Sibling concordance for clinical features of Duchenne and Becker muscular dystrophies
Pettygrove S , Lu Z , Andrews JG , Meaney FJ , Sheehan DW , Price ET , Fox DJ , Pandya S , Ouyang L , Apkon SD , Powis Z , Cunniff C . Muscle Nerve 2014 49 (6) 814-21 INTRODUCTION: The correlation of markers of disease severity among brothers with Duchenne or Becker muscular dystrophy has implications for clinical guidance and clinical trials. METHODS: Sibling pairs with Duchenne or Becker muscular dystrophy (n = 60) were compared for ages when they reached clinical milestones of disease progression, including ceased ambulation, scoliosis of ≥ 20 degrees , and development of cardiomyopathy. RESULTS: The median age at which younger brothers reached each milestone, compared with their older brothers ranged from 25 months younger for development of cardiomyopathy to 2 months older for ceased ambulation. For each additional month of ambulation by the older brother, the hazard of ceased ambulation by the younger brother decreased by 4%. CONCLUSIONS: The ages when siblings reach clinical milestones of disease vary widely between siblings. However, the time to ceased ambulation for older brothers predicts the time to ceased ambulation for their younger brothers. |
Million hearts: prevalence of leading cardiovascular disease risk factors - United States, 2005-2012
Ritchey MD , Wall HK , Gillespie C , George MG , Jamal A . MMWR Morb Mortal Wkly Rep 2014 63 (21) 462-7 Each year, approximately 1.5 million U.S. adults have a heart attack or stroke, resulting in approximately 30 deaths every hour and, for nonfatal events, often leading to long-term disability. Overall, an estimated 14 million survivors of heart attacks and strokes are living in the United States. In 2011, the U.S. Department of Health and Human Services, in collaboration with nonprofit and private organizations, launched Million Hearts (http://www.millionhearts.hhs.gov), an initiative focused on implementing clinical and community-level evidence-based strategies to reduce cardiovascular disease (CVD) risk factors and prevent a total of 1 million heart attacks and strokes during the 5-year period 2012-2016. From 2005-2006 to the period with the most current data, analysis of the Million Hearts four "ABCS" clinical measures (for aspirin, blood pressure, cholesterol, and smoking) showed 1) no statistically significant change in the prevalence of aspirin use for secondary prevention (53.8% in 2009-2010), 2) an increase to 51.9% in the prevalence of blood pressure control (in 2011-2012), 3) an increase to 42.8% in the prevalence of cholesterol management (in 2011-2012), and 4) no statistically significant change in the prevalence of smoking assessment and treatment (22.2% in 2009-2010). In addition, analysis of two community-level indicators found 1) a decrease in current tobacco product smoking (including cigarette, cigar, or pipe use) prevalence to 25.1% in 2011-2012 and 2) minimal change in mean daily sodium intake (3,594 mg/day in 2009-2010). Although trends in some measures are encouraging, further reductions of CVD risk factors will be needed to meet Million Hearts goals by 2017. |
Field study of dried blood spot specimens for HIV-1 drug resistance genotyping.
Parry CM , Parkin N , Diallo K , Mwebaza S , Batamwita R , DeVos J , Bbosa N , Lyagoba F , Magambo B , Jordan MR , Downing R , Zhang G , Kaleebu P , Yang C , Bertagnolio S . J Clin Microbiol 2014 52 (8) 2868-75 Dried blood spots (DBS) are an alternative specimen type for HIV drug resistance genotyping in resource-limited settings. Data relating to the impact of DBS storage and shipment conditions on genotyping efficiency under field conditions are limited. We compared genotyping efficiency and resistance profiles of DBS stored and shipped at different temperatures to plasma specimens collected in parallel from patients receiving antiretroviral therapy in Uganda. Plasma and four DBS cards from anti-coagulated venous blood, and a 5th card from finger-prick blood were prepared from 103 HIV-patients with a median VL of 56,795 copies/ml (range 1,081 - 2,964,191). DBS were stored at ambient temperature for 2 or 4 weeks or frozen at -80 degrees C, and shipped from Uganda to the United States, at ambient temperature or frozen on dry ice, for genotyping using a broadly sensitive in-house method. Plasma (97.1%) and DBS (98.1%) stored and shipped frozen had similar genotyping efficiency. DBS stored frozen (97.1%) or at ambient temperature for 2 weeks (93.2%) and shipped at ambient temperature also had similar genotyping efficiency. Genotyping efficiency was reduced for DBS stored at ambient temperature for 4 weeks (89.3%, P=0.03) or prepared from finger-prick blood and stored at ambient temperature for 2 weeks (77.7%, P<0.001) compared to DBS prepared from venous blood and handled similarly. Resistance profiles were similar between plasma and DBS specimens. This study delineates the optimal DBS collection, storage and shipping conditions and opens a new avenue for cost-saving ambient temperature DBS specimen shipments for HIVDR surveillances in resource-limited settings. |
Diversity of the murine antibody response targeting influenza A(H1N1pdm09) hemagglutinin.
Wilson JR , Tzeng WP , Spesock A , Music N , Guo Z , Barrington R , Stevens J , Donis RO , Katz JM , York IA . Virology 2014 458-459 (1) 114-124 We infected mice with the 2009 influenza A pandemic virus (H1N1pdm09), boosted with an inactivated vaccine, and cloned immunoglobulins (Igs) from HA-specific B cells. Based on the redundancy in germline gene utilization, we inferred that between 72-130 unique IgH VDJ and 35 different IgL VJ combinations comprised the anti-HA recall response. The IgH VH1 and IgL VK14 variable gene families were employed most frequently. A representative panel of antibodies were cloned and expressed to confirm reactivity with H1N1pdm09 HA. The majority of the recombinant antibodies were of high avidity and capable of inhibiting H1N1pdm09 hemagglutination. Three of these antibodies were subtype-specific cross-reactive, binding to the HA of A/South Carolina/1/1918(H1N1), and one further reacted with A/swine/Iowa/15/1930(H1N1). These results help to define the genetic diversity of the influenza anti-HA antibody repertoire profile induced following infection and vaccination, which may facilitate the development of influenza vaccines that are more protective and broadly neutralizing. Importance: Protection against influenza viruses is mediated mainly by antibodies, and in most cases this antibody response is narrow, only providing protection against closely related viruses. In spite of this limited range of protection, recent findings indicate that individuals immune to one influenza virus may contain antibodies (generally a minority of the overall response) that are more broadly reactive. These findings have raised the possibility that influenza vaccines could induce a more broadly protective response, reducing the need for frequent vaccine strain changes. However, interpretation of these observations is hampered by the lack of quantitative characterization of the antibody repertoire. In this study, we used single-cell cloning of influenza HA-specific B cells to assess the diversity and nature of the antibody response to influenza hemagglutinin in mice. Our findings help to put bounds on the diversity of the anti-hemagglutinin antibody response, as well as characterizing the cross-reactivity, affinity, and molecular nature of the antibody response. |
Retention in care within 1 year of initial HIV care visit in a multisite US cohort: who's in and who's out?
