Vital Signs: melanoma incidence and mortality trends and projections - United States, 1982-2030
Guy GP Jr , Thomas CC , Thompson T , Watson M , Massetti GM , Richardson LC . MMWR Morb Mortal Wkly Rep 2015 64 (21) 591-596 Skin cancer is the most common form of cancer in the United States, and melanoma is responsible for the most skin cancer deaths with over 9,000 each year. An individual dying from melanoma loses an average of 20.4 years of potential life. Total melanoma treatment costs are about $3.3 billion annually in the United States. Melanoma is the fifth most common cancer for men, and is the seventh most common cancer for women. More than 90% of melanoma cases in the United States are attributed to skin cell damage from ultraviolet (UV) radiation exposure. |
News from CDC: applying a life course approach to primary cancer prevention
Shoemaker ML , Holman DM , Henley SJ , White MC . Transl Behav Med 2015 5 (2) 131-3 Each year, over 1.5 million people in the USA are told that they have cancer [1], a major challenge for everyone facing a cancer diagnosis, as well as for the Centers for Disease Control and Prevention (CDC), the nation’s prevention agency. Cancer is more easily prevented than cured [2], yet many avoidable risk factors remain prevalent. We now understand that cancer is actually many diseases, caused by different factors operating, sometimes synergistically, over many years. A transdisciplinary approach can be used to synthesize and disseminate the disparate knowledge needed to develop and implement effective cancer prevention programs [3, 4]. As we learn more about the multitude of individual, societal, and environmental factors that influence cancer development, we can build on this growing body of scientific knowledge to adopt and implement multifaceted approaches for cancer prevention [5]. CDC uses a comprehensive framework for chronic disease prevention that encompasses four cross-cutting strategies: epidemiology and surveillance, environmental approaches, health systems interventions, and community-clinical linkages [6]. While the activities of CDC’s Division of Cancer Prevention and Control (DCPC) historically have focused primarily on health system interventions related to cancer screening and surveillance through cancer registries, we are exploring new opportunities to apply all four strategies to primary cancer prevention. |
Occupational and environmental bronchiolar disorders
Cummings KJ , Kreiss K . Semin Respir Crit Care Med 2015 36 (3) 366-78 Occupational and environmental causes of bronchiolar disorders are recognized on the basis of case reports, case series, and, less commonly, epidemiologic investigations. Pathology may be limited to the bronchioles or also involve other components of the respiratory tract, including the alveoli. A range of clinical, functional, and radiographic findings, including symptomatic disease lacking abnormalities on noninvasive testing, poses a diagnostic challenge and highlights the value of surgical biopsy. Disease clusters in workplaces and communities have identified new etiologies, drawn attention to indolent disease that may otherwise have been categorized as idiopathic, and expanded the spectrum of histopathologic responses to an exposure. More sensitive noninvasive diagnostic tools, evidence-based therapies, and ongoing epidemiologic investigation of at-risk populations are needed to identify, treat, and prevent exposure-related bronchiolar disorders. |
Impact of arthritis and multiple chronic conditions on selected life domains - United States, 2013
Qin J , Theis KA , Barbour KE , Helmick CG , Baker NA , Brady TJ . MMWR Morb Mortal Wkly Rep 2015 64 (21) 578-582 About half of U.S. adults have at least one chronic health condition, and the prevalence of multiple (two or more) chronic conditions increased from 21.8% in 2001 to 25.5% in 2012. Chronic conditions profoundly affect quality of life, are leading causes of death and disability, and account for 86% of total health care spending. Arthritis is a common cause of disability, one of the most common chronic conditions, and is included in prevalent combinations of multiple chronic conditions. To determine the impact of having arthritis alone or as one of multiple chronic conditions on selected important life domains, CDC analyzed data from the 2013 National Health Interview Survey (NHIS). Having one or more chronic conditions was associated with significant and progressively higher prevalences of social participation restriction, serious psychological distress, and work limitations. Adults with arthritis as one of their multiple chronic conditions had higher prevalences of adverse outcomes on all three life domains compared with those with multiple chronic conditions but without arthritis. The high prevalence of arthritis, its common co-occurrence with other chronic conditions, and its significant adverse effect on life domains suggest the importance of considering arthritis in discussions addressing the effect of multiple chronic conditions and interventions needed to reduce that impact among researchers, health care providers, and policy makers. |
Reduced sexual risk behaviors among young men of color who have sex with men: findings from the Community-Based Organization Behavioral Outcomes of Many Men, Many Voices (CBOP-3MV) Project
Stein R , Shapatava E , Williams W , Griffin T , Bell K , Lyons B , Uhl G . Prev Sci 2015 16 (8) 1147-58 In 2006, the Centers for Disease Control and Prevention (CDC) funded community-based organizations (CBOs) to deliver Many Men, Many Voices (3MV) to young men of color who have sex with men. Although 3MV, a group-level behavioral intervention designed to reduce human immunodeficiency virus (HIV) risk behaviors of black men who have sex with men (MSM), has shown effectiveness when delivered in a controlled research environment, there is limited evidence that the intervention is associated with similar outcomes in "real world" settings. For the current project, CDC funded three CBOs to conduct outcome monitoring of the 3MV intervention to determine if young MSM of color report changes in HIV risk behaviors postintervention. Using a repeated measures design, risk behaviors were collected at baseline and again at 3 and 6 months postintervention. Changes in risk behaviors were assessed using generalized estimating equations. Participants (n = 337) reported decreases in sexual risk behaviors at both follow-up time points, such as sex without a condom, sex without a condom and multiple partners, and sex without a condom with serodiscordant or status unknown partners. Results suggest that 3MV may be an effective tool for reducing HIV risk behaviors in this critical target population. |
Sexually transmitted diseases treatment guidelines, 2015
Workowski KA , Bolan GA . MMWR Recomm Rep 2015 64 1-137 These guidelines for the treatment of persons who have or are at risk for sexually transmitted diseases (STDs) were updated by CDC after consultation with a group of professionals knowledgeable in the field of STDs who met in Atlanta on April 30-May 2, 2013. The information in this report updates the Sexually Transmitted Diseases Treatment Guidelines, 2010 (MMWR Recomm Rep 2010;59 [No. RR-12]). These updated guidelines discuss 1) alternative treatment regimens for Neisseria gonorrhoeae; 2) the use of nucleic acid amplification tests for the diagnosis of trichomoniasis; 3) alternative treatment options for genital warts; 4) the role of Mycoplasma genitalium in urethritis/cervicitis and treatment-related implications; 5) updated HPV vaccine recommendations and counseling messages; 6) the management of persons who are transgender; 7) annual testing for hepatitis C in persons with HIV infection; 8) updated recommendations for diagnostic evaluation of urethritis; and 9) retesting to detect repeat infection. Physicians and other health-care providers can use these guidelines to assist in the prevention and treatment of STDs. |
Statin treatment and mortality: propensity score-matched analyses of 2007-2008 and 2009-2010 laboratory-confirmed influenza hospitalizations
Laidler MR , Thomas A , Baumbach J , Kirley PD , Meek J , Aragon D , Morin C , Ryan PA , Schaffner W , Zansky SM , Chaves SS . Open Forum Infect Dis 2015 2 (1) ofv028 BACKGROUND: Annual influenza epidemics are responsible for substantial morbidity and mortality. The use of immunomodulatory agents such as statins to target host inflammatory responses in influenza virus infection has been suggested as an adjunct treatment, especially during pandemics, when antiviral quantities are limited or vaccine production can be delayed. METHODS: We used population-based, influenza hospitalization surveillance data, propensity score-matched analysis, and Cox regression to determine whether there was an association between mortality (within 30 days of a positive influenza test) and statin treatment among hospitalized cohorts from 2 influenza seasons (October 1, 2007 to April 30, 2008 and September 1, 2009 to April 31, 2010). RESULTS: Hazard ratios for death within the 30-day follow-up period were 0.41 (95% confidence interval [CI], .25-.68) for a matched sample from the 2007-2008 season and 0.77 (95% CI, .43-1.36) for a matched sample from the 2009 pandemic. CONCLUSIONS: The analysis suggests a protective effect against death from influenza among patients hospitalized in 2007-2008 but not during the pandemic. Sensitivity analysis indicates the findings for 2007-2008 may be influenced by unmeasured confounders. This analysis does not support using statins as an adjunct treatment for preventing death among persons hospitalized for influenza. |
Notes from the field: outbreaks of Shigella sonnei infection with decreased susceptibility to azithromycin among men who have sex with men - Chicago and Metropolitan Minneapolis-St. Paul, 2014
