contamination of dried blood spots used in newborn and metabolic screening and its impact on quantitative measurement of amino acids
Chace DH , De Jesus VR , Lim TH , Hannon WH , Clark RH , Spitzer AR . Clin Chim Acta 2011 412 1385-90 BACKGROUND: Markers derived from dextrose (d-glucose) are observed in the MS/MS-based acylcarnitine profiles from dried-blood spots of some premature infants receiving intravenous nutrition. The presence of these markers at m/z 325, 399 and 473 are thought to arise from contamination of blood by total parenteral nutrition (TPN) solutions during specimen collection from premature infants. These solutions contain high concentrations of amino acids and as a result, false-positive screening results for amino acid disorders may occur. This study investigates quantitative parameters of dextrose and amino acids in blood samples enriched with different TPN solutions. METHODS: Whole blood collected in heparin was enriched with three different TPN solutions containing 5, 10 or 12.5% dextrose and amino acids that were originally prepared for delivery of 2.5, 3 or 4g/kg/day of Premasol(R) then spotted onto filter paper cards. Acylcarnitine and amino acid profiles using MS/MS were obtained. Ion ratios of dextrose relative to specific acylcarnitine stable isotope internal standards and amino acid concentrations were obtained. RESULTS: The ion ratios for each of the dextrose markers at m/z 325, 399 and 473 exhibit linearity with the concentration of the dextrose component of TPN added to blood. The lowest detectable dextrose concentration added to blood was 7.6mmol/l at 1:80v/v TPN in blood. Furthermore, the concentrations of amino acids were linear with the concentration of the amino acid component of TPN added to blood. At the lowest detectable concentrations of dextrose marker, the amino acid concentrations were at or above the values considered abnormal in newborn screening laboratories. The molar ratios of amino acids approached the relative quantity of amino acid in the TPN solution with increasing enrichments in blood. CONCLUSIONS: Detection of the combinations of dextrose markers, very high elevations of amino acids and unusual molar ratios can be used to reject a specimen as improperly collected rather than declaring it a false positive and hence reduce false positive rates. This process enhances efficiency, reduces parental anxiety, and improves positive predictive values. |
Musculoskeletal disorder costs and medical claim filing in the US retail trade sector
Bhattacharya A , Leigh JP . Ind Health 2011 49 (4) 517-22 The average costs of Musculoskeletal Disorder (MSD) and odds ratios for filing medical claims related to MSD were examined. The medical claims were identified by ICD 9 codes for four US Census regions within retail trade. Large private firms' medical claims data from Thomson Reuters Inc. MarketScan databases for the years 2003 through 2006 were used. Average costs were highest for claims related to lumbar region (ICD 9 Code: 724.02) and number of claims were largest for low back syndrome (ICD 9 Code: 724.2). Whereas the odds of filing an MSD claim did not vary greatly over time, average costs declined over time. The odds of filing claims rose with age and were higher for females and southerners than men and non-southerners. Total estimated national medical costs for MSDs within retail trade were $389 million (2007 USD). |
Protecting workers in large-scale emergency responses: NIOSH experience in the Deepwater Horizon response
Kitt MM , Decker JA , Delaney L , Funk R , Halpin J , Tepper A , Spahr J , Howard J . J Occup Environ Med 2011 53 (7) 711-5 On April 20, 2010, the Deepwater Horizon (DWH) semisubmersible Mobile Offshore Drilling Unit, located 45 miles southeast off the Louisiana coast, suffered a massive explosion and subsequent fire that ultimately led to the sinking of the Unit. Eleven workers lost their lives as a result of the explosion and fire, and seventeen other workers were injured. Oil from a subsea blowout began flowing into the Gulf of Mexico soon after the explosion, and continued to flow until the well was finally capped on July 15, 2010. | Since that day in April, tens of thousands of workers have engaged in the on- and offshore containment and cleanup activities as part of the DWH response. These workers were deployed by a wide array of response organizations from various federal, state, and local agencies, as well as private businesses and contractors and volunteer organizations. The workers were geographically spread throughout the Gulf of Mexico region in Louisiana, Mississippi, Alabama, and Florida, and were engaged in a range of potentially hazardous activities. Such circumstances presented significant challenges to those who had responsibility for protecting the workers' health and safety. |
The evolution of skin notations for occupational risk assessment: a new NIOSH strategy
