Recurrence of Helicobacter pylori infection in Bolivian children and adults after a population-based "screen and treat" strategy
Sivapalasingam S , Rajasingham A , Macy JT , Friedman CR , Hoekstra RM , Ayers T , Gold B , Quick RE . Helicobacter 2014 19 (5) 343-8 BACKGROUND: Strategies to prevent gastric cancer by decreasing Helicobacter pylori infections in high-prevalence, low-income countries could include a population-based "screen and treat" eradication program. METHODS: We tested residents of two rural villages for H. pylori infection using urea breath test (UBT), treated infected persons using directly observed therapy (DOT), retested for cure, and retested after 1 year later for H. pylori infection. FINDINGS: We tested 1,065 (92%) of 1153 residents from two villages in rural Bolivia. Baseline H. pylori prevalence was 80% (95% confidence interval [CI]: 78-84). Age-specific cure rates were similar (≥92%) after DOT. Among those cured, 12% (95% CI: 8-15) had recurrent infection. Age-specific annual H. pylori recurrence rates for combined villages were 20% (95% CI: 10-29) in persons <5 years, 20% (95% CI: 10-29) in 5-9 years, 8% (95% CI: 1-15) in 10-14 years, and 8% (95% CI: 4-12) in persons ≥15 years. Compared with the referent population, those ≥15 years, recurrent infections were significantly more likely in children <5 years (odds ratios [OR] 2.7, 95% CI: 1.2-5.8) and 5-9 years (OR 2.7, 95% CI: 1.4-5.1). INTERPRETATION: Children <10 years had high H. pylori recurrence rates following a population-based screen and treat program; this H. pylori eradication strategy may not be feasible in high-prevalence, low-income settings. |
Smoking prevalence and cessation characteristics among U.S. adults with and without COPD: findings from the 2011 Behavioral Risk Factor Surveillance System
Schauer GL , Wheaton AG , Malarcher AM , Croft JB . COPD 2014 11 (6) 697-704 INTRODUCTION: Cigarette smoking is a major cause of chronic obstructive pulmonary disease, (COPD) but many persons with COPD continue to smoke. Quitting can help prevent the development of and complications from COPD. This study examined whether smoking and cessation behaviors differed among adults with a) COPD, b) asthma, c) other chronic conditions only, or d) no chronic conditions. METHODS: Smoking and chronic disease status was obtained from 488,909 adults aged >18 years using the Behavioral Risk Factor Surveillance System; 9,476 current smokers and recent quitters in 5 states responded to additional questions about cessation. We computed age-adjusted prevalence of smoking and past-year quit attempts, and used bivariate and multivariable logistic regression to identify correlates of past-year quit attempts. RESULTS: Similar to the overall sample, in the 5-state sample, 47.3% of adults with COPD were current smokers versus 23.1% of those with asthma, 28.8% of adults with other chronic conditions, and 20.0% of those with no chronic conditions. Those with COPD did not differ significantly from those with asthma, other chronic diseases, or no chronic disease in having made a past-year quit attempt (59.7% versus 64.0%, 61.5%, and 53.9%, respectively). Smokers with COPD were significantly more likely than those with no chronic disease to have used cessation treatment resources, including a quitline, counseling, or medication (p <0.001). CONCLUSIONS: Adults with COPD were just as likely as those without COPD to make a past-year quit attempt; however, approximately 40% of smokers with COPD did not try to quit. |
Using simulation to compare 4 categories of intervention for reducing cardiovascular disease risks
Hirsch G , Homer J , Trogdon J , Wile K , Orenstein D . Am J Public Health 2014 104 (7) 1187-95 The Prevention Impacts Simulation Model (PRISM) projects the multiyear impacts of 22 different interventions aimed at reducing risk of cardiovascular disease. We grouped these into 4 categories: clinical, behavioral support, health promotion and access, and taxes and regulation. We simulated impacts for the United States overall and also for a less-advantaged county with a higher death rate. Of the 4 categories of intervention, taxes and regulation reduce costs the most in the short term (through 2020) and long term (through 2040) and reduce deaths the most in the long term; they are second to clinical interventions in reducing deaths in the short term. All 4 categories combined were required to bring costs and deaths in the less-advantaged county down to the national level. |
Lung cancer screening with low-dose computed tomography for primary care providers
Richards TB , White MC , Caraballo RS . Prim Care 2014 41 (2) 307-330 This review provides an update on lung cancer screening with low-dose computed tomography (LDCT) and its implications for primary care providers. One of the unique features of lung cancer screening is the potential complexity in patient management if an LDCT scan reveals a small pulmonary nodule. Additional tests, consultation with multiple specialists, and follow-up evaluations may be needed to evaluate whether lung cancer is present. Primary care providers should know the resources available in their communities for lung cancer screening with LDCT and smoking cessation, and the key points to be addressed in informed and shared decision-making discussions with patients. |
National trends in the prevalence and medical history of angina: 1988 to 2012
Will JC , Yuan K , Ford E . Circ Cardiovasc Qual Outcomes 2014 7 (3) 407-13 BACKGROUND: The prevalence of angina from 1971 to 1994 was relatively flat for whites and blacks. We ask whether the prevalence and medical history of angina have changed during 1988 to 2012. METHODS AND RESULTS: We used the National Health and Nutrition Examination Survey data from 1988 to 2004 and the data from the six 2-year surveys from 2001 to 2012. We calculated trends in both crude and standardized prevalence rates for the Rose questionnaire on angina (symptomatology) and a question asking whether the respondent had ever been told by a medical professional that they had angina (medical history). In 2009 to 2012, there were on average 3.4 million (95% confidence interval, 2.8-4.0 million) people aged ≥40 years in the United States each year with angina (Rose questionnaire) and 4.5 million (95% confidence interval, 3.5-5.1 million) people with a medical history of angina. The burden of angina varied across age, race, and sex categories, and the pattern of variation differed by whether symptomatology or medical history was assessed. Statistically significant declines in the rates for both outcomes were noted, for the most part, in people aged ≥65 years. Age and sex standardized rates declined significantly for whites but not for blacks. CONCLUSIONS: Rates of angina symptoms and medical history of angina have declined among non-Hispanic whites and among adults aged ≥65 years. Blacks have not experienced these same declines. Clearly, additional study is required to understand these declines and to track the future cost and burden of angina in the US population. |
Obese women less likely to have low serum ferritin, Nicaragua
Wendt AS , Jefferds ME , Perrine CG , Halleslevens P , Sullivan KM . Public Health Nutr 2014 18 (4) 1-6 OBJECTIVE: To examine the association between overweight and obesity and serum ferritin among women of reproductive age (15-49 years) in Nicaragua, considering the effect of alpha1-acid glycoprotein (AGP), a marker of inflammation. DESIGN: We analysed data from the 2004-05 Nicaraguan Integrated Surveillance System for Nutrition Interventions. Three logistic regression models were analysed with low serum ferritin (<15 mug/l) as the dependent variable: (i) overweight or obese status and covariates; (ii) model 1 plus AGP; and (iii) model 1 restricted to only women with normal AGP levels (≤1.0 g/l). SETTING: Nicaragua. SUBJECTS: Included in this analysis were 832 non-pregnant mother/caregivers (15-49 years) surveyed in 2004-2005. RESULTS: In the sample, prevalence of overweight and obesity was 31.8 % and 19.2 %, respectively, and 27.6 % had low serum ferritin. In model 1, the adjusted OR of low serum ferritin was 0.74 (95 % CI 0.52, 1.05) for overweight women and 0.42 (95 % CI 0.26, 0.65) for obese women. In model 2, AGP was significantly independently associated with low serum ferritin (adjusted OR=0.56, 95 % CI 0.34, 0.92) while the adjusted OR for overweight and obesity were largely unchanged. Excluding women with elevated AGP did not appreciably affect the relationship between overweight or obesity and low serum ferritin (model 3). CONCLUSIONS: Overall, in this population of reproductive-age women, obese women were less likely to have low serum ferritin levels, and this was independent of inflammation as measured by AGP. |
A population-based evaluation of cervical screening in the United States: 2008-2011
Cuzick J , Myers O , Hunt WC , Robertson M , Joste NE , Castle PE , Benard VB , Wheeler CM . Cancer Epidemiol Biomarkers Prev 2014 23 (5) 765-73 BACKGROUND: Cervical screening consumes substantial resources, but little is known about utilization in the United States or compliance with guideline recommendations. METHODS: To describe population screening coverage, utilization, and outcomes and examine time trends from 2008 to 2011, cervical cytology reports from women residing in New Mexico (981,063 tests from 511,381 women) were evaluated. RESULTS: From 2008 to 2011 cervical screening utilization decreased at all ages, but especially in younger women, with a two-third reduction at ages 15 to 20 years. Ninety-four percent of women ages 25 to 29 years were screened within 48 months but coverage decreased at older ages to 69% at 45 to 49 years and 55% at 60 to 64 years. Intervals between screening tests were significantly longer in 2011 compared with 2008 [HR = 1.23; 95% confidence intervals (CI), 1.22-1.24], although the commonest rescreening interval was 13 months. In 2011, 91.9% of screening tests for women ages 21 to 65 years were negative, 6.6% showed minor abnormalities, and 1.0% high-grade abnormalities. High-grade abnormality rates were relatively constant over time, but minor abnormalities and atypical cells cannot rule out high-grade (ASC-H) were increasing. CONCLUSIONS: This population-based evaluation of cervical screening shows high coverage under the age of 40 years, but lower levels in older women. Screening under age 21 years is becoming less common and screening intervals are lengthening, reflecting updates in national screening guidelines. IMPACT: Assessment of cervical screening intervals and population outcomes is essential for accurately estimating the impact and effectiveness of changing recommendations and vaccination against human papilloma virus infections. |
Health-related quality of life in epilepsy patients receiving anti-epileptic drugs at National Referral Hospitals in Uganda: a cross-sectional study
Nabukenya AM , Matovu JK , Wabwire-Mangen F , Wanyenze RK , Makumbi F . Health Qual Life Outcomes 2014 12 (1) 49 BACKGROUND: Epilepsy is a devastating disorder that impacts on patients' quality of life, irrespective of use of anti epileptic drugs (AEDs). This study estimates the health-related quality of life (HRQOL) and its associated predictors among epilepsy patients receiving AEDs. METHODS: A total of 175 epilepsy patients already receiving AED for at least 3 months were randomly selected and interviewed from mental clinics at Mulago and Butabika national referral hospitals in Uganda between May - July 2011. A HRQOL index, the primary outcome, was constructed using items from Quality Of Life in Epilepsy Inventory (QOLIE-31) and the Hospital Anxiety and Depression Scale (HADS) questionnaires. The internal consistency and adequacy of these items was also computed using Cronbach's alpha and Kaiser-Meyer-Olkin tests. Partial correlations were used to evaluate the contribution of the health dimensions (mental, psychological, social, physical functioning and emotional well being) and, multiple linear regressions to determine factors independently associated with HRQOL. RESULTS: Just about half of the respondents (54%) were males, and nearly two thirds (62%) had received AEDs for at least 12 months. The average age was 26.6 years (SD = 11.1). The overall HRQOL mean score was 58 (SD = 13) on a scale of 0-100. The average scores of different dimensions or subscales ranged from 41 (physical) to 65 (psychological). At least three quarters (75%) of all subscales had good internal consistency and adequacy. The largest variations in the overall HRQOL were explained by social and mental functioning; each accounting for about 30% of the difference in the HRQOL but seizure control features explained a little (6%) variation. Factors negatively associated with HRQOL were poly-therapy (-1.16, p = 0.01) and frequency of seizures (-2.29, p = 0.00). Other factors associated with overall HRQOL included drug side effects, sex, marital status and education. Duration on AEDs was not a significant predictor of HRQOL. CONCLUSION: The HRQOL for epilepsy patients on AEDs is very low. The predictors of low HRQOL were socio factors (marital status, education) and drug side effects, frequency of seizure, and type of therapy. |
History of preterm birth and subsequent cardiovascular disease: a systematic review
Robbins CL , Hutchings Y , Dietz PM , Kuklina EV , Callaghan WM . Am J Obstet Gynecol 2014 210 (4) 285-97 A history of preterm birth (PTB) may be an important lifetime risk factor for cardiovascular disease (CVD) in women. We identified all peer-reviewed journal articles that met study criteria (English language, human studies, female, and adults ≥19 years old), that were found in the PubMed/MEDLINE databases, and that were published between Jan. 1, 1995, and Sept. 17, 2012. We summarized 10 studies that assessed the association between having a history of PTB and subsequent CVD morbidity or death. Compared with women who had term deliveries, women with any history of PTB had increased risk of CVD morbidity (variously defined; adjusted hazard ratio [aHR] ranged from 1.2-2.9; 2 studies), ischemic heart disease (aHR, 1.3-2.1; 3 studies), stroke (aHR, 1.7; 1 study), and atherosclerosis (aHR, 4.1; 1 study). Four of 5 studies that examined death showed that women with a history of PTB have twice the risk of CVD death compared with women who had term births. Two studies reported statistically significant higher risk of CVD-related morbidity and death outcomes (variously defined) among women with ≥2 pregnancies that ended in PTBs compared with women who had at least 2 births but which ended in only 1 PTB. Future research is needed to understand the potential impact of enhanced monitoring of CVD risk factors in women with a history of PTB on risk of future CVD risk. |
Hypertension prevalence, awareness, treatment, and control and sodium intake in Shandong Province, China: baseline results from Shandong-Ministry of Health Action on Salt Reduction and Hypertension (SMASH), 2011
Bi Z , Liang X , Xu A , Wang L , Shi X , Zhao W , Ma J , Guo X , Zhang X , Zhang J , Ren J , Yan L , Lu Z , Wang H , Tang J , Cai X , Dong J , Zhang J , Chu J , Engelgau M , Yang Q , Hong Y , Wang Y . Prev Chronic Dis 2014 11 E88 INTRODUCTION: In China, population-based blood pressure levels and prevalence of hypertension are increasing. Meanwhile, sodium intake, a major risk factor for hypertension, is high. In 2011, to develop intervention priorities for a salt reduction and hypertension control project in Shandong Province (population 96 million), a cross-sectional survey was conducted to collect information on sodium intake and hypertension prevalence, awareness, treatment, and control. METHODS: Complex, multistage sampling methods were used to select a provincial-representative adult sample. Blood pressure was measured and a survey conducted among all participants; condiments were weighed in the household, a 24-hour dietary recall was conducted, and urine was collected. Hypertension was determined by blood pressure measured on a single occasion and self-reported use of antihypertension medications. RESULTS: Overall, 23.4% (95% confidence interval [CI], 20.9%-26.0%) of adults in Shandong were estimated to have hypertension. Among those classified as having hypertension, approximately one-third (34.5%) reported having hypertension, approximately one-fourth (27.5%) reported taking medications, and one-seventh (14.9%) had their blood pressure controlled (<140/<90 mm Hg). Estimated total average daily dietary sodium intake was 5,745 mg (95% CI, 5,428 mg-6,063 mg). Most dietary sodium (80.8%) came from salt and high-salt condiments added during cooking: a sodium intake of 4,640 mg (95% CI, 4,360 mg-4,920 mg). The average daily urinary sodium excretion was 5,398 mg (95% CI, 5,112 mg-5,683 mg). CONCLUSION: Hypertension and excessive sodium intake in adults are major public health problems in Shandong Province, China. |
Decreased basal ganglia activation in subjects with chronic fatigue syndrome: association with symptoms of fatigue
Miller AH , Jones JF , Drake DF , Tian H , Unger ER , Pagnoni G . PLoS One 2014 9 (5) e98156 Reduced basal ganglia function has been associated with fatigue in neurologic disorders, as well as in patients exposed to chronic immune stimulation. Patients with chronic fatigue syndrome (CFS) have been shown to exhibit symptoms suggestive of decreased basal ganglia function including psychomotor slowing, which in turn was correlated with fatigue. In addition, CFS patients have been found to exhibit increased markers of immune activation. In order to directly test the hypothesis of decreased basal ganglia function in CFS, we used functional magnetic resonance imaging to examine neural activation in the basal ganglia to a reward-processing (monetary gambling) task in a community sample of 59 male and female subjects, including 18 patients diagnosed with CFS according to 1994 CDC criteria and 41 non-fatigued healthy controls. For each subject, the average effect of winning vs. losing during the gambling task in regions of interest (ROI) corresponding to the caudate nucleus, putamen, and globus pallidus was extracted for group comparisons and correlational analyses. Compared to non-fatigued controls, patients with CFS exhibited significantly decreased activation in the right caudate (p = 0.01) and right globus pallidus (p = 0.02). Decreased activation in the right globus pallidus was significantly correlated with increased mental fatigue (r2 = 0.49, p = 0.001), general fatigue (r2 = 0.34, p = 0.01) and reduced activity (r2 = 0.29, p = 0.02) as measured by the Multidimensional Fatigue Inventory. No such relationships were found in control subjects. These data suggest that symptoms of fatigue in CFS subjects were associated with reduced responsivity of the basal ganglia, possibly involving the disruption of projections from the globus pallidus to thalamic and cortical networks. |
Population-based analysis of invasive nontypeable pneumococci reveals that most have defective capsule synthesis genes.