Bowen A , Eikmeier D , Talley P , Siston A , Smith S , Hurd J , Smith K , Leano F , Bicknese A , Norton JC , Campbell D . MMWR Morb Mortal Wkly Rep 2015 64 (21) 597-598 Increasing rates of shigellosis among adult males, particularly men who have sex with men (MSM), have been documented in the United States, Canada, and Europe, and MSM appear to be at greater risk for infection with shigellae that are not susceptible to ciprofloxacin or azithromycin. Azithromycin is the first-line empiric antimicrobial treatment for shigellosis among children and is a second-line treatment among adults. Isolates collected in 2014 in two U.S. cities from outbreaks of shigellosis displayed highly similar pulsed-field gel electrophoresis (PFGE) patterns and decreased susceptibility to azithromycin (DSA). This report summarizes and compares the findings from investigations of the two outbreaks, which occurred among MSM in metropolitan Minneapolis-St. Paul, Minnesota, and Chicago, Illinois. |
Hepatitis B screening and prevalence among resettled refugees - United States, 2006-2011
Scott KC , Taylor EM , Mamo B , Herr ND , Cronkright PJ , Yun K , Altshuler M , Shetty S . MMWR Morb Mortal Wkly Rep 2015 64 (21) 570-573 Globally, more than two billion persons have been infected at some time with the hepatitis B virus (HBV), and approximately 3.5 million refugees have chronic HBV infection. The endemicity of HBV varies by region. Because chronic hepatitis B is infectious and persons with chronic infection benefit from treatment, CDC recommends screening for HBV among all refugees who originate in countries where the prevalence of hepatitis B surface antigen (HBsAg; a marker for acute or chronic infection) is ≥2% or who are at risk for HBV because of personal characteristics such as injection drug use or household contact with an individual with HBV infection. Currently, almost all refugees are routinely screened for hepatitis B. However, prevalence rates of HBV infection in refugee populations recently resettled in the United States have not been determined. A multisite, retrospective study was performed to evaluate the prevalence of past HBV infection, current infection, and immunity among refugees resettled in the United States; to better characterize the burden of hepatitis B in this population; and to inform screening recommendations. The study incorporated surveillance data from a large state refugee health program and chart reviews from three U.S. sites that conduct medical screenings of refugees. The prevalence of HBV infection (current or past as determined by available titer levels) varied among refugees originating in different countries and was higher among Burmese refugees than among refugees from Bhutan or Iraq. Current or past HBV infection was also higher among adults (aged >18 years) and male refugees. These data might help inform planning by states and resettlement agencies, as well as screening decisions by health care providers. |
Influenza outbreaks among passengers and crew on two cruise ships: a recent account of preparedness and response to an ever-present challenge
Millman AJ , Kornylo Duong K , Lafond K , Green NM , Lippold SA , Jhung MA . J Travel Med 2015 22 (5) 306-11 BACKGROUND: During spring 2014, two large influenza outbreaks occurred among cruise ship passengers and crew on trans-hemispheric itineraries. METHODS: Passenger and crew information for both ships was obtained from components of the ship medical records. Data included demographics, diagnosis of influenza-like illness (ILI) or acute respiratory illness (ARI), illness onset date, passenger cabin number, crew occupation, influenza vaccination history, and rapid influenza diagnostic test (RIDT) result, if performed. RESULTS: In total, 3.7% of passengers and 3.1% of crew on Ship A had medically attended acute respiratory illness (MAARI). On Ship B, 6.2% of passengers and 4.7% of crew had MAARI. In both outbreaks, passengers reported illness prior to the ship's departure. Influenza activity was low in the places of origin of the majority of passengers and both ships' ports of call. The median age of affected passengers on both ships was 70 years. Diagnostic testing revealed three different co-circulating influenza viruses [influenza A(H1N1)pdm09, influenza A(H3N2), and influenza B] on Ship A and one circulating influenza virus (influenza B) on Ship B. Both ships voluntarily reported the outbreaks to the Centers for Disease Control and Prevention (CDC) and implemented outbreak response plans including isolation of sick individuals and antiviral treatment and prophylaxis. CONCLUSIONS: Influenza activity can become widespread during cruise ship outbreaks and can occur outside of traditional influenza seasons. Comprehensive outbreak prevention and control plans, including prompt antiviral treatment and prophylaxis, may mitigate the impact of influenza outbreaks on cruise ships. |
Correlates of HIV testing among men who have sex with men in three urban areas of Mozambique: missed opportunities for prevention
Horth RZ , Cummings B , Young PW , Mirjahangir J , Sathane I , Nala R , Lane T , Raymond HF . AIDS Behav 2015 19 (11) 1978-89 This is the first study to identify levels of recent HIV testing and associated factors among men who have sex with men (MSM) in Mozambique. Using data from Maputo (n = 493), Beira (n = 572), and Nampula/Nacala (n = 347), collected via respondent-driven sampling in 2011, and excluding those with prior known infection, we found that 30.4 % [95 % confidence interval (CI) 25.0-36.3 %], 42.1 % (95 % CI 36.8-47.3 %) and 29.8 % (95 % CI 22.9-36.9 %), respectively, had recently tested for HIV (≤12 months), while between three and five out of 10 MSM had never tested. A range of factors was associated with recent HIV testing such as familiarity with the modes of transmission, knowledge of antiretroviral treatment for HIV, contact with peer educators and awareness of partner serostatus; yet, surprisingly recent healthcare utilization was not associated with recent testing. Findings provide evidence that structural and behavioral interventions among MSM may play an important role in increasing HIV testing. |
Demographic and health services characteristics associated with testing for sexually transmitted infections among a commercially insured population of HIV-positive patients
Pearson WS , Davis AD , Hoover KW , Gift TL , Owusu-Edusei K , Tao G . J Acquir Immune Defic Syndr 2015 70 (3) 269-74 BACKGROUND: Presence of a sexually transmitted infection (STI) can increase likelihood of HIV transmission and current treatment guidelines indicate that HIV-positive persons should be screened yearly for STIs. Therefore, we examined recent insurance claims data to determine if private insurance beneficiaries who are HIV-positive were receiving recommended STI testing. METHODS: We used data from the 2011 and 2012 Marketscan datasets; a longitudinal, population-based database that collects claims from commercially-insured persons in private insurance and is conducted by Truven Health Analytics. Over a thirteen month period, we calculated rates of testing for chlamydia, gonorrhea and syphilis among an HIV-positive population and determined factors that contributed to differences in testing rates. RESULTS: Overall testing rates were 22.2% for chlamydia, 21.9% for gonorrhea, and 51.1% for syphilis. Significant predictors of STI testing were sex, age, type of health plan, engagement with the healthcare system, and geographic location. Most notably, persons receiving viral load testing were more likely to receive testing for chlamydia (1.72 OR; 1.63-1.81 95% CI), gonorrhea (1.72 OR; 1.64-1.81 95% CI) and syphilis (3.38 OR, 3.25 - 3.53 95% CI) compared to persons not receiving viral load testing. DISCUSSION: Not all commercially-insured HIV-positive patients are receiving recommended testing for STIs. Presence of STIs could affect the transmission of HIV as well as have deleterious effects on health outcomes of the patients. Targeted efforts based on demographics, health plan type and other quality of care measures could help identify populations for whom testing rates for STIs among HIV-positive persons could be improved. |
Effect of cyanuric acid on the inactivation of Cryptosporidium parvum under hyperchlorination conditions
Murphy JL , Arrowood MJ , Lu X , Hlavsa MC , Beach MJ , Hill VR . Environ Sci Technol 2015 49 (12) 7348-55 Cyanuric acid (CYA) is a chlorine stabilizer used in swimming pools to limit UV degradation of chlorine, thus reducing chlorine use and cost. However, CYA has been shown to decrease the efficacy of chlorine disinfection. In the event of a diarrheal incident, CDC recommends implementing 3-log10 inactivation conditions for Cryptosporidium (CT value = 15300 mg.min/L) to remediate pools. Currently, CYA's impact on Cryptosporidium inactivation is not fully determined. We investigated the impact of multiple concentrations of CYA on C. parvum inactivation (at 20 and 40 mg/L free chlorine; average pH 7.6; 25 degrees C). At 20 mg/L free chlorine, average estimated 3-log10 CT values were 17800 and 31500 mg.min/L with 8 and 16 mg/L CYA, respectively, and the average estimated 1-log10 CT value was 76500 mg.min/L with 48 mg/L CYA. At 40 mg/L free chlorine, 3-log10 CT values were lower than those at 20 mg/L, but still higher than those of free chlorine-only controls. In the presence of approximately 100 mg/L CYA, average 0.8- and 1.4-log10 reductions were achieved by 72 h at 20 and 40 mg/L free chlorine, respectively. This study demonstrates CYA significantly delays chlorine inactivation of Cryptosporidium oocysts, emphasizing the need for additional pool remediation options following fecal incidents. |
Are schools safe from indoor radon?