Tedaldi EM , Richardson JT , Debes R , Young B , Chmiel JS , Durham MD , Brooks JT , Buchacz K . J Int Assoc Provid AIDS Care 2014 13 (3) 232-41 Biannual attendance at medical visits is an established measure of retention in HIV care. We examined factors associated with attending at least 2 clinic visits at least 90 days apart among HIV-infected, antiretroviral therapy (ART)-naive HIV Outpatient Study participants entering care during 2000 to 2011. Of 1441 patients, 85% were retained in care during the first year of observation. Starting ART during the year was the strongest correlate of retention (adjusted odds ratio [aOR] 6.4, 95% confidence interval [CI] 4.4-9.4). After adjusting for starting ART, publicly insured patients (aOR 0.6, 95% CI 0.4-1.0), and patients with baseline CD4 counts <200 cells/mm(3) (aOR 0.5, 95% CI 0.3-0.9) or missing CD4 counts (aOR 0.3, 95% CI 0.2-0.6) were less likely to be retained in care. Although most patients had recommended biannual care visits, some ART-naive individuals may require additional interventions to remain in care. Promptly initiating ART may facilitate engagement in care. |
Temporal trends in treatment outcomes for HIV-1 and HIV-2-infected adults enrolled in Cote d'Ivoire's national antiretroviral therapy program
Auld AF , Ekra KA , Shiraishi RW , Tuho MZ , Kouakou JS , Mohamed F , Ettiegne-Traore V , Sabatier J , Essombo J , Adjorlolo-Johnson G , Marlink R , Ellerbrock TV . PLoS One 2014 9 (5) e98183 BACKGROUND: In Cote d'Ivoire during 2004-2007, numbers of ART enrollees increased from <5,000 to 36,943. Trends in nationally representative ART program outcomes have not yet been reported. METHODOLOGY/PRINCIPAL FINDINGS: We conducted a retrospective chart review to assess trends in patient characteristics and attrition [death or loss to follow-up (LTFU)] over time, among a nationally representative sample of 3,682 adults (≥15 years) initiating ART during 2004-2007 at 34 health facilities. Among ART enrollees during 2004-2007, median age was 36, the proportion female was 67%, the proportion HIV-2-infected or dually HIV-1&2 reactive was 5%, and median baseline CD4+ T-cell (CD4) count was 135 cells/microL. Comparing cohorts initiating ART in 2004 with cohorts initiating ART in 2007, median baseline weight declined from 55 kg to 52 kg (p = 0.008) and the proportion weighing <45 kg increased from 17% to 22% (p = 0.014). During 2004-2007, pharmacy-based estimates of the percentage of new ART enrollees ≥95% adherent to ART declined from 74% to 60% (p = 0.026), and twelve-month retention declined from 86% to 69%, due to increases in 12-month mortality from 2%-4% and LTFU from 12%-28%. In univariate analysis, year of ART initiation was associated with increasing rates of both LTFU and mortality. Controlling for baseline CD4, weight, adherence, and other risk factors, year of ART initiation was still strongly associated with LTFU but not mortality. In multivariate analysis, weight <45 kg and adherence <95% remained strong predictors of LTFU and mortality. CONCLUSIONS: During 2004-2007, increasing prevalence among ART enrollees of measured mortality risk factors, including weight <45 kg and ART adherence <95%, might explain increases in mortality over time. However, the association between later calendar year and increasing LTFU is not explained by risk factors evaluated in this analysis. Undocumented transfers, political instability, and patient dissatisfaction with crowded facilities might explain increasing LTFU. |
Tenofovir diphosphate concentrations and prophylactic effect in a macaque model of rectal simian HIV transmission
Anderson PL , Glidden DV , Bushman LR , Heneine W , Garcia-Lerma JG . J Antimicrob Chemother 2014 69 (9) 2470-6 OBJECTIVES: This study evaluated the relationship between intracellular tenofovir diphosphate concentrations in peripheral blood mononuclear cells and prophylactic efficacy in a macaque model for HIV pre-exposure prophylaxis (PrEP). METHODS: Macaques were challenged with simian HIV (SHIV) via rectal inoculation once weekly for up to 14 weeks. A control group (n = 34) received no drug, a second group (n = 6) received oral tenofovir disoproxil fumarate/emtricitabine 3 days before each virus challenge and a third group (n = 6) received the same dosing plus another dose 2 h after virus challenge. PBMCs were collected just before each weekly virus challenge. The relationship between tenofovir diphosphate in PBMCs and prophylactic efficacy was assessed with a Cox proportional hazards model. RESULTS: The percentages of animals infected in the control, one-dose and two-dose groups were 97, 83 and 17, respectively. The mean (SD) steady-state tenofovir diphosphate concentration (fmol/106 cells) was 15.8 (7.6) in the one-dose group and 30.7 (10.1) in the two-dose group. Each 5 fmol tenofovir diphosphate/106 cells was associated with a 40% (95% CI 17%-56%) reduction in risk of SHIV acquisition, P = 0.002. The tenofovir diphosphate concentration associated with a 90% reduction in risk (EC90) was 22.6 fmol/106 cells (95% CI 13.8-60.8). CONCLUSIONS: The prophylactic EC90 for tenofovir diphosphate identified in macaques exposed rectally compares well with the EC90 previously identified in men who have sex with men (MSM; 16 fmol/106 cells, 95% CI 3-28). These results highlight the relevance of this model to inform human PrEP studies of oral tenofovir disoproxil fumarate/emtricitabine for MSM. |
HIV and HCV infection in the United States: whom and how to test
Panneer N , Lontok E , Branson BM , Teo CG , Dan C , Parker M , Stekler JD , DeMaria A Jr , Miller V . Clin Infect Dis 2014 59 (6) 875-82 In the United States, of the 1.1 million persons infected with human immunodeficiency virus (HIV) and the 2.7 million infected with hepatitis C virus (HCV), approximately 16% and 50%, respectively, are unaware of their infection. Highly effective treatments have turned both diseases into manageable conditions, and in the case of hepatitis C, a disease that can be cured. Early diagnosis is imperative so infected persons can take measures to stay healthy, get into care, benefit from therapy, and reduce the risk of transmission. In this report, we review current recommendations provided by the Centers for Disease Control and Prevention (CDC) and the United States Preventive Services Task Force on whom to screen for HIV and HCV infections, and recommendations from the CDC, the Association of Public Health Laboratories, and the Clinical and Laboratory Standards Institute on how to test for these infections. |
Human T-cell leukemia virus type 3 (HTLV-3) and HTLV-4 antisense transcripts-encoded proteins interact and transactivate Jun family-dependent transcription via their atypical bZIP motif
Larocque E , Andre-Arpin C , Borowiak M , Lemay G , Switzer WM , Duc Dodon M , Mesnard JM , Barbeau B . J Virol 2014 88 (16) 8956-70 Human T-cell leukemia virus type 3 and 4 (HTLV-3 and HTLV-4) are recently isolated retroviruses. We have previously characterized HTLV-3 and HTLV-4-encoded antisense genes, termed APH-3 and APH-4 respectively, which, in contrast to HBZ, the HTLV-1 homologue, do not contain a typical bZIP domain. As HBZ differentially modulates the transactivation potential of various Jun family members, the effect of APH-3 and APH-4 on JunD-, c-Jun- and JunB-mediated transcriptional activation was investigated. We first showed that APH-3 and APH-4 up-regulated the transactivation potential of all tested Jun family members. Using a hTERT promoter construct, our results also highlighted that, unlike HBZ which solely modulates hTERT expression via JunD, both APH-3 and APH-4 acted positively on the transactivation of the hTERT promoter mediated by tested Jun factors. Co-immunoprecipitation experiments demonstrated that these Jun proteins interacted with APH-3 and APH-4. Although no activation domain was identified for APH proteins, the activation domain of c-Jun was very important in the observed up-regulation of its activation potential. We further showed that APH-3 and APH-4 required their putative bZIP-like domains and corresponding leucine residues for interaction and modulation of the transactivation potential of Jun factors. Our results thus demonstrate that HTLV-encoded antisense proteins behave differently and that the bZIP-like domains of both APH-3 and APH-4 have retained their interaction potential for Jun members. These studies are important in assessing the differences in HBZ to other antisense proteins, which might further contribute in determining the role of HBZ in HTLV-1-associated diseases. IMPORTANCE SECTION: HBZ, the antisense transcript-encoded protein from HTLV-1, is now well recognized as a potential factor for Adult T-cell Leukemia/Lymphoma development. In order to better appreciate the mechanism of action of HBZ, comparison to antisense proteins from other HTLV viruses is important. Little is known in relation to the seemingly non-pathogenic HTLV-3 and HTLV-4 viruses and studies of their antisense proteins are limited to our previous report study. We are herein demonstrating that Jun transcription factors are differently affected by APH-3 and APH-4 when compared to HBZ. These intriguing findings suggest that these proteins act differently on viral replication but also likely on cellular gene expression and that highlighting their differences of action might lead to important information allowing to understand the link between HBZ, HTLV-1 to ATL in infected individuals. |
Hygiene strategies to prevent methicillin-resistant Staphylococcus aureus skin and soft tissue infections: a cluster-randomized controlled trial among high-risk military trainees