Park IH , Geno KA , Sherwood LK , Nahm MH , Beall B . PLoS One 2014 9 (5) e97825 Since nasopharyngeal carriage of pneumococcus precedes invasive pneumococcal disease, characteristics of carriage isolates could be incorrectly assumed to reflect those of invasive isolates. While most pneumococci express a capsular polysaccharide, nontypeable pneumococci are sometimes isolated. Carriage nontypeables tend to encode novel surface proteins in place of a capsular polysaccharide synthetic locus, the cps locus. In contrast, capsular polysaccharide is believed to be indispensable for invasive pneumococcal disease, and nontypeables from population-based invasive pneumococcal disease surveillance have not been extensively characterized. We received 14,328 invasive pneumococcal isolates through the Active Bacterial Core surveillance program during 2006-2009. Isolates that were nontypeable by Quellung serotyping were characterized by PCR serotyping, sequence analyses of the cps locus, and multilocus sequence typing. Eighty-eight isolates were Quellung-nontypeable (0.61%). Of these, 79 (89.8%) contained cps loci. Twenty-two nontypeables exhibited serotype 8 cps loci with defects, primarily within wchA. Six of the remaining nine isolates contained previously-described aliB homologs in place of cps loci. Multilocus sequence typing revealed that most nontypeables that lacked capsular biosynthetic genes were related to established non-encapsulated lineages. Thus, invasive pneumococcal disease caused by nontypeable pneumococcus remains rare in the United States, and while carriage nontypeables lacking cps loci are frequently isolated, such nontypeable are extremely rare in invasive pneumococcal disease. Most invasive nontypeable pneumococci possess defective cps locus genes, with an over-representation of defective serotype 8 cps variants. |
Evolutionary pathway to increased virulence and epidemic group A Streptococcus disease derived from 3,615 genome sequences.
Nasser W , Beres SB , Olsen RJ , Dean MA , Rice KA , Long SW , Kristinsson KG , Gottfredsson M , Vuopio J , Raisanen K , Caugant DA , Steinbakk M , Low DE , McGeer A , Darenberg J , Henriques-Normark B , Van Beneden CA , Hoffmann S , Musser JM . Proc Natl Acad Sci U S A 2014 111 (17) E1768-76 We sequenced the genomes of 3,615 strains of serotype Emm protein 1 (M1) group A Streptococcus to unravel the nature and timing of molecular events contributing to the emergence, dissemination, and genetic diversification of an unusually virulent clone that now causes epidemic human infections worldwide. We discovered that the contemporary epidemic clone emerged in stepwise fashion from a precursor cell that first contained the phage encoding an extracellular DNase virulence factor (streptococcal DNase D2, SdaD2) and subsequently acquired the phage encoding the SpeA1 variant of the streptococcal pyrogenic exotoxin A superantigen. The SpeA2 toxin variant evolved from SpeA1 by a single-nucleotide change in the M1 progenitor strain before acquisition by horizontal gene transfer of a large chromosomal region encoding secreted toxins NAD(+)-glycohydrolase and streptolysin O. Acquisition of this 36-kb region in the early 1980s into just one cell containing the phage-encoded sdaD2 and speA2 genes was the final major molecular event preceding the emergence and rapid intercontinental spread of the contemporary epidemic clone. Thus, we resolve a decades-old controversy about the type and sequence of genomic alterations that produced this explosive epidemic. Analysis of comprehensive, population-based contemporary invasive strains from seven countries identified strong patterns of temporal population structure. Compared with a preepidemic reference strain, the contemporary clone is significantly more virulent in nonhuman primate models of pharyngitis and necrotizing fasciitis. A key finding is that the molecular evolutionary events transpiring in just one bacterial cell ultimately have produced millions of human infections worldwide. |
Divergent picobirnaviruses in human feces.
Ng TF , Vega E , Kondov NO , Markey C , Deng X , Gregoricus N , Vinje J , Delwart E . Genome Announc 2014 2 (3) The near-complete genomes of two picobirnaviruses (PBVs) in diarrheal stool samples, human picobirnaviruses D and E (HuPBV-D and -E), were genetically characterized. Their RNA-dependent RNA polymerase (RdRp) protein sequences had <66% identities to known PBVs. Due to a single nucleotide insertion, the open reading frame 2 (ORF2) in segment 1 of HuPBV-D was interrupted by a stop codon. A small stem-loop structure overlying the stop codon may result in translational readthrough into the rest of ORF2. |
University students and the risk of HIV and other sexually transmitted infections in Uganda: the Crane Survey
Rutherford GW , Anglemyer A , Bagenda D , Muyonga M , Lindan CP , Barker JL , Johnston L , Hladik W . Int J Adolesc Med Health 2014 26 (2) 209-15 Adolescents and young adults are at high risk of human immunodeficiency virus (HIV) infection in sub-Saharan Africa. Previous reports have found that university students in Africa comprise a sexually active population, although the prevalence of HIV or sexually transmitted infections (STI) has not been measured. We conducted a cross-sectional survey of students from five large universities in Kampala, Uganda, using respondent-driven sampling. We asked students to complete behavioral questionnaires and provide biological samples to test for HIV, Chlamydia trachomatis, Neisseria gonorrhoeae, Treponema pallidum, Trichomonas vaginalis, and bacterial vaginosis. We enrolled 649 students and obtained interpretable data from 640. Around 50% of the respondents were male, and the mean age was 22 years. An estimated 0.8% (95% CI 0.0-2.0) of male students had Chlamydia infection, approximately 4.3% (95% CI 2.0-7.0) had syphilis, 0.4% (95% CI 0.0-0.9) had HIV, and none had gonorrhea. An estimated 32.6% (95% CI 22.4-40.8) of women had bacterial vaginosis, 2.5% (95% CI 0.7-6.3) had Chlamydia infection, 1.7% (95% CI 0.5-3.6) had syphilis, 1.0% (95% CI 0.0-2.4) had gonorrhea, 0.9% (95% CI 0.0-4.2) had trichomoniasis, and 0.9% (95% CI 0.0-1.8) had HIV. We found no significant risk factors for HIV or other STI among males. We also found that not using a condom during the latest sexual intercourse was significantly associated with HIV infection, other STI, or bacterial vaginosis (OR 2.16; 95% 1.26-3.78) among females. We conclude that while university students are sexually active and there is substantial risk for syphilis, there is little evidence of substantially increased HIV risk among them. |
Village-randomized clinical trial of home distribution of zinc for treatment of childhood diarrhea in rural western Kenya
Feikin DR , Bigogo G , Audi A , Pals SL , Aol G , Mbakaya C , Williamson J , Breiman RF , Larson CP . PLoS One 2014 9 (5) e94436 BACKGROUND: Zinc treatment shortens diarrhea episodes and can prevent future episodes. In rural Africa, most children with diarrhea are not brought to health facilities. In a village-randomized trial in rural Kenya, we assessed if zinc treatment might have a community-level preventive effect on diarrhea incidence if available at home versus only at health facilities. METHODS: We randomized 16 Kenyan villages (1,903 eligible children) to receive a 10-day course of zinc and two oral rehydration solution (ORS) sachets every two months at home and 17 villages (2,241 eligible children) to receive ORS at home, but zinc at the health-facility only. Children's caretakers were educated in zinc/ORS use by village workers, both unblinded to intervention arm. We evaluated whether incidence of diarrhea and acute lower respiratory illness (ALRI) reported at biweekly home visits and presenting to clinic were lower in zinc villages, using poisson regression adjusting for baseline disease rates, distance to clinic, and children's age. RESULTS: There were no differences between village groups in diarrhea incidence either reported at the home or presenting to clinic. In zinc villages (1,440 children analyzed), 61.2% of diarrheal episodes were treated with zinc, compared to 5.4% in comparison villages (1,584 children analyzed, p<0.0001). There were no differences in ORS use between zinc (59.6%) and comparison villages (58.8%). Among children with fever or cough without diarrhea, zinc use was low (<0.5%). There was a lower incidence of reported ALRI in zinc villages (adjusted RR 0.68, 95% CI 0.46-0.99), but not presenting at clinic. CONCLUSIONS: In this study, home zinc use to treat diarrhea did not decrease disease rates in the community. However, with proper training, availability of zinc at home could lead to more episodes of pediatric diarrhea being treated with zinc in parts of rural Africa where healthcare utilization is low. TRIAL REGISTRATION: ClinicalTrials.gov NCT00530829. |
Would targeting increase efficiency of syphilis partner services programs? - data from New York City, Philadelphia, Texas, and Virginia
Hoots BE , Lewis FM , Anschuetz G , Schillinger JA , Blank S , Foskey T , Stover JA , Peterman TA . Sex Transm Dis 2014 41 (6) 407-12 BACKGROUND: Targeted partner notification (PN), or limiting PN to groups in which efforts are most successful, has been suggested as a potentially cost-effective alternative to providing PN for all syphilis case-patients. The purpose of this study was to identify index case characteristics associated with highest yield partner elicitation and subsequent case finding to determine whether some groups could be reasonably excluded from PN efforts. METHODS: We examined index case characteristics and PN metrics from syphilis case management records of 4 sexually transmitted disease control programs-New York City, Philadelphia, Texas, and Virginia. Partner elicitation was considered successful when a case-patient named 1 or more partners during interview. Case finding was considered successful when a case-patient had 1 or more partners who were tested and had serologic evidence of syphilis exposure. Associations between case characteristics and proportion of pursued case-patients with successful partner elicitation and case finding were evaluated using chi tests. RESULTS: Successful partner elicitation and new case finding was most likely for index case-patients who were younger and diagnosed at public sexually transmitted disease clinics. However, most characteristics of index case-patients were related to success at only a few sites, or varied in the direction of the relationship by site. Other than late latent case-patients, few demographic groups had a yield far below average. CONCLUSIONS: If implemented, targeted PN will require site-specific data. Sites may consider eliminating PN for late latent case-patients. The lack of demographic groups with a below average yield suggests that sites should not exclude other groups from PN. |
Longitudinal analysis of antibody responses to trachoma antigens before and after mass drug administration
Goodhew EB , Morgan SM , Switzer AJ , Munoz B , Dize L , Gaydos C , Mkocha H , West SK , Wiegand RE , Lammie PJ , Martin DL . BMC Infect Dis 2014 14 (1) 216 BACKGROUND: Blinding trachoma, caused by the bacteria Chlamydia trachomatis, is a neglected tropical disease targeted for elimination by 2020. A major component of the elimination strategy is mass drug administration (MDA) with azithromycin. Currently, program decisions are made based on clinical signs of ocular infection, but we have been investigating the use of antibody responses for post-MDA surveillance. In a previous study, IgG responses were detected in children lacking clinical evidence of trachoma, suggesting that IgG responses represented historical infection. To explore the utility of serology for program evaluation, we compared IgG and IgA responses to trachoma antigens and examined changes in IgG and IgA post-drug treatment. METHODS: Dried blood spots and ocular swabs were collected with parental consent from 264 1-6 year olds in a single village of Kongwa District, central Tanzania. Each child also received an ocular exam for detection of clinical signs of trachoma. MDA was given, and six months later an additional blood spot was taken from these same children. Ocular swabs were analyzed for C. trachomatis DNA and antibody responses for IgA and total IgG were measured in dried bloods spots. RESULTS: Baseline antibody responses showed an increase in antibody levels with age. By age 6, the percentage positive for IgG (96.0%) was much higher than for IgA (74.2%). Antibody responses to trachoma antigens declined significantly six months after drug treatment for most age groups. The percentage decrease in IgA response was much greater than for IgG. However, no instances of seroreversion were observed. CONCLUSIONS: Data presented here suggest that focusing on concordant antibody responses in children will provide the best serological surveillance strategy for evaluation of trachoma control programs. |
Mortality among tuberculosis patients with acquired resistance to second-line anti-tuberculosis drugs - United States, 1993-2008
Ershova JV , Kurbatova EV , Moonan PK , Cegielski JP . Clin Infect Dis 2014 59 (4) 465-72 BACKGROUND: Resistance to second-line anti-tuberculosis drugs (SLD) severely compromises treatment options of drug-resistant tuberculosis (TB). We assessed the association between acquisition of resistance (AR) to second-line injectable drugs (SLI) or fluoroquinolones (FQ) and mortality among TB cases confirmed by positive culture results with available initial and final drug susceptibility test (DST) results. METHODS: We analyzed data from U.S. National TB Surveillance System, 1993-2008. Acquired resistance was defined as drug susceptibility at initial DST but resistance to the same drug at final DST. We compared survival with Kaplan-Meier curves and analyzed the association between AR and mortality using a univariate extended Cox proportional hazards model adjusted for age. RESULTS: Of 2,329 cases with both initial and final DST to SLI, 49 (2.1%) acquired resistance; 13/49 (26.5%) had treatment terminated by death versus 222 (10.0%) of those without AR to SLI (P<0.001). Of 1,187 cases with both initial and final DST to FQ, 32 (2.8%) acquired resistance; 12/32 (37.5%) had treatment terminated by death versus 121 (10.9%) of those without AR to FQ (P=0.001). Controlling for age, mortality was significantly greater among cases with AR to SLD than among cases without AR (adjusted hazard ratio (aHR)[SLI], 2.8; 95% confidence interval (CI),1.4-5.4; aHR[FQ], 1.9; 95% CI,1.0-3.5). MDR TB at treatment initiation, positive HIV status, and extrapulmonary disease were also significantly associated with mortality. CONCLUSION: Mortality was significantly greater among TB cases with AR to SLD. Providers should consider AR to SLD early in treatment, monitor DST results, and avoid premature deaths. |
A novel approach to mixing qualitative and quantitative methods in HIV and STI prevention research
Penman-Aguilar A , Macaluso M , Peacock N , Snead MC , Posner SF . AIDS Educ Prev 2014 26 (2) 95-108 Mixed-method designs are increasingly used in sexually transmitted infection (STI) and HIV prevention research. The authors designed a mixed-method approach and applied it to estimate and evaluate a predictor of continued female condom use (6+ uses, among those who used it at least once) in a 6-month prospective cohort study. The analysis included 402 women who received an intervention promoting use of female and male condoms for STI prevention and completed monthly quantitative surveys; 33 also completed a semistructured qualitative interview. The authors identified a qualitative theme (couples' female condom enjoyment [CFCE]), applied discriminant analysis techniques to estimate CFCE for all participants, and added CFCE to a multivariable logistic regression model of continued female condom use. CFCE related to comfort, naturalness, pleasure, feeling protected, playfulness, ease of use, intimacy, and feeling in control of protection. CFCE was associated with continued female condom use (adjusted odds ratio: 2.8, 95% confidence interval: 1.4-5.6) and significantly improved model fit (p < .001). CFCE predicted continued female condom use. Mixed-method approaches for "scaling up" qualitative findings from small samples to larger numbers of participants can benefit HIV and STI prevention research. |
Ocular molluscum contagiosum atypical clinical presentation
Osadebe LU , Li Y , Damon IK , Reynolds MG , Muyombwe A , Gappy C . Pediatr Infect Dis J 2014 33 (6) 668 Molluscum contagiosum (MC), a common childhood condition, is a cutaneous viral infection caused by poxvirus that replicates in the cytoplasm of epidermal cells.1 It typically produces benign, self-limiting eruptions on skin and mucous membranes. MC lesions are commonly seen on the face, trunks, limbs and genital areas (in sexually active young adults; for more information on molluscum contagiosum, visit the Centers for Disease Control and Prevention website at http://www.cdc.gov/ncidod/dvrd/molluscum/). MC is 1 of the easily overlooked causes of chronic unilateral conjunctivitis refractory to routine treatment,2 and eyelid lesions may assume atypical appearances or may be initially inconspicuous, thereby delaying diagnosis and subsequent treatment. We hereby present 1 such case in a child with several months of chronic conjunctivitis. | On October 25, 2012, a 13-year-old female with a 4-month history of chronic conjunctivitis was referred to an ophthalmologist. Her symptoms began in July with a red, itchy left eye. At that time, she was evaluated by her pediatrician and received a presumptive diagnosis of viral conjunctivitis. When her symptoms failed to resolve, she was referred to an ophthalmologist who felt the condition was consistent with bacterial conjunctivitis and prescribed an antibiotic ointment. When symptoms again did not improve, a second opinion was sought resulting in a presumptive diagnosis of allergic conjunctivitis. At this visit, patanol eye drops were prescribed. Again, symptoms persisted and in September, the patient additionally developed a left upper lid lesion, precipitating a visit to a third ophthalmologist, who diagnosed her with a chalazion and suggested warm compresses. The symptoms failed to resolve and on October 25, 2012, the patient presented to a 4th ophthalmologist. Here, a slit lamp examination revealed follicular conjunctivitis with punctate epithelial erosions on her cornea. Her left upper lid also showed a small umbilcated lesion on the central lid margin. She was diagnosed with a chronic follicular conjunctivitis of the left eye caused by molluscum contagiosum. Excision of the lesion was recommended, and the procedure was performed on November 14, 2012. The patient followed up 10 days after the procedure with complete resolution of symptoms. Two months after the procedure, the patient continued to be symptom free. The excised lesion was sent to Centers for Disease Control and Prevention’s Poxvirus branch. Extracted DNA was found to be positive for MC DNA using a real-time quantitative PCR (qPCR) targeting the MC virus DNA polymerase gene locus (see Supplemental Digital Content 1, http://links.lww.com/INF/B798, which describes assay). |