Foster S , Dent A , Bryant J , Tencza B , Adams E , Dutton ND . J Environ Health 2015 77 (10) 38-40 The U.S. Environmental Protection Agency (U.S. EPA) estimates approximately 21,000 lung cancer deaths are attributable to radon exposure (U.S. EPA, 2003). This number is approximately seven times greater than the number of lung cancer deaths due to secondhand smoke exposure and about twice as many deaths caused by drunk drivers (Centers for Disease Control and Prevention, 2015; Foundation for Advancing Alcohol Responsibility, 2013; National Cancer Institute, 2012). Despite these startling statistics, very few programs are in place to monitor or evaluate indoor radon levels in homes and public buildings in the U.S. Since radon gas is colorless, odorless, and tasteless, testing is the only way to determine its presence (Agency for Toxic Substances and Disease Registry [ATSDR], 2012; U.S. EPA, 2003; U.S. Geological Survey, 1993). When testing reveals levels greater than 4 picocuries per liter (pCi/L), mitigation is recommended by U.S. EPA and several effective strategies for reducing indoor radon levels exist (American Association of Radon Scientists and Technologists, 2014; U.S. EPA, 2010). Given the absence of a national program for radon surveillance and the ubiquitous nature of radon gas, we have undertaken a series of activities to understand the extent to which indoor radon may be a risk for Americans, specifically for children attending public schools, in hopes of increasing awareness about the importance of radon testing. | In 2013, we began a study of the scope and extent of regular and standard radon testing programs in schools across the nation. We learned that many states have active radon testing and mitigation programs. For example, in the last eight years New Jersey has tested 1,705 (51%) public schools (New Jersey Department of Environmental Protection, 2014). We also learned, however, that laws and regulations for reducing radon in schools were scarce (Bernstein, 2013). Additionally, we were surprised to uncover the variations in requirements among different laws. Since our original inquiries, some states have lost funding to support their legislation. Other states have added language in support of testing or radon-resistant new construction practices (Environmental Law Institute, 2014). Policies for radon testing in schools and radon-resistant new construction continue to be uncommon and moving targets. |
Carbon monoxide poisoning deaths in the United States, 1999 to 2012
Sircar K , Clower J , Shin MK , Bailey C , King M , Yip F . Am J Emerg Med 2015 33 (9) 1140-5 BACKGROUND: Unintentional, non-fire related (UNFR) carbon monoxide (CO) poisoning deaths are preventable. Surveillance of the populations most at-risk for unintentional, non-fire related (UNFR) carbon monoxide (CO) poisoning is crucial for targeting prevention efforts. OBJECTIVE: This study provides estimates on UNFR CO poisoning mortality in the United States and characterizes the at-risk populations. METHODS: We used 1999 to 2012 data to calculate death rates. We used underlying and multiple conditions variables from death records to identify UNFR CO poisoning cases. RESULTS: For this study, we identified 6136 CO poisoning fatalities during 1999 to 2012 resulting in an average of 438 deaths annually. The annual average age-adjusted death rate was 1.48 deaths per million. Fifty four percent of the deaths occurred in a home. Age-adjusted death rates were highest for males (2.21 deaths per million) and non-Hispanic blacks (1.74 deaths per million). The age-specific death rate was highest for those aged ≥85 years (6.00 deaths per million). The annual rate of UNFR CO poisoning deaths did not change substantially during the study period, but we observed a decrease in the rate of suicide and unintentional fire related cases. CONCLUSION: CO poisoning was the second most common non-medicinal poisonings death. Developing and enhancing current public health interventions could reduce ongoing exposures to CO from common sources, such as those in the residential setting. |
Swimming in the USA: beachgoer characteristics and health outcomes at US marine and freshwater beaches
Collier SA , Wade TJ , Sams EA , Hlavsa MC , Dufour AP , Beach MJ . J Water Health 2015 13 (2) 531-543 Swimming in lakes and oceans is popular, but little is known about the demographic characteristics, behaviors, and health risks of beachgoers on a national level. Data from a prospective cohort study of beachgoers at multiple marine and freshwater beaches in the USA were used to describe beachgoer characteristics and health outcomes for swimmers and non-swimmers. This analysis included 54,250 participants. Most (73.2%) entered the water; of those, 65.1% put their head under water, 41.3% got water in their mouth and 18.5% swallowed water. Overall, 16.3% of beachgoers reported any new health problem. Among swimmers, 6.6% reported gastrointestinal (GI) illness compared with 5.5% of non-swimmers (unadjusted chi2 p < 0.001); 6.0% of swimmers and 4.9% of non-swimmers reported respiratory illness (p < 0.001); 1.8% of swimmers and 1.0% of non-swimmers reported ear problems (p < 0.001); and 3.9% of swimmers and 2.4% of non-swimmers experienced a rash (p < 0.001). Overall, swimmers reported a higher unadjusted incidence of GI illness and earaches than non-swimmers. Current surveillance systems might not detect individual cases and outbreaks of illness associated with swimming in natural water. Better knowledge of beachgoer characteristics, activities, and health risks associated with swimming in natural water can improve disease surveillance and prioritize limited resources. |
Multinational disease surveillance programs: promoting global information exchange for infectious diseases
Varan AK , Bruniera-Oliveira R , Peter CR , Fonseca-Ford M , Waterman SH . Am J Trop Med Hyg 2015 93 (3) 668-71 Cross-border surveillance for emerging diseases such as Ebola and other infectious diseases requires effective international collaboration. We surveyed representatives from 12 multinational disease surveillance programs between January 2013 and April 2014. Our survey identified programmatic similarities despite variation in health priorities, geography, and socioeconomic context, providing a contemporary perspective on infectious disease surveillance networks. |
Human outbreak of Salmonella typhimurium associated with exposure to locally made chicken jerky pet treats, New Hampshire, 2013
Cavallo SJ , Daly ER , Seiferth J , Nadeau AM , Mahoney J , Finnigan J , Wikoff P , Kiebler CA , Simmons L . Foodborne Pathog Dis 2015 12 (5) 441-6 Pet treats and pet food can be contaminated with Salmonella and other pathogens, though they are infrequently implicated as the source of human outbreaks. In 2013, the New Hampshire Department of Health and Human Services investigated a cluster of Salmonella Typhimurium infections associated with contaminated locally made pet treats. Case-patients were interviewed with standardized questionnaires to assess food, animal, and social histories. Laboratory and environmental investigations were conducted, including testing of clinical specimens, implicated product, and environmental swabs. Between June and October 2013, a total of 43 ill persons were identified. Sixteen patients (37%) were hospitalized. Among 43 case-patients interviewed, the proportion exposed to dogs (95%) and pet treats (69%) in the 7 days prior to illness was statistically higher than among participants in a U.S. population-based telephone survey (61%, p<0.0001 and 16%, p<0.0001, respectively). On further interview, 38 (88%) reported exposure to Brand X Chicken Jerky, the maker of Brand X chicken jerky, or the facility in which it was made. Product testing isolated the outbreak strain from four of four Brand X Chicken Jerky samples, including an unopened package purchased at retail, opened packages collected from patient households, and unpackaged jerky obtained from the jerky maker. A site visit revealed inadequate processing of the chicken jerky, bare-hand contact with the finished product prior to packaging, and use of vacuum-sealed packaging, which may have enabled facultative anaerobic bacteria to proliferate. Seven (78%) of nine environmental swabs taken during the site visit also yielded the outbreak strain. Brand X Chicken Jerky was voluntarily recalled on September 9, 2013. Consumers should be made aware of the potential for locally made products to be exempt from regulation and for animals and animal food to carry pathogens that cause human illness, and be educated to perform hand hygiene after handling pet food or treats. |
A public health perspective on a national precision medicine cohort: balancing long-term knowledge generation with early health benefit.