Ellis MW , Schlett CD , Millar EV , Wilkins KJ , Crawford KB , Morrison-Rodriguez SM , Pacha LA , Gorwitz RJ , Lanier JB , Tribble DR . Clin Infect Dis 2014 58 (11) 1540-8 BACKGROUND: Effective measures are needed to prevent methicillin-resistant Staphylococcus aureus (MRSA) skin and soft tissue infections (SSTIs) in high-risk community settings. The study objective was to evaluate the effect of personal hygiene-based strategies on rates of overall SSTI and MRSA SSTI. METHODS: We conducted a prospective, field-based, cluster-randomized trial in US Army Infantry trainees from May 2010 through January 2012. There were 3 study groups with incrementally increased education and hygiene-based interventions: standard (S), enhanced standard (ES), and chlorhexidine (CHG). The primary endpoints were incidence of overall SSTI and MRSA SSTI. RESULTS: The study included 30 209 trainees constituting 540 platoons (168 S, 192 ES, and 180 CHG). A total of 1203 (4%) participants developed SSTI, 316 (26%) due to MRSA. The overall SSTI rate was 4.15 (95% confidence interval [CI], 3.77-4.58) per 100 person-cycles. SSTI rates by study group were 3.48 (95% CI, 2.87-4.22) for S, 4.18 (95% CI, 3.56-4.90) for ES, and 4.71 (95% CI, 4.03-5.50) for CHG. The MRSA SSTI rate per 100 person-cycles for all groups was 1.10 (95% CI, .91-1.32). MRSA SSTI rates by study group were 1.0 (95% CI, .70-1.42) for S, 1.29 (95% CI, .98-1.71) for ES, and 0.97 (95% CI, .70-1.36) for CHG. CONCLUSIONS: Personal hygiene and education measures, including once-weekly use of chlorhexidine body wash, did not prevent overall SSTI or MRSA SSTI in a high-risk population of military trainees. CLINICAL TRIALS REGISTRATION: NCT01105767. |
Adaptation of the African couples HIV testing and counseling model for men who have sex with men in the United States: an application of the ADAPT-ITT framework
Sullivan PS , Stephenson R , Grazter B , Wingood G , Diclemente R , Allen S , Hoff C , Salazar L , Scales L , Montgomery J , Schwartz A , Barnes J , Grabbe K . Springerplus 2014 3 (1) 249 To respond to the need for new HIV prevention services for men who have sex with men (MSM) in the United States, and to respond to new data on the key role of main partnerships in US MSM epidemics, we sought to develop a new service for joint HIV testing of male couples. We used the ADAPT-ITT framework to guide our work. From May 2009 to July 2013, a multiphase process was undertaken to identify an appropriate service as the basis for adaptation, collect data to inform the adaptation, adapt the testing service, develop training materials, test the adapted service, and scale up and evaluate the initial version of the service. We chose to base our adaptation on an African couples HIV testing service that was developed in the 1980s and has been widely disseminated in low- and middle-income countries. Our adaptation was informed by qualitative data collections from MSM and HIV counselors, multiple online surveys of MSM, information gathering from key stakeholders, and theater testing of the adapted service with MSM and HIV counselors. Results of initial testing indicate that the adapted service is highly acceptable to MSM and to HIV counselors, that there are no evident harms (e.g., intimate partner violence, relationship dissolution) associated with the service, and that the service identifies a substantial number of HIV serodiscordant male couples. The story of the development and scale-up of the adapted service illustrates how multiple public and foundation funding sources can collaborate to bring a prevention adaptation from concept to public health application, touching on research, program evaluation, implementation science, and public health program delivery. The result of this process is an adapted couples HIV testing approach, with training materials and handoff from academic partners to public health for assessment of effectiveness and consideration of the potential benefits of implementation; further work is needed to optimally adapt the African couples testing service for use with male-female couples in the United States. |
Cholera in the United States, 2001-2011: a reflection of patterns of global epidemiology and travel
Loharikar A , Newton AE , Stroika S , Freeman M , Greene KD , Parsons MB , Bopp C , Talkington D , Mintz ED , Mahon BE . Epidemiol Infect 2014 143 (4) 1-9 US cholera surveillance offers insight into global and domestic trends. Between 2001 and 2011, 111 cases were reported to the Centers for Disease Control and Prevention. Cholera was associated with international travel in 90 (81%) patients and was domestically acquired in 20 (18%) patients; for one patient, information was not available. From January 2001 to October 2010, the 42 (47%) travel-associated cases were associated with travel to Asia. In October 2010, a cholera epidemic started in Haiti, soon spreading to the Dominican Republic (Hispaniola). From then to December 2011, 40 (83%) of the 48 travel-associated cases were associated with travel to Hispaniola. Of 20 patients who acquired cholera domestically, 17 (85%) reported seafood consumption; 10 (59%) ate seafood from the US Gulf Coast. In summary, an increase in travel-associated US cholera cases was associated with epidemic cholera in Hispaniola in 2010-2011. Travel to Asia and consumption of Gulf Coast seafood remained important sources of US cholera cases. |
A systematic review of special events to promote breast, cervical and colorectal cancer screening in the United States
Escoffery C , Rodgers KC , Kegler MC , Haardorfer R , Howard DH , Liang S , Pinsker E , Roland KB , Allen JD , Ory MG , Bastani R , Fernandez ME , Risendal BC , Byrd TL , Coronado GD . BMC Public Health 2014 14 (1) 274 BACKGROUND: Special events are common community-based strategies for health promotion. This paper presents findings from a systematic literature review on the impact of special events to promote breast, cervical or colorectal cancer education and screening. METHODS: Articles in English that focused on special events involving breast, cervical, and/or colorectal cancer conducted in the U.S. and published between January 1990 and December 2011 were identified from seven databases: Ovid, Web of Science, CINAHL, PsycINFO, Sociological Abstract, Cochrane Libraries, and EconLit. Study inclusion and data extraction were independently validated by two researchers. RESULTS: Of the 20 articles selected for screening out of 1,409, ten articles on special events reported outcome data. Five types of special events were found: health fairs, parties, cultural events, special days, and plays. Many focused on breast cancer only, or in combination with other cancers. Reach ranged from 50-1732 participants. All special events used at least one evidence-based strategy suggested by the Community Guide to Preventive Services, such as small media, one-on-one education, and reducing structural barriers. For cancer screening as an outcome of the events, mammography screening rates ranged from 4.8% to 88%, Pap testing was 3.9%, and clinical breast exams ranged from 9.1% to 100%. For colorectal screening, FOBT ranged from 29.4% to 76%, and sigmoidoscopy was 100% at one event. Outcome measures included intentions to get screened, scheduled appointments, uptake of clinical exams, and participation in cancer screening. CONCLUSIONS: Special events found in the review varied and used evidence-based strategies. Screening data suggest that some special events can lead to increases in cancer screening, especially if they provide onsite screening services. However, there is insufficient evidence to demonstrate that special events are effective in increasing cancer screening. The heterogeneity of populations served, event activities, outcome variables assessed, and the reliance on self-report to measure screening limit conclusions. This study highlights the need for further research to determine the effectiveness of special events to increase cancer screening. |
Molecular detection of adenoviruses, rhabdoviruses, and paramyxoviruses in bats from Kenya.
Conrardy C , Tao Y , Kuzmin IV , Niezgoda M , Agwanda B , Breiman RF , Anderson LJ , Rupprecht CE , Tong S . Am J Trop Med Hyg 2014 91 (2) 258-266 We screened 217 bats of at least 20 species from 17 locations in Kenya during July and August of 2006 for the presence of adenovirus, rhabdovirus, and paramyxovirus nucleic acids using generic reverse transcription polymerase chain reaction (RT-PCR) and PCR assays. Of 217 bat fecal swabs examined, 4 bats were adenovirus DNA-positive, 11 bats were paramyxovirus RNA-positive, and 2 bats were rhabdovirus RNA-positive. Three bats were coinfected by two different viruses. By sequence comparison and phylogenetic analysis, the Kenya bat paramyxoviruses and rhabdoviruses from this study may represent novel viral lineages within their respective families; the Kenya bat adenoviruses could not be confirmed as novel, because the same region sequences from other known bat adenovirus genomes for comparison were lacking. Our study adds to previous evidence that bats carry diverse, potentially zoonotic viruses and may be coinfected with more than one virus. |
The macroecology of airborne pollen in Australian and New Zealand urban areas
Haberle SG , Bowman DM , Newnham RM , Johnston FH , Beggs PJ , Buters J , Campbell B , Erbas B , Godwin I , Green BJ , Huete A , Jaggard AK , Medek D , Murray F , Newbigin E , Thibaudon M , Vicendese D , Williamson GJ , Davies JM . PLoS One 2014 9 (5) e97925 The composition and relative abundance of airborne pollen in urban areas of Australia and New Zealand are strongly influenced by geographical location, climate and land use. There is mounting evidence that the diversity and quality of airborne pollen is substantially modified by climate change and land-use yet there are insufficient data to project the future nature of these changes. Our study highlights the need for long-term aerobiological monitoring in Australian and New Zealand urban areas in a systematic, standardised, and sustained way, and provides a framework for targeting the most clinically significant taxa in terms of abundance, allergenic effects and public health burden. |
Multistate outbreak of Salmonella enterica serotype Enteritidis infection associated with pet guinea pigs