Outbreak of hepatitis E in urban Bangladesh resulting in maternal and perinatal mortality
Gurley ES , Hossain MJ , Paul RC , Sazzad HM , Islam MS , Parveen S , Faruque LI , Husain M , Ara K , Jahan Y , Rahman M , Luby SP . Clin Infect Dis 2014 59 (5) 658-65 BACKGROUND: Hepatitis E virus (HEV) causes outbreaks of jaundice associated with maternal mortality. Four deaths among pregnant women with jaundice occurred in an urban community near Dhaka in late 2008 and were reported to authorities in January 2009. We investigated the etiology and risk factors for jaundice and death. METHODS: Field workers identified suspect cases, defined as acute onset of yellow eyes or skin, through house-to-house visits. A sub-set of suspect cases was tested for IgM antibodies to HEV to confirm infection. We used logistic regression to identify risk factors for HEV disease and for death. We estimated the increased risk of perinatal mortality associated with jaundice during pregnancy. RESULTS: We identified 4,751 suspect HEV cases during August 2008 - January 2009, including 17 deaths. IgM antibodies to HEV were identified in 56 (77%) of 73 case-patients tested who were neighbors of the case-patients who died. HEV disease was significantly associated with drinking municipal supplied water. Death among persons with HEV disease was significantly associated with being female and taking paracetamol. Among women who were pregnant, miscarriage and perinatal mortality was 2.7 times higher (95% confidence interval 1.2-6.1) in pregnancies complicated by jaundice. CONCLUSIONS: This outbreak of HEV was likely caused by sewerage contamination of the municipal water system. Longer-term efforts to improve access to safe water and license HEV vaccines are needed. However, securing resources and support for intervention will rely upon convincing data about the endemic burden of HEV disease, particularly its role in maternal and perinatal mortality. |
Personal and contextual factors related to delayed HIV diagnosis among men who have sex with men
Nelson KM , Thiede H , Jenkins RA , Carey JW , Hutcheson R , Golden MR . AIDS Educ Prev 2014 26 (2) 122-33 Delayed HIV diagnosis among men who have sex with men (MSM) in the United States continues to be a significant personal and public health issue. Using qualitative and quantitative data from 75 recently tested, HIV-sero-positive MSM (38 delayed and 37 nondelayed testers), the authors sought to further elucidate potential personal and contextual factors that may contribute to delayed HIV diagnosis among MSM. Findings indicate that MSM who experience multiple life stressors, whether personal or contextual, have an increased likelihood of delaying HIV diagnosis. Furthermore, MSM who experience multiple life stressors without the scaffolding of social support, stable mental health, and self-efficacy to engage in protective health behaviors may be particularly vulnerable to delaying diagnosis. Interventions targeting these factors as well as structural interventions targeting physiological and safety concerns are needed to help MSM handle their life stressors more effectively and seek HIV testing in a timelier manner. |
Pharmacokinetic and safety analyses of tenofovir and tenofovir-emtricitabine vaginal tablets in pigtailed macaques
Pereira LE , Clark MR , Friend DR , Garber DA , McNicholl JM , Hendry RM , Doncel GF , Smith JM . Antimicrob Agents Chemother 2014 58 (5) 2665-74 Vaginal rapidly disintegrating tablets (RDTs) containing tenofovir (TFV) or TFV and emtricitabine (FTC) were evaluated for safety and pharmacokinetics in pigtailed macaques. Two separate animal groups (n = 4) received TFV (10 mg) or TFV-FTC (10 mg each) RDTs, administered near the cervix. A third group (n = 4) received 1 ml TFV gel. Blood plasma, vaginal tissue biopsy specimens, and vaginal fluids were collected before and after product application at 0, 0.5, 1, 4, and 24 h. A disintegration time of <30 min following vaginal application of the RDTs was noted, with negligible effects on local inflammatory cytokines, vaginal pH, and microflora. TFV pharmacokinetics were generally similar for both RDTs and gel, with peak median concentrations in vaginal tissues and vaginal secretions being on the order of 10(4) to 10(5) ng/g (147 to 571 muM) and 10(6) ng/g (12 to 34 mM), respectively, at 1 to 4 h postdose. At 24 h, however, TFV vaginal tissue levels were more sustained after RDT dosing, with median TFV concentrations being approximately 1 log higher than those with gel dosing. FTC pharmacokinetics after combination RDT dosing were similar to those of TFV, with peak median vaginal tissue and fluid levels being on the order of 10(4) ng/g (374 muM) and 10(6) ng/g (32 mM), respectively, at 1 h postdose with levels in fluid remaining high at 24 h. RDTs are a promising alternative vaginal dosage form, delivering TFV and/or FTC at levels that would be considered inhibitory to simian-human immunodeficiency virus in the macaque vaginal microenvironment over a 24-h period. |
Prevalence of hepatitis C virus infection in US Hispanic/Latino adults: results from the NHANES 2007-2010 and HCHS/SOL studies
Kuniholm MH , Jung M , Everhart JE , Cotler S , Heiss G , McQuillan G , Kim RS , Strickler HD , Thyagarajan B , Youngblood M , Kaplan RC , Ho GY . J Infect Dis 2014 209 (10) 1585-90 Prevalence of hepatitis C virus (HCV) antibody has been reported in Mexican Americans, but its prevalence in other US Hispanic/Latino groups is unknown. We studied 2 populations of US Hispanic/Latino adults; 3210 from the National Health and Nutrition Examination Survey (NHANES) 2007-2010 and 11 964 from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL). Age-standardized prevalence of HCV antibody was similar in NHANES 2007-2010 (1.5%) and HCHS/SOL (2.0%) but differed significantly by Hispanic/Latino background in HCHS/SOL (eg, 11.6% in Puerto Rican men vs 0.4% in South American men). These findings suggest that the HCV epidemic among US Hispanics/Latinos is heterogeneous. |
Protein binding of rifapentine and the 25-desacetyl metabolite in patients with pulmonary tuberculosis
Egelund EF , Weiner M , Singh RP , Prihoda TJ , Gelfond JA , Derendorf H , Mac Kenzie WR , Peloquin CA . Antimicrob Agents Chemother 2014 58 (8) 4904-10 Rifapentine is highly protein bound in blood, but the free, unbound drug is the microbiologically active fraction. In this exploratory study, we characterized the free plasma fraction of rifapentine in 41 patients with tuberculosis. We found lower total rifapentine concentration but significantly higher free rifapentine in African patients of Black race compared to non-Africans. These data support larger pharmacokinetic/pharmacodynamic studies to confirm these findings and assess free rifapentine in relation to microbiological and clinical outcomes. |
Enhanced personal contact with HIV patients improves retention in primary care: a randomized trial in six U.S. HIV clinics
Gardner LI , Giordano TP , Marks G , Wilson TE , Craw JA , Drainoni ML , Keruly JC , Rodriguez AE , Malitz F , Moore RD , Bradley-Springer LA , Holman S , Rose CE , Girde S , Sullivan M , Metsch LR , Saag M , Mugavero MJ . Clin Infect Dis 2014 59 (5) 725-34 BACKGROUND: To determine whether enhanced personal contact with HIV-infected patients across time improves retention in care compared with existing standard of care (SOC) practices, and whether brief skills training improves retention beyond enhanced contact. METHODS: The study, conducted at 6 US HIV clinics, included 1,838 patients with a recent history of inconsistent clinic attendance, and new patients. Each clinic randomized participants to one of three arms and continued to provide SOC practices to all enrollees: Enhanced contact with interventionist (EC; brief face-to-face meeting upon returning for care visit, interim visit call, appointment reminder calls, missed visit call); EC+skills (organization, problem solving, and communication skills); or SOC-only. The intervention was delivered by project staff for 12 months following randomization. The outcomes during that 12-month period were (1) percentage of participants attending at least one primary care visit in three consecutive 4-month intervals (visit constancy), and (2) proportion of kept/scheduled primary care visits (visit adherence). RESULTS: Log-binomial risk ratios comparing intervention arms against the SOC arm demonstrated better outcomes in both the EC and EC+skills arms (visit constancy: RRs=1.22 (1.09-1.36) and 1.22 (1.09-1.36); visit adherence: RR=1.08 (1.05-1.11) and 1.06 (1.02-1.09), all ps<0.01). Intervention effects were observed in numerous patient subgroups, although lower in patients reporting unmet needs or illicit drug use. CONCLUSION: Enhanced contact with patients improved retention in HIV primary care compared to existing SOC practices. A brief patient skill-building component did not improve retention further. Additional intervention elements may be needed for patients reporting illicit drug use or who have unmet needs. |
Estimated paediatric mortality associated with influenza virus infections, United States, 2003-2010
Wong KK , Cheng P , Foppa I , Jain S , Fry AM , Finelli L . Epidemiol Infect 2014 143 (3) 1-8 Death certificate reports and laboratory-confirmed influenza deaths probably underestimate paediatric deaths attributable to influenza. Using US mortality data for persons aged <18 years who died during 28 September 2003 to 2 October 2010, we estimated influenza-attributable deaths using a generalized linear regression model based on seasonal covariates, influenza-certified deaths (deaths for which influenza was a reported cause of death), and occurrence during the 2009 pandemic period. Of 32 783 paediatric deaths in the death categories examined, 853 (3%) were influenza-certified. The estimated number of influenza-attributable deaths over the study period was 1.8 [95% confidence interval (CI) 1.3-2.8] times higher than the number of influenza-certified deaths. Influenza-attributable deaths were 2.1 (95% CI 1.5-3.4) times higher than influenza-certified deaths during the non-pandemic period and 1.1 (95% CI 1.0-1.8) times higher during the pandemic. Overall, US paediatric deaths attributable to influenza were almost twice the number reported by death certificate codes in the seasons prior to the 2009 pandemic. |
Estimating the number of persons who inject drugs in the United States by meta-analysis to calculate national rates of HIV and hepatitis C virus infections
Lansky A , Finlayson T , Johnson C , Holtzman D , Wejnert C , Mitsch A , Gust D , Chen R , Mizuno Y , Crepaz N . PLoS One 2014 9 (5) e97596 BACKGROUND: Injection drug use provides an efficient mechanism for transmitting bloodborne viruses, including human immunodeficiency virus (HIV) and hepatitis C virus (HCV). Effective targeting of resources for prevention of HIV and HCV infection among persons who inject drugs (PWID) is based on knowledge of the population size and disparity in disease burden among PWID. This study estimated the number of PWID in the United States to calculate rates of HIV and HCV infection. METHODS: We conducted meta-analysis using data from 4 national probability surveys that measured lifetime (3 surveys) or past-year (3 surveys) injection drug use to estimate the proportion of the United States population that has injected drugs. We then applied these proportions to census data to produce population size estimates. To estimate the disease burden among PWID by calculating rates of disease we used lifetime population size estimates of PWID as denominators and estimates of HIV and HCV infection from national HIV surveillance and survey data, respectively, as numerators. We calculated rates of HIV among PWID by gender-, age-, and race/ethnicity. RESULTS: Lifetime PWID comprised 2.6% (95% confidence interval: 1.8%-3.3%) of the U.S. population aged 13 years or older, representing approximately 6,612,488 PWID (range: 4,583,188-8,641,788) in 2011. The population estimate of past-year PWID was 0.30% (95% confidence interval: 0.19 %-0.41%) or 774,434 PWID (range: 494,605-1,054,263). Among lifetime PWID, the 2011 HIV diagnosis rate was 55 per 100,000 PWID; the rate of persons living with a diagnosis of HIV infection in 2010 was 2,147 per 100,000 PWID; and the 2011 HCV infection rate was 43,126 per 100,000 PWID. CONCLUSION: Estimates of the number of PWID and disease rates among PWID are important for program planning and addressing health inequities. |
General influenza infection control policies and practices during the 2009 H1N1 influenza pandemic: a survey of women's health, obstetric, and neonatal nurses
Ruch-Ross HS , Zapata LB , Williams JL , Ruhl C . Am J Infect Control 2014 42 (6) e65-70 BACKGROUND: An evaluation of infection control practices was conducted following the release of the Centers for Disease Control and Prevention (CDC) guidance regarding the care of pregnant women during the 2009 H1N1 influenza pandemic. This paper describes 9 general hospital practices. METHODS: A questionnaire was distributed electronically to 12,612 members of the Association of Women's Health, Obstetric, and Neonatal Nurses (AWHONN). Respondents (N = 2,304) who reported working in obstetric or neonatal settings during the pandemic completed the questionnaire. RESULTS: Most (73%) respondents considered the Centers for Disease Control and Prevention's guidance very useful. Significantly more reported a written hospital policy for each practice during versus before the pandemic. Six of the 9 practices were implemented most of the time by at least 70% of respondents; the practices least often implemented were mandatory vaccination of health care personnel involved (52%) and not involved (34%) in direct patient care and offering vaccination to close contacts of newborns prior to discharge (22%). The most consistent factor associated with implementation was the presence of a written policy supporting the practice at the respondent's hospital. CONCLUSION: We offer a descriptive account of general hospital infection control policies and practices during the 2009 H1N1 pandemic. Factors associated with reported implementation may be useful to inform planning to protect women and children for future public health emergencies. |
Geographic distribution of HIV stigma among women of childbearing age in rural Kenya
Akullian A , Kohler P , Kinuthia J , Laserson K , Mills LA , Okanda J , Olilo G , Ombok M , Odhiambo F , Rao D , Wakefield J , John-Stewart G . AIDS 2014 28 (11) 1665-72 OBJECTIVE(S): HIV stigma is considered to be a major driver of the HIV/AIDS pandemic, yet there is a limited understanding of its occurrence. We describe the geographic patterns of two forms of HIV stigma in a cross-sectional sample of women of childbearing age from western Kenya: internalized stigma (associated with shame) and externalized stigma (associated with blame). DESIGN: Geographic studies of HIV stigma provide a first step in generating hypotheses regarding potential community-level causes of stigma and may lead to more effective community-level interventions. METHODS: Spatial regression using generalized additive models and point pattern analyses using K-functions were used to assess the spatial scale(s) at which each form of HIV stigma clusters, and to assess whether the spatial clustering of each stigma indicator was present after adjustment for individual-level characteristics. RESULTS: There was evidence that externalized stigma (blame) was geographically heterogeneous across the study area, even after controlling for individual-level factors (P = 0.01). In contrast, there was less evidence (P = 0.70) of spatial trend or clustering of internalized stigma (shame). CONCLUSION: Our results may point to differences in the underlying social processes motivating each form of HIV stigma. Externalized stigma may be driven more by cultural beliefs disseminated within communities, whereas internalized stigma may be the result of individual-level characteristics outside the domain of community influence. These data may inform community-level interventions to decrease HIV-related stigma, and thus impact the HIV epidemic. |
Global polio perspective
Oberste MS , Lipton HL . Neurology 2014 82 (20) 1831-2 The results of the Global Polio Eradication Initiative that began in 1988 when there was transmission of 350,000 polio cases in 125 countries and has culminated in endemic transmission of only 223 polio cases in 3 countries in 2012 are reviewed. |
Hospital-associated outbreak of Middle East respiratory syndrome coronavirus: a serologic, epidemiologic, and clinical description
Al-Abdallat MM , Payne DC , Alqasrawi S , Rha B , Tohme RA , Abedi GR , Al Nsour M , Iblan I , Jarour N , Farag NH , Haddadin A , Al-Sanouri T , Tamin A , Harcourt JL , Kuhar DT , Swerdlow DL , Erdman DD , Pallansch MA , Haynes LM , Gerber SI . Clin Infect Dis 2014 59 (9) 1225-33 BACKGROUND: In April 2012, the Jordan Ministry of Health (JMoH) investigated an outbreak of lower respiratory illnesses at a hospital in Jordan; two fatal cases were retrospectively confirmed by rRT-PCR to be the first detected cases of Middle East Respiratory Syndrome (MERS-CoV). METHODS: Epidemiologic and clinical characteristics of selected potential cases were assessed through serum blood specimens, medical chart reviews and interviews with surviving outbreak members, household contacts, and healthcare personnel. Cases of MERS-CoV infection were identified using three U.S. Centers for Disease Control and Prevention (CDC) serologic tests for detection of anti-MERS-CoV antibodies. RESULTS: Specimens and interviews were obtained from 124 subjects. Seven previously unconfirmed individuals tested positive for anti-MERS-CoV antibodies by at least two of three serologic tests, in addition to two fatal cases identified by rRT-PCR. The case fatality rate among the nine total cases was 22%. Six cases were healthcare workers at the outbreak hospital, yielding an attack rate of 10% among potentially exposed outbreak hospital personnel. There was no evidence of MERS-CoV transmission at two transfer hospitals having acceptable infection control practices. CONCLUSION: Novel serological tests allowed for the detection of otherwise unrecognized cases of MERS-CoV infection among contacts of a Jordan hospital-associated respiratory illness outbreak in April 2012, resulting in a total of nine test-positive cases. Serologic results suggest that further spread of this outbreak to transfer hospitals did not occur. Most cases had no major, underlying medical conditions; none were on hemodialysis. Our observed case fatality was lower than has been reported from outbreaks elsewhere. |