Khoury MJ , Evans JP . JAMA 2015 313 (21) 2117-8 The new US precision medicine initiative1 has been made possible by improvement and price reduction in genome sequencing, as well as advances in multiple sectors of biotechnology. The initiative includes 2 components: a focus on cancer intended to spur development of new targeted cancer treatments, and a proposal for establishing a national cohort of at least 1 million people to explore genetic and environmental determinants of health and disease. The success of this initiative requires a public health perspective to help ensure generalizability, assess methods of implementation, focus on prevention, and provide an appropriate balance between generation of long-term knowledge and short-term health gains. | Although precision medicine focuses on individualized care, it is impossible to infer causality by working from individual observations. Data from large numbers of people are required to identify characteristics, including genetic markers predictive of treatment response. Moreover, from a public health perspective, collecting information from large numbers of people is far more informative when these people reflect the diversity of the underlying population. Using convenience samples—ie, collected without regard to important factors such as race and ethnicity, age, and sex—can lead to substantial biases and nongeneralizable predictions. This is especially true in genomics because different ancestry may result in differing genomic architecture of health and disease states. | The concept of precision prevention may therefore be valuable for efficiently targeting preventive strategies to the specific subsets of a population that will derive maximal benefit. |
Cryptosporidium genotypes and subtypes distribution in river water in Iran.
Mahmoudi MR , Nazemalhosseini-Mojarad E , Kazemi B , Haghighi A , Mirzaei A , Mohammadiha A , Jahantab S , Xiao L , Karanis P . J Water Health 2015 13 (2) 600-606 Little is known about the diversity and public health significance of Cryptosporidium species in river waters in Iran. In the present study, we determined the genotype and subtype distribution of Cryptosporidium spp. in river water samples in Iran. A total of 49 surface water samples were collected from rivers and surface water in Guilan and Tehran provinces during 2009-2010. Water samples were filtrated through a 1.2-mum pore size membrane filter or by Filta-Max filter followed by immunomagnetic separation or sucrose purification methods. Genotype and subtype of Cryptosporidium were identified by sequence analysis of the 18S rRNA and 60 kDa glycoprotein (gp60) genes, respectively. A total of 24 (48.97%) water samples were positive for Cryptosporidium species by the 18sRNA-based polymerase chain reaction (PCR)-sequencing technique. DNA sequencing revealed the presence of five species of Cryptosporidium (C. parvum, C. hominis, C. muris, C. andersoni, and C. canis) in the water samples of the study area and, to our knowledge, the first report of C. muris in Iran. The results of GP60 gene analysis showed that all C. parvum and C. hominis isolates belonged to the IId and Id subtype families, respectively. The investigated river water supplies were heavily contaminated by pathogenic species of Cryptosporidium from humans and livestock. There is potential risk of waterborne cryptosporidiosis in humans and animals. |
Serological correlates of protection against a GII.4 norovirus
Atmar RL , Bernstein DI , Lyon GM , Treanor JJ , Al-Ibrahim MS , Graham DY , Vinje J , Jiang X , Gregoricus N , Frenck RW , Moe CL , Chen WH , Ferreira J , Barrett J , Opekun AR , Estes MK , Borkowski A , Baehner F , Goodwin R , Edmonds A , Mendelman PM . Clin Vaccine Immunol 2015 22 (8) 923-9 Noroviruses are the leading cause of acute gastroenteritis worldwide, and norovirus vaccine prevention strategies are under evaluation. The immunogenicity of two doses of bivalent GI.1/GII.4 (50mug VLP of each strain adjuvanted with aluminum hydroxide and MPL) norovirus vaccine administered to healthy adults in a phase 1-2 double-blind, placebo-controlled trial was determined using virus-specific, serum total antibody ELISA, IgG, IgA and histoblood group antigen (HBGA) blocking assays. Trial participants subsequently received an oral live virus challenge with a GII.4 strain and vaccine efficacy results have been reported previously (D.I. Bernstein et al. J Infect Dis 211:870-878, 2015, doi:10.1093/infdis/jiu497). This report assesses the impact of pre-challenge serum antibody levels on infection and illness outcomes. Serum antibody responses were observed in vaccine recipients by all antibody assays, with first dose seroresponse frequencies ranging from 88-100% for the GI.1 antigen and from 69-84% for the GII.4 antigen. There was little increase in antibody level after the second vaccine dose. Among placebo subjects, higher pre-challenge serum anti-GII.4 HBGA-blocking and IgA antibody levels, but not IgG or total antibody levels, were associated with a lower frequency of virus infection and associated illness. Notably, some placebo subjects without measurable serum antibody pre-challenge did not become infected after norovirus challenge. In vaccinees, anti-GII.4 HBGA-blocking antibody levels >1:500 were associated with a lower frequency of moderate-to-severe vomiting or diarrheal illness. In this study, pre-challenge serum HBGA antibody titers correlated with protection in placebo subjects; however, other factors may impact the likelihood of infection and illness after virus exposure. |
Seroprevalence of measles, mumps, rubella and varicella antibodies in the United States population, 2009-2010
Lebo EJ , Kruszon-Moran DM , Marin M , Bellini WJ , Schmid S , Bialek SR , Wallace GS , McLean HQ . Open Forum Infect Dis 2015 2 (1) ofv006 BACKGROUND: In the United States, measles, mumps, rubella, and varicella immunity is now primarily achieved through vaccination. Monitoring population immunity is necessary. METHODS: We evaluated seroprevalence of antibodies to measles, mumps, rubella, and varicella using the National Health and Nutrition Examination Survey during 2009-2010. RESULTS: Measles, mumps, rubella, and varicella seroprevalence was 92.0% (95% confidence interval [CI], 90.9%-93.0%), 87.6% (CI, 85.8%-89.2%), 95.3% (CI, 94.3%-96.2%), and 97.8% (CI, 97.1%-98.3%), respectively. United States (US)-born persons had lower mumps seroprevalence and higher varicella seroprevalence than non-US born persons. CONCLUSIONS: Seroprevalence was high (88%-98%) for all 4 viruses in the US population during 2009-2010. |
Zoster vaccine and the risk of postherpetic neuralgia in patients who developed herpes zoster despite having received the zoster vaccine
Tseng HF , Lewin B , Hales CM , Sy LS , Harpaz R , Bialek S , Luo Y , Jacobsen SJ , Reddy K , Huang PY , Zhang J , Anand S , Bauer EM , Chang J , Tartof SY . J Infect Dis 2015 212 (8) 1222-31 BACKGROUND: Although it is evident that zoster vaccination reduces postherpetic neuralgia (PHN) risk by reducing herpes zoster (HZ) occurrence, it is less clear whether the vaccine protects against PHN among patients who develop HZ despite previous vaccination. METHODS: This cohort study included immunocompetent patients with HZ. The vaccinated cohort included 1155 individuals who were vaccinated against HZ at age ≥60 years and had an HZ episode after vaccination. Vaccinated patients were matched 1:1 by sex and age with unvaccinated patients. Trained medical residents reviewed the full medical record to determine the presence of HZ-related pain at 1, 2, 3, and 6 months after HZ diagnosis. The incidence of PHN was compared between vaccinated and unvaccinated patients. RESULTS: Thirty vaccinated women (4.2%) experienced PHN, compared with 75 unvaccinated women (10.4%), with an adjusted relative risk of 0.41 (95% confidence interval, .26-.64). PHN occurred in 26 vaccinated men (6.0%) versus 25 unvaccinated men (5.8%), with an adjusted relative risk of 1.06 (.58-1.94). These associations did not differ significantly by age. CONCLUSIONS: Among persons experiencing HZ, prior HZ vaccination is associated with a lower risk of PHN in women but not in men. This sex-related difference may reflect differences in healthcare-seeking patterns and deserve further investigation. |
Impact of health insurance status on vaccination coverage among adult populations