Bartholomew ML , Heffernan RT , Wright JG , Klos RF , Monson T , Khan S , Trees E , Sabol A , Willems RA , Flynn R , Deasy MP , Jones B , Davis JP . Vector Borne Zoonotic Dis 2014 14 (6) 414-21 Salmonella causes about one million illnesses annually in the United States. Although most infections result from foodborne exposures, animal contact is an important mode of transmission. We investigated a case of Salmonella enterica serotype Enteritidis (SE) sternal osteomyelitis in a previously healthy child who cared for two recently deceased guinea pigs (GPs). A case was defined as SE pulsed-field gel electrophoresis (PFGE) XbaI pattern JEGX01.0021, BlnI pattern JEGA26.0002 (outbreak strain) infection occurring during 2010 in a patient who reported GP exposure. To locate outbreak strain isolates, PulseNet and the US Department of Agriculture National Veterinary Service Laboratories (NVSL) databases were queried. Outbreak strain isolates underwent multilocus variable-number tandem repeat analysis (MLVA). Traceback and environmental investigations were conducted at homes, stores, and breeder or broker facilities. We detected 10 cases among residents of eight states and four NVSL GP outbreak strain isolates. One patient was hospitalized; none died. The median patient age was 9.5 (range, 1-61) years. Among 10 patients, two purchased GPs at independent stores, and three purchased GPs at different national retail chain (chain A) store locations; three were chain A employees and two reported GP exposures of unknown characterization. MLVA revealed four related patterns. Tracebacks identified four distributors and 92 sources supplying GPs to chain A, including one breeder potentially supplying GPs to all case-associated chain A stores. All environmental samples were Salmonella culture-negative. A definitive SE-contaminated environmental source was not identified. Because GPs can harbor Salmonella, consumers and pet industry personnel should be educated regarding risks. |
Declines in large wildlife increase landscape-level prevalence of rodent-borne disease in Africa
Young HS , Dirzo R , Helgen KM , McCauley DJ , Billeter SA , Kosoy MY , Osikowicz LM , Salkeld DJ , Young TP , Dittmar K . Proc Natl Acad Sci U S A 2014 111 (19) 7036-41 Populations of large wildlife are declining on local and global scales. The impacts of this pulse of size-selective defaunation include cascading changes to smaller animals, particularly rodents, and alteration of many ecosystem processes and services, potentially involving changes to prevalence and transmission of zoonotic disease. Understanding linkages between biodiversity loss and zoonotic disease is important for both public health and nature conservation programs, and has been a source of much recent scientific debate. In the case of rodent-borne zoonoses, there is strong conceptual support, but limited empirical evidence, for the hypothesis that defaunation, the loss of large wildlife, increases zoonotic disease risk by directly or indirectly releasing controls on rodent density. We tested this hypothesis by experimentally excluding large wildlife from a savanna ecosystem in East Africa, and examining changes in prevalence and abundance of Bartonella spp. infection in rodents and their flea vectors. We found no effect of wildlife removal on per capita prevalence of Bartonella infection in either rodents or fleas. However, because rodent and, consequently, flea abundance doubled following experimental defaunation, the density of infected hosts and infected fleas was roughly twofold higher in sites where large wildlife was absent. Thus, defaunation represents an elevated risk in Bartonella transmission to humans (bartonellosis). Our results (i) provide experimental evidence of large wildlife defaunation increasing landscape-level disease prevalence, (ii) highlight the importance of susceptible host regulation pathways and host/vector density responses in biodiversity-disease relationships, and (iii) suggest that rodent-borne disease responses to large wildlife loss may represent an important context where this relationship is largely negative. |
Prenatal polybrominated diphenyl ether exposures and neurodevelopment in U.S. children through 5 years of age: the HOME study
Chen A , Yolton K , Rauch SA , Webster GM , Hornung R , Sjodin A , Dietrich KN , Lanphear BP . Environ Health Perspect 2014 122 (8) 856-62 BACKGROUND: Polybrominated diphenyl ethers (PBDEs) are persistent chemicals that were widely used as flame retardants in furniture, carpet padding, car seats and other consumer products over the past three decades. OBJECTIVE: To examine whether in utero exposure to PBDEs is associated with child cognitive function and behavior in a U.S. study sample. METHODS: In a prospective birth cohort, we measured maternal serum concentrations of BDE-47 and other PBDE congeners in 309 women at 16 weeks of gestation during 2003-2006 and followed their children in Cincinnati, Ohio. We measured cognitive and motor abilities using the Bayley Scales of Infant Development-II at ages 1, 2, 3 years; intelligence using the Wechsler Preschool and Primary Scale of Intelligence-III at age 5 years; and children's behaviors using the Behavioral Assessment System for Children-2 annually at ages 2-5 years. We used linear mixed models or Generalized Estimating Equations with adjustment for potential confounders to estimate associations between these outcomes and log10-transformed PBDE concentrations. RESULTS: The geometric mean of BDE-47 in maternal serum (20.1 ng/g lipid) was comparable to U.S. adult national reference values. Prenatal BDE-47 was not significantly associated with Bayley Mental or Psychomotor Development Indices at 1-3 years, but a ten-fold increase in prenatal BDE-47 was associated with a 4.5-point decrease (95% CI: -8.8, -0.1) in Full Scale IQ and a 3.3-point increase (95% CI: 0.3, 6.3) in the hyperactivity score at age 5 years. CONCLUSIONS: Prenatal exposure to PBDEs was associated with lower IQ and higher hyperactivity scores in children. |
ESR evidence for in vivo formation of free radicals in tissue of mice exposed to single-walled carbon nanotubes
Shvedova AA , Kisin ER , Murray AR , Mouithys-Mickalad A , Stadler K , Mason RP , Kadiiska M . Free Radic Biol Med 2014 73 154-65 Nanomaterials are being utilized in an increasing variety of manufactured goods. Because of their unique physico-chemical, electrical, mechanical and thermal properties, single walled carbon nanotubes (SWCNTs) have found numerous applications in the electronics, aerospace, chemical, polymer and pharmaceutical industries. Previously, we have reported that pharyngeal exposure of C57BL/6 mice to SWCNTs caused dose-dependent formation of granulomatous bronchial interstitial pneumonia, fibrosis, oxidative stress, acute inflammatory/cytokine responses and a decrease in pulmonary function. In the current study, we used electron spin resonance (ESR) to directly assess whether exposure to respirable SWCNTs caused formation of free radicals in the lungs and in two distant organs, the heart and liver. Here we report that exposure to partially purified SWCNTs (HiPco, CNI, Inc, TX) resulted in the augmentation of oxidative stress as evidenced by ESR detection of a-(4-pyridyl-1-oxide)-N-tert-butylnitrone (POBN) spin-trapped carbon-centered lipid-derived radicals recorded shortly after the treatment. This was accompanied by a significant depletion of antioxidants and elevated biomarkers of inflammation presented by recruitment of inflammatory cells and an increase in pro-inflammatory cytokines in the lungs, as well as development of multifocal granulomatous pneumonia, interstitial fibrosis and suppressed pulmonary function. Moreover, pulmonary exposure to SWCNTs also caused the formation of carbon-centered lipid-derived radicals in the heart and liver at later time points (day 7 post exposure). Additionally, SWCNTs induced a significant accumulation of oxidatively modified proteins, an increase in lipid peroxidation products, depletion of antioxidants and an inflammatory response in both the heart and the liver. Furthermore, the iron chelator deferoxamine (DFO) noticeably reduced lung inflammation and oxidative stress indicating an important role of metal-catalyzed species in lung injury caused by SWCNTs. Overall, we provided direct evidence that lipid-derived free radicals are a critical contributor to tissue damge induced by SWCNTs not only in the lungs, but in distant organs. |
Health assessment of gasoline and fuel oxygenate vapors: neurotoxicity evaluation
O'Callaghan JP , Daughtrey WC , Clark CR , Schreiner CA , White R . Regul Toxicol Pharmacol 2014 70 S35-42 Sprague Dawley rats were exposed via inhalation to vapor condensates of either gasoline or gasoline combined with various fuel oxygenates to assess potential neurotoxicity of evaporative emissions. Test articles included vapor condensates prepared from "baseline gasoline" (BGVC), or gasoline combined with methyl tertiary butyl ether (G/MTBE), ethyl t-butyl ether (G/ETBE), t-amyl methyl ether (G/TAME), diisopropyl ether (G/DIPE), ethanol (G/EtOH), or t-butyl alcohol (G/TBA). Target concentrations were 0, 2000, 10000 or 20000 mg/mg3 and exposures were for 6 hours/day, 5 days/wk for 13 wks. The functional observation battery (FOB) with the addition of motor activity (MA) testing, hematoxylin and eosin staining of brain tissue sections, and brain regional analysis of glial fibrillary acidic protein (GFAP) were used to assess behavioral changes, traditional neuropathology and astrogliosis, respectively. FOB and MA data for all agents, except G/TBA, were negative. G/TBA behavioral effects resolved during recovery. Neuropathology was negative for all groups. Analyses of GFAP revealed increases in multiplebrain regions largely limited to males of the G/EtOH group, findings indicative of minor gliosis, most significantly in the cerebellum. Small changes (both increases and decreases) in GFAP were observed for other test agents but effects were not consistent across sex, brain region or exposure concentration. |
Campylobacter fetus infections in humans: exposure and disease
Wagenaar JA , van Bergen MA , Blaser MJ , Tauxe RV , Newell DG , van Putten JP . Clin Infect Dis 2014 58 (11) 1579-86 Campylobacter fetus can cause intestinal illness and, occasionally, severe systemic infections. Infections mainly affect persons at higher risk, including elderly and immunocompromised individuals and those with occupational exposure to infected animals. Outbreaks are infrequent but have provided insight into sources. Source attribution of sporadic cases through case-control interviews has not been reported. The reservoirs for C. fetus are mainly cattle and sheep. Products from these animals are suspected as sources for human infections. Campylobacter fetus is rarely isolated from food, albeit selective isolation methods used in food microbiology are not suited for its detection. We hypothesize that the general population is regularly exposed to C. fetus through foods of animal origin, cross-contaminated foodstuffs, and perhaps other, as yet unidentified, routes. Campylobacter fetus infection should be suspected particularly in patients with nonspecific febrile illness who are immunocompromised or who may have been occupationally exposed to ruminants. |
Translational research is a key to nongeneticist physicians' genomics education.