An intervention to support HIV pre-exposure prophylaxis (PrEP) adherence in HIV serodiscordant couples in Uganda
Psaros C , Haberer JE , Katabira E , Ronald A , Tumwesigye E , Campbell JD , Wangisi J , Mugwanya K , Kintu A , Enyakoit M , Thomas KK , Donnell D , Krows M , Kidoguchi L , Ware N , Baeten JM , Celum C , Bangsberg DR , Safren SA . J Acquir Immune Defic Syndr 2014 66 (5) 522-9 BACKGROUND: Daily pre-exposure prophylaxis (PrEP) is an effective HIV prevention strategy, but adherence is required for maximum benefit. To date, there are no empirically supported PrEP adherence interventions. This manuscript describes the process of developing a PrEP adherence intervention and presents results on its impact on adherence. METHODS: The Partners PrEP Study was a placebo-controlled efficacy trial of daily oral tenofovir and emtricitabine/tenofovir PrEP among uninfected members of HIV serodiscordant couples. An ancillary adherence study was conducted at three study sites in Uganda. Participants with <80% adherence as measured by unannounced pill count received an additional adherence counseling intervention based on Lifesteps, an evidence-based HIV treatment adherence intervention, based on principles of cognitive-behavioral theory. FINDINGS: Of the 1,147 HIV seronegative participants were enrolled in the ancillary adherence study, 168 (14.6%) triggered the adherence intervention. Of participants triggering the intervention, 62% were male; median age was 32.5 years. The median number of adherence counseling sessions was 10. Mean adherence during the month before the intervention was 75.7%, and increased significantly to 84.1% in the month after the first intervention session (p<0.001). The most frequently endorsed adherence barriers at session one were travel and forgetting. INTERPRETATION: A PrEP adherence intervention was feasible in a clinical trial of PrEP in Uganda and PrEP adherence increased after the intervention. Future research should identify PrEP users with low adherence for enhanced adherence counseling and determine optimal implementation strategies for interventions to maximize PrEP effectiveness. |
Knowledge of norovirus prevention and control among infection preventionists
Kosa KM , Cates SC , Hall AJ , Brophy JE , Frasier A . Am J Infect Control 2014 42 (6) 676-8 A Web-based survey was administered to infection preventionists (IPs) (N = 941) to characterize awareness and knowledge of norovirus (NoV). Only 44% of respondents correctly identified NoV as one of the 3 most common foodborne pathogens in the United States, and 5% correctly identified the 3 most common settings for NoV outbreaks. Several gaps in IPs' knowledge of NoV were identified; specifically, IPs could benefit from learning more about the natural history of NoV, modes of transmission, and cleaning and disinfection processes. |
Connecting race and place: a county-level analysis of white, black, and Hispanic HIV prevalence, poverty, and level of urbanization
Vaughan AS , Rosenberg E , Shouse RL , Sullivan PS . Am J Public Health 2014 104 (7) e77-84 OBJECTIVES: We evaluated the role of poverty in racial/ethnic disparities in HIV prevalence across levels of urbanization. METHODS: Using national HIV surveillance data from the year 2009, we constructed negative binomial models, stratified by urbanization, with an outcome of race-specific, county-level HIV prevalence rates and covariates of race/ethnicity, poverty, and other publicly available data. We estimated model-based Black-White and Hispanic-White prevalence rate ratios (PRRs) across levels of urbanization and poverty. RESULTS: We observed racial/ethnic disparities for all strata of urbanization across 1111 included counties. Poverty was associated with HIV prevalence only in major metropolitan counties. At the same level of urbanization, Black-White and Hispanic-White PRRs were not statistically different from 1.0 at high poverty rates (Black-White PRR = 1.0, 95% confidence interval [CI] = 0.4, 2.9; Hispanic-White PRR = 0.4, 95% CI = 0.1, 1.6). In nonurban counties, racial/ethnic disparities remained after we controlled for poverty. CONCLUSIONS: The association between HIV prevalence and poverty varies by level of urbanization. HIV prevention interventions should be tailored to this understanding. Reducing racial/ethnic disparities will require multifactorial interventions linking social factors with sexual networks and individual risks. |
Formal and informal support of family caregivers managing medications for patients who receive end-of-life care at home: a cross-sectional survey of caregivers
Joyce BT , Berman R , Lau DT . Palliat Med 2014 28 (9) 1146-55 BACKGROUND: Managing medications is a complex responsibility of family caregivers caring for end-of-life patients. This study characterizes caregivers with and without formal/informal support managing medications for patients who receive end-of-life care at home. AIM: To explore factors related to caregivers' support with managing medications for end-of-life home hospice patients. DESIGN: A convenience-sampled, cross-sectional telephone survey. SETTING/PARTICIPANTS: Computer-assisted telephone interviews were administered to 120 caregivers managing medications, who were referred by five Chicago-based home hospice services. We measured caregivers' additional formal (paid) and informal (unpaid) support with managing medications, and caregiver/patient socio-demographic, relational, and health characteristics. RESULTS: While 47 (39%) had no additional support with managing medications, 27 (22.5%) had formal support, 37 (31%) informal, and 9 (7.5%) both. Seven caregivers (19%) with formal and 13 (31%) with informal support reported disagreements concerning treatment plans. Caregivers lacking formal support tended to be racial/ethnic minorities, live with the patient in their home, or report greater emotional burden. Caregivers with formal support tended to report higher education/income, lower mutuality, or care for a patient with over 6 months' hospice enrollment. Caregivers lacking informal support tended to be spousal caregivers, live with the patient, or have experience caring for another dying person. CONCLUSION: Our study suggests that high proportions of caregivers may not have support managing medications for patients receiving hospice care at home. More research should examine whether the observed variations in obtaining support indicate disparities or unmet needs among caregivers. Disagreement about treatment with formal/informal support also warrants further investigation. |
Kenya's emergency-hire nursing programme: a pilot evaluation of health service delivery in two districts
Vindigni SM , Riley PL , Kimani F , Willy R , Warutere P , Sabatier JF , Kiriinya R , Friedman M , Osumba M , Waudo AN , Rakuom C , Rogers M . Hum Resour Health 2014 12 16 OBJECTIVE: To assess the feasibility of utilizing a small-scale, low-cost, pilot evaluation in assessing the short-term impact of Kenya's emergency-hire nursing programme (EHP) on the delivery of health services (outpatient visits and maternal-child health indicators) in two underserved health districts with high HIV/AIDS prevalence. METHODS: Six primary outcomes were assessed through the collection of data from facility-level health management forms-total general outpatient visits, vaginal deliveries, caesarean sections, antenatal care (ANC) attendance, ANC clients tested for HIV, and deliveries to HIV-positive women. Data on outcome measures were assessed both pre-and post-emergency-hire nurse placement. Informal discussions were also conducted to obtain supporting qualitative data. FINDINGS: The majority of EHP nurses were placed in Suba (15.5%) and Siaya (13%) districts. At the time of the intervention, we describe an increase in total general outpatient visits, vaginal deliveries and caesarean sections within both districts. Similar significant increases were seen with ANC attendance and deliveries to HIV-positive women. Despite increases in the quantity of health services immediately following nurse placement, these levels were often not sustained. We identify several factors that challenge the long-term sustainability of these staffing enhancements. CONCLUSIONS: There are multiple factors beyond increasing the supply of nurses that affect the delivery of health services. We believe this pilot evaluation sets the foundation for future, larger and more comprehensive studies further elaborating on the interface between interventions to alleviate nursing shortages and promote enhanced health service delivery. We also stress the importance of strong national and local relationships in conducting future studies. |
Cost-benefit study of school nursing services
Wang LY , Vernon-Smiley M , Gapinski MA , Desisto M , Maughan E , Sheetz A . JAMA Pediatr 2014 168 (7) 642-8 IMPORTANCE: In recent years, across the United States, many school districts have cut on-site delivery of health services by eliminating or reducing services provided by qualified school nurses. Providing cost-benefit information will help policy makers and decision makers better understand the value of school nursing services. OBJECTIVE: To conduct a case study of the Massachusetts Essential School Health Services (ESHS) program to demonstrate the cost-benefit of school health services delivered by full-time registered nurses. DESIGN, SETTING, AND PARTICIPANTS: Standard cost-benefit analysis methods were used to estimate the costs and benefits of the ESHS program compared with a scenario involving no school nursing service. Data from the ESHS program report and other published studies were used. A total of 477 163 students in 933 Massachusetts ESHS schools in 78 school districts received school health services during the 2009-2010 school year. INTERVENTIONS: School health services provided by full-time registered nurses. MAIN OUTCOMES AND MEASURES: Costs of nurse staffing and medical supplies incurred by 78 ESHS districts during the 2009-2010 school year were measured as program costs. Program benefits were measured as savings in medical procedure costs, teachers' productivity loss costs associated with addressing student health issues, and parents' productivity loss costs associated with student early dismissal and medication administration. Net benefits and benefit-cost ratio were calculated. All costs and benefits were in 2009 US dollars. RESULTS: During the 2009-2010 school year, at a cost of $79.0 million, the ESHS program prevented an estimated $20.0 million in medical care costs, $28.1 million in parents' productivity loss, and $129.1 million in teachers' productivity loss. As a result, the program generated a net benefit of $98.2 million to society. For every dollar invested in the program, society would gain $2.20. Eighty-nine percent of simulation trials resulted in a net benefit. CONCLUSIONS AND RELEVANCE: The results of this study demonstrated that school nursing services provided in the Massachusetts ESHS schools were a cost-beneficial investment of public money, warranting careful consideration by policy makers and decision makers when resource allocation decisions are made about school nursing positions. |
Notes from the field: Coccidioides immitis identified in soil outside of its known range - Washington, 2013
Marsden-Haug N , Hill H , Litvintseva AP , Engelthaler DM , Driebe EM , Roe CC , Ralston C , Hurst S , Goldoft M , Gade L , Wohrle R , Thompson GR , Brandt ME , Chiller T . MMWR Morb Mortal Wkly Rep 2014 63 (20) 450 Coccidioidomycosis ("valley fever") is caused by inhaling spores of the soil-dwelling fungi Coccidioides immitis or Coccidioides posadasii. Most infections are subclinical. When clinical manifestations do occur (typically 1-4 weeks after exposure), they are similar to those associated with influenza or community-acquired pneumonia. Disseminated disease is rare. Residual pulmonary nodules can lead to chronic lung disease. Fluconazole or other triazoles often are used for treatment, but mild cases often resolve without specific therapy. A total of 17,802 cases were reported in the United States in 2012. |
Renal function of participants in the Bangkok Tenofovir Study, Thailand, 2005-2012
Martin M , Vanichseni S , Suntharasamai P , Sangkum U , Mock PA , Gvetadze RJ , Curlin ME , Leethochawalit M , Chiamwongpaet S , Cherdtrakulkiat T , Anekvorapong R , Leelawiwat W , Chantharojwong N , McNicholl JM , Paxton LA , Kittimunkong S , Choopanya K . Clin Infect Dis 2014 59 (5) 716-24 BACKGROUND: Tenofovir disoproxil fumarate (tenofovir) has been associated with renal dysfunction in people infected with HIV receiving combination antiretroviral treatment. We reviewed data from an HIV pre-exposure prophylaxis trial to determine if tenofovir use was associated with changes in renal function in an HIV-uninfected population. METHODS: During the trial, 2413 HIV-uninfected people who inject drugs were randomized to receive tenofovir or placebo. We assessed the renal function of trial participants with the Cockcroft-Gault, Modification of Diet in Renal Disease (MDRD), and Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations using t-tests for cross-sectional analysis and linear regression for longitudinal analysis. RESULTS: Creatinine clearance and glomerular filtration rate (GFR) results were lower at 24, 36, 48, and 60 months in the tenofovir group compared with the placebo group. Results declined more in the tenofovir group than in the placebo group during follow-up using the Cockcroft-Gault (p<0.001) and CKD-EPI (p=0.007) equations, but not MDRD (p=0.12). Creatinine clearance measured when study drug was stopped was lower in the tenofovir than placebo group (p<0.001); but the difference resolved when tested a median of 20 months later (p=0.12). CONCLUSION: We found small, but significant decreases in cross-sectional measures of creatinine clearance and GFR in the tenofovir group compared with the placebo group and modest differences in downward trends in longitudinal analysis using the Cockcroft-Gault and CKD-EPI equations. These results suggest that with baseline assessments of renal function and routine monitoring of creatinine clearance during follow-up, tenofovir can be used safely for HIV pre-exposure prophylaxis. |
Emergency water treatment with bleach in the United States: the need to revise EPA recommendations
Lantagne D , Person B , Smith N , Mayer A , Preston K , Blanton E , Jellison K . Environ Sci Technol 2014 48 (9) 5093-100 During emergencies in the United States, the Environmental Protection Agency (EPA) currently recommends using bottled water, or boiling or treating water by adding (1)/8 teaspoon (or 8 drops) of bleach to 1 gal of water. This bleach recommendation is internally inconsistent, a relatively high chlorine dose (5.55-8.67 mg/L), and unsupported by evidence. In this study, bleach was added in three different dosages to six waters available to emergency-affected populations in each of six states; free chlorine residual (FCR) and Escherichia coli/total coliforms were measured 1-24 h after treatment. Data were analyzed using four efficacy criteria. Results indicated the dosages in the current EPA recommendation are unnecessarily high to ensure (1) maintenance of FCR for 24 h after treatment, (2) absence of E. coli/total coliforms, and (3) establishment of a CT-factor sufficient to inactivate Giardia lamblia and enteric viruses 1 h after treatment. Additionally, emergency-prone populations did not have the materials to complete treatment with bleach in their household. Therefore, we recommend EPA review and revise the current recommendation to establish an internally consistent, criteria-based recommendation that is usable by emergency-affected populations. We also recommend investigating the use of new or commercially available water treatment products for emergency response in the United States. |
Overview and quality assurance for the oral health component of the National Health and Nutrition Examination Survey (NHANES), 2009-2010
Dye BA , Li X , Lewis BG , Iafolla T , Beltran-Aguilar ED , Eke PI . J Public Health Dent 2014 74 (3) 248-56 OBJECTIVE: In 2009-2010, the oral health component for the National Health and Nutrition Examination Survey (NHANES) focused on adult periodontal health and included a full mouth periodontal examination as well as a series of questions adminis during the home interview. During this period, intraoral assessments were conducted by dental hygienists. METHODS: This report provides oral health content information and results of dental examiner reliability for data collected during NHANES 2009-2010 on 7,189 persons aged 3-19 years and 30 years and older representing the US civilian, noninstitutionalized population in these age groups. RESULTS: For caries and dental sealant assessments, Kappa statistics ranged from 0.71 to 1.00. Kappa scores for moderate and severe periodontitis using the Centers for Disease Control and Prevention/American Academy of Periodontology case definition guidelines was 0.70, but were lower for other periodontal status definitions. When defining moderate or severe periodontitis based on the NHANES 2003-2004 study, protocols using data from only three facial periodontal sites, the Kappa scores were 0.64 and 0.55. Interclass correlation coefficients (ICCs) for mean attachment loss were 0.80 or higher for both examiners. Site-specific mean attachment loss ICCs were generally higher for interproximal measurements compared with mid-facial and mid-lingual measurements. CONCLUSION: Overall, the data reliability analyses conducted for 2009-2010 indicate an acceptable level of data quality and that examiner (dental hygienist) performance in this data collection cycle is similar to prior survey periods since the NHANES continuous survey began in 1999. |
Multilocus sequence typing confirms wild birds as the source of a Campylobacter outbreak associated with the consumption of raw peas.