Lu PJ , O'Halloran A , Williams WW . Am J Prev Med 2015 48 (6) 647-61 INTRODUCTION: Underinsurance is a barrier to vaccination among children. Information on vaccination among adults aged ≥18 years by insurance status is limited. This study assesses vaccination coverage among adults aged ≥18 years in the U.S. in 2012 by health insurance status and access to care characteristics. METHODS: The 2012 National Health Interview Survey data were analyzed in 2014 to estimate vaccination coverage among adults aged ≥18 years by health insurance status for seven routinely recommended vaccines. RESULTS: Influenza vaccination coverage among adults aged ≥18 years without or with health insurance was 14.4% versus 44.3%, respectively; pneumococcal vaccination coverage among adults aged 18-64 years with high-risk conditions was 9.8% versus 23.0%; tetanus and diphtheria toxoid (Td) coverage (age ≥18 years) was 53.2% versus 64.5%; tetanus, diphtheria, and acellular pertussis (Tdap) coverage (age ≥18 years) was 8.4% versus 15.7%; hepatitis A (HepA) coverage (age 18-49 years) was 16.6% versus 19.8%; hepatitis B (HepB) coverage (age 18-49 years) was 27.5% versus 38.0%; shingles coverage (age ≥60 years) was 6.1% versus 20.8%; and human papillomavirus (HPV) coverage (women aged 18-26 years) was 20.9% versus 39.8%. In addition, vaccination coverage differed by insurance type, whether respondents had a regular physician, and number of physician contacts. CONCLUSIONS: Overall, vaccination coverage among adults aged ≥18 years is lower among uninsured populations. Implementation of effective strategies is needed to help improve vaccination coverage among adults aged ≥18 years, especially those without health insurance. |
Impact of withholding breastfeeding at the time of vaccination on the immunogenicity of oral rotavirus vaccine - a randomized trial
Ali A , Kazi AM , Cortese MM , Fleming JA , Moon S , Parashar UD , Jiang B , McNeal MM , Steele D , Bhutta Z , Zaidi AK . PLoS One 2015 10 (6) e0127622 BACKGROUND: Breast milk contains anti-rotavirus IgA antibodies and other innate immune factors that inhibit rotavirus replication in vitro. These factors could diminish the immunogenicity of oral rotavirus vaccines, particularly if breastfeeding occurs close to the time of vaccine administration. METHODS: Between April 2011 and November 2012, we conducted an open label, randomized trial to compare the immunogenicity of Rotarix (RV1) in infants whose breastfeeding was withheld one hour before through one hour after vaccination with that in infants breastfed at the time of vaccination. The trial was conducted in the peri-urban area of Ibrahim Hyderi in Karachi, Pakistan. Both groups received three doses of RV1 at 6, 10 and 14 weeks of age. Seroconversion (anti-rotavirus IgA antibodies ≥20 U/mL in subjects seronegative at 6 weeks of age) following three vaccine doses (6, 10 and 14 weeks) was determined at 18 weeks of age (primary objective) and seroconversion following two doses (6 and 10 weeks) was determined at 14 weeks of age (secondary objective). RESULTS: Four hundred eligible infants were randomly assigned in a 1:1 ratio between the withholding breastfeeding and immediate breastfeeding arms. Overall, 353 (88.3%) infants completed the study according to protocol; 181 in the withholding breastfeeding group and 172 in the immediate breastfeeding group. After three RV1 doses, anti-rotavirus IgA antibody seroconversion was 28.2% (95% CI: 22.1; 35.1) in the withholding arm and 37.8% (95% CI: 30.9; 45.2) in the immediate breastfeeding arm (difference: -9.6% [95% CI: -19.2; 0.2] p=0.07). After two doses of RV1, seroconversion was 16.6% (95% CI: 11.9; 22.7) in the withholding arm and 29.1% (95% CI: 22.8, 36.3) in the immediate breastfeeding arm (difference: -12.5% [95% CI: -21.2,-3.8] p=0.005). CONCLUSIONS: Withholding breastfeeding around the time of RV1 vaccine administration did not lead to increased anti-rotavirus IgA seroconversion compared with that seen with a breastfeed at the time of vaccination. On the contrary, IgA seroconversion in infants immediately breastfed tended to be higher than in those withheld from a feeding. Our findings suggest that breastfeeding should be continued adlib around the time of rotavirus vaccination and withholding breastfeeding at that time is unlikely to improve the vaccine immunogenicity. TRIAL REGISTRATION: ClinicalTrials.gov NCT01199874. |
Influenza activity - United States, 2014-15 season and composition of the 2015-16 influenza vaccine
Appiah GD , Blanton L , D'Mello T , Kniss K , Smith S , Mustaquim D , Steffens C , Dhara R , Cohen J , Chaves SS , Bresee J , Wallis T , Xu X , Abd Elal AI , Gubareva L , Wentworth DE , Katz J , Jernigan D , Brammer L . MMWR Morb Mortal Wkly Rep 2015 64 (21) 583-590 During the 2014-15 influenza season in the United States, influenza activity increased through late November and December before peaking in late December. Influenza A (H3N2) viruses predominated, and the prevalence of influenza B viruses increased late in the season. This influenza season, similar to previous influenza A (H3N2)-predominant seasons, was moderately severe with overall high levels of outpatient illness and influenza-associated hospitalization, especially for adults aged ≥65 years. The majority of circulating influenza A (H3N2) viruses were different from the influenza A (H3N2) component of the 2014-15 Northern Hemisphere seasonal vaccines, and the predominance of these drifted viruses resulted in reduced vaccine effectiveness. This report summarizes influenza activity in the United States during the 2014-15 influenza season (September 28, 2014-May 23, 2015) and reports the recommendations for the components of the 2015-16 Northern Hemisphere influenza vaccine. |
Deaths reported to the Vaccine Adverse Event Reporting System (VAERS), United States, 1997-2013
Moro PL , Arana J , Cano M , Lewis P , Shimabukuro TT . Clin Infect Dis 2015 61 (6) 980-7 BACKGROUND: Vaccines are among the safest medical products in use today. Hundreds of millions of vaccinations are administered in the United States each year. Serious adverse reactions are uncommon. However, temporally associated deaths can occur following vaccination. To characterize main causes of death among reports submitted to the US Vaccine Adverse Event Reporting System (VAERS), a spontaneous vaccine safety surveillance system. METHODS: We searched VAERS for US reports of death after any vaccination from 7/1/1997-12/31/2013. Available medical records, autopsy reports and death certificates were reviewed to identify cause of death. RESULTS: VAERS received 2,149 death reports, most (N=1,469;68.4%) in children. Median age was 0.5 years (range 0-100 years); males accounted for 1,226 (57%) reports. The total annual number of death reports generally decreased during the latter part of the study period. Most common causes of death among 1,244 child reports with available death certificates/autopsy reports included: sudden infant death syndrome (N=544;44%), asphyxia (N=74;6.0%), septicemia (N=61;4.9%), and pneumonia (N=57;4.6%). Among 526 adult reports, most common causes of death included: diseases of the circulatory (N=247;46.9%) and respiratory systems (N=77;14.6%), certain infections and parasitic diseases (N=62;11.8%), and malignant neoplasms (N=20;3.8%). For child death reports, 79.4% received more than one vaccine on the same day. Inactivated influenza vaccine given alone was most commonly associated with death reports in adults (51.4%). CONCLUSIONS: No concerning pattern was noted among death reports submitted to VAERS during 1997-2013. The main causes of death were consistent with the most common causes of death in the US population. |
Rotavirus vaccines at the threshold of implementation in India
Tate JE , Arora R , Kang G , Parashar UD . Natl Med J India 2014 27 (5) 245-8 India is poised to introduce rotavirus vaccines into its routine childhood immunization programme. Substantial data ara available on disease and economic burden of rotavirus gastroenteritis and on circulating strains in India, which highlight the public health need for a rotavirus vaccine. A locally manufactured oral rotavirus vaccine has been licensed in India and it has been shown to be effective against severe rotavirus gastroenteritis in Indian children. The Government of India has announced that the vaccine will be included in the universal immunization n programme. Careful planning and preparation for post-licensure impact and safety evaluations will ensure that additional high quality benefit-risk data will be available for India. |
Prevalence of sexual violence against children and use of social services - seven countries, 2007-2013
Sumner SA , Mercy AA , Saul J , Motsa-Nzuza N , Kwesigabo G , Buluma R , Marcelin LH , Lina H , Shawa M , Moloney-Kitts M , Kilbane T , Sommarin C , Ligiero DP , Brookmeyer K , Chiang L , Lea V , Lee J , Kress H , Hillis SD . MMWR Morb Mortal Wkly Rep 2015 64 (21) 565-569 Sexual violence against children erodes the strong foundation that children require for leading healthy and productive lives. Globally, studies show that exposure to violence during childhood can increase vulnerability to a broad range of mental and physical health problems, ranging from depression and unwanted pregnancy to cardiovascular disease, diabetes, and sexually transmitted diseases, including human immunodeficiency virus (HIV). Despite this, in many countries, the extent of sexual violence against children is unknown; estimates are needed to stimulate prevention and response efforts and to monitor progress. Consequently, CDC, as a member of the global public-private partnership known as Together for Girls, collaborated with Cambodia, Haiti, Kenya, Malawi, Swaziland, Tanzania, and Zimbabwe to conduct national household surveys of children and youth aged 13-24 years to measure the extent of violence against children. The lifetime prevalence of experiencing any form of sexual violence in childhood ranged from 4.4% among females in Cambodia to 37.6% among females in Swaziland, with prevalence in most countries greater than 25.0%. In most countries surveyed, the proportion of victims that received services, including health and child protective services, was ≤10.0%. Both prevention and response strategies for sexual violence are needed. |