Feero WG , Manolio TA , Khoury MJ . Genet Med 2014 16 (12) 871-3 Several recent publications detailing the clinical application of next-generation sequencing technologies mark a milestone in the journey from base pairs to the bedside.1,2 A technology assessment by a major insurer lends credence to the idea that the clinical use of sequencing technologies is no longer viewed as a research endeavor.3 The expansion of the clinical application of new sequencing technologies raises a wide range of complex issues in the health-care system.4 Recently, Manolio and Murray5 described the outcomes of a workshop convened by the National Human Genome Research Institute to discuss the growing opportunities for educating nongeneticist physicians and other health-care providers in genomics. As a result of the workshop, an Inter-Society Coordinating Committee on Practitioner Education in Genomics was formed to facilitate interactions among professional societies intended to increase the expertise of practitioners in applying genomics in clinical care. This represents a renewed US national attempt to increase genomics competency among a key group of critical decision makers. In this commentary, we explore some of the key contextual issues that are likely to mediate genomics educational demand and ultimately determine the success of genomics educational programs for nongeneticist health professionals, especially physicians. | Physicians comprise a highly heterogeneous population. In the United States alone, there are 24 medical specialties recognized by the American Board of Medical Specialties and hundreds of professional societies and organizations that play a role in the educational pipeline of physicians from undergraduate education through retirement. Widespread adoption of even simple interventions with the best evidence of health benefits—such as ensuring that aspirin and β-blockers are routinely employed in secondary prevention of coronary heart disease—is surprisingly difficult to attain. Genomic science and the clinical technologies that have arisen from its application are dauntingly complex, leading a former director of the National Heart Lung and Blood Institute of the National Institutes of Health to quip regarding the translation of genomic discoveries to patient care, “If we didn’t do it with aspirin, how can we expect to do it with DNA?”6 Genomics has the additional burden of attempting to rise to the surface in a tumult of healthcare system changes. |
Draft Genome Sequence of Bacillus cereus Strain BcFL2013, a Clinical Isolate Similar to G9241.
Gee JE , Marston CK , Sammons SA , Burroughs MA , Hoffmaster AR . Genome Announc 2014 2 (3) Bacillus cereus strains, such as G9241, causing anthrax-like illnesses have recently been discovered. We report the genome sequence of a clinical strain, B. cereus BcFL2013, which is similar to G9241, recovered from a patient in Florida. |
Evaluation of the impact of a simple hand-washing and water-treatment intervention in rural health facilities on hygiene knowledge and reported behaviours of health workers and their clients, Nyanza Province, Kenya, 2008
Sreenivasan N , Gotestrand SA , Ombeki S , Oluoch G , Fischer TK , Quick R . Epidemiol Infect 2014 143 (4) 1-8 Many clinics in rural western Kenya lack access to safe water and hand-washing facilities. To address this problem, in 2005 a programme was initiated to install water stations for hand washing and drinking water in 109 health facilities, train health workers on water treatment and hygiene, and motivate clients to adopt these practices. In 2008, we evaluated this intervention's impact by conducting observations at facilities, and interviewing staff and clients about water treatment and hygiene. Of 30 randomly selected facilities, 97% had water stations in use. Chlorine residuals were detectable in at least one container at 59% of facilities. Of 164 interviewed staff, 79% knew the recommended water-treatment procedure. Of 298 clients, 45% had received training on water treatment at a facility; of these, 68% knew the recommended water-treatment procedure. Use of water stations, water treatment, and client training were sustained in some facilities for up to 3 years. |
Invasive group A Streptococcus infections associated with liposuction surgery at outpatient facilities not subject to state or federal regulation
Beaudoin AL , Torso L , Richards K , Said M , Van Beneden C , Longenberger A , Ostroff S , Wendt J , Dooling K , Wise M , Blythe D , Wilson L , Moll M , Perz JF . JAMA Intern Med 2014 174 (7) 1136-42 IMPORTANCE: Liposuction is one of the most common cosmetic surgery procedures in the United States. Tumescent liposuction, in which crystalloid fluids, lidocaine, and epinephrine are infused subcutaneously before cannula-assisted aspiration of fat, can be performed without intravenous or general anesthesia, often at outpatient facilities. However, some of these facilities are not subject to state or federal regulation and may not adhere to appropriate infection control practices. OBJECTIVE: To describe an outbreak of severe group A Streptococcus (GAS) infections among persons undergoing tumescent liposuction at 2 outpatient cosmetic surgery facilities not subject to state or federal regulation. DESIGN: Outbreak investigation (including cohort analysis of at-risk patients), interviews using a standardized questionnaire, medical record review, facility assessment, and laboratory analysis of GAS isolates. SETTING AND PARTICIPANTS: Patients undergoing liposuction at 2 outpatient facilities, one in Maryland and the other in Pennsylvania, between July 1 and September 14, 2012. MAIN OUTCOMES AND MEASURES: Confirmed invasive GAS infections (isolation of GAS from a normally sterile site or wound of a patient with necrotizing fasciitis or streptococcal toxic shock syndrome), suspected GAS infections (inflamed surgical site and either purulent discharge or fever and chills in a patient with no alternative diagnosis), postsurgical symptoms and patient-reported experiences related to his or her procedure, and emm types, T-antigen types, and antimicrobial susceptibility of GAS isolates. RESULTS: We identified 4 confirmed cases and 9 suspected cases, including 1 death (overall attack rate, 20% [13 of 66]). One instance of likely secondary GAS transmission to a household member occurred. All confirmed case patients had necrotizing fasciitis and had undergone surgical debridement. Procedures linked to illness were performed by a single surgical team that traveled between the 2 locations; 2 team members (1 of whom reported recent cellulitis) were colonized with a GAS strain that was indistinguishable by laboratory analysis of the isolates from the case patients. Facility assessments and patient reports indicated substandard infection control, including errors in equipment sterilization and infection prevention training. CONCLUSIONS AND RELEVANCE: This outbreak of severe GAS infections was likely caused by transmission from colonized health care workers to patients during liposuction procedures. Additional oversight of outpatient cosmetic surgery facilities is needed to assure that they maintain appropriate infection control practices and other patient protections. |
Progress toward polio eradication - worldwide, 2013-2014
Moturi EK , Porter KA , Wassilak SG , Tangermann RH , Diop OM , Burns CC , Jafari H . MMWR Morb Mortal Wkly Rep 2014 63 (21) 468-72 In 1988, the World Health Assembly of the World Health Organization (WHO) resolved to interrupt wild poliovirus (WPV) transmission worldwide, and in 2012, the World Health Assembly declared the completion of global polio eradication a programmatic emergency for public health. By 2013, the annual number of WPV cases had decreased by >99% since 1988, and only three countries remained that had never interrupted WPV transmission: Afghanistan, Nigeria, and Pakistan. This report summarizes global progress toward polio eradication during 2013-2014 and updates previous reports. In 2013, a total of 416 WPV cases were reported globally from eight countries, an 86% increase from the 223 WPV cases reported from five countries in 2012. This upsurge in 2013 was caused by a 60% increase in WPV cases detected in Pakistan, and by outbreaks in five previously polio-free countries resulting from international spread of WPV. In 2014, as of May 20, a total of 82 WPV cases had been reported worldwide, compared with 34 cases during the same period in 2013. Polio cases caused by circulating vaccine-derived poliovirus (cVDPV) were detected in eight countries in 2013 and in two countries so far in 2014. To achieve polio eradication in the near future, further efforts are needed to 1) address health worker safety concerns in areas of armed conflict in priority countries, 2) to prevent further spread of WPV and new outbreaks after importation into polio-free countries, and 3) to strengthen surveillance globally. Based on the international spread of WPV to date in 2014, the WHO Director General has issued temporary recommendations to reduce further international exportation of WPV through vaccination of persons traveling from currently polio-affected countries. |
Etiology of childhood diarrhea following rotavirus vaccine introduction: a prospective, population-based study in Nicaragua
Becker-Dreps S , Bucardo F , Vilchez S , Zambrana LE , Liu L , Weber DJ , Pena R , Barclay L , Vinje J , Hudgens MG , Nordgren J , Svensson L , Morgan DR , Espinoza F , Paniagua M . Pediatr Infect Dis J 2014 33 (11) 1156-63 BACKGROUND: Nicaragua was the first developing nation to implement routine immunization with the pentavalent rotavirus vaccine (RV5). In this RV5-immunized population, understanding infectious etiologies of childhood diarrhea is necessary to direct diarrhea treatment and prevention efforts. METHODS: We followed a population-based sample of children less than 5 years in Leon, Nicaragua for diarrhea episodes through household visits. Information was obtained on RV5 history and sociodemographics. Stool samples collected during diarrhea episodes and among healthy children underwent laboratory analysis for viral, bacterial, and parasitic enteropathogens. Detection frequency and incidence of each enteropathogen was calculated. RESULTS: The 826 children in the cohort experienced 677 diarrhea episodes during 607.5 child-years of exposure time (1.1 episodes per child-year). At least one enteropathogen was detected among 61.1% of the 337 diarrheal stools collected. The most common enteropathogens among diarrheal stools were: norovirus (20.4%), sapovirus (16.6%), enteropathogenic Escherichia coli (EPEC, 11.3%), Entamoeba histolytica/dispar (8.3%), Giardia lamblia (8.0%), and enterotoxigenic E.coli (ETEC, 7.7%), with rotavirus detected among 5.3% of diarrheal stools. EPEC and ETEC were frequently detected among stools from healthy children. Among children with diarrhea, norovirus was more commonly detected among younger children (< 2 years) and G. lamblia was more commonly detected among older children (2-4 years). The mean age of rotavirus detection was 34.6 months. CONCLUSIONS: In this Central American community following RV5 introduction, rotavirus was not commonly detected among children with diarrhea. Prevention and appropriate management of norovirus and sapovirus should be considered to further reduce the burden of diarrheal disease. |