Kwan PS , Xavier C , Santovenia M , Pruckler J , Stroika S , Joyce K , Gardner T , Fields PI , McLaughlin J , Tauxe RV , Fitzgerald C . Appl Environ Microbiol 2014 80 (15) 4540-6 From August to September 2008, the Centers for Disease Control and Prevention (CDC) assisted the Alaska Division of Public Health with an outbreak investigation of campylobacteriosis occurring among the residents of Southcentral Alaska. During the investigation, pulsed-field gel electrophoresis (PFGE) of Campylobacter jejuni isolates from human, raw pea and wild bird fecal samples confirmed the epidemiologic link between illness and the consumption of raw peas contaminated by Sandhill cranes from 15 of 43 epidemiologically-linked human isolates. However, an association between the remaining epidemiologically-linked human infections and the pea and wild bird isolates was not established. To better understand the molecular epidemiology of the outbreak, C. jejuni isolates (n=130; 59 humans, 40 peas and 31 wild birds) were further characterized by multi-locus sequence typing (MLST). Here, we present the molecular evidence to demonstrate the association of many more human C. jejuni infections associated with the outbreak with raw peas and wild bird feces. Among all sequence types (STs) identified, 26 (67%) of 39 were novel and exclusive to the outbreak. Five clusters of overlapping STs (n=32 isolates; 17 humans, 2 peas and 13 wild birds) were identified. In particular, Cluster E (n=7 isolates, ST-5049) consisted of isolates from humans, peas and wild birds. Novel STs clustered closely with isolates typically associated with wild birds and the environment, but distinct from lineages commonly seen in human infections. Novel STs and alleles recovered from human outbreak isolates allowed additional infections caused by these rare genotypes to be attributed to the contaminated raw peas. |
Using online reviews by restaurant patrons to identify unreported cases of foodborne illness - New York City, 2012-2013
Harrison C , Jorder M , Stern H , Stavinsky F , Reddy V , Hanson H , Waechter H , Lowe L , Gravano L , Balter S . MMWR Morb Mortal Wkly Rep 2014 63 (20) 441-5 While investigating an outbreak of gastrointestinal disease associated with a restaurant, the New York City Department of Health and Mental Hygiene (DOHMH) noted that patrons had reported illnesses on the business review website Yelp (http://www.yelp.com) that had not been reported to DOHMH. To explore the potential of using Yelp to identify unreported outbreaks, DOHMH worked with Columbia University and Yelp on a pilot project to prospectively identify restaurant reviews on Yelp that referred to foodborne illness. During July 1, 2012-March 31, 2013, approximately 294,000 Yelp restaurant reviews were analyzed by a software program developed for the project. The program identified 893 reviews that required further evaluation by a foodborne disease epidemiologist. Of the 893 reviews, 499 (56%) described an event consistent with foodborne illness (e.g., patrons reported diarrhea or vomiting after their meal), and 468 of those described an illness within 4 weeks of the review or did not provide a period. Only 3% of the illnesses referred to in the 468 reviews had also been reported directly to DOHMH via telephone and online systems during the same period. Closer examination determined that 129 of the 468 reviews required further investigation, resulting in telephone interviews with 27 reviewers. From those 27 interviews, three previously unreported restaurant-related outbreaks linked to 16 illnesses met DOHMH outbreak investigation criteria; environmental investigation of the three restaurants identified multiple food-handling violations. The results suggest that online restaurant reviews might help to identify unreported outbreaks of foodborne illness and restaurants with deficiencies in food handling. However, investigating reports of illness in this manner might require considerable time and resources. |
Notes from the field: trichinellosis caused by consumption of wild boar meat - Illinois, 2013
Greene YG , Padovani T , Rudroff JA , Hall R , Austin C , Vernon M . MMWR Morb Mortal Wkly Rep 2014 63 (20) 451 On March 6, 2013, the Cook County Department of Public Health (Chicago, Illinois) contacted the Illinois Department of Public Health regarding a diagnosis of trichinellosis in a patient who had consumed wild boar and deer meat obtained by hunting at a Missouri ranch January 16-18. Trichinellosis is a parasitic infection caused by consumption of undercooked infected meat, most commonly from carnivorous or omnivorous animals. |
Emergence and prevalence of non-H2S-producing Salmonella enterica serovar Senftenberg isolates belonging to a novel sequence type 1751 in China
Yi S , Xie J , Liu N , Li P , Xu X , Li H , Sun J , Wang J , Liang B , Yang C , Wang X , Hao R , Wang L , Wu Z , Zhang J , Wang Y , Huang L , Sun Y , Klena JD , Meng J , Qiu S , Song H . J Clin Microbiol 2014 52 (7) 2557-65 Salmonella enterica serovar Senftenberg is a common non-typhoidal Salmonella serotype which causes human Salmonella infections worldwide. In this study, 182 S. Senftenberg isolates including 17 atypical non-H2S-producing isolates were detected in China from 2005-2011. The microbiological and genetic characteristics of the non-H2S-producing and selected H2S-producing isolates were determined by using pulsed-field gel electrophoresis (PFGE), multilocus sequence typing (MLST), and clustered regularly interspaced short palindromic repeat (CRISPR) analysis. The phs operons were amplified and sequenced. The 17 non-H2S-producing and 36 H2S-producing isolates belonged to 7 sequence types (STs) including 3 new STs: ST1751, ST1757 and ST1758. Fourteen (14/17) of the non-H2S-producing isolates belonged to ST1751 and had the distinct PFGE patterns. All 17 non-H2S-producing isolates had a nonsense mutation at position 1621 of phsA. H2S-producing and non-H2S-producing S. Senftenberg were isolated from the same stool sample from three patients; isolates from the same patients displayed the same antimicrobial susceptibility, ST, and PFGE pattern, but could be discriminated based on CRISPR spacers. Non-H2S-producing S. Senftenberg isolates belonging to ST1751 have been prevalent in Shanghai, China. It's possible that these emerging organisms will disseminate further because they are difficult to detect. Thus, we should strengthen the surveillance for the spread of this atypical S. Senftenberg variant. |
Utilizing population controls in rare-variant case-parent association tests.
Jiang Y , Satten GA , Han Y , Epstein MP , Heinzen EL , Goldstein DB , Allen AS . Am J Hum Genet 2014 94 (6) 845-53 There is great interest in detecting associations between human traits and rare genetic variation. To address the low power implicit in single-locus tests of rare genetic variants, many rare-variant association approaches attempt to accumulate information across a gene, often by taking linear combinations of single-locus contributions to a statistic. Using the right linear combination is key-an optimal test will up-weight true causal variants, down-weight neutral variants, and correctly assign the direction of effect for causal variants. Here, we propose a procedure that exploits data from population controls to estimate the linear combination to be used in an case-parent trio rare-variant association test. Specifically, we estimate the linear combination by comparing population control allele frequencies with allele frequencies in the parents of affected offspring. These estimates are then used to construct a rare-variant transmission disequilibrium test (rvTDT) in the case-parent data. Because the rvTDT is conditional on the parents' data, using parental data in estimating the linear combination does not affect the validity or asymptotic distribution of the rvTDT. By using simulation, we show that our new population-control-based rvTDT can dramatically improve power over rvTDTs that do not use population control information across a wide variety of genetic architectures. It also remains valid under population stratification. We apply the approach to a cohort of epileptic encephalopathy (EE) trios and find that dominant (or additive) inherited rare variants are unlikely to play a substantial role within EE genes previously identified through de novo mutation studies. |
Sex in a lifetime: sexual behaviors in the United States by lifetime number of sex partners, 2006-2010
Haderxhanaj LT , Leichliter JS , Aral SO , Chesson HW . Sex Transm Dis 2014 41 (6) 345-52 Using data from the 2006-2010 National Survey of Family Growth, we found that lifetime number of vaginal sex partners is positively associated with the number of sex partners in the past 12 months and negatively associated with age at first vaginal intercourse among 15- to 44-year-old male and female respondents. |
A multidimensional framework for the meanings of the sexual double standard and its application for the sexual health of young black women in the U.S
Fasula AM , Carry M , Miller KS . J Sex Res 2014 51 (2) 170-83 There has been debate in the literature as to whether a sexual double standard (SDS) currently exists in the United States. Studies vary greatly in how the SDS is operationalized, making it difficult to interpret findings across studies and translate academic literature into applied fields such as public health. To advance academic and applied research, we propose a multidimensional framework for the SDS that can accommodate complex and nuanced meanings, is flexible enough to allow for the dynamic nature of social ideologies, and is grounded in an understanding of social systems of inequality. In this article, we describe three dimensions that define the broad elements of the SDS: (a) polarized (hetero)sexualities, (b) active male and passive female roles, and (c) the power struggle narrative. To illustrate the use of the framework, we contextualize each dimension in terms of the intersection of race and gender for young Black women in the United States. And finally, to apply the framework, we explore the effects the SDS can have on sexual health and suggest some directions for public health interventions. These analyses lay the groundwork for more complex and comprehensive investigations of the SDS and its effects on sexual health. |
Donor-derived West Nile virus infection in solid organ transplant recipients: report of four additional cases and review of clinical, diagnostic, and therapeutic features.
Winston DJ , Vikram HR , Rabe IB , Dhillon G , Mulligan D , Hong JC , Busuttil RW , Nowicki MJ , Mone T , Civen R , Tecle SA , Trivedi KK , Hocevar SN . Transplantation 2014 97 (9) 881-9 We describe four solid-organ transplant recipients with donor-derived West Nile virus (WNV) infection (encephalitis 3, asymptomatic 1) from a common donor residing in a region of increased WNV activity. All four transplant recipients had molecular evidence of WNV infection in their serum and/or cerebrospinal fluid (CSF) by reverse transcription polymerase chain reaction (RT-PCR) testing. Serum from the organ donor was positive for WNV IgM but negative for WNV RNA, whereas his lymph node and spleen tissues tested positive for WNV by RT-PCR. Combination therapy included intravenous immunoglobulin (4 cases), interferon (3 cases), fresh frozen plasma with WNV IgG (2 cases), and ribavirin (1 case). Two of the four transplant recipients survived.Review of the 20 published cases of organ-derived WNV infection found that this infection is associated with a high incidence of neuroinvasive disease (70%) and severe morbidity and mortality (30%). Median time to onset of symptomatic WNV infection was 13 days after transplantation (range 5-37 days). Initial unexplained fever unresponsive to antibiotic therapy followed by rapid onset of neurologic deficits was the most common clinical presentation. Confirmation of infection was made by testing serum and CSF for both WNV RNA by RT-PCR and WNV IgM by serological assays. Treatment usually included supportive care, reduction of immunosuppression, and frequent intravenous immunoglobulin. The often negative results for WNV by current RT-PCR and serological assays and the absence of clinical signs of acute infection in donors contribute to the sporadic occurrence of donor-derived WNV infection. Potential organ donors should be assessed for unexplained fever and neurological symptoms, particularly if they reside in areas of increased WNV activity. |
Foodborne listeriosis acquired in hospitals
Silk BJ , McCoy MH , Iwamoto M , Griffin PM . Clin Infect Dis 2014 59 (4) 532-40 Listeriosis is characterized by bacteremia or meningitis. We searched for listeriosis case series and outbreak investigations published in English by 2013, and assessed the strength of evidence for foodborne acquisition among patients who ate hospital food. We identified 30 reports from 13 countries. Among the case series, the median proportion of cases considered hospital-acquired was 25% (range, 9-67%). The median number of outbreak-related illnesses considered hospital-acquired was 4.0 (range, 2-16). All patients were immunosuppressed in 18 (75%) of 24 reports with available data. Eight outbreak reports with strong evidence for foodborne acquisition in a hospital implicated sandwiches (3 reports), butter, pre-cut celery, Camembert cheese, sausage, and tuna salad (1 report each). Foodborne acquisition of listeriosis among hospitalized patients is well documented internationally. The number of listeriosis cases could be reduced substantially by establishing hospital policies for safe food preparation for immunocompromised patients and by not serving them higher-risk foods. |
System factors to explain H1N1 state vaccination rates for adults in US emergency response to pandemic
Davila-Payan C , Swann J , Wortley PM . Vaccine 2014 32 (25) 3088-93 INTRODUCTION: During the 2009-2010 H1N1 pandemic, vaccine in short supply was allocated to states pro rata by population, yet the vaccination rates of adults differed by state. States also differed in their campaign processes and decisions. Analyzing the campaign provides an opportunity to identify specific approaches that may result in higher vaccine uptake in a future event of this nature. OBJECTIVE: To determine supply chain and system factors associated with higher state H1N1 vaccination coverage for adults in a system where vaccine was in short supply. METHODS: Regression analysis of factors predicting state-specific H1N1 vaccination coverage in adults. Independent variables included state campaign information, demographics, preventive or health-seeking behavior, preparedness funding, providers, state characteristics, and H1N1-specific state data. RESULTS: The best model explained the variation in state-specific adult vaccination coverage with an adjusted R-squared of 0.76. We found that higher H1N1 coverage of adults is associated with program aspects including shorter lead-times (i.e., the number of days between when doses were allocated to a state and were shipped, including the time for states to order the doses) and less vaccine directed to specialist locations. Higher vaccination coverage is also positively associated with the maximum number of ship-to locations, past seasonal influenza vaccination coverage, the percentage of women with a Pap smear, the percentage of the population that is Hispanic, and negatively associated with a long duration of the epidemic peak. CONCLUSION: Long lead-times may be a function of system structure or of efficiency and may suggest monitoring or redesign of distribution processes. Sending vaccine to sites with broad access could be useful when covering a general population. Existing infrastructure may be reflected in the maximum number of ship-to locations, so strengthening routine influenza vaccination programs may help during emergency vaccinations also. Future research could continue to inform program decisions. |
Timely versus delayed early childhood vaccination and seizures
Hambidge SJ , Newcomer SR , Narwaney KJ , Glanz JM , Daley MF , Xu S , Shoup JA , Rowhani-Rahbar A , Klein NP , Lee GM , Nelson JC , Lugg M , Naleway AL , Nordin JD , Weintraub E , DeStefano F . Pediatrics 2014 133 (6) e1492-9 BACKGROUND: Little is known regarding the timing of childhood vaccination and postvaccination seizures. METHODS: In a cohort of 323 247 US children from the Vaccine Safety Datalink born from 2004 to 2008, we analyzed the association between the timing of childhood vaccination and the first occurrence of seizure with a self-controlled case series analysis of the first doses of individual vaccines received in the first 2 years of life. RESULTS: In infants, there was no association between the timing of infant vaccination and postvaccination seizures. In the second year of life, the incident rate ratio (IRR) for seizures after receipt of the first measles-mumps-rubella vaccine (MMR) dose at 12 to 15 months was 2.65 (95% confidence interval [CI] 1.99-3.55); the IRR after an MMR dose at 16 to 23 months was 6.53 (95% CI 3.15-13.53). The IRR for seizures after receipt of the first measles-mumps-rubella-varicella vaccine (MMRV) dose at 12 to 15 months was 4.95 (95% CI 3.68-6.66); the IRR after an MMRV dose at 16 to 23 months was 9.80 (95% CI 4.35 -22.06). CONCLUSIONS: There is no increased risk of postvaccination seizure in infants regardless of timing of vaccination. In year 2, delaying MMR vaccine past 15 months of age results in a higher risk of seizures. The strength of the association is doubled with MMRV vaccine. These findings suggest that on-time vaccination is as safe with regard to seizures as delayed vaccination in the first year of life, and that delayed vaccination in the second year of life is associated with more postvaccination seizures than on-time vaccination. |
Modeling the potential impact of vaccination on the epidemiology of congenital cytomegalovirus infection
Lanzieri TM , Bialek SR , Ortega-Sanchez IR , Gambhir M . Vaccine 2014 32 (30) 3780-6 BACKGROUND: Understanding the potential for vaccination to change cytomegalovirus (CMV) epidemiology is important for developing CMV vaccines and designing clinical trials. METHODS: We constructed a deterministic, age-specific and time-dependent mathematical model of pathogen transmission, parameterized using CMV seroprevalence from the United States and Brazil, to predict the impact of vaccination on congenital CMV infection. FINDINGS: Concurrent vaccination of young children and adolescents would result in the greatest reductions in congenital CMV infections in populations with moderate and high baseline maternal seroprevalence. Such a vaccination strategy, assuming 70% vaccine efficacy, 90% coverage and 5-year duration of protection, could ultimately prevent 30-50% of congenital CMV infections. At equilibrium, this strategy could result in a 30% reduction in congenital CMV infections due to primary maternal infection in the United States but a 3% increase in Brazil. The potential for an increase in congenital CMV infections due to primary maternal infections in Brazil was not predicted with use of a vaccine that confers protection for greater than 5 years. INTERPRETATION: Modeling suggests that vaccination strategies that include young children will result in greater declines in congenital CMV infection than those restricted to adolescents or women of reproductive age. Our study highlights the critical need for better understanding of the relative contribution of type of maternal infection to congenital CMV infection and disease, the main focus of vaccine prevention. |
Persistence of serogroup C antibody responses following quadrivalent meningococcal conjugate vaccination in United States military personnel