Dotson GS , Chen CP , Gadagbui B , Maier A , Ahlers HW , Lentz TJ . Regul Toxicol Pharmacol 2011 61 (1) 53-62 This article presents an overview of a strategy for assignment of hazard-specific skin notations (SK), developed by the National Institute for Occupational Safety and Health (NIOSH). This health hazard characterization strategy relies on multiple SKs capable of delineating systemic (SYS), direct (DIR), and immune-mediated (SEN) adverse effects caused by dermal exposures to chemicals. One advantage of the NIOSH strategy is the ability to combine SKs when it is determined that a chemical may cause multiple adverse effects following dermal contact (e.g., SK: SYS-DIR-SEN). Assignment of the SKs is based on a weight-of-evidence (WOE) approach, which refers to the critical examination of all available data from diverse lines of evidence and the derivation of a scientific interpretation based on the collective body of data including its relevance, quality, and reported results. Numeric cutoff values, based on indices of toxic potency, serve as guidelines to aid in consistently determining a chemical's relative toxicity and hazard potential. The NIOSH strategy documents the scientific rationale for determination of the hazard potential of a chemical and the subsequent assignment of SKs. A case study of acrylamide is presented as an application of the NIOSH strategy. |
Injuries to hired crop workers in the United States-a descriptive analysis of a national probability survey
Wang S , Myers JR , Layne LA . Am J Ind Med 2011 54 (10) 734-47 BACKGROUND: Little empirical data are available examining the injury experience of hired crop workers in the United States (US). This study analyzed work-related injury data collected on these workers from a national survey. METHODS: Data were collected through the National Agricultural Workers Survey (NAWS) for the federal fiscal years 1999, 2002, 2003, and 2004. These data provided descriptive injury characteristics and rate estimates from a sample of 13,604 crop farm workers. RESULTS: The injury rate was 4.3 injuries per 100 week-based full-time equivalents (FTE(WB) ). The majority of the injuries occurred to male (84%) and Mexican born (72%) workers. Shuttle migrants had the highest injury rate at 7.2 injuries/100 FTE(WB) . Workers reporting one or more health conditions and workers reporting one or more musculoskeletal complaints had higher injury. The most common injury events were overexertion from lifting (20%), being struck by hand held objects (13%), and falls to a lower level (10%). Injuries due to falls to a lower level accounted for the highest average number of restricted workdays (45 days). CONCLUSIONS: The use of hand tools, falls, and lifting overexertion injuries were identified as significant causes of injury among hired crop workers. Increased injury risk was also seen for crop workers with existing health or musculoskeletal complaints. These results are useful for targeting injury prevention efforts and future research needs for this unique worker population. Am. J. Ind. Med. (c) 2011 Wiley-Liss, Inc. |
Chronic rhinofacial mucormycosis caused by Mucor irregularis (Rhizomucor variabilis) in India
Hemashettar BM , Patil RN , O'Donnell K , Chaturvedi V , Ren P , Padhye AA . J Clin Microbiol 2011 49 (6) 2372-5 In this article, we describe a chronic case of rhinofacial mucormycosis caused by Mucor irregularis, formerly known as Rhizomucor variabilis var. variabilis, a rare mycotic agent in humans. The infection caused progressive destruction of the nasal septum and soft and hard palate, leading to collapse of the nose bridge and an ulcerative gaping hole. The mucoralean mold cultured from a nasal biopsy specimen was determined by multilocus DNA sequence data to be conspecific with M. irregularis. |
An overview of home health aides: United States, 2007
Bercovitz A , Moss A , Sengupta M , Park-Lee EY , Jones A , Harris-Kojetin LD . Natl Health Stat Report 2011 (34) 1-31 OBJECTIVES: This report presents national estimates of home health aides providing assistance in activities of daily living (ADLs) and employed by agencies providing home health and hospice care in 2007. Data are presented on demographics, training, work environment, pay and benefits, use of public benefits, and injuries. METHODS: Estimates are based on data collected in the 2007 National Home Health Aide Survey. Estimates are derived from data collected during telephone interviews with home health aides providing assistance with ADLs and employed by agencies providing home health and hospice care. RESULTS: In the United States in 2007, 160,700 home health and hospice aides provided ADL assistance and were employed by agencies providing home health and hospice care. Most home health aides were female; approximately one-half were white and one-third black. Approximately one-half of aides were at least 35 years old. Two-thirds had an annual family income of less than $40,000. More than 80% received initial training to become a home health aide and more than 90% received continuing education classes in the previous 2 years. Almost three-quarters of aides would definitely become a home health aide again, and slightly more than one-half of aides would definitely take their current job again. The average hourly pay was $10.88 per hour. Almost three-quarters of aides reported that they were offered health insurance by their employers, but almost 19% of aides had no health insurance coverage from any source. More than 1 in 10 aides had had at least one work-related injury in the previous 12 months. CONCLUSIONS: The picture that emerges from this analysis is of a financially vulnerable workforce, but one in which the majority of aides are satisfied with their jobs. The findings may be useful in informing initiatives to train, recruit, and retain these direct care workers. |