The impact of pre-existing antibody on subsequent immune responses to meningococcal A-containing vaccines
Idoko OT , Okolo SN , Plikaytis B , Akinsola A , Viviani S , Borrow R , Carlone G , Findlow H , Elie C , Kulkarni PS , Preziosi MP , Ota M , Kampmann B . Vaccine 2014 32 (33) 4220-7 Major epidemics of serogroup A meningococcal meningitis continue to affect the African meningitis belt. The development of an affordable conjugate vaccine against the disease became a priority for World Health Organization (WHO) in the late 1990s. Licensing of meningococcal vaccines has been based on serological correlates of protection alone, but such correlates might differ in different geographical regions. If high pre-vaccination antibody concentrations/titers impacts on the response to vaccination and possibly vaccine efficacy, is not clearly understood. We set out to define the pre-vaccination Meningococcal group A (Men A) antibody concentrations/titers in The Gambia and study their impact on the immunogenicity of Men A containing vaccines. Data from subjects originally enrolled in studies to test the safety and immunogenicity of the MenA vaccine recently developed for Africa meningococcal A polysaccharide conjugated to tetanus toxoid, MenAfriVac(R) (PsA-TT) were analyzed. Participants had been randomized to receive either the study vaccine PsA-TT or the reference quadrivalent plain polysaccharide vaccine containing meningococcal groups A, C, W, and Y, Mencevax(R) ACWY, GlaxoSmithKline (PsACWY) in a 2:1 ratio. Venous blood samples were collected before and 28 days after vaccination. Antibodies were assayed by enzyme-linked immunosorbent assay (ELISA) for geometric mean concentrations and serum bactericidal antibody (SBA) for functional antibody. The inter age group differences were compared using ANOVA and the pre and post-vaccination differences by t test. Over 80% of the ≥19 year olds had pre-vaccination antibody concentrations above putatively protective concentrations as compared to only 10% of 1-2 year olds. Ninety-five percent of those who received the study vaccine had ≥4-fold antibody responses if they had low pre-vaccination concentrations compared to 76% of those with high pre-vaccination concentrations. All subjects with low pre-vaccination titers attained ≥4-fold responses as compared to 76% with high titers where study vaccine was received. Our data confirm the presence of high pre-vaccination Men A antibody concentrations/titers within the African meningitis belt, with significantly higher concentrations in older individuals. Although all participants had significant increase in antibody levels following vaccination, the four-fold or greater response in antibody titers were significantly higher in individuals with lower pre-existing antibody titers, especially after receiving PsA-TT. This finding may have some implications for vaccination strategies adopted in the future. |
Serodiagnosis as adjunct assay for pertussis infection in Sao Paulo, Brazil
Vaz-de-Lima LR , Martin MD , Pawloski LC , Leite D , Rocha KC , de Brito CA , Vaz TM , Martins LM , Alvarenga DP , Ribeiro AF , Carvalhanas TR , Nakasaki RM , Oliveira SS , Waldman EA , Tondella ML . Clin Vaccine Immunol 2014 21 (5) 636-40 Pertussis remains an important public health problem in many countries despite extensive immunization. Cultures and real-time PCR (RT-PCR) assays are the recommended pertussis diagnostic tests, but they lack sensitivity at the later stage of the disease. This study introduces the IgG anti-pertussis toxin enzyme-linked immunosorbent assay (PT ELISA) in our routine diagnosis to improve disease burden estimation. Serum samples and nasopharyngeal swabs (n = 503) were collected at the same time from patients presenting with cough illness suspected of being pertussis and tested by the PT ELISA and culture and/or RT-PCR, respectively. Patients were separated into three age groups: group 1, <1 year (n = 260; mean age, 3 months), group 2, 1 to 6 years (n = 81; mean age, 3 years), and group 3, ≥7 years (n = 162; mean age, 26 years). The times (means) from cough onset to specimen collection were 16, 24, and 26 days, respectively. In group 1, 83 (82.2%) of 101 positive cases were positive for pertussis by culture/RT-PCR, while 40 (39.6%) tested positive by PT ELISA. In group 2, 6 (19.4%) of 31 positive cases were culture/RT-PCR positive, and 29 (93.6%) were seropositive. In group 3, 13 (13.8%) of 94 positive cases were positive by culture/RT-PCR and 91 (96.8%) were positive by serology. Culture/RT-PCR detected more cases of pertussis in infants (P < 0.0001), whereas the PT ELISA detected more cases in adolescents and adults (P < 0.0001). The timing between cough onset and specimen collection or recent vaccination may have partially affected our results. Serology is a suitable, cost-effective, and complementary pertussis diagnostic tool, especially among older children, adolescents, and adults during the later disease phase. |
IgM, IgG, and IgA antibody responses to influenza A(H1N1)pdm09 hemagglutinin in infected persons during the first wave of the 2009 pandemic in the United States
Li ZN , Lin SC , Carney PJ , Li J , Liu F , Lu X , Liu M , Stevens J , Levine M , Katz JM , Hancock K . Clin Vaccine Immunol 2014 21 (8) 1054-60 Novel influenza A(H1N1)pdm09 virus caused an influenza pandemic in 2009. IgM, IgG, and IgA antibody responses to A(H1N1)pdm09 hemagglutinin (HA) following A(H1N1)pdm09 virus infection were analyzed to understand antibody isotype responses. Age-matched control sera collected from U.S. residents in 2007 and 2008 were used to establish baseline levels of cross-reactive antibodies. IgM responses often used as an indicator of primary virus infection were mainly detected in young patient groups (≤5 yrs and 6-15 yrs), not in older age group, despite the genetic and antigenic differences between the HA of A(H1N1)pdm09 virus and pre-2009 seasonal H1N1 viruses. IgG and IgA responses to A(H1N1)pdm09 HA were detected in all age groups of infected persons. In persons aged 17-80 years, paired acute and convalescent serum samples demonstrated a four-fold or greater increase in the IgG and IgA responses to A(H1N1)pdm09 HA in 80% and 67% of A(H1N1)pdm09 virus-infected persons, respectively. The IgG antibody response to A(H1N1)pdm09 HA was cross-reactive with HAs from H1, H3, H5, and H13 subtypes suggesting that infections with subtypes other than A(H1N1)pdm09 could result in false positives by ELISA. Lower sensitivity compared to hemagglutination inhibition and microneutralization assays and the detection of cross-reactive antibodies against homologous and heterologous subtype are major drawback for application of ELISA in influenza serologic studies. |
In the United States, a mother's plans for infant feeding are associated with her plans for employment
Mirkovic KR , Perrine CG , Scanlon KS , Grummer-Strawn LM . J Hum Lact 2014 30 (3) 292-297 BACKGROUND: The American Academy of Pediatrics recommends 6 months of exclusive breastfeeding, however, only 16% of US infants meet this recommendation. Shorter exclusive/predominant breastfeeding durations have been observed from women who return to work early and/or full-time. OBJECTIVE: We assessed the relationship between prenatal plans for maternity leave duration and return to full-time/part-time status and plans for exclusive breastfeeding. METHODS: This study included 2348 prenatally employed women from the Infant Feeding Practices Study II (2005-2007) who planned to return to work in the first year postpartum. Bivariate analysis and logistic regression were used to describe the association of maternity leave duration and return status with plans for infant feeding. RESULTS: Overall, 59.5% of mothers planned to exclusively breastfeed in the first few weeks. Mothers planning to return to work within 6 weeks had 0.60 times the odds (95% confidence interval [CI], 0.46-0.77) and mothers planning to return between 7 and 12 weeks had 0.72 times the odds (95% CI, 0.56-0.92) of planning to exclusively breastfeed compared with mothers who were planning to return after 12 weeks. Prenatal plans to return full-time (≥ 30 hours/week vs part-time) were also associated with lower odds of planning to exclusively breastfeed (adjusted odds ratio = 0.61; 95% CI, 0.51-0.77). CONCLUSION: Mothers planning to return to work before 12 weeks and/or full-time were less likely to plan to exclusively breastfeed. Longer maternity leave and/or part-time return schedules may increase the proportion of mothers who plan to exclusively breastfeed. |
Congenital cytomegalovirus-related hospitalizations in infants <1 year of age, United States, 1997-2009