Patel M , Romero-Steiner S , Broderick MP , Thomas CG , Plikaytis BD , Schmidt DS , Johnson SE , Milton AS , Carlone GM , Clark TA , Messonnier NE , Cohn AC , Faix DJ . Vaccine 2014 32 (30) 3805-9 Serogroup C meningococcal (MenC) disease accounts for one-third of all meningococcal cases and causes meningococcal outbreaks in the U.S. Quadrivalent meningococcal vaccine conjugated to diphtheria toxoid (MenACYWD) was recommended in 2005 for adolescents and high risk groups such as military recruits. We evaluated anti-MenC antibody persistence in U.S. military personnel vaccinated with either MenACYWD or meningococcal polysaccharide vaccine (MPSV4). Twelve hundred subjects vaccinated with MenACYWD from 2006 to 2008 or MPSV4 from 2002 to 2004 were randomly selected from the Defense Medical Surveillance System. Baseline serologic responses to MenC were assessed in all subjects; 100 subjects per vaccine group were tested during one of the following six post-vaccination time-points: 5-7, 11-13, 17-19, 23-25, 29-31, or 35-37 months. Anti-MenC geometric mean titers (GMT) were measured by rabbit complement serum bactericidal assay (rSBA) and geometric mean concentrations (GMC) by enzyme-linked immunosorbent assay (ELISA). Continuous variables were compared using the Wilcoxon rank sum test and the proportion of subjects with an rSBA titer ≥8 by chi-square. Pre-vaccination rSBA GMT was <8 for the MenACWYD group. rSBA GMT increased to 703 at 5-7 months post-vaccination and decreased by 94% to 43 at 3 years post-vaccination. GMT was significantly lower in the MenACWYD group at 5-7 months post-vaccination compared to the MPSV4 group. The percentage of MenACWYD recipients achieving an rSBA titer of ≥8 decreased from 87% at 5-7 months to 54% at 3 years. There were no significant differences between vaccine groups in the proportion of subjects with a titer of ≥8 at any time-point. GMC for the MenACWYD group was 0.14mug/mL at baseline, 1.07mug/mL at 5-7 months, and 0.66mug/mL at 3 years, and significantly lower than the MPSV4 group at all time-points. Anti-MenC responses wane following vaccination with MenACYWD; a booster dose is needed to maintain protective levels of circulating antibody. |
A qualitative analysis of the impact of healthcare personnel influenza vaccination requirements in California
Khodyakov D , Uscher-Pines L , Lorick SA , Lindley MC , Shier V , Harris K . Vaccine 2014 32 (25) 3082-7 OBJECTIVE: Using qualitative methods, we explored the implementation of California's 2007 influenza immunization requirements of hospital-based health care personnel (HCP). METHODS: We conducted nine case studies of California hospitals with different HCP vaccination rates and policies. Case studies consisted of interviewing 13 hospital representatives and analyzing relevant hospital documents, including influenza policies. We also conducted 13 semi-structured phone interviews with key state and county public health officials, union representatives, and officials of various professional healthcare organizations. RESULTS: Our qualitative results suggest that California's vaccination requirements likely did not increase influenza vaccination uptake among HCP. The law was not strong enough to compel hospitals with low and medium vaccination rates to improve their vaccination efforts, and hospitals with high vaccination rates were able to comply fully with the law by continuing to do what they were already doing - namely offering vaccinations to HCP, providing education about the risks of influenza and the benefits of vaccination, and obtaining signed declinations from those who refuse vaccination. Nonetheless, we found that by publicly raising the issue of influenza vaccination in the context of public safety and healthcare quality, California's law encouraged hospitals to develop and implement data systems to monitor the effectiveness of vaccination promotion efforts and prompted discussions, and, in some cases, adoption of stricter vaccination requirements at hospital or county levels. CONCLUSIONS: Our findings generally support the literature that suggests that permissive influenza vaccination requirements, though politically feasible, provide little direct incentive for hospitals to focus efforts on increasing HCP vaccination rates. |
Effectiveness of typhoid vaccination in US travelers
Mahon BE , Newton AE , Mintz ED . Vaccine 2014 32 (29) 3577-9 Typhoid vaccination is recommended in the United States before travel to countries where typhoid fever is endemic, though little information is available on its effectiveness in travelers. We estimated typhoid vaccination effectiveness (VE) by comparing vaccination status in cases of typhoid fever and paratyphoid fever (Salmonella Paratyphi A infection, against which typhoid vaccine offers no protection) reported in the United States. We included travelers to Southern Asia and excluded persons <2 years old and cases in which vaccination status was not reported. From 2008 through 2011, 744 eligible cases (602 typhoid, 142 paratyphoid A) were reported to CDC. Typhoid vaccination was reported for 5% (29/602) of typhoid patients and for 20% (29/142) of paratyphoid A patients. Estimated VE was 80% (95% confidence interval, 66-89%). Because of missing data, we could not estimate VE for specific vaccines. We demonstrated moderate effectiveness of typhoid vaccination in US travelers, supporting vaccination recommendations. |
Booster immune response in children 6-7 years of age, randomly assigned to four groups with two MMR vaccines applied by aerosol or by injection
Diaz-Ortega JL , Bennett JV , Castaneda-Desales D , Quintanilla DM , Martinez D , Castro JF . Vaccine 2014 32 (29) 3680-6 IMPORTANCE: Aerosol immunization may be a useful tool to reach and sustain the elimination of measles, rubella, and congenital rubella syndrome. We compared booster seroresponses to aerosolized or injected MMR vaccines containing different strains of measles (Attenuvax or Edmonston-Zagreb) and mumps (Jeryl-Lynn or Leningrad-Zagreb). OBJECTIVE: To assess the safety and immunogenicity of two MMR: Vaccines administered by aerosol. METHODS: A randomized and controlled clinical trial was conducted to evaluate the safety and booster responses to the MMR SII (Serum Institute of India) and MMR II (Merck Sharp & Dhome) vaccines, both of which were administered by aerosol (ae) or injection (inj) to Mexican children aged 6-7 years in elementary schools. The seroresponses were evaluated by PRN (measles) and ELISA (rubella and mumps). Adverse events were followed-up for 28 days after the immunization. RESULTS: Two hundred and fifty-three of 260 children completed the one-month follow-up. All participants reached protective seropositivity for measles and rubella after immunization, and 98.3 to 100% reached protective seropositivity for mumps (p=0.552). The proportions of the seroresponses (a 2-fold rise from the baseline antibody titers) to measles were 38.3% for MMR SII (ae), 31.3% for MMR II (ae), 37.5% for MMR SII (inj), and 44.6% for MMR II (inj) (p=0.483). The seroresponses for rubella were 26.7% for MMR SII (ae), 31.3% for MMR II (ae), 46.9% for MMR SII (inj), and 40.0% for MMR II (inj) (p=0.086). The seroresponse to mumps were 31.7% for MMR SII (ae), 25.0% for MMR II (ae), 48.4% for MMR SII (inj), and 53.9% for MMR II (inj) (p=0.002). The difference in the seroresponse of a 4-fold rise from the baseline antibody titers was not statistically significant. Only mild adverse events were noted. CONCLUSION: Aerosolized vaccines were as safe and as immunogenic as injected vaccines. PROTOCOL REGISTRATION: CMN 2010-005 (National Regulatory Authority). |
Duration of protection after infant hepatitis B vaccination series
Middleman AB , Baker CJ , Kozinetz CA , Kamili S , Nguyen C , Hu DJ , Spradling PR . Pediatrics 2014 133 (6) e1500-7 BACKGROUND: Little is known about duration of protection after the infant primary series of hepatitis B (HB) vaccine in settings of low HB endemicity. This study sought to determine the proportion of adolescents immunized as infants who had protective titers of antibody to hepatitis B surface antigen (anti-HBs) before and after a challenge dose of vaccine. METHODS: US-born 16- through 19-year-olds who received a recombinant HB vaccine 3-dose series initiated within 7 days of birth (group 1) or at ≥4 weeks of age (group 2) and completed by 12 months of age were enrolled. Participants had serologic testing before and 2 weeks after randomization to receive a challenge dose of 10 microg or 20 microg of Engerix-B. Baseline and postchallenge levels of anti-HBs were compared by group, challenge dosage, and demographic and behavioral characteristics. RESULTS: At baseline, 24% had protective anti-HBs levels of ≥10 IU/mL; 92% achieved protective levels after challenge dose. Although group 1 had a lower proportion of seroprotection at baseline, group and challenge dosage were not associated with postchallenge proportion of seroprotection. Being in group 2, higher test dosage, higher baseline geometric mean titer, and nonwhite race were associated with significantly higher geometric mean titer after challenge dose. CONCLUSIONS: More than 90% of study participants immunized against HB as infants exhibited a seroprotective response to a challenge dose of vaccine. Duration of protection from the primary infant HB vaccine series extended through the adolescent years in the setting of low HB endemicity. |
Detection of Rickettsia rickettsii, Rickettsia parkeri, and Rickettsia akari in skin biopsy specimens using a multiplex real-time polymerase chain reaction assay.
Denison AM , Amin BD , Nicholson WL , Paddock CD . Clin Infect Dis 2014 59 (5) 635-42 BACKGROUND: Rickettsia rickettsii, R. parkeri, and R. akari are the most common causes of spotted fever group rickettsioses indigenous to the United States. Infected patients characteristically present with a maculopapular rash, often accompanied by an inoculation eschar. Skin biopsy specimens are often obtained from these lesions for diagnostic evaluation. However, a species-specific diagnosis is achieved infrequently from pathologic specimens because immunohistochemical stains do not differentiate among the causative agents of spotted fever group rickettsiae, and existing PCR assays generally target large gene segments that may be difficult or impossible to obtain from formalin-fixed tissues. METHODS: This work describes the development and evaluation of a multiplex real-time PCR assay for the detection of these three Rickettsia species from formalin-fixed, paraffin-embedded (FFPE) skin biopsy specimens. RESULTS: The multiplex PCR assay was specific at discriminating each species from FFPE controls of unrelated bacterial, viral, protozoan, and fungal pathogens that cause skin lesions, as well other closely related spotted fever group Rickettsia species. CONCLUSIONS: This multiplex real-time PCR demonstrates greater sensitivity than nested PCR assays in FFPE tissues and provides an effective method to specifically identify cases of Rocky Mountain spotted fever, rickettsialpox, and R. parkeri rickettsiosis by using skin biopsy specimens. |
Recombinant protein- and synthetic peptide-based immunoblot test for diagnosis of neurocysticercosis
Noh J , Rodriguez S , Lee YM , Handali S , Gonzalez AE , Gilman RH , Tsang VC , Garcia HH , Wilkins PP . J Clin Microbiol 2014 52 (5) 1429-34 One of the most well-characterized tests for diagnosing neurocysticercosis (NCC) is the enzyme-linked immunoelectrotransfer blot (EITB) assay developed at the CDC, which uses lentil lectin-bound glycoproteins (LLGP) extracted from Taenia solium cysticerci. Although the test is very reliable, the purification process for the LLGP antigens has been difficult to transfer to other laboratories because of the need for expensive equipment and technical expertise. To develop a simpler assay, we previously purified and cloned the diagnostic glycoproteins in the LLGP fraction. In this study, we evaluated three representative recombinant or synthetic antigens from the LLGP fraction, individually and in different combinations, using an immunoblot assay (recombinant EITB). Using a panel of 249 confirmed NCC-positive and 401 negative blood serum samples, the sensitivity of the recombinant EITB assay was determined to be 99% and the specificity was 99% for diagnosing NCC. We also tested a panel of 239 confirmed NCC-positive serum samples in Lima, Peru, and found similar results. Overall, our data show that the performance characteristics of the recombinant EITB assay are comparable to those of the LLGP-EITB assay. This new recombinant- and synthetic antigen-based assay is sustainable and can be easily transferred to other laboratories in the United States and throughout the world. |
Use of nonhuman primates in research in North America
Lankau EW , Turner PV , Mullan RJ , Galland GG . J Am Assoc Lab Anim Sci 2014 53 (3) 278-82 In North America, the biomedical research community faces social and economic challenges to nonhuman primate (NHP) importation that could reduce the number of NHP available for research needs. The effect of such limitations on specific biomedical research topics is unknown. The Association of Primate Veterinarians (APV), with assistance from the Centers for Disease Control and Prevention, developed a survey regarding biomedical research involving NHP in the United States and Canada. The survey sought to determine the number and species of NHP maintained at APV members' facilities, current uses of NHP to identify the types of biomedical research that rely on imported animals, and members' perceived trends in NHP research. Of the 149 members contacted, 33 (22%) replied, representing diverse facility sizes and types. Cynomolgus and rhesus macaques were the most common species housed at responding institutions and comprised the majority of newly acquired and imported NHP. The most common uses for NHP included pharmaceutical research and development and neuroscience, neurology, or neuromuscular disease research. Preclinical safety testing and cancer research projects usually involved imported NHP, whereas research on aging or degenerative disease, reproduction or reproductive disease, and organ or tissue transplantation typically used domestic-bred NHP. The current results improve our understanding of the research uses for imported NHP in North America and may facilitate estimating the potential effect of any future changes in NHP accessibility for research purposes. Ensuring that sufficient NHP are available for critical biomedical research remains a pressing concern for the biomedical research community in North America. |
Comparison of lead and tin concentrations in air at a solder manufacturer from the closed-face 37 mm cassette with and without a custom cellulose-acetate cassette insert
Lee EG , Chisholm WP , Burns DA , Nelson JH , Kashon ML , Harper M . J Occup Environ Hyg 2014 11 (12) 0 A polyvinyl chloride (PVC) cassette insert with PVC filter (ACCU-CAP) in a 37-mm closed -face cassette (CFC) was designed for gravimetric analysis. A customized version of the ACCU-CAP, also to be used in the CFC, was manufactured from an acid-digestible cellulose-acetate cassette insert joined to a mixed cellulose ester (MCE) filter for wet chemical analysis. The aim of this study was to compare metal particle concentrations as sampled by the customized insert (CI) in a CFC sampler with the traditional sampling method using only a MCE filter in the CFC. Thirty-nine personal and 13 area samples were taken using paired filter-based CFC and the CI in CFC samplers at a solder manufacturing plant. The CI was removed from its CFC, digested and analyzed as a whole. The MCE filter from the typical CFC was removed for analysis and then the interior of the cassette was wiped with Ghost Wipe for a separate analysis. The MCE filter only, Ghost Wipe, and CI were separately dissolved in heated nitric acid for ICP-MS analysis. Overall, the geometric mean concentration of the filter-only (FO) samples was considerably lower than that of the CI samples, by 53% for lead and 32% for tin. However, if the FO analysis was added to the corresponding Ghost Wipe analysis, i.e., filter+interior wipe (FW), the geometric mean concentrations of the FW results were similar to those of the CI results (by 113% for lead and 98% for tin). For both lead and tin the comparison of (log-transformed) metal concentrations between the FW and CI results showed no statistically significant difference (p-value = 0.3009 for lead and 0.800 for tin), while the comparison between the FO and CI results shows statistically significant differences (all p-values<0.05). In conclusion, incorporating the sampler internal non-filter deposits by wiping or use of an internal filter capsule gave higher results than analyzing only the filter. Close agreement between the two methods of including non-filter deposits is an indication of general equivalency. |
Detection of anthrax protective antigen (PA) using europium labeled anti-PA monoclonal antibody and time-resolved fluorescence
Stoddard RA , Quinn CP , Schiffer JM , Boyer AE , Goldstein J , Bagarozzi DA , Soroka SD , Dauphin LA , Hoffmaster AR . J Immunol Methods 2014 408 78-88 Inhalation anthrax is a rare but acute infectious disease following adsorption of Bacillus anthracis spores through the lungs. The disease has a high fatality rate if untreated, but early and correct diagnosis has a significant impact on case patient recovery. The early symptoms of inhalation anthrax are, however, non-specific and current anthrax diagnostics are primarily dependent upon culture and confirmatory real-time PCR. Consequently, there may be a significant delay in diagnosis and targeted treatment. Rapid, culture-independent diagnostic tests are therefore needed, particularly in the context of a large scale emergency response. The aim of this study was to evaluate the ability of monoclonal antibodies to detect anthrax toxin proteins that are secreted early in the course of B. anthracis infection using a time-resolved fluorescence (TRF) immunoassay. We selected monoclonal antibodies that could detect protective antigen (PA), as PA83 and also PA63 and LF in the lethal toxin complex. The assay reliable detection limit (RDL) was 6.63 x 10-6muM (0.551ng/ml) for PA83 and 2.51 x 10-5muM (1.58ng/ml) for PA63. Despite variable precision and accuracy of the assay, PA was detected in 9 out of 10 sera samples from anthrax confirmed case patients with cutaneous (n=7), inhalation (n=2), and gastrointestinal (n=1) disease. Anthrax Immune Globulin (AIG), which has been used in treatment of clinical anthrax, interfered with detection of PA. This study demonstrates a culture-independent method of diagnosing anthrax through use of monoclonal antibodies to detect PA and LF in the lethal toxin complex. |
A duplex recombinant viral nucleoprotein microbead immunoassay for simultaneous detection of seroresponses to human respiratory syncytial virus and metapneumovirus infections
Zhang Y , Brooks WA , Goswami D , Rahman M , Luby SP , Erdman DD . J Virol Methods 2014 206 55-62 Serologic diagnosis of human respiratory syncytial virus (hRSV) and human metapneumovirus (hMPV) infections has been shown to complement virus detection methods in epidemiologic studies. Enzyme immunoassays (EIAs) using cultured virus lysate antigens are often used to diagnose infection by demonstration of a ≥4-fold rises in antibody titer between acute and convalescent serum pairs. In this study, hRSV and hMPV nucleocapsid (recN) proteins were expressed in a baculovirus system and their performance compared with virus culture lysate antigen in EIAs using paired serum specimens collected from symptomatic children. The recN proteins were also used to develop a duplex assay based on the Luminex microbead-based suspension array technology, where diagnostic rises in antibody levels could be determined simultaneously at a single serum dilution. Antibody levels measured by the recN and viral lysate EIAs correlated moderately (hRSV, r2=0.72; hMPV, r2=0.76); the recN EIAs identified correctly 35 of 37 (94.6%) and 48 of 50 (96%) serum pairs showing diagnostic antibody rises by viral lysate EIAs. Purified recN proteins were then coupled to microbeads and serum pairs were tested at a single dilution on a Luminex MAGPIX(R) analyzer. The duplex recN assay identified correctly 33 of 39 (85%) and 41 of 47 (86.7%) serum pairs showing diagnostic rises to hRSV and hMPV, respectively. The recN assay permitted simultaneous testing for acute hRSV and hMPV infections and offers a platform for expanded multiplexing of other respiratory virus assays. |
Reflections on 50 years of newborn screening.