Brief report: associations between in-person and electronic bullying victimization and missing school because of safety concerns among U.S. high school students
Steiner RJ , Rasberry CN . J Adolesc 2015 43 1-4 Although associations between bullying and health risk behaviors are well-documented, research on bullying and education-related outcomes, including school attendance, is limited. This study examines associations between bullying victimization (in-person and electronic) and missing school because of safety concerns among a nationally representative sample of U.S. high school students. We used logistic regression analyses to analyze data from the 2013 national Youth Risk Behavior Survey of students in grades 9-12. In-person and electronic victimization were each associated with increased odds of missing school due to safety concerns compared to no bullying victimization. Having been bullied both in-person and electronically was associated with greater odds of missing school compared to electronic bullying only for female students and in-person bullying only for male students. Collaborations between health professionals and educators to prevent bullying may improve school attendance. |
Serum biomarkers of treatment response within a randomized clinical trial for pulmonary tuberculosis
Jayakumar A , Vittinghoff E , Segal MR , MacKenzie WR , Johnson JL , Gitta P , Saukkonen J , Anderson J , Weiner M , Engle M , Yoon C , Kato-Maeda M , Nahid P . Tuberculosis (Edinb) 2015 95 (4) 415-20 RATIONALE: Biomarkers for monitoring response to anti-tuberculosis treatment are needed. We explored immune markers previously published as having predictive capability for 8 week culture status in 39 adults enrolled in a clinical trial in Kampala, Uganda. METHODS: We consecutively selected 20 HIV-negative pulmonary TB subjects with positive cultures, and 19 subjects with negative cultures at the end of intensive phase therapy. At baseline and after 8 weeks, serum was assayed for nine cytokines and soluble cytokine receptors using multiplexed platforms or ELISA. We evaluated their association with week 8 culture status first using single-variable logistic models, then using cross-validated estimates of the C-statistic, a measure of discrimination, of candidate models including 2 or 3 analytes in addition to age. RESULTS: All but one analyte decreased from baseline to week 8 (all p < 0.01). Individual biomarkers were not associated with 8 week culture status. Logistic models including increasing age, higher baseline soluble tumor necrosis factor receptor alpha 1 (sTNF-R1), and higher week 8 C-reactive protein (CRP) concentration classified subjects by culture status with up to 85% accuracy and acceptable discrimination (cross-validated C-statistic 0.76) and calibration (Hosmer-Lemeshow P > 0.2). CONCLUSION: Exploratory post-hoc models including sTNF-R1, CRP, and age, classified 8 week culture status with promising accuracy. |
Profile and morphology of fungal aerosols characterized by field emission scanning electron microscopy (FESEM)
Afanou KA , Straumfors A , Skogstad A , Skaar I , Hjeljord L , Skare O , Green BJ , Tronsmo A , Eduard W . Aerosol Sci Technol 2015 49 (6) 423-435 Fungal aerosols consist of spores and fragments with diverse array of morphologies; however, the size, shape, and origin of the constituents require further characterization. In this study, we characterize the profile of aerosols generated from Aspergillus fumigatus, A. versicolor, and Penicillium chrysogenum grown for 8 weeks on gypsum boards. Fungal particles were aerosolized at 12 and 20 L min-1 using the Fungal Spore Source Strength Tester (FSSST) and the Stami particle generator (SPG). Collected particles were analyzed with field emission scanning electron microscopy (FESEM). We observed spore particle fraction consisting of single spores and spore aggregates in four size categories, and a fragment fraction that contained submicronic fragments and three size categories of larger fragments. Single spores dominated the aerosols from A. fumigatus (median: 53%), while the submicronic fragment fraction was the highest in the aerosols collected from A. versicolor (median: 34%) and P. chrysogenum (median: 31%). Morphological characteristics showed near spherical particles that were only single spores, oblong particles that comprise some spore aggregates and fragments (<3.5 m), and fiber-like particles that regroup chained spore aggregates and fragments (>3.5 m). Further, the near spherical particles dominated the aerosols from A. fumigatus (median: 53%), while oblong particles were dominant in the aerosols from A. versicolor (68%) and P. chrysogenum (55%). Fiber-like particles represented 21% and 24% of the aerosols from A. versicolor and P. chrysogenum, respectively. This study shows that fungal particles of various size, shape, and origin are aerosolized, and supports the need to include a broader range of particle types in fungal exposure assessment. © 2015 STAMI National Institute of Occupational Health. |
Evaluation of BBL Sensi-Discs and FTA cards as sampling devices for detection of rotavirus in stool samples
Tam KI , Esona MD , Williams A , Ndze VN , Boula A , Bowen MD . J Virol Methods 2015 222 41-6 Rotavirus is the most important cause of severe childhood gastroenteritis worldwide. Rotavirus vaccines are available and rotavirus surveillance is carried out to assess vaccination impact. In surveillance studies, stool samples are stored typically at 4 degrees C or frozen to maintain sample quality. Uninterrupted cold storage is a problem in developing countries because of power interruptions. Cold-chain transportation of samples from collection sites to testing laboratories is costly. In this study, we evaluated the use of BBL Sensi-Discs and FTA(R) cards for storage and transportation of samples for virus isolation, EIA, and RT-PCR testing. Infectious rotavirus was recovered after 30 days of storage on Sensi-Discs at room temperature. We were able to genotype 98-99% of samples stored on Sensi-Discs and FTA(R) cards at temperatures ranging from -80 degrees C to 37 degrees C up to 180 days. A field sampling test using samples prepared and shipped from Cameroon, showed that both matrices yielded 100% genotyping success compared with whole stool and Sensi-Discs demonstrated 95% concordance with whole stool in EIA testing. The utilization of BBL Sensi-Discs and FTA(R) cards for stool sample storage and shipment has the potential to have great impact on global public health by facilitating surveillance and epidemiological investigations of rotavirus strains worldwide at a reduced cost. |
Maternal occupational exposure to polycyclic aromatic hydrocarbons and craniosynostosis among offspring in the National Birth Defects Prevention Study
O'Brien JL , Langlois PH , Lawson CC , Scheuerle A , Rocheleau CM , Waters MA , Symanski E , Romitti PA , Agopian AJ , Lupo PJ . Birth Defects Res A Clin Mol Teratol 2015 106 (1) 55-60 BACKGROUND: Evidence in animal models and humans suggests that exposure to polycyclic aromatic hydrocarbons (PAHs) may lead to birth defects. To our knowledge, this relationship has not been evaluated for craniosynostosis, a birth defect characterized by the premature closure of sutures in the skull. We conducted a case-control study to examine associations between maternal occupational exposure to PAHs and craniosynostosis. METHODS: We used data from craniosynostosis cases and control infants in the National Birth Defects Prevention Study (NBDPS) with estimated delivery dates from 1997 to 2002. Industrial hygienists reviewed occupational data from the computer-assisted telephone interview and assigned a yes/no rating of probable occupational PAH exposure for each job from 1 month before conception through delivery. We used logistic regression to assess the association between occupational exposure to PAHs and craniosynostosis. RESULTS: The prevalence of exposure was 5.3% in case mothers (16/300) and 3.7% in control mothers (107/2,886). We observed a positive association between exposure to PAHs during the 1 month before conception through the third month of pregnancy and craniosynostosis (odds ratio [OR] = 1.75; 95% confidence interval [CI], 1.01-3.05) after adjusting for maternal age and maternal education. The number of cases for each craniosynostosis subtype limited subtype analyses to sagittal craniosynostosis; the odds ratio remained similar (OR = 1.76, 95% CI, 0.82-3.75), but was not significant. CONCLUSION: Our findings support a moderate association between maternal occupational exposure to PAHs and craniosynostosis. Additional work is needed to better characterize susceptibility and the role PAHs may play on specific craniosynostosis subtypes. |