Lopez AS , Ortega-Sanchez IR , Bialek SR . Pediatr Infect Dis J 2014 33 (11) 1119-23 BACKGROUND: An estimated 3,600 infants born with congenital cytomegalovirus (cCMV) infection annually in the United States (US) are symptomatic at birth. The proportion of infants with symptomatic cCMV infection who require hospitalization is unknown yet important for understanding the full disease and economic burdens of cCMV. METHODS: Data from the Healthcare Cost and Utilization Project Kids' Inpatient Databases were analyzed to determine numbers and rates of cCMV-related hospitalizations among infants for 1997, 2000, 2003, 2006 and 2009, the years the survey was conducted. A cCMV-related hospitalization was defined as a hospitalization with an ICD-9 code of 771.1 in an infant without HIV or transplant-related codes. After applying hospital type-specific cost-to-charge ratios and adjusting to 2012 US dollars, total medical costs associated with cCMV-related hospitalizations were assessed. Results were extrapolated to represent national estimates. RESULTS: Among infants <1 year of age in the United States, an estimated annual average of 747 cCMV-related hospitalizations (18.6/100,000 per year) were coded during the five study years; 408 (55%) were among infants <1 month of age (122.0/100,000 per year). Approximately 4% of hospitalizations among infants <1 year resulted in death. Total estimated annual costs associated with cCMV-related hospitalizations among US infants <1 year was at least $14.3 million. CONCLUSIONS: cCMV infection is associated with substantial numbers of hospitalizations, medical costs, and mortality among US infants. The true burden and costs of cCMV disease are likely much higher than our estimates when underascertainment of cCMV and total costs related to services and hospitalizations beyond the first year of life are considered. |
Consumption of sugar-sweetened beverages among US adults in 6 states: Behavioral Risk Factor Surveillance System, 2011
Park S , Pan L , Sherry B , Blanck HM . Prev Chronic Dis 2014 11 E65 INTRODUCTION: Sugar-sweetened beverage (SSB) intake is linked to weight gain. Our objective was to examine state-specific SSB intake and behavioral characteristics associated with SSB intake. METHODS: We used data from the 2011 Behavioral Risk Factor Surveillance System for 38,978 adults aged 18 years or older from 6 states: Delaware, Hawaii, Iowa, Minnesota, New Jersey, and Wisconsin. Multivariate logistic regression was used to estimate adjusted odds ratios for characteristics associated with SSB intake from regular soda and fruit drinks. RESULTS: Overall, 23.9% of adults drank SSBs at least once a day. Odds of drinking SSBs 1 or more times per day were significantly greater among younger adults; males; non-Hispanic blacks; adults with lower education; low-income adults or adults with missing income data; adults living in Delaware, Iowa, and Wisconsin versus those living in Minnesota; adults with fruit intake of less than 1 time a day versus 1 or more times a day; adults who were physically inactive versus highly active adults; and current smokers versus nonsmokers. Odds for drinking SSBs 1 or more times per day were significantly lower among adults with 100% fruit juice intake of less than 1 time per day versus 1 or more times per day and among adults who drank alcohol versus those who did not drink alcohol. CONCLUSION: SSB intake varied by states and certain sociodemographic and behavioral characteristics. States can use findings from this study to tailor efforts to decrease SSB intake and to encourage consumption of more healthful beverages (eg, water) among their high-risk populations. |
Metrological assessment of a portable analyzer for monitoring the particle size distribution of ultrafine particles
Stabile L , Cauda E , Marini S , Buonanno G . Ann Occup Hyg 2014 58 (7) 860-76 Adverse health effects caused by worker exposure to ultrafine particles have been detected in recent years. The scientific community focuses on the assessment of ultrafine aerosols in different microenvironments in order to determine the related worker exposure/dose levels. To this end, particle size distribution measurements have to be taken along with total particle number concentrations. The latter are obtainable through hand-held monitors. A portable particle size distribution analyzer (Nanoscan SMPS 3910, TSI Inc.) was recently commercialized, but so far no metrological assessment has been performed to characterize its performance with respect to well-established laboratory-based instruments such as the scanning mobility particle sizer (SMPS) spectrometer. The present paper compares the aerosol monitoring capability of the Nanoscan SMPS to the laboratory SMPS in order to evaluate whether the Nanoscan SMPS is suitable for field experiments designed to characterize particle exposure in different microenvironments. Tests were performed both in a Marple calm air chamber, where fresh diesel particulate matter and atomized dioctyl phthalate particles were monitored, and in microenvironments, where outdoor, urban, indoor aged, and indoor fresh aerosols were measured. Results show that the Nanoscan SMPS is able to properly measure the particle size distribution for each type of aerosol investigated, but it overestimates the total particle number concentration in the case of fresh aerosols. In particular, the test performed in the Marple chamber showed total concentrations up to twice those measured by the laboratory SMPS-likely because of the inability of the Nanoscan SMPS unipolar charger to properly charge aerosols made up of aggregated particles. Based on these findings, when field test exposure studies are conducted, the Nanoscan SMPS should be used in tandem with a condensation particle counter in order to verify and correct the particle size distribution data. |
Roof instability: what reportable noninjury roof falls in underground coal mines can tell us
Bajpayee TS , Pappas DM , Ellenberger JL . Prof Saf 2014 59 (3) 57-62 Roof falls are a major hazard in underground mining. Roof bolting is the primary means of supporting the mine roof in underground coal mines. Despite great strides in the design of support systems, roof falls continue to occur in bolted areas. Noninjury roof fall reports provide insight into the characteristics of roof falls. This study examined 11,600 noninjury roof fall reports to identify geological contributors to roof falls. The goal is to provide data that can help improve roof-fall-related safety by providing direction for the research and development of improved support systems and mine layout alternatives. |
Application of fatigue management systems: small mines and low technology solutions
Eiter BM , Steiner L , Kelhart A . Min Eng 2014 66 (4) 69-75 The impact of fatigue is seen not only in its effect on job performance of haul truck operators but also on the health of the operator and the productivity at the mine site. Its impact can even extend outside of the mine site to the health and well-being of the surrounding community (Fourie et al., 2010). In this paper, a case study of a small surface mining organization is presented. The goal is to highlight the fatigue risk management system implemented at the studied mine site. Mine safety personnel who were interviewed discuss the changes made to the infrastructure of the mine, to administrative areas such as the number of shifts and the use of vacation time, as well as the implementation of new technology into haulage vehicles. This paper reviews how these changes are supported in the research literature. |
The origin and diversification of the merozoite surface protein 3 (msp3) multi-gene family in Plasmodium vivax and related parasites.
Rice BL , Acosta MM , Pacheco MA , Carlton JM , Barnwell JW , Escalante AA . Mol Phylogenet Evol 2014 78 172-84 The genus Plasmodium is a diversified group of parasites with more than 200 known species that includes those causing malaria in humans. These parasites use numerous proteins in a complex process that allows them to invade the red blood cells of their vertebrate hosts. Many of those proteins are part of multi-gene families; one of which is the merozoite surface protein-3 (msp3) family. The msp3 multi-gene family is considered important in the two main human parasites, Plasmodium vivax and Plasmodium falciparum, as its paralogs are simultaneously expressed in the blood stage (merozoite) and are immunogenic. There are large differences among Plasmodium species in the number of paralogs in this family. Such differences have been previously explained, in part, as adaptations that allow the different Plasmodium species to invade their hosts. To investigate this, we characterized the array containing msp3 genes among several Plasmodium species, including P. falciparum and P. vivax. We first found no evidence indicating that the msp3 family of P. falciparum was homologous to that of P. vivax. Subsequently, by focusing on the diverse clade of nonhuman primate parasites to which P. vivax is closely related, where homology was evident, we found no evidence indicating that the interspecies variation in the number of paralogs was an adaptation related to changes in host range or host switches. Overall, we hypothesize that the evolution of the msp3 family in P. vivax is consistent with a model of multi-allelic diversifying selection where the paralogs may have functionally redundant roles in terms of increasing antigenic diversity. Thus, we suggest that the expressed MSP3 proteins could serve as "decoys", via antigenic diversity, during the critical process of invading the host red blood cells. |
Testicular swelling due to lymphatic filariasis after brief travel to Haiti
Marcos LA , Shapley NP , Eberhard M , Epstein JI , Fox LM , Magill A , Nutman TB . Am J Trop Med Hyg 2014 91 (1) 89-91 After 6 months of a trip to Haiti, a 25-year-old healthy man presented with a 6-week history of a very slow progressive intermittent bilateral testicular pain and swelling. The biopsies in both testicles revealed the presence of a dead filarial parasite. Polymerase chain reaction products of the DNA from the biopsy were shown to have a 100% identity to Wuchereria bancrofti. Despite being uncommon in travelers, this presentation of W. bancrofti highlights the possibility of acquiring W. bancrofti during short-term trips to highly endemic regions of the world (i.e., Haiti). |
Neglected parasitic infections: what every family physician needs to know
Woodhall D , Jones JL , Cantey PT , Wilkins PP , Montgomery SP . Am Fam Physician 2014 89 (10) 803-11 Neglected parasitic infections, including Chagas disease, toxocariasis, cysticercosis, and toxoplasmosis, affect millions of persons in the United States. Relatively few resources have been devoted to surveillance, prevention, and treatment of these diseases. Chagas disease primarily affects Latin American immigrants and can cause heart failure and death if not treated. Immediate antiparasitic treatment is indicated for most patients with acute Chagas disease. Treatment is recommended for patients younger than 18 years who have chronic Chagas disease and is generally recommended for adults younger than 50 years who do not have advanced cardiomyopathy; treatment decisions for other patients should be made on an individual basis. Toxocariasis primarily affects children and can cause gastrointestinal, respiratory, and ophthalmologic disease. Treatment options include albendazole and mebendazole. Patients with ocular infection require referral to an ophthalmologist. Neurocysticercosis, a form of cysticercosis, is the most common infectious cause of seizures in some parts of the United States. Initial treatment should focus on symptom control. Humans generally acquire toxoplasmosis by eating undercooked contaminated meat or ingesting things that have been contaminated with cat feces. Congenital infection can result in miscarriage or adverse fetal effects. Treatment is recommended for immunosuppressed persons, pregnant women, and immunocompetent persons with severe symptoms. |