Boyle CA , Bocchini JA Jr , Kelly J . Pediatrics 2014 133 (6) 961-3 Newborn screening (NBS) began 50 years ago with the ability to screen for phenylketonuria from dried-blood spots and prevent long-term disability through dietary intervention. Now nearly all of the 4 million infants born in the United States are screened for a wide array of significant medical conditions by using dried-blood spots and point-of-care tests, leading to early diagnosis and treatment of more than 12 500 newborns each year. NBS is an unqualified public health success; it saves lives, prevents severe disability, and is a good use of limited health care dollars. NBS is not a test, but a complex system that includes the initial screen to identify infants with a high probability of having the condition, a follow-up diagnostic test to identify true cases, and the ongoing treatment of the condition. To make this system efficient and effective requires several key players, including public health, primary and specialty care providers, and families. On this anniversary of NBS, we would like to share our reflections on these 3 perspectives, acknowledging that they capture only some of the important considerations and advances in NBS. |
Risk factors for infectious disease death among infants in the United States
Person MK , Esposito DH , Holman RC , Mehal JM , Stoll BJ . Pediatr Infect Dis J 2014 33 (11) e280-5 BACKGROUND: Infectious diseases (IDs) are an important cause of infant mortality in the United States. This study describes maternal and infant characteristics associated with infant ID deaths in the United States. METHODS: Infant deaths with an ID underlying cause of death occurring in the United States were examined using the 2008-2009 Period Linked Birth/Infant Death public use data files. Average annual ID infant mortality rates (IMRs) for singleton infants were calculated. A retrospective case-control study was conducted to determine infant and maternal risk factors for infant ID death among low (LBW) and normal (NBW) birth weight groups. Controls were defined as infants surviving to the end of their birth year. Risk factors for infant ID deaths were determined through multivariable logistic regression. RESULTS: An estimated 3,843 infant ID deaths occurred in the United Sates during 2008-2009, an overall ID IMR of 47.5 deaths per 100,000 live births. The mortality rates for LBW and NBW infants were 514.8 and 15.5, respectively. Male sex, younger maternal age (<25 years), a live birth order of fourth or more, and low 5-minute Apgar score were associated with increased ID death among LBW and NBW infants. Additionally, black maternal race was associated with increased ID death among LBW infants, and having an unmarried mother was associated with increased ID death among NBW infants. CONCLUSIONS: Awareness of associations with infant ID death should help in development of further strategic measures to reduce infant ID morbidity and mortality. |
Serum cotinine and whole blood folate concentrations in pregnancy
Prasodjo A , Pfeiffer CM , Fazili Z , Xu Y , Liddy S , Yolton K , Savitz DA , Lanphear BP , Braun JM . Ann Epidemiol 2014 24 (7) 498-503 e1 PURPOSE: Prenatal tobacco smoke exposure may be associated with low maternal folate levels that increase the risk of adverse infant and child health outcomes by reducing folate availability during fetal development. METHODS: Using data from the Health Outcomes and Measures of the Environment Study, we examined the relationship between secondhand or active tobacco smoke exposure and whole blood folate concentrations in pregnant women from Cincinnati, Ohio (n = 362) at approximately 16-week gestation. We used multivariable linear regression to examine the association between continuous or categorical serum cotinine levels and whole blood folate levels, adjusting for sociodemographic, dietary, and perinatal variables. RESULTS: After adjustment for potential confounders, an interquartile range increases in serum cotinine concentration (0.012-0.224 ng/mL) was suggestively associated with decreased whole blood folate levels (beta, -23 nmol/L; 95% confidence interval (CI), -49, 3; P value = .08). Compared with unexposed women, reductions in mean whole blood folate were observed among active smokers (beta, -94, 95% CI, 195, 6 nmol/L; P value = .40); smaller reductions were observed among women with secondhand exposure (beta, 26; CI, 84, 32 nmol/L; P value = .07). CONCLUSIONS: Consistent with prior studies, active smoking was associated with reduced whole blood folate levels among these pregnant women. Secondhand tobacco smoke exposures were associated with small and imprecise reductions in whole blood folate levels. |
Perinatal HIV prevention outcomes in U.S.-born versus foreign-born blacks, PSD Cohort, 1995-2004
Myles RL , Artstein-McNassar M , Dean HD , Bohannon B , Melville SK , Yeager R , Wheeling J , Rose CE , Zhu J , Dominguez KL . J Immigr Minor Health 2014 17 (4) 1010-8 We examined differences in HIV-infected U.S.-born and foreign-born black mothers who delivered perinatally HIV-exposed and -infected children during 1995-2004 in the Pediatric Spectrum of HIV Disease Project, a longitudinal cohort study. Prevalence ratios were calculated to explain differences in perinatal HIV prevention opportunities comparing U.S.-born to foreign-born and African-born to Caribbean-born black mothers. U.S.-born compared with foreign-born HIV-infected black mothers were significantly more likely to have used cocaine or other non-intravenous illicit drugs, exchanged money or drugs for sex, known their HIV status before giving birth, received intrapartum antiretroviral (ARV) prophylaxis, and delivered a premature infant; and were significantly less likely to have received prenatal care or delivered an HIV-infected infant. African-born compared with Caribbean-born black mothers were more likely to receive intrapartum ARV prophylaxis. These differences by maternal geographical origin have important implications for perinatal HIV transmission prevention, and highlight the validity of disaggregating data by racial/ethnic subgroups. |
Expanded Quality Management Using Information Power (EQUIP): protocol for a quasi-experimental study to improve maternal and newborn health in Tanzania and Uganda
Hanson C , Waiswa P , Marchant T , Marx M , Manzi F , Mbaruku G , Rowe A , Tomson G , Schellenberg J , Peterson S . Implement Sci 2014 9 (1) 41 BACKGROUND: Maternal and newborn mortality remain unacceptably high in sub-Saharan Africa. Tanzania and Uganda are committed to reduce maternal and newborn mortality, but progress has been limited and many essential interventions are unavailable in primary and referral facilities. Quality management has the potential to overcome low implementation levels by assisting teams of health workers and others finding local solutions to problems in delivering quality care and the underutilization of health services by the community. Existing evidence of the effect of quality management on health worker performance in these contexts has important limitations, and the feasibility of expanding quality management to the community level is unknown. We aim to assess quality management at the district, facility, and community levels, supported by information from high-quality, continuous surveys, and report effects of the quality management intervention on the utilization and quality of services in Tanzania and Uganda. METHODS: In Uganda and Tanzania, the Expanded Quality Management Using Information Power (EQUIP) intervention is implemented in one intervention district and evaluated using a plausibility design with one non-randomly selected comparison district. The quality management approach is based on the collaborative model for improvement, in which groups of quality improvement teams test new implementation strategies (change ideas) and periodically meet to share results and identify the best strategies. The teams use locally-generated community and health facility data to monitor improvements. In addition, data from continuous health facility and household surveys are used to guide prioritization and decision making by quality improvement teams as well as for evaluation of the intervention. These data include input, process, output, coverage, implementation practice, and client satisfaction indicators in both intervention and comparison districts. Thus, intervention districts receive quality management and continuous surveys, and comparison districts-only continuous surveys. DISCUSSION: EQUIP is a district-scale, proof-of-concept study that evaluates a quality management approach for maternal and newborn health including communities, health facilities, and district health managers, supported by high-quality data from independent continuous household and health facility surveys. The study will generate robust evidence about the effectiveness of quality management and will inform future nationwide implementation approaches for health system strengthening in low-resource settings. TRIAL REGISTRATION: PACTR201311000681314. |
Knowledge and attitudes of adults towards smoking in pregnancy: results from the HealthStyles(c) 2008 Survey
Polen KN , Sandhu PK , Honein MA , Green KK , Berkowitz JM , Pace J , Rasmussen SA . Matern Child Health J 2014 19 (1) 144-54 Smoking during pregnancy is causally associated with many adverse health outcomes. Quitting smoking, even late in pregnancy, improves some outcomes. Among adults in general and reproductive-aged women, we sought to understand knowledge and attitudes towards prenatal smoking and its effects on pregnancy outcomes. Using data from the 2008 HealthStyles(c) survey, we assessed knowledge and attitudes about prenatal smoking and smoking cessation. We classified respondents as having high knowledge if they gave ≥5 correct responses to six knowledge questions regarding the health effects of prenatal smoking. We calculated frequencies of correct responses to assess knowledge about prenatal smoking and estimated relative risk to examine knowledge by demographic and lifestyle factors. Only 15 % of all respondents and 23 % of reproductive-aged women had high knowledge of the adverse effects of prenatal smoking on pregnancy outcomes. Preterm birth and low birth weight were most often recognized as adverse outcomes associated with prenatal smoking. Nearly 70 % of reproductive-aged women smokers reported they would quit smoking if they became pregnant without any specific reasons from their doctor. Few respondents recognized the benefits of quitting smoking after the first trimester of pregnancy. Our results suggest that many women lack knowledge regarding the increased risks for adverse outcomes associated with prenatal smoking. Healthcare providers should follow the recommendations provided by the American Congress of Obstetricians and Gynecologists, which include educating women about the health risks of prenatal smoking and the benefits of quitting. Healthcare providers should emphasize quitting smoking even after the first trimester of pregnancy. |
Cytomegalovirus infection among infants in California neonatal intensive care units, 2005-2010
Lanzieri TM , Bialek SR , Bennett MV , Gould JB . J Perinat Med 2014 42 (3) 393-9 AIM: To assess the burden of congenital and perinatal cytomegalovirus (CMV) disease among infants hospitalized in neonatal intensive care units (NICUs). METHODS: CMV infection was defined as a report of positive CMV viral culture or polymerase chain reaction at any time since birth in an infant hospitalized in a NICU reporting to California Perinatal Quality Care Collaborative during 2005-2010. RESULTS: One hundred and fifty-six (1.7 per 1000) infants were reported with CMV infection, representing an estimated 5% of the expected number of live births with symptomatic CMV disease. Prevalence was higher among infants with younger gestational ages and lower birth weights. Infants with CMV infection had significantly longer hospital stays and 14 (9%) died. CONCLUSIONS: Reported prevalence of CMV infection in NICUs represents a fraction of total expected disease burden from CMV in the newborn period, likely resulting from underdiagnosis and milder symptomatic cases that do not require NICU care. More complete ascertainment of infants with congenital CMV infection that would benefit from antiviral treatment may reduce the burden of CMV disease in this population. |
CFD modelling of sampling locations for early detection of spontaneous combustion in long-wall gob areas
Yuan L , Smith AC . Int J Min Miner Eng 2012 4 (1) 50-62 In this study, computational fluid dynamics (CFD) modeling was conducted to optimize gas sampling locations for the early detection of spontaneous heating in longwall gob areas. Initial simulations were carried out to predict carbon monoxide (CO) concentrations at various regulators in the gob using a bleeder ventilation system. Measured CO concentration values at these regulators were then used to calibrate the CFD model. The calibrated CFD model was used to simulate CO concentrations at eight sampling locations in the gob using a bleederless ventilation system to determine the optimal sampling locations for early detection of spontaneous combustion. |
A novel method for assessing respiratory deposition of welding fume nanoparticles
Cena LG , Keane MJ , Chisholm WP , Stone S , Harper M , Chen BT . J Occup Environ Hyg 2014 11 (12) 771-80 Welders are exposed to high concentrations of nanoparticles. Compared to larger particles, nanoparticles have been associated with more toxic effects at the cellular level, including the generation of more reactive oxygen species activity. Current methods for welding-fume aerosol exposures do not differentiate between the nano-fraction and the larger particles. The objectives of this work are to establish a method to estimate the respiratory deposition of the nano-fraction of selected metals in welding fumes and test this method in a laboratory setting. Manganese (Mn), Nickel (Ni), Chromium (Cr) and hexavalent chromium (Cr(VI)) are commonly found in welding fume aerosols and have been linked with severe adverse health outcomes. Inductively coupled plasma mass spectrometry (ICP-MS) and ion chromatography (IC) were evaluated as methods for analyzing the content of Mn, Ni, Cr and Cr(VI) nanoparticles in welding fumes collected with nanoparticle respiratory deposition (NRD) samplers. NRD samplers collect nanoparticles at deposition efficiencies that closely resemble physiological deposition in the respiratory tract. The limits of detection (LODs) and quantitation (LOQs) for ICP-MS and IC were determined analytically. Mild and stainless steel welding fumes generated with a robotic welder were collected with NRD samplers inside a chamber. LODs (LOQs) for Mn, Ni, Cr, and Cr(VI) were 1.3 mug (4.43 mug); 0.4 mug (1.14 mug), 1.1 mug (3.33 mug), and 0.4 mug (1.42 mug), respectively. Recovery of spiked samples and certified welding fume reference material was greater than 95%. When testing the method, the average percentage of total mass concentrations collected by the NRD samplers was approximately 30% for Mn, approximately 50% for Cr and approximately 60% for Ni, indicating that a large fraction of the metals may lay in the nanoparticle fraction. This knowledge is critical to the development of toxicological studies aimed at finding links between exposure to welding fume nanoparticles and adverse health effects. Future work will involve the validation of the method in workplace settings. |
Pharmaceutical dust exposure at pharmacies using automatic dispensing machines: a preliminary study
Fent KW , Mueller C . J Occup Environ Hyg 2014 11 (11) 695-705 Automatic dispensing machines (ADMs) used in pharmacies concentrate and dispense large volumes of pharmaceuticals, including uncoated tablets that can shed dust. We evaluated 43 employees' exposures to pharmaceutical dust at three pharmacies where ADMs were used. We used an optical particle counter to identify tasks that generated pharmaceutical dust. We collected 72 inhalable dust air samples in or near the employees' breathing zones. In addition to gravimetric analysis, our contract laboratory used internal methods involving liquid chromatography to analyze these samples for active pharmaceutical ingredients (APIs) and/or lactose, an inactive filler in tablets. We had to choose samples for these additional analyses because many methods used different extraction solvents. We selected 57 samples for analysis of lactose. We used real-time particle monitoring results, observations, and information from employees on the dustiness of pharmaceuticals to select 28 samples (including 13 samples that were analyzed for lactose) for analysis of specific APIs. Pharmaceutical dust was generated during a variety of tasks like emptying and refilling of ADM canisters. Using compressed air to clean canisters and manual count machines produced the overall highest peak number concentrations (19,000-580,000 particles/L) of smallest particles (count median aerodynamic diameter ≤ 2 mum). Employees who refilled, cleaned, or repaired ADM canisters, or hand filled prescriptions were exposed to higher median air concentrations of lactose (5.0-12 mug/m3) than employees who did other jobs (0.04-1.3 mug/m3), such as administrative/office work, labeling/packaging, and verifying prescriptions. We detected 10 APIs in air, including lisinopril, a drug prescribed for high blood pressure, levothyroxine, a drug prescribed for hypothyroidism, and methotrexate, a hazardous drug prescribed for cancer and other disorders. Three air concentrations of lisinopril (1.8-2.7 mug/m3) exceeded the lower bound of the manufacturer's hazard control band (1-10 mug/m3). All other API air concentrations were below applicable occupational exposure limits. Our findings indicate that some pharmacy employees are exposed to multiple APIs and that measures are needed to control those exposures. |
Physical assaults among education workers: findings from a statewide study
Tiesman HM , Hendricks S , Konda S , Hartley D . J Occup Environ Med 2014 56 (6) 621-7 OBJECTIVE: Enumerate and describe physical assaults occurring to Pennsylvania education workers. METHODS: A cross-sectional survey was mailed to a random sample of 6450 workers, stratified on gender, occupation, and region. Logistic regression was used to examine risk factors for physical assault. RESULTS: During the 2009-2010 school year, 309 of 2514 workers were assaulted 597 times. Special education teachers, urban workers, and those in their first 3 years of employment were at an increased risk. Most assaults did not lead to medical care or time away from work; however, those assaulted were significantly more likely to find work stressful, have low job satisfaction, and consider leaving the education field (adjusted odds ratio [AOR] = 2.5 [95% CI = 1.5 to 4.1]; AOR = 2.4 [95% CI = 1.5 to 3.9]; AOR = 10.7 [95% CI = 4.1 to 28.1]). CONCLUSIONS: Although education workers experienced few serious physical assaults, the impact of this violence was considerable. |
Cities with camera-equipped taxicabs experience reduced taxicab driver homicide rates: United States, 1996-2010
Chaumont Menendez C , Amandus H , Damadi P , Wu N , Konda S , Hendricks S . Crime Sci 2014 3 (1) 4 BACKGROUND: Driving a taxicab remains one of the most dangerous occupations in the United States, with leading homicide rates. Although safety equipment designed to reduce robberies exists, it is not clear what effect it has on reducing taxicab driver homicides. FINDINGS: Taxicab driver homicide crime reports for 1996 through 2010 were collected from 20 of the largest cities (>200,000) in the United States: 7 cities with cameras installed in cabs, 6 cities with partitions installed, and 7 cities with neither cameras nor partitions. Poisson regression modeling using generalized estimating equations provided city taxicab driver homicide rates while accounting for serial correlation and clustering of data within cities. Two separate models were constructed to compare (1) cities with cameras installed in taxicabs versus cities with neither cameras nor partitions and (2) cities with partitions installed in taxicabs versus cities with neither cameras nor partitions. Cities with cameras installed in cabs experienced a significant reduction in homicides after cameras were installed (adjRR=0.11, CL 0.06-0.24) and compared to cities with neither cameras nor partitions (adjRR=0.32, CL 0.15-0.67). Cities with partitions installed in taxicabs experienced a reduction in homicides (adjRR=0.78, CL 0.41-1.47) compared to cities with neither cameras nor partitions, but it was not statistically significant. CONCLUSIONS: The findings suggest cameras installed in taxicabs are highly effective in reducing homicides among taxicab drivers. Although not statistically significant, the findings suggest partitions installed in taxicabs may be effective. |
Cryptosporidium spp., Giardia duodenalis, Enterocytozoon bieneusi and other intestinal parasites in young children in Lobata province, Democratic Republic of São Tomé and Principe.