Maternal occupational pesticide exposure and risk of congenital heart defects in the National Birth Defects Prevention Study
Rocheleau CM , Bertke SJ , Lawson CC , Romitti PA , Sanderson WT , Malik S , Lupo PJ , Desrosiers TA , Bell E , Druschel C , Correa A , Reefhuis J . Birth Defects Res A Clin Mol Teratol 2015 103 (10) 823-33 BACKGROUND: Congenital heart defects (CHDs) are common birth defects, affecting approximately 1% of live births. Pesticide exposure has been suggested as an etiologic factor for CHDs, but previous results were inconsistent. METHODS: We examined maternal occupational exposure to fungicides, insecticides, and herbicides for 3328 infants with CHDs and 2988 unaffected control infants of employed mothers using data for 1997 through 2002 births from the National Birth Defects Prevention Study, a population-based multisite case-control study. Potential pesticide exposure from 1 month before conception through the first trimester of pregnancy was assigned by an expert-guided task-exposure matrix and job history details self-reported by mothers. Odds ratios (ORs) and 95% confidence intervals (CIs) were estimated using multivariable logistic regression. RESULTS: Maternal occupational exposure to pesticides was not associated with CHDs overall. In examining specific CHD subtypes compared with controls, some novel associations were observed with higher estimated pesticide exposure: insecticides only and secundum atrial septal defect (OR = 1.8; 95% CI, 1.3-2.7, 40 exposed cases); both insecticides and herbicides and hypoplastic left heart syndrome (OR = 5.1; 95% CI, 1.7-15.3, 4 exposed cases), as well as pulmonary valve stenosis (OR = 3.6; 95% CI, 1.3-10.1, 5 exposed cases); and insecticides, herbicides, and fungicides and tetralogy of Fallot (TOF) (OR = 2.2; 95% CI, 1.2-4.0, 13 exposed cases). CONCLUSION: Broad pesticide exposure categories were not associated with CHDs overall, but examining specific CHD subtypes revealed some increased odds ratios. These results highlight the importance of examining specific CHDs separately. Because of multiple comparisons, additional work is needed to verify these associations. |
The National Birth Defects Prevention Study: a review of the methods
Reefhuis J , Gilboa SM , Anderka M , Browne ML , Feldkamp ML , Hobbs CA , Jenkins MM , Langlois PH , Newsome KB , Olshan AF , Romitti PA , Shapira SK , Shaw GM , Tinker SC , Honein MA . Birth Defects Res A Clin Mol Teratol 2015 103 (8) 656-69 BACKGROUND: The National Birth Defects Prevention Study (NBDPS) is a large population-based multicenter case-control study of major birth defects in the United States. METHODS: Data collection took place from 1998 through 2013 on pregnancies ending between October 1997 and December 2011. Cases could be live born, stillborn, or induced terminations, and were identified from birth defects surveillance programs in Arkansas, California, Georgia, Iowa, Massachusetts, New Jersey, New York, North Carolina, Texas, and Utah. Controls were live born infants without major birth defects identified from the same geographical regions and time periods as cases by means of either vital records or birth hospitals. Computer-assisted telephone interviews were completed with women between 6 weeks and 24 months after the estimated date of delivery. After completion of interviews, families received buccal cell collection kits for the mother, father, and infant (if living). RESULTS: There were 47,832 eligible cases and 18,272 eligible controls. Among these, 32,187 (67%) and 11,814 (65%), respectively, provided interview information about their pregnancies. Buccal cell collection kits with a cytobrush for at least one family member were returned by 19,065 case and 6,211 control families (65% and 59% of those who were sent a kit). More than 500 projects have been proposed by the collaborators and over 200 manuscripts published using data from the NBDPS through December 2014. CONCLUSION: The NBDPS has made substantial contributions to the field of birth defects epidemiology through its rigorous design, including case classification, detailed questionnaire and specimen collection, large study population, and collaborative activities across Centers. |
Disseminating results: community response and input on Kisumu breastfeeding study
Ondenge K , McLellan-Lemal E , Awuonda E , Angira F , Mills LA , Thomas T . Transl Behav Med 2015 5 (2) 207-15 Communicating findings to study participants and their communities is a practice that often gets overlooked or receives low prioritization by research investigators, but is crucially important. The purpose of this study was to describe the process and community response to the dissemination of results from the Kisumu Breastfeeding Study (KiBS), specifically in terms of (1) community research knowledge and expectations and (2) impressions of result dissemination efforts. A qualitative evaluation was completed for 10 result dissemination events using focus group discussions (FGDs) (n = 10; total number of participants = 98). An inductive, thematic qualitative data analysis was completed in NVivo 8.0. Overall, FGD participants expressed great appreciation for being given information on the study results. Participants had a good understanding of what research entails and had specific expectations for the process, including that the community receive information about the study, not only at the end of the study but also at regular intervals throughout the study's conduct. They also wanted to receive the communications from a credible source, the principal investigator preferably. Other expectations centered on better community and research interactions and development and the use of community collaborators. Impressions of KiBS result dissemination events were positive, but suggestions for the future included having the event in a larger area, inviting more people, having more written materials, and putting the information in an entertaining format such as skits or movies. Sharing study findings with local community members is essential and beneficial to the researchers' long-term engagement with communities and importantly, the successful implementation of study findings when appropriate. It is imperative that dissemination of results be embedded as an integral part of research project planning and development. |
Role of chest computed tomography in prevention of occupational respiratory disease: review of recent literature
Weissman DN . Semin Respir Crit Care Med 2015 36 (3) 433-48 This review provides an update on literature published over the past 5 years that is relevant to using chest computed tomography (CT) as a tool for preventing occupational respiratory disease. An important area of investigation has been in the use of low-dose CT (LDCT) to screen asbestos-exposed populations for lung cancer. Two recent systematic reviews have reached conclusions in support of screening. Based on the limited evidence that is currently available, the Finnish Institute of Occupational Health has recommended LDCT screening in asbestos-exposed individuals if their personal combination of risk factors yields a risk for lung cancer equal to that needed for entry into the National Lung Screening Trial. It has also recommended further research, such as to document the optimal frequency of screening and the effectiveness of screening. Recent literature continues to support high-resolution CT (HRCT) as being more sensitive than chest radiography in detecting pneumoconiosis. However, there are insufficient data to determine the effectiveness of HRCT screening in improving individual outcomes if used in screening for pneumoconiosis and its routine use for this purpose cannot be recommended. However, if HRCT is used to evaluate populations, recent literature shows that the International Classification of HRCT for Occupational and Environmental Respiratory Diseases provides an important tool for reproducible evaluation and recording of findings. HRCT is an important tool for individual patient management and recent literature has documented that chest HRCT findings are significantly associated with outcomes such as pulmonary function and mortality. |
Seat and seatbelt accommodation in fire apparatus: anthropometric aspects
Hsiao H , Whitestone J , Wilbur M , Lackore JR , Routley JG . Appl Ergon 2015 51 137-151 This study developed anthropometric information on U.S. firefighters to guide fire-apparatus seat and seatbelt designs and future standards development. A stratified sample of 863 male and 88 female firefighters across the U.S. participated in the study. The study results suggested 498 mm in width, 404 mm in depth, and 365–476 mm in height for seat pans; 429–522 mm in width and 542 mm in height for seat back; 871 mm in height for head support; a seat space of 733 mm at shoulder and 678 mm at hip; and a knee/leg clearance of 909 mm in fire truck cab. Also, 1520 mm of lap belt web effective length and 2828 mm of lap-and-shoulder belt web effective length were suggested. These data for fire-truck seats and seatbelts provide a foundation for fire apparatus manufacturers and standards committees to improve firefighter seat designs and seatbelt usage compliance. |