An evaluation of methods for assessing the quality of case management for inpatients with malaria in Benin
Mace KE , Gueye AS , Lynch MF , Tassiba EM , Rowe AK . Am J Trop Med Hyg 2014 91 (2) 354-60 To improve healthcare quality for hospitalized patients with malaria in Benin, a feasible and valid evaluation method is needed. Because observation of inpatients is challenging, chart abstraction is an attractive option. However, the quality of inpatient charts is unknown. We employed three methods in five hospitals to assess 11 signs of malaria and severe disease: 1) chart abstraction (probability sample of inpatients), 2) chart abstraction compared to interviews of inpatients and health workers (HWs), and 3) abstraction from charts of recently discharged inpatients compared to interviews with HWs. Method 1 showed that of 473 malaria signs (from 43 charts), 178 (38%, 95% confidence interval 24-51%) were documented. Method 2 showed that 96% (45 of 47) of documented signs were valid. Method 3 suggests that 65% (36 of 55) of non-documented signs were assessed (but not documented) by HWs. Chart abstraction was feasible and documented data were valid, but results should be interpreted cautiously in consideration of low levels of documentation. |
Exposure to multiple parasites is associated with the prevalence of active convulsive epilepsy in sub-Saharan Africa
Kamuyu G , Bottomley C , Mageto J , Lowe B , Wilkins PP , Noh JC , Nutman TB , Ngugi AK , Odhiambo R , Wagner RG , Kakooza-Mwesige A , Owusu-Agyei S , Ae-Ngibise K , Masanja H , Osier FH , Odermatt P , Newton CR . PLoS Negl Trop Dis 2014 8 (5) e2908 BACKGROUND: Epilepsy is common in developing countries, and it is often associated with parasitic infections. We investigated the relationship between exposure to parasitic infections, particularly multiple infections and active convulsive epilepsy (ACE), in five sites across sub-Saharan Africa. METHODS AND FINDINGS: A case-control design that matched on age and location was used. Blood samples were collected from 986 prevalent cases and 1,313 age-matched community controls and tested for presence of antibodies to Onchocerca volvulus, Toxocara canis, Toxoplasma gondii, Plasmodium falciparum, Taenia solium and HIV. Exposure (seropositivity) to Onchocerca volvulus (OR = 1.98; 95%CI: 1.52-2.58, p<0.001), Toxocara canis (OR = 1.52; 95%CI: 1.23-1.87, p<0.001), Toxoplasma gondii (OR = 1.28; 95%CI: 1.04-1.56, p = 0.018) and higher antibody levels (top tertile) to Toxocara canis (OR = 1.70; 95%CI: 1.30-2.24, p<0.001) were associated with an increased prevalence of ACE. Exposure to multiple infections was common (73.8% of cases and 65.5% of controls had been exposed to two or more infections), and for T. gondii and O. volvulus co-infection, their combined effect on the prevalence of ACE, as determined by the relative excess risk due to interaction (RERI), was more than additive (T. gondii and O. volvulus, RERI = 1.19). The prevalence of T. solium antibodies was low (2.8% of cases and 2.2% of controls) and was not associated with ACE in the study areas. CONCLUSION: This study investigates how the degree of exposure to parasites and multiple parasitic infections are associated with ACE and may explain conflicting results obtained when only seropositivity is considered. The findings from this study should be further validated. |
Development of a framework to measure health profession regulation strengthening
McCarthy CF , Kelley MA , Verani AR , St Louis ME , Riley PL . Eval Program Plann 2014 46c 17-24 This paper describes the development of a framework to evaluate the progress and impact of a multi-year US government initiative to strengthen nursing and midwifery professional regulation in sub-Saharan Africa. The framework was designed as a capability maturity model, which is a stepwise series of performance levels that describe the sophistication of processes necessary to achieve an organization's objectives. A model from the field of software design was adapted to comprise the key functions of a nursing and midwifery regulatory body and describe five stages of advancing each function. The framework was used to measure the progress of five countries that received direct assistance to strengthen regulations and to benchmark the status of regulations in the 17 countries participating in the initiative. The framework captured meaningful advancements in regulatory strengthening in the five supported countries and the level of regulatory capacity in participating countries. The project uses the framework to assess yearly progress of supported countries, track the overall impact of the project on national and regional nursing regulation, and to identify national and regional priorities for regulatory strengthening. It is the first of its kind to document and measure progress toward sustainably strengthening nursing and midwifery regulation in Africa. |
The role of epidemiology in evidence-based policy making: a case study of tobacco use in youth
Aldrich MC , Hidalgo B , Widome R , Briss P , Brownson RC , Teutsch SM . Ann Epidemiol 2014 25 (5) 360-5 PURPOSE: Sound public health policy is based on relevant and timely information. A brief review of the history of youth tobacco control illustrates the central role of epidemiology to inform policy choices and evaluate their consequences. METHODS: A narrative review was conducted. RESULTS: Epidemiologic studies have shown that most smokers begin as adolescents or young adults and individuals who reach their mid-20s as nonsmokers are unlikely to ever become smokers. This key recognition made it clear that long-term tobacco control must prevent initiation of smoking among youth. Over time, tobacco use prevention interventions have evolved, increasing in reach and effectiveness as they moved from initially focusing on the individual to an approach that targets both populations and communities. Effective interventions for preventing youth smoking include raising tobacco prices, clean indoor air laws, and intensive mass media campaigns. CONCLUSIONS: Great strides have been made in youth tobacco control but 18% of high-school students continue to smoke. It is up to epidemiologists, fellow scientists, practitioners, and advocates to assure that strategies that are known to work are fully implemented and to continue to find more successful solutions that can further lower the incidence of youth smoking initiation and can address new tobacco products and changing contexts. |
Cigarette prices and smoking prevalence after a tobacco tax increase - Turkey, 2008 and 2012
Kostova D , Andes L , Erguder T , Yurekli A , Keskinkilic B , Polat S , Culha G , Kilinc EA , Tasti E , Ersahin Y , Ozmen M , San R , Ozcebe H , Bilir N , Asma S . MMWR Morb Mortal Wkly Rep 2014 63 (21) 457-61 Raising the price of tobacco products has been shown to reduce tobacco consumption in the United States and other high-income countries, and evidence of this impact has been growing for low- and middle-income countries as well. Turkey is a middle-income country surveyed by the Global Adult Tobacco Survey (GATS) twice in a 4-year period, in 2008 and 2012. During this time, the country introduced a policy raising its Special Consumption Tax on Tobacco and implemented a comprehensive tobacco control program banning smoking in public places, banning advertising, and introducing graphic health warnings. The higher tobacco tax took effect in early 2010, allowing sufficient time for subsequent changes in prices and smoking to be observed by the time of the 2012 GATS. This report uses data from GATS Turkey to examine how cigarette prices changed after the 2010 tax increase, describe the temporally associated changes in smoking prevalence, and learn whether this smoking prevalence changed more in some demographic groups than others. From 2008 to 2012, the average price paid for cigarettes increased by 42.1%, cigarettes became less affordable, and smoking prevalence decreased by 14.6%. The largest reduction in smoking was observed among persons with lower socioeconomic status (SES), highlighting the potential role of tax policy in reducing health disparities across socioeconomic groups. |
Does every US smoker bear the same cigarette tax?
Xu X , Malarcher A , OHalloran A , Kruger J . Addiction 2014 109 (10) 1741-9 AIMS: To evaluate state cigarette excise tax pass-through rates for selected price-minimizing strategies. DESIGN: Multivariate regression analysis of current smokers from a stratified, national, dual-frame telephone survey. SETTING: United States. PARTICIPANTS: A total of 16,542 adult current smokers aged 18 years or older. MEASUREMENTS: Cigarette per pack prices paid with and without coupons were obtained for pack versus carton purchase, use of generic brands versus premium brands, and purchase from Indian reservations versus outside Indian reservations. FINDINGS: The average per pack prices paid differed substantially by price-minimizing strategy. Smokers who used any type of price-minimizing strategies paid substantially less than those who did not use these strategies (p<0.05). Premium brand users who purchased by pack in places outside Indian reservations paid the entire amount of the excise tax together with an additional premium of 7-10 cents per pack for every $1 increase in excise tax (pass-through rate of 1.07-1.10, p<0.05). In contrast, carton purchasers, generic brand users, or those who were likely to made their purchases on Indian reservations paid only 30-83 cents per pack for every $1 tax increase (pass-through rate of 0.30-0.83, p<0.05). CONCLUSIONS: Many smokers in the US are able to avoid the full impact of state excise tax on cost of smoking by buying cartons, using generic brands and buying from Indian reservations. |
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