Lobo ML , Augusto J , Antunes F , Ceita J , Xiao L , Codices V , Matos O . PLoS One 2014 9 (5) e97708 Rare systemic studies concerning prevalence of intestinal parasites in children have been conducted in the second smallest country in Africa, the Democratic Republic of Sao Tome and Principe. Fecal specimens from 348 children (214 in-hospital attending the Aires de Menezes Hospital and 134 from Agostinho Neto village) in Sao Tome Island were studied by parasitological and molecular methods. Of the 134 children from Agostinho Neto, 52.2% presented intestinal parasites. 32.1% and 20.2% of these children had monoparasitism and polyparasitism, respectively. Ascaris lumbricoides (27.6%), G. duodenalis (7.5%), T. trichiura (4.5%) and Entamoeba coli (10.5%) were the more frequent species identified in the children of this village. Giardia duodenalis (7.5%) and E. bieneusi (5.2%) were identified by PCR. Nested-PCR targeting G. duodenalis TPI identified Assemblage A (60%) and Assemblage B (40%). The E. bieneusi ITS-based sequence identified genotypes K (57.1%), KIN1 (28.6%) and KIN3 (14.3%). Among the 214 in-hospital children, 29.4% presented intestinal parasites. In 22.4% and 7.0% of the parasitized children, respectively, one or more species were concurrently detected. By microscopy, A. lumbricoides (10.3%) and Trichiuris trichiura (6.5%) were the most prevalent species among these children, and Cryptosporidium was detected by PCR in 8.9% of children. GP60 locus analysis identified 6.5% of C. hominis (subtypes IaA27R3 [35.7%], IaA23R3 [14.3%], IeA11G3T3 [28.6%] and IeA11G3T3R1 [21.4%]) and 2.3% of C. parvum (subtypes IIaA16G2R1 [20.0%], IIaA15G2R1 [20.0%], IIdA26G1 [40.0%] and IIdA21G1a [20.0%]). G. duodenalis and E. bieneusi were identified in 0.5% and 8.9% of the in-hospital children, respectively. G. duodenalis Assemblage B was characterized. The E. bieneusi genotypes K (52.6%), D (26.4%), A (10.5%) and KIN1 (10.5%) were identified. Although further studies are required to clarify the epidemiology of these infectious diseases in this endemic region the significance of the present results highlights that it is crucial to strength surveillance on intestinal pathogens. |
Mind the gaps - the epidemiology of poor-quality anti-malarials in the malarious world - analysis of the WorldWide Antimalarial Resistance Network database
Tabernero P , Fernandez FM , Green M , Guerin PJ , Newton PN . Malar J 2014 13 139 BACKGROUND: Poor quality medicines threaten the lives of millions of patients and are alarmingly common in many parts of the world. Nevertheless, the global extent of the problem remains unknown. Accurate estimates of the epidemiology of poor quality medicines are sparse and are influenced by sampling methodology and diverse chemical analysis techniques. In order to understand the existing data, the Antimalarial Quality Scientific Group at WWARN built a comprehensive, open-access, global database and linked Antimalarial Quality Surveyor, an online visualization tool. Analysis of the database is described here, the limitations of the studies and data reported, and their public health implications discussed. METHODS: The database collates customized summaries of 251 published anti-malarial quality reports in English, French and Spanish by time and location since 1946. It also includes information on assays to determine quality, sampling and medicine regulation. RESULTS: No publicly available reports for 60.6% (63) of the 104 malaria-endemic countries were found. Out of 9,348 anti-malarials sampled, 30.1% (2,813) failed chemical/packaging quality tests with 39.3% classified as falsified, 2.3% as substandard and 58.3% as poor quality without evidence available to categorize them as either substandard or falsified. Only 32.3% of the reports explicitly described their definitions of medicine quality and just 9.1% (855) of the samples collected in 4.6% (six) surveys were conducted using random sampling techniques. Packaging analysis was only described in 21.5% of publications and up to twenty wrong active ingredients were found in falsified anti-malarials. CONCLUSIONS: There are severe neglected problems with anti-malarial quality but there are important caveats to accurately estimate the prevalence and distribution of poor quality anti-malarials. The lack of reports in many malaria-endemic areas, inadequate sampling techniques and inadequate chemical analytical methods and instrumental procedures emphasizes the need to interpret medicine quality results with caution. The available evidence demonstrates the need for more investment to improve both sampling and analytical methodology and to achieve consensus in defining different types of poor quality medicines. |
Pseudo-romana sign due to botfly infestation
Granada MD , Samaniego SB , Cantey PT , Gall WK , Wormser GP . Infect Dis Clin Pract (Baltim Md) 2014 22 (3) 180-184 We report a patient who presented with unilateral periorbital edema after a short-term travel to an endemic area for Chagas disease and exposure to triatomine (reduviid) bugs. The diagnosis, however, was furuncular myiasis, not Chagas disease. This case emphasizes that there are multiple parasitic agents besides Trypanosoma cruzi that may be associated with clinical findings consistent with Romana sign. |
2014 Consensus Statement from the first Economics of Physical Inactivity Consensus (EPIC) conference (Vancouver)
Davis JC , Verhagen E , Bryan S , Liu-Ambrose T , Borland J , Buchner D , Hendriks MR , Weiler R , Morrow JR Jr , van Mechelen W , Blair SN , Pratt M , Windt J , Al-Tunaiji H , Macri E , Khan KM . Br J Sports Med 2014 48 (12) 947-51 This article describes major topics discussed from the 'Economics of Physical Inactivity Consensus Workshop' (EPIC), held in Vancouver, Canada, in April 2011. Specifically, we (1) detail existing evidence on effective physical inactivity prevention strategies; (2) introduce economic evaluation and its role in health policy decisions; (3) discuss key challenges in establishing and building health economic evaluation evidence (including accurate and reliable costs and clinical outcome measurement) and (4) provide insight into interpretation of economic evaluations in this critically important field. We found that most methodological challenges are related to (1) accurately and objectively valuing outcomes; (2) determining meaningful clinically important differences in objective measures of physical inactivity; (3) estimating investment and disinvestment costs and (4) addressing barriers to implementation. We propose that guidelines specific for economic evaluations of physical inactivity intervention studies are developed to ensure that related costs and effects are robustly, consistently and accurately measured. This will also facilitate comparisons among future economic evidence. |
Final program evaluation methods and results of a National Lymphedema Management Program in Togo, West Africa
Ziperstein J , Dorkenoo M , Datagni M , Drexler N , Murphy M , Sodahlon Y , Mathieu E . J Epidemiol Glob Health 2014 4 (2) 125-33 In order to eliminate Lymphatic Filariasis (LF) as a public health problem, the World Health Assembly recommends an approach which includes interruption of transmission of infection and the alleviation of morbidity. In 2000, the Togolese National Program to Eliminate Lymphatic Filariasis (PNELF) started the annual mass drug administrations and in 2007, the program added a morbidity component for the management of lymphedema. This manuscript describes the methods of an evaluation aimed at assessing the strengths and weaknesses of the Togolese National Lymphedema Morbidity Program. The evaluation was conducted through in-depth interviews with stakeholders at each programmatic level. Interviews focused on message dissemination, health provider training, patient self-care practices, social dynamics, and program impact. The evaluation demonstrated that the program strengths include the standardization and in-depth training of health staff, dissemination of the program's treatment message, a positive change in the community's perception of lymphedema, and successful patient recruitment and training in care techniques. The lessons learned from this evaluation helped to improve Togo's program, but may also provide guidance and strategies for other countries desiring to develop a morbidity program. The methods of program evaluation described in this paper can serve as a model for monitoring components of other decentralized national health programs in low resource settings. |
Predicting temporal trends in total absenteeism rates for civil service employees of a federal public health agency
Spears DR , McNeil C , Warnock E , Trapp J , Oyinloye O , Whitehurst V , Decker KC , Chapman S , Campbell M , Meechan P . J Occup Environ Med 2014 56 (6) 632-8 OBJECTIVE: This study evaluates the predictability in temporal absences trends due to all causes (total absenteeism) among employees at a federal agency. The objective is to determine how leave trends vary within the year, and determine whether trends are predictable. METHODS: Ten years of absenteeism data from an attendance system were analyzed for rates of total absence. RESULTS: Trends over a 10-year period followed predictable and regular patterns during a given year that correspond to major holiday periods. Temporal trends in leave among small, medium, and large facilities compared favorably with the agency as a whole. CONCLUSIONS: Temporal trends in total absenteeism rates for an organization can be determined using its attendance system. The ability to predict employee absenteeism rates can be extremely helpful for management in optimizing business performance and ensuring that an organization meets its mission. |
Informing drug development and clinical practice through patient-centered outcomes research
Coon CD , Lau DT . Clin Ther 2014 36 (5) 616-8 In the last 2 decades, the health care field has made an effort to emphasize the patient experience and voice in the quality and value of health care in the United States. US Food and Drug Administration (FDA) guidance on patient-reported outcome (PRO) instruments in obtaining labeling claims, some may argue, is the endeavor that has helped push patient-centered outcomes to the forefront of health care research. Although PRO instruments have been used for years, especially in the field of psychology research, they have gained favor over time as a means for diagnosing medical conditions, assessing treatment efficacy, understanding the burden of illness, and gaining insight into the impact of disease directly from the patient’s own perspective. The concept of patient-centered outcomes allows for health care research to go beyond its traditional model, with a focus on the impact of disease and treatment on a patient’s quality of life from his or her own eyes. | Although the patient’s voice has increasingly been incorporated into pharmaceutical clinical trials and clinical practice, researchers and clinicians are still striving to define and apply ways by which the patient can be the focal point of the health care industry. This special issue of Clinical Therapeutics compiles conceptual and empirical articles that explore and discuss scientific approaches to incorporating the patient’s voice into health care research. Our intention was to continue the dialogue on advancing patient-centered outcomes research to better inform drug development and clinical practice. |
Acute sinusitis and pharyngitis as inappropriate indications for antibiotic use
Sanchez GV , Hicks LA . Antimicrob Agents Chemother 2014 58 (6) 3572 We read with interest the study by Donnelly and colleagues (1) which explored antibiotic prescriptions for ambulatory emergency department (ED) visits in the United States. As public health researchers, we agree with the authors' assertion that their findings “highlight opportunities for reducing inappropriate antibiotic use among adult ED ARTI [acute respiratory tract infection] patients and for optimizing treatment for antibiotic-appropriate ARTI” (1). However, these study results should be interpreted with one important clarification regarding the categories in which infections were classified. | In this work, the authors define “antibiotic-appropriate” ARTIs as otitis media, sinusitis, pharyngitis, and nonviral pneumonia. However, it is well established that sinusitis and pharyngitis are caused predominantly by viral pathogens. In acute rhinosinusitis, for instance, the incidence of bacterial infections is estimated to be only 2% to 10%, with a secondary bacterial infection occurring in approximately 0.5% to 2% of adult cases (2). Similarly, group A streptococcal (GAS) pharyngitis, the primary indication to treat a sore throat with an antibiotic, accounts for only 5% to 15% of cases among adults and 20% to 30% of such visits for children (3). Recent clinical practice guidelines emphasize using strict diagnostic criteria to establish a bacterial diagnosis for these infections, as well as the use of first-line targeted antibiotics, such as penicillin and amoxicillin (2, 4). |
Antimicrobial stewardship in long-term care facilities
Rhee SM , Stone ND . Infect Dis Clin North Am 2014 28 (2) 237-246 Although antimicrobial stewardship has been shown to improve microbiologic susceptibility patterns, decrease drug toxicities, and lower overall drug costs in the inpatient setting, there are few studies assessing programs in the long-term care (LTC) setting. Implementing antimicrobial stewardship programs in LTC settings can be challenging as the LTC setting houses a unique population of frail and older adults with several preexisting conditions and multiple risk factors for colonization with multidrug-resistant organisms. Antimicrobial stewardship has an important role in decreasing inappropriate antibiotic use, encouraging targeted treatment of specific disease states, and limiting the untoward effects and costs of antimicrobials in this vulnerable population. |
Applied public health training: a graduate's perspective
Callahan T . Am J Public Health 2014 104 (6) e1 I was pleased to see Fried et al.1 make the case for a new era of graduate public health curriculum focused on integrated, problem-based learning and the companion article by Begg et al.2 describe the new MPH curriculum at Columbia University as a model for an integrated, problem-based curriculum. Graduate public health training needs to adapt to new models to adequately prepare the next generation of public health leaders to effectively manage the complex public health problems of the present. |
The Project Connect health systems intervention: linking sexually experienced youth to sexual and reproductive health care
Dittus PJ , De Rosa CJ , Jeffries RA , Afifi AA , Cumberland WG , Chung EQ , Martinez E , Kerndt PR , Ethier KA . J Adolesc Health 2014 55 (4) 528-34 PURPOSE: To evaluate a health systems intervention to increase adolescents' receipt of high-quality sexual and reproductive health care services. METHODS: Quasi experimental design. Twelve high schools in a large public school district were matched into pairs. Within each pair, schools were assigned to condition so that no control school shared a geographic border with an intervention school. Five yearly surveys (T1, T2, ..., T5) were administered from 2005 to 2009 (N = 29,823) to students in randomly selected classes in grades 9-12. Community-based providers of high-quality sexual and reproductive health care services were listed on a referral guide for use by school nurses to connect adolescents to care. RESULTS: Statistically significant effects were found for intervention school females on three outcomes, relative to controls. Relative to T1, receipt of birth control in the past year was greater at T4 (adjusted odds ratio [AOR] = 1.85; 95% confidence interval [CI], 1.09-3.15) and T5 (AOR = 2.22; 95% CI, 1.32-3.74). Increases in sexually transmitted disease testing and/or treatment in the past year were greater in T1-T3 (AOR = 1.78; 95% CI, 1.05-3.02), T1-T4 (AOR = 1.73; 95% CI, 1.01-2.97), T1-T5 (AOR = 1.97; 95% CI, 1.17-3.31), and T2-T5 (AOR = 1.76; 95% CI, 1.06-2.91). Increases in ever receiving an HIV test were greater in T1-T4 (AOR = 2.14; 95% CI, 1.08-4.26). Among males, no intervention effects were found. CONCLUSIONS: A school-based structural intervention can improve female adolescents' receipt of services. |
Methamphetamine-induced toxicity: an updated review on issues related to hyperthermia
Matsumoto RR , Seminerio MJ , Turner RC , Robson MJ , Nguyen L , Miller DB , O'Callaghan JP . Pharmacol Ther 2014 144 (1) 28-40 Reports of methamphetamine-related emergency room visits suggest that elevated body temperature is a universal presenting symptom, with lethal overdoses generally associated with extreme hyperthermia. This review summarizes the available information on methamphetamine toxicity as it pertains to elevations in body temperature. First, a brief overview of thermoregulatory mechanisms is presented. Next, central and peripheral targets that have been considered for potential involvement in methamphetamine hyperthermia are discussed. Finally, future areas of investigation are proposed, as further studies are needed to provide greater insight into the mechanisms that mediate the alterations in body temperature elicited by methamphetamine. |
Identification and epidemiology of a rare HoBi-like pestivirus strain in Bangladesh.
Haider N , Rahman MS , Khan SU , Mikolon A , Gurley ES , Osmani MG , Shanta IS , Paul SK , Macfarlane-Berry L , Islam A , Desmond J , Epstein JH , Daszak P , Azim T , Luby SP , Zeidner N , Rahman MZ . Transbound Emerg Dis 2014 61 (3) 193-8 The genus pestivirus of the family flaviviridae consists of four recognized species: bovine viral diarrhoea virus 1 (BVDV-1), bovine viral diarrhoea virus 2 (BVDV-2), classical swine fever virus and border disease virus. A new putative pestivirus species tentatively named as either 'HoBi-like pestivirus' or BVDV-3 has recently been identified in Brazil, Italy and Thailand. Despite reports of serological evidence of BVDV in Bangladesh, the types of the virus circulating in cattle have not been identified. We conducted surveillance in cattle from May 2009 to August 2010 in three government veterinary hospitals to characterize BVDV in cattle of Bangladesh. We tested serum for BVDV using an antigen-capture ELISA. Of 638 cattle samples, 3% (16/638) tested positive for BVDV antigen. The ELISA-positive samples were selected for further molecular detection and characterization of BVDV. Molecular analysis of the partial 5' untranslated region (UTR) nucleotide sequences of BVDV-positive samples identified the rare HoBi-like pestivirus or BVDV-3 virus circulating in cattle of Bangladesh. The identification of this rare HoBi-like pestivirus or BVDV-3 strain in Bangladesh warrants further surveillance to evaluate its impact on livestock production. |
Content Index (Achived Edition)
- Chronic Diseases and Conditions
- Communicable Diseases
- Community Health Services
- Disease Reservoirs and Vectors
- Drug Safety
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- Immunity and Immunization
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- Maternal and Child Health
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- Occupational Safety and Health
- Parasitic Diseases
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- Program Evaluation
- Public Health Leadership and Management
- Reproductive Health
- Substance Use and Abuse
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