Surveillance for occupational respiratory diseases in developing countries
Antao VC , Pinheiro GA . Semin Respir Crit Care Med 2015 36 (3) 449-54 The burden of chronic diseases, including occupational respiratory diseases (ORDs), is increasing worldwide. Nevertheless, epidemiological data on these conditions are scarce in most countries. Therefore, it is important to conduct surveillance to monitor ORDs, particularly in developing countries, where the working population is especially vulnerable and the health system infrastructure is usually weak. This article provides a general framework for the implementation of ORD surveillance in developing countries. The main objectives of surveillance are to describe incidence and prevalence of ORDs, as well as to identify sentinel events and new associations between occupational exposures and health outcomes. Diseases with high morbidity and mortality and those in which early diagnosis with standardized tests are available are especially suitable for surveillance activities. Simple strategies, preferably using existing resources and technology, are the best option for surveillance in developing countries. This article offers examples of specific surveillance systems that are in place in Brazil, China, Cuba, India, and South Africa. |
Individual and work factors related to perceived work ability and labor force outcomes
McGonagle AK , Fisher GG , Barnes-Farrell JL , Grosch JW . J Appl Psychol 2015 100 (2) 376-98 Perceived work ability refers to a worker's assessment of his or her ability to continue working in his or her job, given characteristics of the job along with his or her resources. Perceived work ability is a critical variable to study in the United States, given an aging workforce, trends to delay retirement, and U.S. policy considerations to delay the age at which full Social Security retirement benefits may be obtained. Based on the job demands-resources model, cognitive appraisal theory of stress, and push/pull factors related to retirement, we proposed and tested a conceptual model of antecedents and outcomes of perceived work ability using 3 independent samples of U.S. working adults. Data regarding workers' job characteristics were from self-report and Occupational Information Network measures. Results from relative importance analysis indicated that health and sense of control were consistently and most strongly related to work ability perceptions relative to other job demands and job and personal resources when perceived work ability was measured concurrently or 2 weeks later in samples with varying occupations. Job demands (along with health and sense of control) were most strongly related to work ability perceptions when perceived work ability was measured in a manufacturing worker sample 1.6 years later. Perceived work ability also predicted lagged labor force outcomes (absence, retirement, and disability leave) while controlling for other known predictors of each. Consistent indirect effects were observed from health status and sense of control to all 3 of these outcomes via perceived work ability. |
Cancer incidence and metolachlor use in the Agricultural Health Study: an update
Silver SR , Bertke SJ , Hines CJ , Alavanja MC , Hoppin JA , Lubin JH , Rusiecki JA , Sandler DP , Beane Freeman LE . Int J Cancer 2015 137 (11) 2630-43 Metolachlor, a widely used herbicide, is classified as a Group C carcinogen by the U.S. Environmental Protection Agency based on increased liver neoplasms in female rats. Epidemiologic studies of the health effects of metolachlor have been limited. The Agricultural Health Study (AHS) is a prospective cohort study including licensed private and commercial pesticide applicators in Iowa and North Carolina enrolled 1993-7. We evaluated cancer incidence through 2010/2011 (NC/IA) for 49,616 applicators, 53% of whom reported ever using metolachlor. We used Poisson regression to evaluate relations between two metrics of metolachlor use (lifetime days, intensity-weighted lifetime days) and cancer incidence. We saw no association between metolachlor use and incidence of all cancers combined (n=5701 with a 5-year lag) or most site-specific cancers. For liver cancer, in analyses restricted to exposed workers, elevations observed at higher categories of use were not statistically significant. However, trends for both lifetime and intensity-weighted lifetime days of metolachor use were positive and statistically significant with an unexposed reference group. A similar pattern was observed for follicular-cell lymphoma, but no other lymphoma subtypes. An earlier suggestion of increased lung cancer risk at high levels of metolachlor use in this cohort was not confirmed in this update. This suggestion of an association between metolachlor and liver cancer among pesticide applicators is a novel finding and echoes observation of increased liver neoplasms in some animal studies. However, our findings for both liver cancer and follicular-cell lymphoma warrant follow-up to better differentiate effects of metolachlor use from other factors. |
Acrolein exposure in U.S. tobacco smokers and non-tobacco users: NHANES 2005-2006
Alwis KU , deCastro BR , Morrow JC , Blount BC . Environ Health Perspect 2015 123 (12) 1302-8 BACKGROUND: Acrolein is a highly reactive alpha, beta unsaturated aldehyde and respiratory irritant. Acrolein is formed during combustion (e.g. burning tobacco or biomass), during high-temperature cooking of foods, and in vivo as a product of oxidative stress and polyamine metabolism. No biomonitoring reference data has been reported to characterize acrolein exposure of the U.S. population. OBJECTIVES: Our goals were to: a) evaluate two acrolein metabolites in urine - N-Acetyl-S-(3-hydroxypropyl)-L-cysteine (3HPMA) and N-acetyl-S-(2-carboxyethyl)-L-cysteine (CEMA) - as biomarkers of exposure to acrolein for the U.S. population by age, sex, race, and smoking status; and b) assess tobacco smoke as a predictor of acrolein exposure. METHODS: We analyzed urine from National Health and Nutrition Examination Survey (NHANES 2005-2006) participants ≥ 12 years-old (n = 2,866) for 3HPMA and CEMA using ultra high performance liquid chromatography coupled with electrospray ionization tandem mass spectrometry (UPLC/ESI-MSMS). Sample-weighted linear regression models stratified for non-tobacco users vs. tobacco smokers (as defined by serum cotinine and self-report) characterized the association of urinary 3HPMA and CEMA with tobacco smoke exposure, adjusting for urinary creatinine, sex, age, and race/ethnicity. RESULTS: 3HPMA and CEMA levels were higher among tobacco smokers (cigarettes, cigars and pipe users) compared with non-tobacco users. The median 3HPMA levels for tobacco smokers and non-tobacco were 1089 and 219 microg/g creatinine respectively. Similarly, median CEMA levels were 203 microg/g creatinine for tobacco smokers and 78.8 microg/g creatinine for non-tobacco users. Regression analysis showed that serum cotinine was a significant positive predictor (p <0.0001) of both 3HPMA and CEMA among tobacco smokers. CONCLUSIONS: Tobacco smoke was a significant predictor of acrolein exposure in the U.S. population. |
Coxiella burnetii exposure in northern sea otters Enhydra lutris kenyoni
Duncan C , Gill VA , Worman K , Burek-Huntington K , Pabilonia KL , Johnson S , Fitzpatrick KA , Weller C , Kersh GJ . Dis Aquat Organ 2015 114 (1) 83-7 Valvular endocarditis has been well described in northern sea otters Enhydra lutris kenyoni of Alaska and in many cases no cause has been identified. It is also one of the most common conditions observed in people with chronic Coxiella burnetii infection. Given the high levels of C. burnetii exposure in marine mammals distributed throughout the same geographic range as the northern sea otter, and the presence of valvular lesions seen in otters, the objective of this study was to determine the level of C. burnetii exposure in otters and investigate any association between exposure, infection and valvular disease in this species. Archived serum from 75 live captured, apparently healthy otters (25 from each of 3 stocks) and 30 dead otters were tested for C. burnetii antibodies by indirect florescent antibody assay (IFA). Archived bone marrow and heart valves were tested for C. burnetii DNA by real-time PCR (qPCR). Overall, the seroprevalence in live otters was 17%, with significantly more exposed animals in the south central (40%) stock relative to the southwest (8%) and southeast (4%). The seroprevalence of animals sampled post mortem was 27%, although none of the bone marrow or heart valve samples were positive by qPCR. Results of this study failed to demonstrate a significant association between C. burnetii infection and valvular endocarditis in sea otters; however, the differing seroprevalence suggests that exposure opportunities vary geographically. |
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