Estimating the potential health impact and costs of implementing a local policy for food procurement to reduce the consumption of sodium in the County of Los Angeles
Gase LN , Kuo T , Dunet D , Schmidt SM , Simon PA , Fielding JE . Am J Public Health 2011 101 (8) 1501-7 OBJECTIVES: We examined approaches to reduce sodium content of food served in settings operated or funded by the government of the County of Los Angeles, California. METHODS: We adapted health impact assessment methods to mathematically simulate various levels of reduction in the sodium content of food served by the County of Los Angeles and to estimate the reductions' potential impacts on mean systolic blood pressure (SBP) among food-service customers. We used data provided by county government food-service vendors to generate these simulations. RESULTS: Our analysis predicted that if the postulated sodium-reduction strategies were implemented, adults would consume, on average, 233 fewer milligrams of sodium each day. This would correspond to an average decrease of 0.71 millimeters of mercury in SBP among adult hypertensives, 388 fewer cases of uncontrolled hypertension in the study population, and an annual decrease of $629,724 in direct health care costs. CONCLUSIONS: Our findings suggest that a food-procurement policy can contribute to positive health and economic effects at the local level. Our approach may serve as an example of sodium-reduction analysis for other jurisdictions to follow. (Am J Public Health. Published online ahead of print June 16, 2011: e1-e7. doi:10.2105/AJPH.2011.300138). |
The Centers for Disease Control and Prevention's maternal health response to 2009 H1N1 influenza
Mosby LG , Ellington SR , Forhan SE , Yeung LF , Perez M , Shah MM , MacFarlane K , Laird SK , House LD , Jamieson DJ . Am J Obstet Gynecol 2011 204 S7-12 We describe the efforts of the Maternal Health Team, which was formed to address the needs of pregnant and breastfeeding women during the Centers for Disease Control and Prevention's (CDC's) 2009 pandemic influenza A (2009 H1N1) emergency response. We examined the team's activities, constructed a timeline of key pandemic events, and analyzed the Maternal Health 2009 H1N1 inquiry database. During the pandemic response, 9 guidance documents that addressed the needs of pregnant and breastfeeding women and their providers were developed by the Maternal Health Team. The Team received 4661 maternal health-related inquiries that came primarily from the public (75.5%) and were vaccine related (69.3%). Peak inquiry volume coincided with peak hospitalizations (October-November 2009). The Maternal Health 2009 H1N1 inquiry database proved useful to identify information needs of the public and health care providers during the pandemic. |
Reproductive health assessment after disaster: introduction to the RHAD toolkit
Zotti ME , Williams AM . J Womens Health (Larchmt) 2011 20 (8) 1123-7 This article reviews associations between disaster and the reproductive health of women, describes how Hurricane Katrina influenced our understanding about postdisaster reproductive health needs, and introduces a new toolkit that can help health departments assess postdisaster health needs among women of reproductive age. |
Mental health promotion in public health: perspectives and strategies from positive psychology
Kobau R , Seligman ME , Peterson C , Diener E , Zack MM , Chapman D , Thompson W . Am J Public Health 2011 101 (8) e1-9 Positive psychology is the study of what is "right" about people-their positive attributes, psychological assets, and strengths. Its aim is to understand and foster the factors that allow individuals, communities, and societies to thrive. Cross-sectional, experimental, and longitudinal research demonstrates that positive emotions are associated with numerous benefits related to health, work, family, and economic status. Growing biomedical research supports the view that positive emotions are not merely the opposite of negative emotions but may be independent dimensions of mental affect. The asset-based paradigms of positive psychology offer new approaches for bolstering psychological resilience and promoting mental health. Ultimately, greater synergy between positive psychology and public health might help promote mental health in innovative ways. (Am J Public Health. Published online ahead of print June 16, 2011:e1-e9. doi:10.2105/AJPH.2010.300083). |
Content Index (Achived Edition)
- Chronic Diseases and Conditions
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- Genetics and Genomics
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CDC Science Clips is an online, continuously updated, searchable database of scientific literature published by CDC authors. Each article features an Altmetric Attention Score to track social and mainstream media mentions. If you are aware of a CDC-authored publication that does not appear in this database, please let us know.
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